Rap Music And Its Effect On Society Essay - 1277 Words

Most people think that it is only classical music that has a positive effect on society because of its soft tune and melody, but in fact rap music can have that same effect. The reason that some people think rap music leads to violence is because gang members can often be found listening to rap music, and they dress in the urban clothing style of rappers. The reality is that rap music is greatly misunderstood. The media often portrays rap music as negative and focuses on rap music more when it is related to something undesirable. Teenagers relate to rap music because it expresses some of the feelings they feel and encourages them to stand out. Although some lyrics can be provocative, rap music has the tendency to unite. Rap is actually a very old word. You can find the term popping up as early as the 15th and 16th century in Britain. Initially the word rap meant to strike or to hit. A few centuries later a slight variation of this definition appeared which meant to speak or talk. In America around the 1960’s it began to pop up in the black community and was used as a slang word to mean that someone was talking or having a conversation.(Cole Mize) Rap is way to express feelings about the different things that are going on in our society. Blaming rap has always be there when society had nothing else to blame for the problems that were going on. Some critics think that rap is distasteful and violent but since it is so wildly popular it just something we are going to have dealShow MoreRelatedRap Music And Its Effects On Society1535 Words   |  7 Pageshit single â€Å"Coco†. Rap wasn’t always this bad, back when Rap first started with a group by the name of Sugar Hill Gang and their hit single to begin the era â€Å"Rapper’s Delight† Rap was about peace, harmony and just hanging out at a party, but r=this precedent split into more violent distorted versions of the genre such as the more 1990s popular genre of â€Å"Gangsta Rap† or the more recent rap music that glorifies sexual themes, practices and criminal mischief. This violent rap music has been seen to haveRead MoreRap Music And Its Effects On Society1860 Words   |  8 PagesWho some call the call the godfather of rap, Eazy E, once said, â€Å"Who gave it that title, gangsta rap? It s reality rap. It s about what s really going on. † There has been a great injustice done to the form of expression called rap. In essence rap is just lyrics over a basic beat or rhythm. Many members of society today assume that rap is a dangerous and violent influence, however what they seem to be ignorant of is the fact that rap music is actually beneficial. The majority of the world we liveRead MoreRap Music And Its Effect On Society1915 Words   |  8 PagesAs a whole, â€Å"Rap music† is a misrepresentation of black culture. Rap teaches youth that violence, demeaning women and participating in criminal activity are acceptable in today’s society. Despite the rap artists’ that do use self-expression as a means of changing the way listeners view society, rap music contradicts the good that it can create. Rap is proven detrimental toward society, despite the political views most believe it provides. Simply stated, raps contradictive nature makes it impossibleRead MoreThe Impact Of Rap Music On Today s Society867 Words   |  4 PagesThe impact of rap music in today’s society is extremely substantial. Many Americans listen to rap music, even though different rap artist discuss various issues in their songs, it may influences their fans to do the same. A large amount of rap music contains explicit lyrics that describe illegal activities, aggression, and sexual content. Researchers from Iowa State University and the Texas Department of Human Services found that aggressive music lyrics increase aggressive thought and feelings, mightRead MoreEssay on Rap and Hip Hop Do Not Affect Society Negatively987 Words   |  4 Pages Rap and hip hop music have been debated many times over the years about whether or not this choice of music affects society negatively. As you will learn from this presentation, rap does not affect society negatively and is a great choice of music. It helps save lives, relieves stress, and tells vital messages to learn from. According to dictionary.com, the definition of hip hop is defined as, â€Å"the popular subculture of big-city teenagers, which includes rap music, breakdancing, and graffiti artRead MoreEssay about Rap. Simply Music, or Something More?683 Words   |  3 Pagesthe adoption of rap music into the entertainment industry is no different. There are an innumerable amount of viewpoints on whether rap music is to be admonished for the objectification of and disrespect towards women or simply accepted as another expression of modern society. Even those these two opposing viewpoints are vastly different, there are opportunities for those who listen to this type of music to develop their intelligence on the various topics discussed in modern rap. There are many peopleRead MoreThe Debate Of Hip Hop Music1509 Words   |  7 PagesA constant debate amongst society is whether or not certain genres of music have an impact on the behavior of listeners, whether that impact is positive or negative. Would a person steal because of a song they heard? Would a person murder another human due to the lyrics of their favorite song? Questions like these are often asked and very rarely answered. The main genre of debate: hip hop music. Though the debate continues to go on in today’s society, the answer has never been given. In fact, someRead MoreThe Effects Of Rap Music On Social Behavior Essay1693 Words   |  7 PagesIn society today, it is highly noticed that the role of rap music messages and video images of violence causes an increase in negative emotions, thoughts and behaviors which could lead to violence amongst youth. Rap music has been at the center of concern in regards to the potential harmful effect of violent media on s ocial behavior amongst youth. This potential behavior could be seen in the music video titled â€Å"Kim† by Eminem. In this music video, the storyline, language and sound encourages hostileRead MoreDepiction of Women in Lyrics Essay1223 Words   |  5 PagesMusic has become ingrained within our every day lives. It ranges from the music we hear during commercials to popular mainstream artists playing over the radio, the lyrics of music has shaped roles and standards for both men and women. In the past four decades, lyrics have begun to increasingly depict sex, sexual violence and male dominance. With teenagers being the main audience for the music media the lyrics are typically aimed for that age group. Because of the targeted age group the lyrics haveRead MoreRap Music : Hip Hop Essay1509 Words   |  7 PagesRap, or hip hop as some call it, ranks in the top ten of most popular music genres in the world. Since it burst on the scene in the late 1970s, rap music changed the l andscape of the music industry, especially for African-American artists. The genre accredited some of the biggest names in the music industry. Popular artists like LL Cool J, Tupac, Notorious B. I. G., Jay-Z, Kanye West, and many others produce, or have produced, millions of hip-hop records. The secret to the success of hip hop centers

Network And Computer Systems Become Universal And Exposed,...

INTRODUCTION As networks and computer systems become universal and exposed, security threats and risks continue to grow more rapidly. This causes enormous threats; therefore, Security specialists and experts are continuously trying to find solutions for these kinds of threats through different methods like attack signatures and looking for methods to prevent them. Nevertheless, as solutions are formed, new types of threats emerge, for example spam mails, spywares, worms and Trojans just to mention a few. A growing program problem in our technologically advanced society is the increase in security related issues for small to medium industries (infosec reading room, n.d.).The digital age has also appeared with a variation of benefits to organization such as Just Love and individuals. Information technologies are becoming more broadly used every day. As networks and computer systems become more pervasive, security threats and risks continue to grow more rapidly, therefore transferring data from paper and pen environments to computer systems does not always happen. Increasing complication and sophistication of the ever-growing information technologies has prompted unique and unparalleled challenges for organizations such as mine to protect their information assets. The Internet is such a marvel that an organization today cannot operate without it, but on the other hand too, living with the Internet also opens the organization to threats like viruses, hackers and internet fraudShow MoreRe latedBasic Home Computer Network and Computer Network Security Plan1208 Words   |  5 PagesGenerally, computer network security systems and structures considered robust are preceded not by software and hardware but by careful planning. A typical computer network security plan must take into consideration a wide range of security risks and vulnerabilities and from that, develop a road map to reduce such exposure. Given the need to protect the integrity and confidentiality of data as well as other system quality attributes, the need to mitigate exposure cannot be overstated. Security Risks InRead MoreInformation System Risks1562 Words   |  7 PagesInformation System Risk Management Claudia I. Campos CJA 570 Cyber Crime and Information Systems Security July 5, 2010 Steven Bolt Abstract The realization of potential risks to an organizations information system has been increased in the past few years. The principles of risk management, vulnerabilities, internal threats, and external threats is the first step in determining which levels of security are necessary to protect and limit the risks to an organizations information system. ThisRead MoreNetwork Security : A Secure Platform For Computers2050 Words   |  9 PagesNetworking security the process of taking physical and software preemptive evaluations to protect the underlying network foundation from unauthorized admittance, misuse, glitch, modification, demolish, imprudent revelation, thereby creating a secure platform for computers, users and programs to implement their permitted critical functions within a secure environment. Network security has become significant due to the patent that can be obtained through the Internet. There are essentially two differentRead MoreSecurity in the Cloud Essay2440 Words   |   10 Pagesusers face security threats both from outside and inside the cloud. Many of the security issues involved in protecting clouds from outside threats are similar to those already facing large data centers. In the cloud, however, this responsibility is divided among potentially many parties, including the cloud user, the cloud vendor, and any third-party vendors that users rely on for security-sensitive software or configurations. The cloud user is responsible for application-level security. The cloudRead MoreAndroid Os Security: Advantages and Disadvantages2930 Words   |  12 PagesAndroid OS Security: Advantages and Disadvantages In the field of computing, few inventions, innovations or technological improvements, have been moving quite like wireless technology. With the advent of fourth generation cell phones and networks (4G), there have literally been leaps and bounds made in the realm of personal computing, productivity and data sharing. It is this increased connectivity both in our personal and business lives that introduce risks to intrusion, corruption or theft ofRead MoreIntro to Information Systems11970 Words   |  48 Pagesprocessing. A. IT architecture B. IT infrastructure C. information technology D. management information systems E. IT services ANS: D REF: 1.1 Information Systems: Concepts and Definitions _____ is (are) data that have been organized to have meaning and value to a recipient. A. data B. information C. knowledge D. experience E. wisdom ANS: B REF: 1.1 Information Systems: Concepts and Definitions If Amazon uses a list of all your purchases (books bought, price paid, dates) toRead MoreThe Cloud Of Cloud Computing2417 Words   |  10 Pagesimpression that there is an unlimited supply. Cloud computing is networking from remote servers hosted on the World Wide Web. Instead of storing, managing, and processing data on local servers and personal computers, the cloud retrieve data from other computers that are centralized or within the network. Cloud computing enable clients to purchase services that are only needed (Ackerman 2011). The term â€Å"cloud† is not fairly new (Mohamed, 2009). The cloud can be dated back to the sixties. During the sixtiesRead MoreVulnerability Assessment ( Va )3159 Words   |  13 Pages1. Introduction Security is a standout amongst the most difficult and complex issue in Information Technology (IT) today. Security causes millions of dollars loss to the different organizations every year. Even if 99% of all assaults result from known vulnerabilities and flawed misconfigurations, an answer is most certainly not direct. With a crowd of networks, operating system and application related vulnerabilities, security specialists are getting the opportunity to be logically aware of the needRead MoreIs Privacy Law Trumps Telecommunication Law? Discuss?4398 Words   |  18 Pagestelecommunication law? Discuss. Answer: Telecommunication law content issues which raise privacy concerns are generally presumed to concern the protection of privacy information, and conversation between individuals. In case of telecommunication system call detail records, caller?s information, internet conversation details and many more are retained by government and commercial organisation for different legal and business purpose. When the data is retained by government then the data is storedRead MoreSector Briefing : Dtl Power Corporation7811 Words   |  32 Pageswas significantly increased in the post- World War II era (Smithsonian Institution, 2002 . With this demand came private companies that had created independent systems soon realized that interconnecting their systems with each other resulted in a more efficient system (Institute for Energy Research, 2014). The interconnection of these systems is still in use today and is commonly referred to as the power grid (U.S. Energy Information Administration). One challenge that electrical providers face it

