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

Why did the French loose the war in Vietnam? Essay -- essays research

  Ã‚  Ã‚  Ã‚  Ã‚  Q. Why did the French loose the war in Vietnam?   Ã‚  Ã‚  Ã‚  Ã‚  In April of 1956 the last remaining French troops would leave Vietnam. After over 200 years of influence and rule, the French at last realized that the occupation and control of Vietnam was an unreachable goal. In consideration of the many blunders (both militarily and political) , and the outright ignorance of the French high command, any efforts to stabilize Vietnamese nationalism and to maintain french rule over Vietnam were thwarted. Thus the French were defeated by an inferior force, and the question of how such an anomaly could occur lies within the 200 years of rule, and the many mistakes made through out way.   Ã‚  Ã‚  Ã‚  Ã‚  To completely understand how France could be defeated by a simple army of Vietnamese peasants, one must first acknowledge a brief history of the Franco-Vietnamese relationship. French Jesuits first arrived in Vietnam in 1634, in hopes of bringing over â€Å"souls† to the catholic church. The majority of Vietnamese are Buddhist, and many locals opposed the presence of the French. By the mid 1700's France would sign a treaty with the Vietnamese gaining protection for the Jesuits in return for French assistance in helping the Vietnamese fight their Chinese invaders. With the rest of Europe carving up the world in the mid 1800's, France now looked to Vietnam as an extension of its Empire. A successful invasion of Vietnam in 1859 gave the french control over Saigon. The invasion was in response to the murder of French Catholics, and looked to be for a time a just cause. However it was just a cover story for the French to settle in and eventually rape Vietnam of it’s raw materials and its culture. Thus from 1861 to the birth of Ho Chi Minh in 1890, French troops would conquer most of what is modern day Vietnam to their own discretion. The discretion of the French must be noted as racially bias. The term â€Å"white man’s burden,† best describes the presence of the French in Vietnam from the period of 1890-1939. Essentially the french believed everything about them was superior to the Vietnamese. Culture, language, religion, and race. This would not settle to well with many Vietnamese, however things would turn worse for the French with the outbreak of WWII.   Ã‚  Ã‚  Ã‚  Ã‚  I would like to argue that the tr... ... the Viet Minh. However by April it was clear that the French forces were losing the battle, and it was now it was clear that the French were putting their last remaining efforts in to Dien Ben Phu. It was an all or nothing situation. The French high command had hoped that Giap would throw his army in to the will of the occupying French forces and in the end be forced to retreat and regroup with a battered down weak force. However this was not the case and by May 7th the remaining French forces at Dien ben Phu will surrender. Peace talks between the French and Viet Minh open up in May of 1954. The agreement at Geneva would once again split Vietnam in to two. The North would be a pro Communist government at Hanoi led by Ho Chi Minh, and the South a pro democratic government backed by the United States out of Saigon. By 1956 the last remaining French forces would leave Vietnam, and a new struggle would begin in the South. The beginning of the American War in Vietnam was just around the corner. The Viet Minh had defeated a major European power, however it would be another 20 years before the reunification was complete.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚   Why did the French loose the war in Vietnam? Essay -- essays research   Ã‚  Ã‚  Ã‚  Ã‚  Q. Why did the French loose the war in Vietnam?   Ã‚  Ã‚  Ã‚  Ã‚  In April of 1956 the last remaining French troops would leave Vietnam. After over 200 years of influence and rule, the French at last realized that the occupation and control of Vietnam was an unreachable goal. In consideration of the many blunders (both militarily and political) , and the outright ignorance of the French high command, any efforts to stabilize Vietnamese nationalism and to maintain french rule over Vietnam were thwarted. Thus the French were defeated by an inferior force, and the question of how such an anomaly could occur lies within the 200 years of rule, and the many mistakes made through out way.   Ã‚  Ã‚  Ã‚  Ã‚  To completely understand how France could be defeated by a simple army of Vietnamese peasants, one must first acknowledge a brief history of the Franco-Vietnamese relationship. French Jesuits first arrived in Vietnam in 1634, in hopes of bringing over â€Å"souls† to the catholic church. The majority of Vietnamese are Buddhist, and many locals opposed the presence of the French. By the mid 1700's France would sign a treaty with the Vietnamese gaining protection for the Jesuits in return for French assistance in helping the Vietnamese fight their Chinese invaders. With the rest of Europe carving up the world in the mid 1800's, France now looked to Vietnam as an extension of its Empire. A successful invasion of Vietnam in 1859 gave the french control over Saigon. The invasion was in response to the murder of French Catholics, and looked to be for a time a just cause. However it was just a cover story for the French to settle in and eventually rape Vietnam of it’s raw materials and its culture. Thus from 1861 to the birth of Ho Chi Minh in 1890, French troops would conquer most of what is modern day Vietnam to their own discretion. The discretion of the French must be noted as racially bias. The term â€Å"white man’s burden,† best describes the presence of the French in Vietnam from the period of 1890-1939. Essentially the french believed everything about them was superior to the Vietnamese. Culture, language, religion, and race. This would not settle to well with many Vietnamese, however things would turn worse for the French with the outbreak of WWII.   Ã‚  Ã‚  Ã‚  Ã‚  I would like to argue that the tr... ... the Viet Minh. However by April it was clear that the French forces were losing the battle, and it was now it was clear that the French were putting their last remaining efforts in to Dien Ben Phu. It was an all or nothing situation. The French high command had hoped that Giap would throw his army in to the will of the occupying French forces and in the end be forced to retreat and regroup with a battered down weak force. However this was not the case and by May 7th the remaining French forces at Dien ben Phu will surrender. Peace talks between the French and Viet Minh open up in May of 1954. The agreement at Geneva would once again split Vietnam in to two. The North would be a pro Communist government at Hanoi led by Ho Chi Minh, and the South a pro democratic government backed by the United States out of Saigon. By 1956 the last remaining French forces would leave Vietnam, and a new struggle would begin in the South. The beginning of the American War in Vietnam was just around the corner. The Viet Minh had defeated a major European power, however it would be another 20 years before the reunification was complete.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  

Ways to Save Energy

We live in the State of Louisiana and our electric is supplied by Enterer formally Gulf States utilities. Enterer provides electric for the states of Arkansas, Louisiana, Mississippi, New Orleans and Texas. Enterer supplies their electric to our parish from River Bend Nuclear Station in Saint Branchville, Louisiana in West Felicia Parish which Is only 17 minutes from where we are In Jackson, Louisiana. I did not have to research for the source of electric that our company use because this is where my second oldest son works.At this time Enterer is also using renewable energy such as wind and hydro also In producing some of their electric. Last year at this time our electric bill was very high but I reduced our bill this year by only using lights that are needed at that moment, by setting our A/C at 780, only using our oven on the stove as needed, and reducing the usage of our microwave, of course everything in our home is electric so that do cause some problems, some people Just walk out of a room and leave the light on or go out of the door with the air on and leave the door open.The idea of having heating oil or coal coming from Russia would put a change thin a lot of households, imagine having to pay close to $500-$600 Just for lights, there would be a big change with all people because this meaner that the amount of time that it take to use your stove for cooking would change, even the time that is spent on the internet for class or Just for fun would change and all those days from having a television on Just for noise In the background would have to end also.Electric coming from Russia would mean a reduce of usage because there would be a raise in the price of oil, gas and coal. Currently the debate that has my attention has to do with the usage of high ethanol gas. This gas supposed to be cleaner and reduce the emission from regular gas. Currently our ozone layer is steady being destroyed from pollutions that are entering the environment.Having high ethan ol gas would help to reduce this emission but then also having flex-fuel vehicles or an electric vehicle would count towards helping the environment. Explaining Chart: Electric usage for television, computer, electric stove, oven usage on two days, hot water for bathing, cordless phone going down needed recharging, A/C on for cooling the home, ceiling fan on in the living room. Solar: Came to a good usage blinds up on windows did not have to use lights as often.Gas: Two days In a row gas had to be put in our truck, husband and son job hunting and these two days were spent going out of East Felicia Parish looking for work, Gas was use going to the doctor for my monthly check-up which also made more gas added to the truck. Chart enclosed References Smith, J. Dune 26, 2011). How to Improve Your Homes Energy Efficiency Rating retrieved trot mm. ‘. Correspondence. Com on August 21, 2013 Enterer The Power of People retrieved from wry. Enterer. Com on August

Plato’s Attack on Poetry

Poetry In order to understand Plato's attack on poetry we have to take in consideration the political and social context of Athens at that time. It was the context where Plato devoted all his efforts to uplift the moral condition of the individuals and the well being of the state. The aim of his literary criticism was to educate the youth and form them into good citizens of his ideal state. It was the age of political decline and the moral and educational standard of the citizens were in a poor state. The epics of Homer were very much rooted in every sphere of the society, and the influence of the poets on the society was too deep. Plato being a philosopher, to prove the superiority of the philosophy, he severely attacked poetry. Apart from poetry he criticized every other form of arts. Plato’s concepts on art were base son his