Blanket Purchase Agreements Essay Research Paper New free essay sample

Blanket Purchase Agreements Essay, Research Paper New Process Qualified houses will be awarded Blanket Purchase Agreements ( BPAs ) and will be assigned a alone designation codification. Individual procurance demands will be posted to the Office of Procurement # 8217 ; s Home Page in the signifier of Requests for Quotation ( RFQs ) . BPA receivers will be notified via electronic mail of any procurement opportunities/RFQs. Merely houses with standing BPAs will be granted entree to the RFQs, and merely those houses will be eligible to submit citations with monetary values and any other information required by the RFQ, along with their alone designation codification. Under this new process, any interested party is eligible to use for a BPA award. Presently, the Scope of BPAs for this procedure covers three groupings of products/services. To measure up for award, providers must affirmatively show they have the capableness and a record of successful past public presentation. Interested parties must undergo an rating and choice procedure to measure up for BPA awards. We will write a custom essay sample on Blanket Purchase Agreements Essay Research Paper New or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page This procedure may dwell of multiple phases ( Initial Phase, Second Phase and Third Phase ) , based upon specific factors. Initial Phase: Offerers must finish the initial application and subject it to the PTO Office of Procurement via the Internet. If the PTO has sufficient positive information on, experience with, and prior cognition of the house, award may be made without farther action. If non, offerers will be notified that they must subject extra information as required in the 2nd stage. Second Phase: Offerer s will be required to subject 20 past public presentation mentions. Customer mentions must be current ( work performed within the last 12 months ) , and must reference work similar in nature of the type of BPA for which the offerer is using. Instruction manuals on where to subject the mention information will be provided at the clip of presentment that this information is required. If PTO is unable to find whether a BPA award is advantageous at this phase, offerers will be notified that extra information is required in the 3rd stage. Third Phase: Offerers must supply specific information as requested by the Contracting Officer. This may include a elaborate capableness booklet, and grounds that the house possesses the necessary installations ( warehouse, physical operations and stock lists, production equipment, etc. ) . At this clip we may besides necessitate an offerer to subject letters from makers attesting that the offerer is a warranted/authorized trader for the declared merchandises, every bit good as a corporate history, and fiscal information. Evaluation and Award The PTO militias the option to do an award upon initial entries ( initial stage ) based on personal cognition of bureau procurement staff that any peculiar house is qualified, capable, and has a satisfactory past public presentation record. Other houses which are requested to supply extra information will be evaluated against the undermentioned past public presentation and capableness standards. The determination on whether any house is eligible for award is entirely at the discretion of the Contracting Officer.

UML and its uses Essay Example For Students

UML and its uses Essay Unified Modeling Language (UML) is a non-proprietary, third generation modeling and specification language. The use of UML is not only for software modeling. It can also be used for modeling hardware (engineering systems) and is used for business process modeling and organizational structure modeling. The UML is an open method used to specify, visualize, construct and document the artifacts of an object-oriented software-intensive system under development. The UML represents a compilation of best engineering practices which have proven to be successful in modeling large, complex systems, especially at the architectural level.For large enterprise applications ones that run core business applications and must be running to keep a company going has to be more than just various code modules. In order for there to be a clear structured architecture there must be a way to enable scalability, security and have a beefy execution that programmers can quickly find and fix bugs that show up after the original programmers have moved to other projects. We will write a custom essay on UML and its uses specifically for you for only $16.38 $13.9/page Order now The benefits of structure (and of modeling and design) compound as application size grows large. Another benefit of structure is that it enables code reuse: Design time is the easiest time to structure an application or program as a collection of self-contained modules or components. Using UML a business no matter what the size can achieve the foundation and layout of the goals they are looking to accomplish. With UML You can model just about any type of application, running on any type and combination of hardware, operating system, programming language, and network, in UML. Its flexibility lets you model distributed applications that use just about any middleware on the market. This is the reason that UML fits the business community.

The Baroque Period and Henry Eccles essays

The Baroque Period and Henry Eccles essays During the Baroque period (1600-1750), music evolved amid religious wars between the Protestants and Catholics as well as the exploration and colonization of the New World. With the rise of middle class cultures throughout Europe, much of music-making centered in the home. As musical instruments developed technically, the level of expertise and virtuosity improved. The major-minor tonality system was established in this period and harmony was written with figured bass, so the performer had more freedom to improvise the chords. The basso continuo, or bass part, was often played by harpsichord and cello. Well known composers of the Baroque period include Henry Purcell (1659-1695), Vivaldi (1678-1741), Jean-Joseph Mouret (1682-1738), Johann sebastian Bach (1685-1750), and George Frideric Handel 1685-1759). A lesser known composer and violinist was Henry Eccles (1670-1743). By the time Joseph Handel entered the music scene in England, Henry Eccles (1670-1742) was already a respected London composer and violinist. He was the second son of Solomon Eccles and brother of John Eccles, who were both composers and musicians. According to the Dictionary of National Biography, Henry Eccles played in the court of King Louis XIV from 1694 to 1710.1 By 1716, he's no longer on the list of Chamberlayne's Notitia in the British Museum, which implies that this is when he moved to Paris. Eccles produced in two volumes the Twelve Excellent Solos for the Violin in 1720. The first book contains sonatas that are adaptations from Italian Giuseppe Valentini's Alletamenti (op. 8). 2 Eccles felt under appreciated in England, which may be why he moved to Paris. There he became a member of the King's band. In 1732, he published Twelve Sonatas for Gamba and Figured Bass. Most notable is the Bass Sonata in G minor. These sonatas were also heavily influenced by Valentini. 3 There were no copyright laws back then. Since Eccles was greatly influenced...