Theory of Ideas. He believed that ideas are the ultimate reality. The ideas of everything are the original pattern and the things are the copies. So he viewed all forms of art as merely copies of copy, twice moved from reality. Things itself being imperfect and copies of the ideas, their reproduction in art must be more imperfect. He believed that the works of art takes man away from reality rather than leading to it. It neither helped to mould the character nor to promote the well being of the state. These were the basic principles underlined behind Plato’s critics on arts in general. Plato criticizes poetry in several of his dialogues, beginning with Apology, his first work, and ending with Laws, his last. Plato’s critics on poetry are basically concerned of two standards. The first concern was for the good of the individual and the state. Based on this standard he finds in poetry more to condemn it than approve. Same like his concepts about the other types of arts, his concepts about poetry also was under severe critic due to its unrealistic nature and its incapacity to be worthy to the society and individual. He severely condemned the incapacity of the art forms to get in to the roots/ reality and being concerned with only the twice removed reality. This was the first standard he used to condemn the poetry and other art forms in general. He attacked poetry on four grounds—moral, emotional, intellectual and utilitarian. Poetic inspiration: Poets does not write what he has thought to say, but because he is inspired. It means they do not compose the poem based on some virtue and reason, but based on some impulses and non rational kind coming from supernatural source. A sudden outpouring of the soul based on the sudden impulse of the moment does not be based on reason. Hence their pronouncements are unreliable and uncertain. They are not safe guides and it cannot be followed, it also cannot make the individuals a better citizens and the state a better organization. There might be some truth in them, for they are divinely inspired, but such partial and imperfect truths must be carefully examined. Such truths cannot use as substitute for knowledge based on reason. As the poems are based on the ‘divinely inspired’ and completely based on inspiration, sometimes the poets themselves cannot explain what they write. Another aspect of poetry which he criticizes is, the imitation or blind reliance on the passionate elements of the soul. He Plato divides the soul into three parts: (1) rational, (2) spirited, (3) appetitive. The imitation of the non rational part of the soul will give grater pleasure. The poets and the other artists imitates this baser, non rational part of the soul, and it leads them to away from reality and reason and become merely indulged in emotional outburst. The poets will be ashamed in their real life of the emotional over pouring which takes place during their poetic or other artistic performances. He condemns poetry in Republic X, for the poets, â€Å"they feed and water the passions instead of drying them up, and let them rule instead of ruling them as they ought to be ruled, with a view to the happiness and virtue of ‘mankind.† Based on all these ideas he strongly condemned poetry and argued that poetry cannot take the place of philosophy. The emotional appeal of poetry: Plato’s another charge against poetry is its appeal to the emotion. Being a product of inspiration, it effects emotion rather than reason, the heart rather than intellect. Emotions being just impulses like the poetic inspiration it cannot be trusted and act as safe guide as reason. The poetry at the time of Plato was tragic, in which the weeping and wailing were indulged to move the hearts of the spectators. He says in the republic â€Å"for f we let our own sense of pity grow strong by feeding upon the griefs of others, it is not easy to restrain it in the case of our own sufferings†. Non moral character. Plato’s another criticism against poetry is its lack of concern with morality. Poetry (and drama) is not conducive to social morality as poets pander to the popular taste and narrate tales of man's pleasant vices. Poe ts tell lies about gods. Gods and their representative heroes are represented as corrupt, immoral and dishonest in the epics of the poets (especially of Homer). This pervert public taste and morality. Children tend to imitate the doings of gods and other heroes as told to them by their mothers, they fashion their own conduct on what they read. It also hurt him to see virtue often coming to grief in the literature esteemed in his days – epics of Homer, narrative verse of Hesiod and tragedies of Aeschylus and Euripides. He says in republic â€Å"they give us to understand that many evil livers are happy and many righteous men unhappy†. Plato attacks poetry on intellectual grounds as well: poets have no knowledge of truth, for they imitate appearances and not the truth of things, illusions instead of reality. Poets, like painters, imitate the surface of things. Beyond the world of the senses there is another world, the world of ideal reality, where concepts, like truth, virtue, beauty, etc. , exist in an ideal form. Poetry is the product of futile ignorance. The poet who imitates without really knowing what he is imitating is demonstrating both his lack of useful purpose and his lack of knowledge. At last Plato says that â€Å"no poetry should be admitted save hymns to the gods and panegyrics on famous men. † The poets may be honoured, but they must be banished from his ideal state.

Six Cities in Canada essays

Six Cities in Canada essays CANADIAN POPULATION CHANGE IN SIX CITIES Population Change in Six Canadian Cities Since the first moment that humans arrived in Canada, Canada has undergone many changes and will continue to do so as time goes on. One of the most remarkable aspects is the growth and development of large cities throughout the country. Although Canada is the second largest country in the world, Canada's population remains centralised around those regions where opportunities are available. Because of the amount of opportunities and other social factors, people from across the world move to large diverse Canadian cities, such as Chicoutimi-Jonquiere, Montreal, Oshawa, Toronto, Winnipeg, and Vancouver. Between 1991 and 1996, Canadian cities have changed significantly. Using the mentioned cities as studies to show Canada's growth, figures show that Winnipeg and Oshawa follow somewhat the same trends as well as Toronto and Vancouver. Chicoutimi-Jonquiere and Montreal on the other hand follow their own patterns. The latter two are much more different from the others because they are French dominated cities. However, most trends occurring in all six cities are results of Canadian history. Populations in these cities are very different, Toronto has the highest population and a relatively high population increase between 1991 and 1996 due to a number of factors. When settlers first settled in Canada, they settled along the southern strip of what are now Ontario and Quebec. Since then Canada's centre has remained in these regions and attracts many immigrants with its high level of employment and opportunities. Toronto remains more attractive to immigrants however due to its culturally diverse population and upscale employment opportunities. Montreal, who has a very large population, is however not as quick with growing its population because of the current instability due to separatists and because most immigrants are not Francophones cau...

How To Automate Social Media With CoSchedule Get Your Time Back

How To Automate Social Media With Get Your Time Back Is social media marketing impossible without automation tools? Close to it. Even if you’re Wonder Woman, there’s too much that needs your attention to handle by yourself. Social automation tools make it possible for your team to do more in less time, as well as making the impossible easy (like posting 25 times a day while getting anything else done). However, with so many options out there, how do you choose the best tool set? One word: . With our all-in-one marketing calendar platform, you can automate your social media marketing in one place (and keep the rest of your marketing organized, too). This post is going to walk you through how it all works, from how to set up your accounts, to how to use some of our most popular features like ReQueue and Best Time Scheduling. How To Automate Your Social Media With And Get Your Time BackWhat Is Social Media Automation? Social media automation is the process of scheduling social media content to publish automatically without manual effort. Automate Your Social Media With Free For 14 Days Were about to cover all kinds of cool stuff you can do with . If youre not already a customer, grab a free trial below and follow along! Social Media Automation Best Practices Like anything else in the realm social media, there are major do’s and don’ts as well as best practices that will help you get the most out of your automation process. Read Before You Share If you’re sharing content, it’s important that you read the whole article or consume the piece in its entirety. Why? You need to be able to create messaging that shows actual understanding of what it’s about. People can tell if you haven’t read the content before posting it. You also want to make sure that a piece of content fits your brand. Headlines don’t always explain everything, and the last thing your team wants to do is post an article that doesn’t have anything to do with what your company does. Plus it’s lazy and you don’t want to be lazy when it comes to social media. #social #media tip: always read before you share!Automate Your Social Media Promotions For Publishing New Content Our next best practice for automating social media marketing is to create new social media campaigns anytime your team creates a new piece of content. You spend a lot of time working on that content, so dont waste the opportunity to promote it. Shut Off Your Automated Campaigns During A Company Crisis It happened. Suddenly your company is in PR crisis mode, which means the first thing your team needs to do is shut off your automatic social campaigns. There is nothing worse than when a company is already facing a crisis, and suddenly a tweet goes out about something irrelevant It comes off as insensitive to what’s already happening with the company and could make the situation worse. If your team goes into a crisis mode, pop into your calendar and find your social campaigns: Either turn them off until the crisis has passed: Or push their publish date back a week or two, until you’re back in control of the situation: When in doubt, consult your PR disaster plan  or speak to your communications team on what steps to take. Recommended Reading: How to Build a Thorough Social Media Policy to Prevent Emergencies Facing a #social #media crisis? Dont forget to turn off any #automated campaigns.Use ReQueue To Reshare Evergreen Social Media Content You should be sure to maximize the life of your evergreen content by resharing it on social media. But wouldn’t people become annoyed seeing the same social message? Not exactly because