Stories about Great Thinkers and Inventors

Stories about Great Thinkers and Inventors The following stories about great thinkers and inventors will help to motivate your students and enhance their appreciation of the contributions of inventors. As students read these stories, they will also realize the inventors are male, female, old, young, minority, and majority. They are ordinary people who follow through with their creative ideas to make their dreams a reality. FRISBEE  ® The term FRISBEE did not always refer to the familiar plastic disks we visualize flying through the air. Over 100 years ago, in Bridgeport, Connecticut, William Russell Frisbie owned the Frisbie Pie Company and delivered his pies locally. All of his pies were baked in the same type of 10 round tin with a raised edge, wide brim, six small holes in the bottom, and Frisbie Pies on the bottom. Playing catch with the  tins  soon became a popular local sport. However, the tins were slightly dangerous when a  toss  was missed. It became the Yale custom to yell Frisbie when throwing a pie tin. In the 40s when plastic emerged, the pie-tin game was recognized as a manufacturable and marketable product. Note:  FRISBEE  Ã‚ ® is a registered trademark of Wham-O Mfg. Co. Earmuffs Baby, Its Cold Outside Baby, Its Cold Outside may have been the song running through 13-year-old Chester Greenwoods head one cold December day in 1873. To protect his ears while ice skating, he found a piece of wire, and with his grandmothers help, padded the ends. In the beginning, his friends laughed at him. However, when they realized that he was able to stay outside skating long after they had gone inside freezing, they stopped laughing. Instead, they began to ask Chester to make ear covers for them, too. At age 17 Chester applied for a patent. For the next 60 years, Chesters factory made earmuffs, and earmuffs made Chester rich. BAND-AID  ® At the turn of the century, Mrs. Earl Dickson, an inexperienced cook, often burned and cut herself. Mr. Dickson, a Johnson and Johnson employee, got plenty of practice in hand bandaging. Out of concern for his wifes safety, he began to prepare bandages ahead of time so that his wife could apply them by herself. By combining a piece of surgical tape and a piece of gauze, he fashioned the first crude adhesive strip bandage. LIFE-SAVERS  ® Candy During the hot summer of 1913, Clarence Crane, a chocolate candy manufacturer, found himself facing a dilemma. When he tried to ship his chocolates to candy shops in other cities they melted into gooey blobs. To avoid dealing with the mess, his customers were deferring their orders until cool weather. In order to retain his customers, Mr. Crane needed to find a substitute for the melted chocolates. He experimented with hard candy which wouldnt melt during shipment. Using a machine designed for making medicine pills, Crane produced small, circular candies with a hole in the middle. The birth of LIFE SAVERS! Note on Trademarks  ® is the symbol for a registered trademark. The trademarks on this page are words used to name the inventions. Thomas Alva Edison If I were to tell you that  Thomas Alva Edison  had shown signs of inventive genius at an early age, you probably would not be surprised. Mr. Edison achieved enormous fame with his lifelong contributions of volumes of inventive technology. He received the first of his 1,093 U.S. patents by age 22. In the book, Fire of Genius, Ernest Heyn reported on a remarkable resourceful young Edison, though some of his earliest  tinkering  clearly lacked merit. Age 6 By the age of six, Thomas Edisons experiments with fire were said to have cost his father a barn. Soon after that, it is reported that young Edison tried to launch the first human balloon by persuading another youth to swallow large quantities of effervescing powders to inflate himself with gas. Of course, the experiments brought quite unexpected results! Chemistry and electricity held great fascination for this child,  Thomas Edison. By his early teens, he had designed and perfected his first real invention, an electrical cockroach control system. He glued parallel strips of tinfoil to a wall and wired the strips to the poles of a powerful battery, a deadly shock for the unsuspecting insect. As a dynamo of  creativity, Mr. Edison stood as decidedly unique; but as a child with a curious, problem-solving nature, he was not alone. Here are some more inventive children to know and appreciate. Age 14 At age 14, one schoolboy invented a rotary brush device to remove husks from wheat in the flour mill run by his friends father. The young inventors name?  Alexander Graham Bell. Age 16 At 16, another of our junior achievers saved pennies to buy materials for his chemistry experiments. While still a teenager, he set his mind on developing a commercially viable aluminum refining process. By age 25,  Charles Hall  received a patent on his revolutionary electrolytic process. Age 19 While only 19 years old, another imaginative young person designed and built his first  helicopter. In the summer of 1909, it very nearly flew. Years later,  Igor Sikorsky  perfected his design and saw his early dreams change aviation history.  Silorsky  was inducted into the National Inventors Hall of Fame in 1987. The are more childhood problem-solvers that we can mention. Perhaps youve heard about: Samuel Colts  childhood experience with underwater explosives;Fourteen-year-old Robert Fultons manually operated paddlewheel; andGuglielmo Marconis early mechanical/electrical tinkering.Even television tinker,  Philo T. Farnsworth, conceived his optical scanning idea at the tender age of 14. Inventions Inventions tell something about the inventors place in the society in which they live, a closeness to certain kinds of problems, and possession of certain skills. It is not surprising that up until the mid 20th Century, womens inventions were often related to childcare, housework, and healthcare, all traditional female occupations. In recent years, with access to specialized training and broader job opportunities, women are applying their creativity to many new kinds of problems, including those requiring high technology. While women have frequently come up with new ways to make their work easier, they have not always received credit for their ideas. Some stories about early women inventors show that women often recognized that they were entering a mans world, and shielded their work from the public eye by allowing men to patent their inventions. Catherine Greene Although  Eli Whitney  received a  patent for a cotton gin, Catherine Greene is said to have posed both the problem and the basic idea to Whitney. Furthermore, according to Matilda Gage, (, 1883), his first model, fitted with wooden teeth, did not do the work well, and Whitney was about to throw the work aside when Mrs. Greene proposed the substitution of wire to catch the cotton seeds. Margaret Knight Margaret Knight, remembered as the female Edison, received some 26 patents for such diverse items as a window frame and sash, machinery for cutting shoe soles, and improvements to internal combustion engines. Her most significant patent was for machinery that would automatically fold and glue paper bags to create square bottoms, an invention which dramatically changed shopping habits. Workmen reportedly refused her advice when first installing the equipment because, after all, what does a woman know about machines? More about  Margaret Knight Sarah Breedlove Walker Sarah Breedlove Walker, the daughter of former slaves, was orphaned at seven and widowed by 20.  Madame Walker  is credited with inventing hair lotions, creams, and an improved hair styling hot comb. But her greatest achievement may be the development of the Walker System, which included a broad offering of cosmetics, licensed Walker Agents, and Walker Schools, which offered meaningful employment and personal growth to thousands of Walker Agents, mostly Black women. Sarah Walker was the first American woman  self-made millionaire. More about  Sarah Breedlove Walker Bette Graham Bette Graham hoped to be an artist, but circumstances led her into secretarial work. Bette, however, was not an accurate typist. Fortunately, she recalled that artists could correct their mistakes by painting over them with gesso, so she invented a quick drying paint to cover her typing mistakes. Bette first prepared the secret formula in her kitchen using a hand mixer, and her young son helped to pour the mixture into little bottles. In 1980, the Liquid Paper Corporation, which Bette Graham built, was sold for over $47 million. More about   Bette  GRaham Ann Moore Ann Moore, a Peace Corps volunteer, saw how African women carried babies on their backs by tying cloth around their bodies, leaving both hands free for other work. When she returned to the United States, she designed a carrier which became the popular SNUGLI. Recently Ms. Moore received another patent for a carrier to conveniently transport oxygen cylinders. People needing oxygen for breathing assistance, who were previously confined to stationary oxygen tanks, can now move about more freely. Her company now sells several versions including lightweight backpacks, handbags, shoulder bags, and wheelchair/walker carriers for portable cylinders. Stephanie Kwolek Stephanie Kwolek, one of Duponts leading chemists, discovered the miracle fiber, Kevlar, which has five times the strength of steel by weight. Uses for Kevlar are seemingly endless, including ropes and cables for oil drilling rigs, canoe hulls, boat sails, automobile bodies and tires, and military and motorcycle helmets. Many Viet Nam veterans and police officers are alive today because of protection provided by bullet-proof vests made from Kevlar. Because of its strength and lightness, Kevlar was chosen as the material for the Gossamer Albatross, a pedal airplane flown across the English Channel. Kwolek was inducted into the National Inventors Hall of Fame in 1995. More on  Stephanie Kwolek Gertrude B. Elion Gertrude B. Elion, 1988 Nobel laureate in Medicine, and Scientist Emeritus with Burroughs Wellcome Company, is credited with the synthesis of two of the first successful drugs for Leukemia, as well as Imuron, an agent to prevent the rejection of kidney transplants, and Zovirax, the first selective antiviral agent against herpes virus infections. Researchers who discovered AZT, a breakthrough treatment for AIDS, used Elions protocols. Elion was inducted into the National Inventors Hall of Fame in 1991, the first woman inductee. More on Gertrude B. Elion Did you Know That.. windshield wipers were patented by  Mary Anderson  in 1903?dandruff shampoo was patented by Josie Stuart in 1903?a dishwasher was patented by  Josephine Cochrane  in 1914?the first disposable diaper was patented by Marion Donovan in 1951?a compact portable hair dryer was patented by Harriet J. Stern in 1962?a dough product for frozen pizza was patented by Rose Totino in 1979?the Melitta Automatic Drip Coffee Maker was patented by Melitta Benz in Germany in 1908? Between 1863 and 1913, approximately 1,200 inventions were patented by minority  inventors.  Many  more were unidentified because they hid their race to avoid discrimination or sold their inventions to others. The following stories are about a few of the  great minority  inventors. Elijah McCoy Elijah McCoy  earned  about 50 patents, however, his most  famous one  was for a metal or glass cup that fed oil to bearings through a small-bore tube. Elijah McCoy was born in Ontario, Canada, in 1843, the son of slaves who had fled Kentucky. He died in Michigan in 1929. More about  Elijah McCoy Benjamin Banneker Benjamin Banneker created the first striking clock made of wood in America. He became known as the Afro-American Astronomer. He published an almanac and with his knowledge of mathematics and astronomy, he assisted in the surveying and planning of the new city of Washington, D.C. More about  Benjamin Banneker Granville Woods Granville Woods  had more than 60  patents. Known as the Black Edison, he improved Bells telegraph and created an electrical motor that made the underground subway possible. He also improved the airbrake. More about  Granville Woods Garrett Morgan Garrett Morgan  invented an improved  traffic signal. He also invented a safety hood for firefighters. More about  Garrett Morgan George Washington Carver George Washington Carver aided the Southern states with his  many inventions. He discovered over 300 different products made from the peanut which, until Carver, was considered a lowly food fit for hogs. He dedicated himself to teaching others, learning and working with nature. He created over 125 new products with the sweet potato and taught poor farmers how to rotate crops to  improve  their soil and their cotton.  George Washington Carver  was a great scientist and inventor who learned to be a careful observer and who was honored throughout the world for his creation of new things. More about  George Washington Carver