social media messages have a short lifespan. For Facebook, it’s about two hours and thirty minutes, while Twitter is a maximum of 18 minutes. That means that your team should reuse that content again to make sure your audience actually sees it. Re-posting your content can be time-consuming though. That’s where a tool like ReQueue  comes in. ReQueue is an intelligent social media queue that allows users to reshare content at the click of a button and simply forget it. Not to mention that ReQueue is super simple to activate. Just scroll down to the post you want to add to your queue: Scroll to the bottom and toggle the ReQueue switch to on: Select your queue feed and the tool will take it from there: #social #media tip: use #ReQueue in @to reshare posts auto-magically:Use Best Time Scheduling To Automate Posting Times The final best practice we’ll cover is sending your posts at the best times. Why? During peak times when your audience is the most active, you have the best chance at getting more eyeballs on your content. Now with Best Time Scheduling  in  ,  you don’t have to sit and look up the best times to post anymore.  It’ll do that automatically for you. How can you active this fantastic feature? Go to your calendar and select a social post: Scroll down to the bottom: Select Best Time from the dropdown menu and let do the rest: Avoid These  Cardinal Sins Of Social Media Automation The ability to automate your social media is an awesome power, but with that power comes the responsibility of using it correctly. So these are some faux pas you should avoid at all cost. Automatic Direct Messages (DM) Nothing grinds my gears more than when I follow someone on Twitter and an automatic message shows up in my direct message folder. While it may seem like a good idea to thank everyone who follows you, it comes off like spam. No one wants to read a hollow sentiment  they know every other follower is getting. So, just say no to automated DMs. Just say no to automated DMs.Automated Responses To Customer Complaints There’s a very good reason why you should never, ever send automated responses to customer complaints. Applebee’s  found that out the hard way a few years ago when they started copying and pasting the same comment over and over to angry customers. When someone is already fired up on social media, they want to know they’ve been heard. Automating your company’s response sends a clear message that their opinion doesn’t matter to you and adds  gas  to the flame. Never automate responses to customer complaints on #social #media.Schedule One Message Across Multiple Networks While it may seem like a great social media hack, your team needs to avoid is posting the same message across multiple networks. Each social network has different requirements and best practices. Not to mention unique audiences and purposes. For example, your LinkedIn content might be professional, while your tweets might be more fun and light-hearted. There’s an easy way to optimize every post for each network, though.  Use the Social Message Optimizer. Using this free  web-based  tool is simple. First, type your message into the field and select which type of post you’re going to be sharing: After hitting score my message, you’ll have feedback on how to improve your post for every network. You can edit the message without changing it for the whole group: Once you find the right fit, copy the content into your calendar: Use the Social Message Optimizer to tailor each post to every network.Setting Up Your Account For Social Automation Get your team members that will be working on social media marketing  set up in your organization’s  account. In the settings tab of your calendar underneath Team is a spot for you to add new team members: To start, enter their email address: They should receive an email that walks them through how to set up their account: Once their account is set up, a short onboarding session will walk them through how to use the tool: If your team needs more profiles than what is available with your plan, you can add more by going to Billing and adding extra profiles for an additional fee instead of upgrading your whole plan. Once your users are in, you need to connect your company’s profiles. To do this go to your settings menu and under Social Profiles, select Connect A Social Profile: Select the channel you want to connect: Available profiles or pages will surface allowing you to pick which ones you’d like to connect: Your newly connected profile should show in your connected profiles feed: Creating Ad Hoc Social Media Posts Ad-hoc social media posts are one-off posts that stand by themselves (rather than being part of a broader coordinated campaign). . These normally don’t connect to a piece of content that your team has created but they can link out to landing pages, videos,  etc. Go to your calendar and choose the day that you want to schedule your message and click +: Select Social Message from your content options: Choose the channel that you want to send your message on: Craft your post: To add a photo or video to your message, change the message type to the media type you want to add and your media by clicking the +add image or +add video: Select the file you want to upload: Once your file is uploaded you’ll be able to preview how it will look on the channel: To add a link, scroll over to the link tab, and enter your web address at the bottom of the post: You can now schedule your post, using Best Time Scheduling: You can also customize your time by selecting Custom Time from the dropdown menu and changing it: Then let’s say that your post is performing incredibly well. You can enable ReQueue to reshare that post and keep its momentum going. If you haven’t set up ReQueue yet, you need to walk through a small series of steps to get the system started. First go to left-hand side bar menu, select ReQueue and +New Group: Groups allow users to create different ReQueue content groups, so when you set up a new group you need to name it, determine what dates you want the group to send messages on, and decide how many messages the group can send in a given time period: There are two different ways you can add messages to your ReQueue group. One is toggling the ReQueue switch to on, like we showed you earlier. The other is to write your message directly in ReQueue. Select your group and click on Add Message: Craft your message like you would in the regular calendar: The last step in setting up your ReQueue is setting up how often ReQueue will fill the gaps in your calendar. To start, select Go to my ReQueue Settings in the upper right-hand corner: Then you’ll see a calendar where you can select the time frame and day that you want ReQueue to send your messages in: Finally, you need to set how many messages you want ReQueue to send per  day on each channel: Recommended Reading: How to Write For Social Media to Create the Best Posts Promoting Content With Social Media  Campaigns in Did you know that you can create social media campaigns to promote your WordPress content in one place with ? Creating content in is easy. Go back to your content list by selecting + in the upper right-hand corner and selecting the piece of content: Title your and create your content as usual: Then you can schedule your social media messages within your piece of content. To start select Add a Social Campaign: will automatically populate a social media schedule for you that you can add messages to. Simply click the +: To add a message outside the standard campaign set, scroll to the bottom, select Custom Date  and adjust the date at the bottom of the message: You can add as many messages as you want to promote your content. Now let’s say you want to create a 25 message campaign for every piece of content that you write. You wouldn’t want to re-create those messages for every piece of content that you create. That’s where Social Templates and Social Helpers come into play. To start, select the square icon under Social Campaigns and select +New Template: Title your template: Then add in the number of messages you want to send for each campaign. You’ll be able to select dates as well as social channels: Then you’re going to create your text helpers. These allow you to automatically fill in text for your social campaigns without having to manually go through each post and enter it. Select +New Helper, and then +Text Helper: Create title tags for each new social helper. At this point you can either enter the text you want the message to fill in or leave it blank for a more customizable approach to each campaign: Now you’re going to add the text helpers to the posts that you’ve created. That will allow to automatically populate them in your campaign. Select the brackets in the upper right-hand corner of each message, and select the helper you want to add: Next, you’re going to add image helpers to your campaign which will automatically add the photos you upload to your scheduled messages. Go back to your helper menu, and select Image Helper: Label your image helpers the same way that you labeled your text helpers. Do not add photos in your template. Select the message that you want to add an image to by clicking on the camera icon: The image helper title will appear. Click to add it to your template: Once you have your text and image helpers in place you can apply the template to any campaign by selecting the campaign name from the social template menu and clicking apply: In the template,  add your copy to your text helpers,  and select the camera button to add images to each of your image helpers: After you’ve uploaded all your images,  check your messages to see if the text and image helpers have been applied: WordPress + social media + @= success.Creating Standalone Social Media Campaigns Finally, let’s  walk through creating   standalone social media campaigns. These campaigns don’t directly connect to a piece of WordPress  content  in your calendar. First you need to add Social Campaigns to your custom content types. To do this go to your settings and scroll down to content types: Scroll down and choose Social Campaign from the drop-down menu: Then go to the content menu in your calendar and select Social Campaign: Title your campaign and set the date it will start: You can either add in the messages in manually by selecting the + icon or adding a social template: From there you can follow the steps that were previously outlined. Easy, right? Heres how to automate all your #social #media #campaigns in @.Automate Your Social Media Approval Process So, creating social content in is easy, right?   But, once you’ve created those posts,  your social media manager, editor, or client might still need to approve all those posts. And let’s face it, if you have tons of  posts to approve,  it  could take FOREVER. What if there was a way to automate that approval process? Setting Up Task Templates The first step in automating your approval process is setting up tasks templates that allow you to apply your to-do list into any social media piece. To create a task template, click into a piece of content, select the square box in the corner, and select +New Template: Title your template: Add in tasks that your team needs to complete in order to finish a project: Assign team members in your calendar to the tasks by clicking +Assign or clicking the arrow on the right-hand side of the task. You can also assign due dates for the task by choosing a day before publishing or creating a custom date in the Due dropdown menu: Once you have your tasks created and assign in your template, you can apply that template to any piece of content by selecting the square box in the top right-hand corner, and choosing your template: Adding Approval Steps To Your Workflows Someone on your team (or your client’s team) is probably responsible for approving content. Writing posts in Word docs and sending them back and forth via email isn’t exactly efficient, though. There has to be a better way, right? That’s where task approval steps in come in. You can assign approvals for any task in your task template and your team members won’t be able to check off the task until it’s been approved by a manager. To set this up, go back into your task template and click the arrow on the right-hand side. In the template, it will say Requires Approval From. Select the person that needs to approve the task contents: When the content creator is ready for the approver to check their work, a dash will appear in the box. This will alert the manager that content is ready for them to view: Managers will then be able to approve the task: Once the task is approved the usual checkmark will appear: Using task templates will help get your team out of their inbox and organized in one place. Improve social media approval workflows in @. Learn how:How To Measure Social Media Performance What if automagically gathered your social media data and packaged it into a few easy to download reports? Top Content Report You publish a ton of content and trying to find what’s doing well and connecting with your audience can be hard. ’s Top Content Report automatically reports on your most-shared content across social media. To find your Top Content Report, go to the left-hand side  of your dashboard, select Analytics,  and then Top Content Report: The first thing you’ll see is your top content for all time as well as the number of social shares that have been generated from the post. It’s important to note that Twitter shares are not included in these numbers due to the fact that Twitter revoked it’s API access: You can sort your top content by type: Who owns the content: And the time it was published: Now it couldn’t be easier to find your top content all in one place. Did you know @has robust #social #analytics capabilities? Its true!Social Engagement Reports But the reporting automation doesn’t stop there. also has Social Engagement Reports which break down engagement data  across all your social networks. To find them go back to the analytics home screen and select Social Engagement Report. The top of the report shows your engagement rate overall and breaks it down for each channel. You can also adjust the date that your data is being pulled from: The next section of the report details network performance and breaks down specific account performance as well: The final part of your report breaks down your top messages that were sent in a specific time period. You can see overall top performers as well as a breakdown of your top posts per channel: Another cool feature about the social engagement report is that you can schedule a pre-made PDF or CSV file to be delivered straight to your inbox. To set up your delivery schedule, go of your report and click Schedule: Choose your frequency: Then enter in the email addresses of the people the report needs to go to and viola! You’re done:

Relative Deprivation and Deprivation Theory

Relative Deprivation and Deprivation Theory Relative deprivation is formally defined as an actual or perceived lack of resources required to maintain the quality of life- diet, activities, and material possessions- to which various socioeconomic groups or individuals within those groups have grown accustomed, or are considered to be the accepted norm within the group. Key Takeaways Relative deprivation is the lack of resources (money, rights, or social equality) necessary to maintain the quality of life considered typical within a given socioeconomic group. Relative deprivation often contributes to the rise of social change movements, such as the U.S. Civil Rights Movement.Absolute deprivation or absolute poverty is a potentially life-threatening situation that occurs when income falls below a level adequate to maintain food and shelter. In simpler terms, relative deprivation is a feeling that you are generally â€Å"worse off† than the people you associate with and compare yourself to. For example, when you can only afford a compact economy car, but your coworker, while getting the same salary as you, drives a fancy luxury sedan, you may feel relatively deprived. Relative Deprivation Theory: Definition, Examples, and History As defined by social theorists and political scientists,  Relative Deprivation Theory suggests that people who feel they are being deprived of almost anything considered essential in their society- whether money, rights, political voice or status- will organize or join social movements dedicated to obtaining the things of which they feel deprived. For example, relative deprivation has been cited as one of the causes of the U.S. Civil Rights Movement of the 1960s, the struggle of Blacks to gain social and legal equality with whites. Similarly, many gay people join the same-sex marriage movement in order to acquire the same legal recognition of their marriages enjoyed by straight people. In some cases, relative deprivation has been cited as a factor driving incidents of social disorder