Exxon Mobile and Shell Research Paper Example | Topics and Well Written Essays - 750 words

Exxon Mobile and Shell - Research Paper Example Shell is also engaged in same type of oil business as Mobil did even though their abilities are comparatively less than that of the Exxon Mobil Company. This paper briefly compares Exxon Mobil and Shell in terms of their current policies, the way of operation, marketing strategies and international expansion etc. Record oil prices for the past few years helped oil companies in general and Exxon Mobil in particular to accumulate huge profits. The financial conditions of Exxon Mobil is far better than Shell. â€Å"Exxon Company has nearly $40 billion in cash reserves and another $225 billion in repurchased stock. Thats enough money to pay a nearly 60 percent premium, in cash, for every share of its next largest competitor - Royal Dutch Shell† (Daily News). In short Shell is nothing in front of Mobil as far as the market capitalization or financial abilities are concerned even though Shell is placed second behind the Exxon (see the figure given below for more details). According to many economical and business analysts, Exxon may buy the Royal Dutch Shell Oil Company in the near future itself in order to establish an absolute monopoly in the oil market. Even though the oil prices were rising up, Shell like oil companies failed to develop new projects to take advantage of the favorable business climate. On the other hand, Exxon Mobil succeeded developing new projects for the maximum exploitation of the higher oil price. Both shell and Exxon Mobil give more priority to the evaluation of market interests as part of their marketing strategies. The call for energy efficient vehicles and environment friendly energy sources is growing in the world because of the severe environmental problems caused by the burning of fossil fuels. Under such circumstances, it is not advisable for these oil companies to increase their production beyond certain levels. They are closely watching the market trends and making changes in their oil prices

Internet banking applications Research Paper Example | Topics and Well Written Essays - 2250 words

Internet banking applications - Research Paper Example According to the research as soon as technology bulged out from the conventional manual working trends, people who were tired of time consuming repetitive tasks obliged, and accepted it. That is the sole reason behind technology gaining sudden fame and it is only the charisma of technology that the power of mainframes is now present in handhelds. Such rapid advancement in technology was due to man’s eagerness and need of making things work on his fingertips. Technology, soon after its introduction in the markets and after the revelation of its endless benefits became a necessity for everyone. From MNCs to home users, technology is everywhere. The usage of technology of course is different with everyone but the truth is that it is used everywhere in some capacity or the other. Banking is one of the oldest businesses in the world. Since the evolution of human mind, human beings are constantly involved in making transactions and carrying out trade and business. Slowly but steadil y, the banking system also gained popularity and became popular. This meant that the clientele of each bank were increasing exponentially. Therefore, banking theories and studies became a crux part of finance and accounting curriculum. It was soon realized that banks should use the numeric computation and storage power of computers to enhance their business processes. This made competition stiffer and this is by virtue of this competition that value added services were introduced by banks. These value added services such as ATM’s and Internet Banking not only provided the banks competitive edge but also first mover advantage. This influx of technology not only introduced several different technologies at the workplace but also ensure that banks were making great sales as customers were willing to pay more for these value added services (Ghaziri, 1998). The term ‘Internet Banking’ was coined in 1980’s (Scholasticus, n.d.) but it’s no more a technical jargon these days as even basic customers who have very little knowledge of internet can use this technology to make financial transactions. This idea of doing online transactions got very modest reception when it was first launched primarily because of high internet costs and the vulnerability of such applications. The idea of virtual transactions didn’t appeal the conventional users but time proved them, otherwise. The aim of this dissertation is to do a threadbare analysis on internet banking applications that are currently in use in the industry. Some relevant questions that we will look to answer are: How actually these internet banking applications work? Are these applications really worth it? How these internet banking applications have evolved over the period of time and what extra features are now available in these applications? These questions will just act as the starting point of our research and will be answered comprehensively. Moreover, a peep into currently used architectures and applications themselves will also be a point of focus throughout our studies. 2. Objectives The objectives of this research are clearly elicited and they will help in providing a broader overview of the complete architecture that is normally being deployed in a bank. To calculate ROI generated because of this value added feature To perform trend analysis on different internet banking applications To determine different KPI’s that will help us analyze an internet banking application’s efficiency To study the general 3-tier architecture of a complete internet banking application To study factors that can further enhance an internet banking application To study peripheral applications that work with mainstream Internet Banking application To examine other channels that interact and study if they can work in line with the internet banking application To determine factors that can affect internet banking software’s performance 3. Background The forerunner of the modern times, Internet Banking was started as distance

Different Styles of Imitation Essay Example for Free

Different Styles of Imitation Essay In The Transmission of Knowledge by Juan Luis Vives, Vives describes his idea of proper imitation. His basic theory is that people are not innately born with skills of art or rhetoric and therefore, these skills are obtained through the imitation of other skilled artists or rhetoricians. This idea is parallel to those of Petrarch and Alberti. Petrarch and Vives both say that proper imitation should be analogous to the way a son resembles his father. Vives says A son is said to be like his father, not so much in that he recalls his features, his face and form, but because shows to us his fathers manners, his disposition, his talk, his gait, his movements, and as it were his very life, which issues forth in his actions as he goes abroad, from the inner seat of the spirit, and shows his real self to us. (190) Petrarch says, similarly, As soon as we see the son, he recalls the father to us, although if we should measure every feature we should find them all different.(199) The father to son resemblance is the basis of imitation to both these authors. They both believe that a good writer should use imitation in a way where what they imitate resembles the original, but does it not duplicate it. For Petrarch and Vives, this can be achieved by properly integrating reading with writing. They both believe that by reading something and being able to digest it thoroughly, one can transport the overall idea and feeling of what he read onto his own writing. This creates a deep imitation, rather than copying what a writer says in different words. Both authors use the father to son metaphor to show that imitation should be meaningful and evocative. Petrarch supplements this idea by claiming that reading should be an alterative to experience. As one would in a sense experience the father through the son, one should similarly be able to experience the author a writer imitates. To illustrate this he referrers to wandering and transport throughout his works. Specifically, Petrarch interchanges writing with experience when he describes climbing Mont Ventroux. He says But nature is not overcome by a mans devices; a corporeal thing cannot reach the heights by descending and, further, there I leaped in my winged thought from things corporeal to what is incorporeal and addressed myself in words like these (39) The physical and spiritual are linked so closely together that they transport and overlap one another. According to Petrarch, characteristics like this are traits of a good imitator. Vives also relates to the kind of imitation which interchanges the bodily action with spiritual. He describes an oration, which links actions with rhetoric. He says But these modern imitators regard not so much the mind of the orator in his expression, as the outward appearance of his words and the external for of his style. (191) Both writers believe that by interchanging techne which psyche, one can properly imitate and transcend a deeper significance of what the writer is imitating. Although Petrarch and Vives share similar ideas, they also hold a contradictory belief: Petrarch only imitates Cicero, while Vives believes that one should imitate several models to create a single work. Although Vives clearly states that Cicero is the best model for writing in the conversational style: Caesar and Epistles of Cicero will come into the first rank of conversational style, (192) he also states that one should comprise writing by mimicking several writers: The more models we have and the less likeness there is between them, the greater is the progress of eloquence. (190) Foremost, Petrarch is not writing in the conversational style, instead he using the plain style. Therefore, he should mimic another writer from the list Vives has specified. Also, Petrarch is only interested in imitating one writer, Cicero. He defends the Ciceronian tradition by writing only in Ciceros style. For this reason, Petrarch does not read other writers, like Dante, because he is afraid that he will become the product of what he reads, ideas and style. Instead he immerses himself in Ciceros style by reading his work in such depth that he essentially writes in Ciceros style without knowing he is doing so. Vives respects Ciceros work, but he does not believe that Cicero is the best writer. Other than Vives belief that Petrarch should have imitated several conversationalists, Vives also states that imitation of Ciceros work is useful and safe, but not of his style; for if anyone cannot achieve success in the attempt he will degenerate into redundant, nerveless, vulgar and plebeian kind of writer. (191) Therefore, the difference between Vives and Petrarch is that Vives believes that one should imitate several writers and that Cicero is not the best writer. Further, he offers a list of writers which should be imitated when trying to achieve a certain style. Petrarch, on the other hand, writes in Ciceros style and believes that Cicero should be imitated while engaging in every kind of writing. Alberti was an author who was more like Vives in this sense. He also believed that one should embrace all the things which would make something beautiful into one. For example, he says that all arts are linked to painting somehow, and that all arts take from incorporate the skills associated with painting into their works: The architect, if I am not mistaken, takes from the painter architraves, bases, capitals, columns, faà ¯Ã‚ ¿Ã‚ ½ades and other similar things. All the smiths, sculptors, shops and guilds are governed by the rules and art of the painter. It is scarcely possible to find any superior art which is not concerned with painting. so that whatever beauty is found can be said to be born of painting .(Book II) Furthermore, it was important to Alberti to imitate the laws of nature, rather than nature itself. He pointed out that an architect should mimic the structure of reality and the geometry hidden in reality. Like Vives and Petrarch, Alberti joined the bodily with the spi ritual to create the perfect art. But, he resembles Vives, in the sense that he believes that one should imitate several things to create one thing. One difference between Alberti and Vives is that Vives believes that one should start out imitating a person who is not the best at what he does, but someone who is better than the imitator. Eventually, according to Vives, one should be able to move up in rank and imitate the best. He says it is a wise precept of M. Fabius Quintilian that boys should not at first attempt to rise to emulation of their master, lest their strength fail them. An easier and quicker method will be to let them imitate someone more learned than themselves among their fellows, and contending with him let them gradually rise to copying their master himself. (189) Alberti does not mention this method of imitation. Instead he says that when it comes to art, on must have the favors of nature. (Book I) In other words, Alberti strongly believes that one should have a natural talent for what he is doing, and that the gradual chain of improvement is not necessarily an established method, as Vives indicates. Also, Alberti uses a style that is short and to the point. He says I beg that I may be pardoned if, where I above all wish to be understood, I have given more care to making my words clear than ornate. I believe that which follows will be less tedious to the reader. (Book I) This type of frankness is a distinguished style of writing. He uses simple rhetoric so that his audience can grasp the idea quickly. This kind of style corresponds to the type of art he is writing about. He says that he writing about a new type of art: We are, however, building anew an art of painting about which nothing, as I see it, has been written since this age.(Book II) His new style is imitating his concept of having a different type of manual towards art. Also, his main is to gear away from the Ancients and more towards the Florentine. By changing his style of writing he is achieving this, not only through what he saying about graduating art from mechanical to liberal, but also through his style and techne. Both Alberti and Vives spend time discussing subject matter. Vives splits up who should be imitated based on the subject of the piece being writer. Similarly, Alberti pays attention to the subject matter of the painting. He says that an image can only bring pleasure of the subject matter of the painting brings pleasure. Alberti believes that one must imitate the feeling he wants the viewer to have in the subject of his painting for the artwork to be successful. This is what Vives is saying when he illustrates that one must pick the best writer in the subject that he wants to write about and imitate that style to be successful. Both Petrarch and Alberti can be compared with Vives and his ideas on imitation. To all three writers imitation plays a huge role on how to present written and artistic works. All three of them believe that imitation of others will lead to success. Further, they believe that imitation is the only way to learn how to write properly. Alberti adds another assumption: he says that to be the best, one must imitate, but before the imitation process takes place, one must have a natural talent for art. Petrarch and Alberti both believe that one must mimic what they believe is the right tradition through their styles. Petrarch believes in the Ciceronian tradition and follows in Ciceros footsteps by imitating his style. Alberti is more concerned with understanding than the use of eloquent language. Overall, to all three writers imitation plays a huge role in their understanding of how written works influence their audiences.

A Comparison of Freedom in Secrets and Lies, One Flew Over the Cuckoos Nest, and Beloved :: comparison compare contrast essays

Freedom in Secrets and Lies, One Flew Over the Cuckoo's Nest, and Beloved      Ã‚  Ã‚  Ã‚  Ã‚     The word freedom has a different meaning for everyone based on their individual circumstances. Webster's Dictionary also provides many definitions for freedom, the most   relevent to this paper being: a) the absence of necessity, coercion, or constraint in choice or action; b) liberation from slavery or restraint or from the power of another. I believe that Webster's Dictionary explains freedom the best when it states that "freedom has a broad range of application from total absence of restraint to merely a sense of not being unduly hampered or frustrated." Since it is really a philosophical question whether a total absence of restraint is really possible, or even desirable, I think mine and most people's general use of the word tends to be more on the side of not being unduly hampered or frustrated.      The two movies Secrets and Lies and One Flew Over the Cuckoo's Nest, and Toni Morrison's novel Beloved all deal with different types and degrees of freedom and the lack there of. Secrets and Lies is about a middle-aged woman who had to grow up at a very young age and never had the freedom to enjoy, or even have, a childhood. One Flew Over the Cuckoo's Nest is the story of a group of patients in a mental hospital who's routine lives are forever changed by a newly committed patient who's life is anything but routine. Beloved follows the shattered lives of the family of an ex-slave living in Ohio after the end of the Civil War and the abolishment of slavery. Even though each deal with very different circumstances, by comparing the lives of each set of characters in these three stories many parallels can be drawn between them. The freedom restrictions imposed in each story are all different, yet the characters' actions are similar. The characters go to drastic lengths when there freedoms are infringed upon, the most drastic occuring when a newly achieved freedom is lost. Before understanding a new freedom the characters have no problem living without it. However once new freedoms are realized the characters are unrelenting in their fight to preserve them.