like rioting, looting, terrorism, and civil wars. In this nature, social movements and their associated disorderly acts can often be attributed to the grievances of people who feel they are being denied resources to which they are entitled. Development of the concept of relative deprivation is often attributed to American sociologist Robert K. Merton, whose study of American soldiers during World War II revealed that soldiers in the Military Police were far less satisfied with their opportunities for promotion than regular GIs. In proposing one the first formal definitions of the relative deprivation, British statesman and sociologist Walter Runciman listed the effect’s four required conditions: A person does not have something.That person knows other people who have the thing.That person wants to have the thing.That person believes he or she has a reasonable chance of getting the thing.   Runciman also drew a distinction between â€Å"egoistic† and â€Å"fraternalistic† relative deprivation. According to Runciman, egoistic relative deprivation is driven by an individual’s feelings of being treated unfairly compared to others in the group. For example, an employee who feels he or she should have gotten a promotion that went to another employee may feel relatively deprived. Fraternalistic relative deprivation is more often associated with massive group social movements like the Civil Rights Movement. Relative vs. Absolute Deprivation Relative and absolute deprivation are measures of poverty in a given country. Absolute deprivation describes a condition at which household income falls below a level needed to maintain the basic necessities of life like food and shelter. Relative deprivation describes a level of poverty at which household income drops to a certain percentage below the country’s median income. For example, a country’s level of relative poverty could be set at 50 percent of its median income. While absolute poverty can threaten one’s very survival, relative poverty is more likely to limit one’s ability to participate fully in their society. In 2015, the World Bank Group set the worldwide absolute poverty level at $1.90 a day per person based on purchasing power parities (PPP) rates. Critiques Critics of relative deprivation theory have argued that it fails to explain why some people who, though deprived of rights or resources, fail to take part in social movements meant to attain those things. During the Civil Rights Movement, for example, Black people who refused to participate in the movement were derisively referred to as â€Å"Uncle Toms† by other Blacks in reference to the excessively obedient slave depicted in Harriet Beecher Stowe’s 1852 novel â€Å"Uncle Tom’s Cabin.† However, proponents of relative deprivation theory argue that many of these people simply want to avoid the conflicts and life difficulties they might encounter by joining the movement with no guarantee of a better life as a result.   Relative deprivation theory does not account for people who take part in movements that do not seem to materially benefit them, such as the animal rights movement. In many of these cases, for example, straight people who march alongside lesbian and gay rights activists, or wealthy people who demonstrate against policies that perpetuate poverty or income inequality, are believed to do so more out of a sense of empathy or sympathy than feelings of relative deprivation. Sources Curran, Jeanne and Takata, Susan R. Robert K. Merton. California State University, Dominguez Hills. (February 2003).Duclos, Jean-Yves. Absolute and Relative Deprivation and the Measurement of Poverty. University Laval, Canada (2001).Runciman, Walter Garrison. Relative deprivation and social justice: a study of attitudes to social inequality in twentieth-century England. Routledge Kegan Paul (1966). ISBN-10: 9780710039231.

Effects of a chilld owning a dog Essay Example | Topics and Well Written Essays - 250 words

Effects of a chilld owning a dog - Essay Example Dog ownership is the easiest way for a child to develop friendship with the same in a natural way. It helps a child to consider the dog as a lifelong companion. Jack Canfield states that dog ownership plays a vital role in a child’s overall growth and development (Canfield 366). Besides, it will help the child to learn the basics of healthy social interactions and relations. At the same time, dog ownership helps a child to build friendship with his/ her peers because a person who considers his /her pet as a lifelong companion can never neglect others. Dog ownership helps a child to learn more about how the dog keeps its emotional equilibrium by balancing it feelings. For instance, emotions are not stable for a dog. When it feels anger, it begins to bark. But this does not prove that dogs bark all the time. At the same time, a child learns from its dog that emotions are not constant but will change according to situations. The very term ‘ownership’ is symbolic of leadership. For instance, dog ownership helps a child to learn the basic lessons of leadership. Besides, it helps the owner to be a good leader and a follower. For instance, in some critical situations, dogs guide their owners and leadership is automatically transferred to the follower (say, the dog). So, dog owning is really helpful for a child to be a real leader in future life. Summing, one can see that dog ownership exerts positive influence on a child and is helpful for overall development. Besides, growth and development in social interactions, emotions and leadership qualities is equally important. So one can see that pet ownership teach a child to acquire certain essential