Flooring Company Business Plan Essay

JD Epoxy has established a website that gives general information about products and services. The website will be developed with more detailed functions so it can offer customer services like consultation, Q&A, and reservations. Also, JD Epoxy plans to use the website for links to other social media like Facebook, Youtube and Blogger to connect with customers more closely, and there will be video materials introducing the JD Epoxy team that will deliver a friendly and trustworthy image to customers. Presently Daniel minimizes costs by managing the business from his home. He rents grinders, vacuums, and application tools from Gestion Anny-Picard, and Simplex. He purchases supplies on a per-project basis from CTM adhesives. He plans to open a warehouse in the West Island area as his client base increases, in order to keep an inventory of supplies and purchase equipment. As business continues to grow, he will add an office space to the warehouse. Presently all of the installation work is done by Daniel and Yannick. As contracts increase, they will need to hire additional labor, which will enable them to concentrate on other tasks. The usual installation process takes a couple of days, so having multiple teams will boost the productivity of the business. For the time being Daniel will continue to deal with customers directly by phone and by visiting them in person for estimations. Once financing is ready, JD Epoxy will set up a customer service department to deal with clients. The customer service department will answer the phone, respond to questions and take reservations from customers, as well as attending to the website services. The team will be composed of at least two people in the beginning, so that they can rotate break times, since there should be constant service during business hours. Once website traffic and call volume increases, the customer service team will be expanded to limit wait times. When a customer calls for a consultation, Daniel visits in person to give a more detailed quote and provide explanations about the service procedures. This is a very important role in this business since customers can change their minds during this step, so it requires someone with professional knowledge and great communication skills to interact with the customer. That is why Daniel prefers to visit customers himself at this point rather than sending an employee. However, JD Epoxy will start to prepare a sales consultation department for the future. There will be intense training for customer visitation and quoting. The sales consultation department will be necessary when appointments increase and will allow a more flexible schedule to customers, since overlapping appointments will be possible once the department is in place. The sales consultation department is very important in the JD Epoxy organization since they will represent the company on the front line and speak on behalf of the company, bringing in actual contracts that lead to profits. The accounting department will deal with financing, taxes, and payroll. This department should be organized from the beginning, since JD Epoxy is a partnership, and delegating the accounting work to a third party will give a more objective overview of the company’s financial state and preserves a fair relationship between the partners. The accounting department will start with one inside book keeper working in liaison with an external accounting firm, until JD Epoxy can select a CFO. JD Epoxy will establish a marketing team which will support the sales department by providing target regions and information for sales pitches. This department will work closely with the sales and accounting departments to coordinate the marketing budget and set sales objectives. JD Epoxy will have a general administration department that organizes documents and handles day-to-day office tasks such as routing calls and dealing with suppliers. This department has an important role because they act as the glue that binds all the other departments together, tracking procedures from beginning to end. This department will start with one employee, and expand as needed. These five departments should fit together like nuts and bolts. Each department needs the others’ support at all times. They should be able to share their opinions and information openly. There will be regular meetings and events with all departments present to encourage teamwork and motivation. The glue of the business will center around a management software that Daniel will program. This software will follow clients throughout the whole workflow of the business. All departments will work on the same software and they will update the customer information as it passes through the business: marketing to sales, to production, and finally to clientele satisfaction. This software will track all information of the client and respective projects. At the end of the year, we will know exactly the sales ratio per marketing tool and per period, the gallons bought and used, the hourly estimates and charges, etc. We will then precisely analyze the business and be able to correct faults rapidly. Work Flow: Organizational Structure Goal: JD Epoxy Based on the sales projection JD Epoxy sales revenue will be around $75,000 in 2013 and grow to $150,000, $300,000, and $500,000 in the following years. The SME report (NAICS code # 23833), shows how much members of this industry are spending for wages and labor. For instance, companies with revenue around $70,000 spend $11,000 for wages and labor, while those with revenue around $300,000 spend $77,000 for wages and labor. Since we should include the CEO’s salary in this cost, from 2013 to 2016, JD Epoxy cannot pay for full time employees; they can only afford part time employees when needed. In 2017, JD Epoxy can start to offer full time positions to part time employees and begin hiring full time employees thereafter.

Recruitment and Selection Os a Sales and Marketing Manager

Company has around 15 Vacancies at any given time and 80% of new hires are leaving within probation period. Further he has recruited a former owner of a catering service in UK as the â€Å"Sales and Marketing Manager† of ABC Biscuit Company promising that Mr. Benjamin will bring at least 10 new foreign customers within the first 6 months, and Mr. Benjamin has not introduced any of customers to the company he has only given total cost of exceeding Rs. 250,000/= per month to the company. Possible alternatives were given like Do Post Mortems, Help the problematic employee to get back on track, Offer an internal transfer and Termination etc.This project report discusses the importance of good recruitment at technical and managerial levels and the implications that are encountered as a result of ad hoc recruitment processes. Recruitment is a responsibility of every manager in the Organization. The Project report is divided into five sections namely: Problem Identification; Right nu mber of people at right jobs at right times; Handling Mr. Benjamin’s situation; Conclusion; Recommended Recruitment and Selection Procedure for ABC Biscuit Company. 2. Problem Identification Managing people is a definite challenge both at strategic or even organizational levels.Thus, human resources are well managed and developed in alignment with the organizational goals and strategies. It has been observed that for any organization to achieve its stated objectives and goals there is the need for management to put in place policies or strategies that will help attract the best of employees to strive towards the achievement of organizational objectives. It has also been observed that the performance output of employees of ABC Biscuit Company is of prime concern to management of ABC Biscuit Company as it affects pproduactivity and the development of the company.Following are some major issues that have been found in ABC Biscuit Company; 2. 1 Poor HR Planning and Management An incompetent and poorly functioning human resources department reflects the overall state of affairs of an organization and its possible uncompetitive position in the marketplace. According to ABC Biscuit Company case study, company has around 15 vacancies at any given time which proof that company has bad HR planning. Bad HR planning ensures that the HR assets of the organization are not aligned to organizational goals and objectives. . 2 High turn over It has also been observed that the performance output of employees of ABC Biscuit Company is of prime concern to management of ABC Biscuit Company as it affects pproduactivity and the development of the bank. Importantly, some of the new employees who are not able to improve and adjust to their new working environment resign within first 6 months of their job leading to employee turnover of 80% and this affects the organization in terms of cost and pproduactivity. 2. 3 Finance manager handling all recruitmentsNot having a proper Huma n Resource Management is a disaster for any company. As we can see from ABC Biscuit Company, Higher Management has appointed Finance Manager (Mr. De Silva) to handle all recruitment of the company which is a wrong decision. When Finance manager perform multiple roles, according to case study give Mr. De Silva has to handle all recruitment apart from finance management, HR processes unlikely to become a priority unless a crisis occurs. Most of the employees whom he has recruited were his relatives and once who are known to him.Clearly we can understand that Mr. De Silva has lack of Human Resource Management knowledge. Without having a proper sound recruitment and selection procedure, he has simply recruited relatives and friends for his own personal benefits. 2. 4 Poor recruitment As a consequence of appointing Finance manager to handle all recruitments, Mr. De Silva has recruited Mr. Benjamin, former owner of a Catering Service in UK as the Sales and Marketing Manager of ABC Biscuit Company. This wrong decision has led to a massive issue for the company.There is no hiring strategy in ABC Biscuit Company, without a hiring strategy we unconsciously gravitate to hiring people who share our personality traits, which can lead to clash of personality and a division of expectations. 3. Right number of people at right jobs at right times Selecting the right person for the job has never been more important than it is today. Hiring the right people for the right positions at the right time is a key ingredient in creating a successful company. This is not easy to do, and most companies falter in this area.In order to ensure ABC Biscuit Company place right number of people at right jobs at right times following can be taken it to action; 3. 1 Build and nurture relationships with every business unit Managers and executives of ABC Biscuit Company need to be connected to other business units and departments so they know when activities in those areas of the business are like ly to create products.

Statistics and management sciences

Statistics and management sciences Free Online Research Papers Statistics is â€Å"The mathematics of the collection, organization, and interpretation of numerical data, especially the analysis of population characteristics by inference from sampling.† (The American Heritage ® Dictionary) â€Å"The collection, presentation, analysis and interpretation of the numerical data. The facts which are dealt with must be capable of numerical expressions.† â€Å"Statistics is a discipline which is concerned with designing experiments and other data collection, summarizing information to aid understanding, drawing conclusions from data, and estimating the present or predicting the future.† (The University of Melbourne) The word statistics originated from Latin word â€Å"status† meaning â€Å"state†. Earlier it was identified solely with displays of data and charts pertaining to the economic, demographic and political situations prevailing in a country. Even today a major segment of the general public thinks this way. However gigantic advances during the twentieth century have enabled statistics to grow and has made it important as a discipline of database reasoning. WHAT IS MANAGEMENT SCIENCES? Management science (MS) is the discipline of using mathematical modeling and other analytical methods, to help make better business management decisions. A management science is the application of scientific techniques that enable managers to make better decisions. Good decision-making can enhance the efficiency, productivity and profits of business firms. Management Sciences techniques are applied in many business functional areas, including supply chain and logistics management, inventory control, quality control, operations planning, production scheduling, sales forecasting, financial management, enterprise data mining, and customer relationship management. For instance, mathematical models can be used to create dependable flight schedules and crew shifts for airlines. Quantitative techniques can be used in deciding on service centre location, controlling production, or implementing statistical quality control in manufacturing companies. These techniques can also be used by service organizations such as banks, hospitals and investment firms to increase productivity, to provide better services to their customers and to increase prof its. In this era of technological advancement in information technology, management sciences makes extensive uses of information technology to effectively model and solve large and complex management problems. RELATIONSHIP OF STATISTICS AND MANAGEMENT SCIENCES The statistics plays a very crucial role in the field of management science. It is practically in practice in the organizations. The management’s main responsibility is to make logically sound decisions and the base of the decisions is the data that depends on the work and the statistical tools. So the statistical is inevitable for the business. Role of statistics in management sciences is discussed below: 1) HELPS IN MAKING SENSE TO NUMERICAL INFORMATION Every manager operating in business environment requires as much information as possible about the characteristics of that environment. The most important thing is that majority of information required is of numerical nature for example interest rates, stock market prices, money supply, market demand strength, an auditor’s concern about number and size of errors found in account receivable etc. These information in raw form are impossible to comprehend fully. Statistician’s role involves the extraction and synthesis of the important features of a large body of numerical information. One objective is to give sense to numerical data by summarizing in such a way that a clearly understandable picture emerges. At some places simple and straightforward numerical or graphical summary is sufficient whereas at times you need to employ heavy artillery of formal techniques to provide a good basis for deeper analysis. QUALITY AND PRODUCTIVITY IMPROVEMENT The world marketplace has faced immense competition over the past few decades. An international revolution in quality and productivity improvement has heightened pressure on economies. In order to survive the need is to mobilize workforce for continuous commitment to quality improvement. Improvement is possible knowing the current standards of quality provided and surveying what is required. At this stage, statistical skills in the collection and presentation of summaries are required. MONITORING ADVERTISING CLAIMS The public is constantly bombarded with commercials that claim the superiority of one product brand in comparison to others. When such comparisons are founded on sound experimental evidence, they serve to educate the consumers. Not infrequently however, misleading advertising claims are made due to insufficient experimentation, faulty analysis of data, or even blatant manipulation of experimental results. Government agencies and consumer groups must be prepared to verify the comparative quality of products by using adequate data collection procedures and proper methods of statistical analysis. HELPS IN REMOVING UNCERTAINTY Statistics does not deal with question of WHAT IS but of WHAT COULD BE or WHAT PROBABLY IS. At a time when assertions are made its not possible to tell surely of what is going to be the truth. This means that there is element of uncertainty. For example: The price of IBM stock will be higher in six months than it is right now. If the federal budget deficit is high as predicted, interest rates will remain high for rest of the years. Although an analyst may believe that anticipated developments over the next few months are such that price of IBM stock is likely to rise over six months period, he or she will not be certain of this. This means that this possibility exists but to what extent or how much more likely to rise? This is answered with the help of statistical probability tools. SAMPLING Before bringing new product in market, a manufacturer wants to arrive at some assessment of the likely level of demand, and a market research survey may be undertaken. He wants to know about potential population of all buyers. However, it is prohibitively expensive, if not impossible, for a typical market research survey to contact every member of that population. Rather a small sample of population members will be contacted, and any conclusions about the population will be based on information obtained from sample. The technique of sampling large population is largely used in business. For example decisions about whether a production process is operating correctly are based on the quality of a sample from its output. When we have information on a sample from population, it is generally straightforward to summarize the numerical sample data. However taking a sample is merely a means to an end. The objective is not to make statements about the sample but, rather, to draw conclusion about the wider population. Thus an important problem for statisticians involves the extent to which it is possible to generalize about a population, based on results obtained from a sample. RESEARCH ANALYSIS Statistics studies possibility and nature of a relationship between two or more variables of interest. For example, what would be effect of 5% increase in price on demand of automobiles? Economics says other things remaining same an increase in price brings decrease in demand. This theory is qualitative. It does not tell us how much demand will fall. Now we must collect quantitative information in order to assess how demand has responded to price changes in the past. Now we will base our assessment on premise that what happened in past is likely to be repeated after proposed current price increase. Objective of using numerical information is to learn something about the relationship between the variables of interest. Procedures for analyzing relationships are possible only through statistics. FORECASTING Reliable predictions are needed in business. Investment decisions must be made well ahead of time at which a new product can be brought to market, forecasts of likely market conditions some years into the future is desirable. For established products, short term sales forecasts are important in setting of inventory levels and production schedules. In forming economic policy, the government requires forecasts of likely outcomes for variables such as gross domestic product, unemployment, and inflation etc. Forecasts of future values are obtained through the discovery of regularities in past behavior. Thus data are collected on past behavior of the variable to be predicted, and on the behavior of other related variables. The analysis of this information may then suggest likely future trends using statistical tools. DRAWING INFERENCES FROM TOOLS The tools and techniques that compromise business statistics include those specially designed to describe data such as charts, graphs and numerical measures. Also included are inferential tools that help decision makers draw inferences from a set of data. Inferential tools include estimation and hypothesis testing. The inferential tools includes two things the estimation and hypothesis testing. ESTIMATION In situations where one would like to know about all the data in large data sets but it is impractical to work with all the data, decision makers can use techniques to estimate what the larger data set looks like. The estimates are formed by looking closely at a subset of the larger data set. HYPOTHESIS DEVELOPMENT Once the decision maker identified the important variables in a situation and established the relationship among them through logical reasoning in the theoretical framework the decision maker is in a better position to test whether the relationship that have been theorized do in fact hold true. By testing these relationships scientifically through appropriate statistical analysis or through negative case analysis in qualitative research we are able to obtain reliable information on what kind of relationships exist among the variables operating in the problem situation. The results of these tests offer the decision maker some clues as to what could be changed in the situation to solve the problem. Formulating such testable statements is called hypothesis development. INTERPRETATION The results is interpreted in the light of the limitations of the original material. Too exact conclusions must not be drawn from data which themselves are but approximations. It is essential however, that the investigator discovers and clarify all the useful and applicable meaning which is present in its data. FACTOR OF CARELESSNESS ELIMINATED Human beings cannot go through life without making mistakes, but should be reduced to a minimum. Factor of carelessness is eliminated by the use of statistics in business decisions by managers. MANAGING ORGANIZATIONAL FUNCTIONS Companies are organized on basis of functions performed by them and that is why they are referred as functional organizations. Organizations perform three primary functions of finance, marketing and operations. Their secondary functions include maintaining accounting record, human resources management and information systems. Statistics help managers convert data into information which in turn plays a critical role in decision making. CAPITAL BUDGETING Capital budgeting is the process by which a firm generates, analyzes and selects the projects that it will invest in. The most important issue addressed is composition of firm’s product line. Once a product is developed its financial feasibility is a must to be examined. Revenues and costs associated with the project are also important to be known. The probability concept is helpful in dealing with uncertainty surrounding the projected values of future cash flows. SUCCESS OF PROMOTIONAL TOOLS Promotion is final component of marketing mix. A company must communicate with consumers to inform them about the company and its product and make them buy the product. Promotional tools available to achieve these objectives include advertising, public relations, sales promotion and personal selling. Statistical methods can be used to help assess how successful these tools have been in generating sales. LOCATION ANALYSIS AND LOGISTICS A critical decision for any firm is where to locate its production facility, storage center or retail outlet. The circumstances that effect location decision depend on type or facility. A variety of statistical techniques can be employed to help make the decision of choosing appropriate location as per requirements of business. PROJECT MANAGEMENT Project evaluation and review techniques and critical path method are management science procedures that help control and plan large scale projects. Probability distributions such as the normal distribution are applied in this topic. HUMAN RESOURCE MANAGEMENT People related decisions by a firm are dealt in functional area of Human Resource Management. It involves activities such as recruitment, training, performance appraisal, compensation and motivation. The HRM must forecast its needs in terms of number of employees required and their skills. If new staff is required then tests must be conducted to employ them on merit basis. The high scorers must be given priority over low scorers. Statistical tools can be used to assess the validity of these tests. Analysis of test results can also help to reveal deficiencies in the training programs. Periodic performance appraisal is important for making decisions regarding retention, compensation and promotion. Statistical methods can be used to assess the compensation program to determine whether it supports performance objectives. INDEX NUMBERS An index number is a statistical device designed to show changes in a variable or a group of related variables with respect to time or geographical location such as wages, income, prices, exports or imports etc over a period of time. Today it’s the most widely used statistical device. They are the indicators of inflationary or deflationary tendencies. Industrial production rising or falling, sales are higher or lower than the previous period are all disclosed by index number. CONCLUSION From the above mentioned heads, it is concluded that statistics plays a key role in the field of management sciences. Research Papers on Statistics and management sciencesThe Project Managment Office SystemRiordan Manufacturing Production PlanIncorporating Risk and Uncertainty Factor in CapitalInfluences of Socio-Economic Status of Married MalesResearch Process Part OneDefinition of Export QuotasOpen Architechture a white paperAnalysis of Ebay Expanding into AsiaBionic Assembly System: A New Concept of SelfPETSTEL analysis of India

Explaining the Invention of the Jigsaw Puzzle

Explaining the Invention of the Jigsaw Puzzle The jigsaw puzzle- that delightful and perplexing challenge wherein a picture made of cardboard or wood has been cut into differently shaped pieces that must be fit together- is widely thought of as an entertaining pastime. But it didn’t start out that way. Believe it or not, the birth of the jigsaw puzzle was rooted in education. A Teaching Aid Englishman John Spilsbury, a London engraver and mapmaker, invented the jigsaw puzzle in 1767. The first jigsaw puzzle was a map of the world. Spilsbury attached a map to a piece of wood and then cut out each country. Teachers used Spilsburys puzzles to teach geography. Students learned their geography lessons by putting the world maps back together. With the invention of the first fret treadle saw in 1865, the ability to create machine-aided curved lines was at hand. This tool, which operated with foot pedals like a sewing machine, was perfect for the creation of puzzles. Eventually, the fret or scroll saw came to also be known as the jigsaw. By 1880, jigsaw puzzles were being machine crafted, and although cardboard puzzles entered the market, wood jigsaw puzzles remained the bigger seller. Mass Production Mass production of jigsaw puzzles began in the 20th century with the advent of die-cut machines. In this process sharp, metal dies for each puzzle were created and, operating like print-making stencils, were pressed down on sheets of cardboard or soft woods to cut the sheet into pieces.   This invention coincided with the golden age of jigsaws of the 1930s. Companies on both sides of the Atlantic churned out a variety of puzzles with pictures depicting everything from domestic scenes to railroad trains.   In the 1930s puzzles were distributed as low-cost marketing tools in the U.S. Companies offered the puzzles for special low prices with the purchase of other items. For example, a newspaper ad from the period trumpets the offer of a $.25 jigsaw of the Maple Leaf hockey team and a $.10 theater ticket with the purchase of Dr. Gardner’s Toothpaste (normally $.39) for just $.49. The industry also created excitement by issuing â€Å"The Jig of the Week† for puzzle fans.   The jigsaw puzzle remained a steady pastime- reusable and a great activity for groups or for an individual- for decades. With the invention of digital applications, the virtual jigsaw puzzle arrived in the 21st century and a number of apps were created allowing users to solve puzzles on their smartphones and tablets.

Myths about Grammar Essay Example | Topics and Well Written Essays - 1250 words

Myths about Grammar - Essay Example The structures are not to be taught to the learners, they will acquire them on their own and if they are to be taught then the lessons are expected to be boring. They will be boring because the students will be required to repeat the different models in grammar (Chomsky, 136). Such teaching activities can be boring. This makes it more questionable. However there are different approaches that are communicative and proficiency based that limit the grammar instructions. There are several grammar claims that should be called grammar myths. There is a myth about split infinitives. You might have heard people saying that you are not supposed to use split infinitives. It is one of the many grammar myths that have been contradicting people for quite a long time. It all started with the Latin writers. (Bryan, 270) How the myth of split infinitives began Not to split infinitives is a notion that is mistaken. Latin was a, model in good writing in the 1800s and different writers tried to make English fit in Latin language. The attempt was unrealistic since the Latin infinitive is always one word and there is no way that it can be split. On the contrary, the infinitive has to be split in the English language (House, 54). No matter how awkward and unattractive the split infinitive is, it is never wrong to use them. There is nothing desirable about split infinitives, but according to H.W Fowler he says that when it comes to real ambiguity, then split infinitives are quite useful (Fowler, 768) .Always feel free to use the split infinitives whenever necessary even when it is a clumsy version. An example of a sentence with a split infinitive is†¦Ã¢â‚¬  We wanted to immediately leave for the airport†Ã¢â‚¬ ¦. This splits an infinitive and is definitely not the right one to use. The other example is â€Å"The committee plans to le gally ban franc disclosures† (LaRocque 61) .This sentence makes it clear that it is necessary to use a split infinitive. A split infinitive A split infinitive is a word that comes in between the particle â€Å"to and the verb. An example of a split infinitive word is â€Å"to go boldly† (Wardhaugh 69) it might seem wrong but then it is not. Split infinitives have been a great controversy among the teachers and the grammar people, but the notion that it is a grammatical myth is a mistake. Henry Fowler the writer of the book Modern English Usage stated that these as superstitions .It is a superstition that has never been legit and different English writers have always been splitting the infinitives ever since the 1300s. The blame has always been put on Henry Alford a Latinist and used to be the Dean of Canterbury in the 19th century. Alford published a book, A Plea for the Queen’s English in 1864 where he declared that â€Å"To† was an inseparable infinitiv e. He probably was influenced by the Latin grammar that infinitive is one word and it can never be split. Like you should not put the word,† Boldly† between an infinitive phrases â€Å"To go-as in â€Å"to boldly go’. This was false. (Alford 171) In the early 20th century the highly respected English writers Henry Fowler, George 0.Curme and many more started explaining that the split infinitive is preferable and accepted. Besides it is hard to split an infinitive, since the particle â€Å"To† is simply a prepositional marker and not part of the infinitive. At times it s never needed. An example like â€Å"She helped me to read† the particle ‘To’ can be dropped. But then because of the grammar myths that still live on, then it becomes difficult for one to drop it. That could explain why it is still in use and considered grammatically correct (Harris, Bruce

What do you consider to be the main differences between a unitarist Essay

What do you consider to be the main differences between a unitarist and pluralist approach to the management of the collective employment relationship - Essay Example Unitarist and Pluralist in the management of collective employment relationships. The unitary approach to management is where there is an integrated and harmonious entity that subsists for common purposes (William & Smith, 2006). This theory portrays the employer and employee relationship to be one where there is harmony and understanding. The main assumption of this theory is that there are a common set of values and these bind the two parties, i.e. the employer and the employee together. Also these ensure that there are no conflicts among the two parties. This is one of the oldest theories that have been developed to describe employment relationship however it is one which clearly and very smoothly connects to the contemporary methods as well. These include the ideas related to the corporate culture and human resources management. However there are a number of drawbacks of this theory as well. Firstly, it fails to recognise the difference between the interests of the managements and those of the employees. The theory only assumes that all decisions made by mana gers is in the interest of the employees. There is a lack of good communication in this theory and including bettered communication is the only mode of explaining the countervailing force in all cases including, individuals, groups and even trade unions. Also as explained by Palmer (1983), where conflicts arise, the conflicts should be resolved by dismissing the employee or with the interference of law. Although the Unitarian theory was available, with the growing amount of complexity and the increased scales of business units, there was a strong need for a theory to be developed to be stronger in nature than that of the Unitarian theory. This theory required being able to accept that there are always a limited amount of conflicts that are present in an organisation and this needed to be a mode of achieving a consensus among the two parties, i.e. the

Effects Of Organic Waste Pollution On The Natural Environment Essay

Effects Of Organic Waste Pollution On The Natural Environment - Essay Example Water cycle that consist of material flow on earth’s surface to water masses are some of the causes of water pollution as the flows collect materials into water bodies and are vulnerable to intentional pollution through domestic and industrial waste disposal. This paper discusses environmental effects of organic waste pollution and reviews an article that uses toxicology to investigate the impacts of water pollution on the natural environment. Effects of organic waste pollution on the natural environment Organic discharge into water bodies has varying effects on the environment. One of the effects of organic pollution is the disintegration of organic matter to changed odour and taste of water. Effects of continuous degradation are accumulation of compounds such as hydrogen sulphide and mercaptans and this leads to gradual increase in changed odour and taste of water that may not be suitable for sensitive flora and fauna. Organic pollutants also destabilize oxygen concentration in water masses. Many factors lead to this shift from equilibrium of water concentration. Processes of organic components of water such as photosynthesis and respiration uses oxygen and may change oxygen concentration in water. Photosynthesis may increase concentration beyond its equilibrium while respiration may reduce the level of concentration. Anaerobic respiration and oxidation of organic pollutants are other factors that can reduce oxygen concentration in water. ... Insufficient oxygen in water may also cause death of aquatic animals. Such deaths further leads to accumulation of organic compounds in water and worsen the problem with oxygen concentration. Death of plants and animals in the water bodies also generate aesthetic effect besides increasing water turbidity (Goel 2006, p 116- 120). Organic pollution also affects levels of production of aquatic plants and animals. As the pollutants begin to invade water bodies, aquatic plants and animals benefits from nutrients that the organic pollutants may contain and this leads to high rates of photosynthesis and respiration among other processes. Increased concentration of organic pollutants however have adverse effects on aquatic lives as respiration rates increase and this leads to aesthetic effect and instability in oxygen concentration. Accumulation of organic pollutants also increases concentration of chemical compounds such as hydrogen sulphide and ammonia, chemicals that have adverse effects on some plant and animal species such as phytoplankton. High levels of organic pollution are also a threat to biodiversity. At normal water conditions, without organic pollutants, all aquatic plants, and animals are able to survive and their populations are constant. High levels of pollution however threaten the lives and less tolerant plants and animals die. Some plants and animals may however be tolerant and survive the harsh conditions due to the pollution. Consequently, aquatic life will consist of the tolerant species that may only be few. Loss of biodiversity from the pollution can also be permanent, unless artificial measures such as reintroduction of the extinct species upon resumption of normal condition in the polluted aquatic environment. Organic

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan Acute Exacerbation of Bronchial Asthma (AEBA) Case Study Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan