Macbeth suggests that great ambition, or inordinate lust for power, ultimately brings ruin free essay sample

William Shakespeare’s ‘Macbeth’ is a play, which tells the story of Macbeth’s rise to power and subsequently his tragic downfall as a result of outside forces and his great ambition, or his excessive use of power. While the play centralizes around the ideas of ambition and power there are also other outside forces and elements, which greatly influenced Macbeth’s decisions and ultimately lead to his ruin. The main root of Macbeth’s ruin was his uncontrollable ambition and how his inordinate lust for power blinded him and took over his former traits. After meeting the ‘weird sisters’, Macbeth is told that he will become king and so his desire for the prophecy to become reality becomes an obsessive trait for him. Macbeth’s ambitions completely change his nature and ultimately alter his views upon the world by ruling out his moral and social conscience. Due to Macbeth’s ambitions, he is filled with the notion of being king and results to murder as the way of attaining the title while completely disregarding his morals. We will write a custom essay sample on Macbeth suggests that great ambition, or inordinate lust for power, ultimately brings ruin or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page He even questions himself as to why he suggests that murder will be the solution to his desires; â€Å"Why do I yield to that suggestion, whose horrid image doth unfix my hair and make my seated heart knock at my ribs. †(A1,S3) Through the quote the reader is made to see that his thought of murder is not intentional as he questions his own imagination, rather it is caused by his natural desires and ambition, which is not under his control. In pursuit of his desires Macbeth is completely blinded by his lust for power and discounts his morals and former traits, which ultimately bring him to his ruin. Even though Macbeth may seem to be the one responsible for his own destruction, Lady Macbeth also plays a major role, which impacts the tragic ending. In his rise to power, Macbeth did not personally have the ambition to take the throne. Even though he had no personal ambition, his greedy wife, Lady Macbeth, pushes him to take action in order to take the throne through murdering those ahead of him. â€Å"What beast was’t, then, that made you break the enterprise to me? When you durst do it, then you were a man. † Lady Macbeth questions his manly hood and furthermore forces Macbeth into direct involvement, which he would prefer to have avoided. Additionally, Lady Macbeth gives him false hope by stating prior to the execution of their plot that they would succeed without any other complications and that their plan would be flawless. However, through being pressured into murdering Duncan many other problems arise and Macbeth realizes that he is not safe as king yet, â€Å"we have scorch’d the snake, not kill’d it. † He then realizes that in order to maintain his safety many other murders have to take place. Thus, Macbeth employs several other murders to cover for the original murder, which Lady Macbeth was responsible for. The reader is made to see how Lady Macbeth manipulates Macbeth into all his decisions and so it is clear to see how she was solely responsible for Macbeth’s ambition, which led him to his own murderous behavior and ultimately his ruin. Macbeth is a man with many imperfections, which ultimately brought his ruin however along with his inordinate lust for power, his overconfidence was another major flaw in his traits that led to his defeat. As time passed, the witches’ influence on Macbeth gradually increased. Driven by dark ambition provoked by the witches, he begins to not only believe in the prophecies, but also commit to them, and puts his full trust in the witches. Towards the end of the play he even goes as far as to command the witches to show him more of the future: â€Å"I conjure you by that which you profess†¦ answer me to that what I ask you. † Because of Macbeth’s overconfidence in the witches, he interprets the apparitions as encouragement instead of warnings and becomes reckless with his actions. He becomes careless because he ignores his rational side, and follows his desires, blindly. A significant example of Macbeth’s overconfidence is towards the end of the play where he faces Macduff. He is convinced that he cannot be harmed by any man of women born, and becomes careless into thinking that he is invincible. He later finds out that Macduff was, â€Å"untimely ripp’d,† from his mother’s womb however it much too late and due to his recklessness he was defeated. Macbeth’s overconfidence and his feeling of security can be said to be his â€Å"biggest enemies,† or flaws, which ultimately brought him to his ruin. Macbeth’s ruin is a result of Lady Macduff misdirecting him and two of his biggest flaws: his overconfidence and his ambitions or inordinate lust for power. These traits that Macbeth developed became more serious over time and his constant need to fulfil his ambition was what blinded him from his social and moral conscience, which ultimately led to his fall.

Public Relation Consultant

Introduction Public Relations (PR) refers to the process of ensuring proper communication between a person, a business or a nonprofit making organization and the public to maintain a good image. A public relation consultant is the person concerned with the above task and ensures that his clients and his company have a positive image towards the public.Advertising We will write a custom research paper sample on Public Relation Consultant specifically for you for only $16.05 $11/page Learn More Most of the companies and organizations have a public relation consultant who deals mostly with the public. Some of the duties of a public relation consultant include dealing with press conferences, works on any information to be publicized on media houses, introducing new products to the public, advertising the company’s product, preparing speeches and representing the company in the community projects[1]. The major concern of a public relation consultant is to portray a positive image of his company to the public. The following essay will explore the field of public relation consultant as per the advantages and disadvantages, the Cost of Element of a public relation firm, how to meet the cost element of a PR firm and the qualification of a PR practitioner. Advantages of a public relation consultant A public relation consultant enables the company to reach as many people as possible without incurring much expense in advertisement. Unlike advertising bodies that only portray the positive image of a company by praising it, PR consultant analyzes a company objectively and critically, enabling the clients to understand the company well without bias or exaggeration. People from different fields of specialization consult public relations firms, thus enabling them to get diversified experience. This makes it easier for the PR firms to fit well in the competitive job market. In addition, people working in fields such as health, business, mass communication, education may consult public relation specialist thus giving them experience in their field of specialization. For instance, they may be acquainted with knowledge on the condition of the market, budgeting, media, among others[2]. Public relations consultants equip its clients with a good reputation and improve their level of competency in the market. Through their advice, they will help their clients to be outstanding and differentiate one business from the other. If the client is not contented with the services of a consulting firm, he can terminate the contract with due notice. This is an advantage to the clients since he/she can be able to get the best consulting services possible.Advertising Looking for research paper on communications media? Let's see if we can help you! Get your first paper with 15% OFF Learn More Through PR services, the public tend to trust one firm’s services and to have confidence in its business. This means that Public Relations improves credibility a great deal. Since one of the PR areas of specialization is in the matters of press, their publication concerning the business gives it the image of a star. Most people like to associate with celebrities; thus, they will flock in the business due to the image portrayed by PR. When a business puts long-term investments to PR, there is a gradual improvement in the profit margins. This is because of the continued public awareness concerning your business, thus increases in sales and therefore benefits of the economies of scale (Hunter, 2009). Disadvantages of public relation consultant A public relations firm may be having insufficient information concerning a client’s field of specialization, thus making a minor impact to the well-being of his business. A public relation consultant may be targeting to taint the image of a company he is working for thus leading to its downfall. Over time, the public image of PR consultants has been tarnished, mak ing the public have a negative attitude towards them. Actually, the media has been in the front line trying to convince the public on the dishonesty of the PR consultants. This has in turn led to most companies shying away from private investors in this field or having their own within their companies. The cost element of a Public Relations Consulting Firm The value of public relation consultancy is not defined but it varies according to the type of business. The biggest challenge in valuing public relations comes from the definition of value, which refers to the monetary worth or material return according to commerce or relative worth. When relative worth comes, it means it is in comparison with something and will differ depending on the region since perceived value differs geographically. Therefore, a PR can be compared to the following elements in order to achieve its value; â€Å"Initial need of the buyer, initial need if the seller, perceived desire of the buyer, perceived des ire of the seller, perceived value of the service, perceived value of the service relative to other service, perceived value of the service delivery person, perceived value of the client† [3]. In most cases, PR deals with service delivery, which takes different time lengths for preparation.Advertising We will write a custom research paper sample on Public Relation Consultant specifically for you for only $16.05 $11/page Learn More Ways of paying the cost element of a PR firm When meeting the cost of a PR firm, it is recommendable to pay for performance in order to ensure accountability from the PR consultants. The image of PR has been tainted for a long time because, for a long time, the clients have been paying for the workload and not the quality of the services. For instance, most of them have been demanding large amounts of retainers for them to continue with their service to the clients. They have been used to long endless meetings of which t he client has to pay for the sitting allowances depending on the length of time spent, and regardless of the quality of their press release, fees had to be paid for it[4]. To save the situation, most clients are now insisting on paying for performance rather than the workload or time. This is a great challenge to the traditional form of PR since clients used to pay lump sums without a guarantee that the PR consultants will meet their aim. The notion that was there traditionally that the service provided had to be paid for anyway made the PR consultants lack accountability. Paying for performance model is closely related to ROI (Return on Investment), which is a performance measure that examines the efficiency of different kinds of investment. To get the value of ROI, you divide the difference between gain of an investment and the cost of the investment by the cost of investment. In this case, the cost of investment should be lower than the gain from the investment. When PR services are paid according to performance, it becomes easier to value its cost with confidence that both the consultant and the client are contented[5]. Qualification of a PR practitioner Basing our essay Britain Chartered Institute of Public Relations (CIPR), a public relations consultant must be a holder of the following qualifications. To be a member of CIPR, a person must have either a CIPR diploma in public relations, or 4 years experience in PR and ratified CIPR qualifications, or 6 years experience in PR and provide a Certificate of Professional/ Personal Development 1year after joining, or 10 years experience in PR. To be an associate of CIPR, one must be a holder of an advanced certificate in PR or ratified CIPR qualifications or 3years experience in PR[6] (ABE, 2006, pg 446) Apart from the professional qualification, a PR ought to have excellent writing skills since most of their work is based in writing press release. He has to be inquisitive and skeptical in order to be able to understand the concept behind each organization. This is because PR consultants explain to others about a certain business or organization thus he should have a broad knowledge in each field e is dealing in. He should be intellectually curious on doing PR in new ways and being expectant[7].Advertising Looking for research paper on communications media? Let's see if we can help you! Get your first paper with 15% OFF Learn More A PR ought to be enthusiastic and passionate in carrying out his duties by examining each part of his work optimistically. He should be dedicated in his work due to the stiff competition in the market and should be updated. He should ensure that he works with integrity and practice transparency in all his articles to avoid tainting his image and that of his clients. He should be humble since dealing with public may at times be humiliating and should share his discoveries generously. Moreover, he should be flexible such that he able to embrace change with little challenges and ready to learn new technology[8]. Conclusion Public relations department plays a major role in every organization because it determines its public image and the welfare of the company. Either it can be part of an organization or it can be employed privately. This kind of job has its pros and cons, thus needs to be handled with care. In the world we are living in today, it is important to gauge the efficiency of the PR performance since if not carried out diligently; it can be hard for a company to shine in the competitive job market. The PR personnel should acquire the necessary attributes through training before practicing consultancy. Bibliography Binkley, Sheena. PR job duties, 2010, http://www.ehow.co.uk/list_6700916_pr-job-duties.html . Horton, James. What does it cost? The value of PR services, 2002. http://www.online-pr.com/Holding/Whatdoesitcost-article.pdf . Konanykhin, Alexander. When It Comes To PR, Pay For Performance, Not Time, 2010. http://advertising.about.com/od/publicrelationsresources/a/guestprperform.htm . Michelle, Sullivan. Top 10 qualities of a PR practitioner in the digital age, 2009. http://michellesullivan.ca/2009/07/top-10-qualities-of-a-pr-practitioner-in-the-digital-age/ . Page, Kogan. British Qualification: A Complete Guide to Professional, Vocational and Academic Qualifications in the UK. London, Kogan Page Limited, 2006. https://books.google.com/books?id=B_4 BJWXYnmkCpg=PA446lpg=PA446dq=qualifications+of+a+PR+practitionersource=blots=qyWRMmZqxnsig=ys2zPrwAKo6rtYNShWrmvYhCwVghl=enei=FcTPTL_FF4yTjAelxsHGBgsa=Xoi=book_resultct=resultresnum=6ved=0CC8Q6AEwBQ#v=onepageq=qualifications%20of%20a%20PR%20practitionerf=true . Reddi, Narasimha. Effective public relations and media strategy. New Delhi, Asoke K. Ghosh, 2009. https://books.google.com/books?id=yhRoWSJlXmICpg=PA116dq=advantages+of+a+public+relation+consultanthl=enei=B5bOTMy5MYvqOeW7gaYBsa=Xoi=book_resultct=resultresnum=2ved=0CC4Q6AEwAQ#v=onepageqf=true . Footnotes Sheena Binkley, PR job duties, 2010, http://www.ehow.co.uk/list_6700916_pr-job-duties.html . Narasimha Reddi, Effective public relations and media strategy, (New Delhi, Asoke K. Ghosh 2009) , pg 119, https://books.google.com/books?id=yhRoWSJlXmICpg=PA116dq=advantages+of+a+public+relation+consultanthl=enei=B5bOTMy5MYvqOeW7gaYBsa=Xoi=book_resultct=resultresnum=2ved=0CC4Q6AEwAQ#v=onepageqf=true James L. Horton, What does it cost ? The value of PR services, 2002, http://www.online-pr.com/Holding/Whatdoesitcost-article.pdf Alexander Konanykhin, When It Comes To PR, Pay For Performance, Not Time, 2010, http://advertising.about.com/od/publicrelationsresources/a/guestprperform.htm . Alexander Konanykhin, ibid. Kogan Page, British Qualification, (London, Kogan Page Limited, 2006), pg 446 https://books.google.com/books?id=B_4BJWXYnmkCpg=PA446lpg=PA446dq=qualifications+of+a+PR+practitionersource=blots=qyWRMmZqxnsig=ys2zPrwAKo6rtYNShWrmvYhCwVghl=enei=FcTPTL_FF4yTjAelxsHGBgsa=Xoi=book_resultct=resultresnum=6ved=0CC8Q6AEwBQ#v=onepageq=qualifications%20of%20a%20PR%20practitionerf=true Michelle Sullivan, Top 10 qualities of a PR practitioner in the digital age 2009 http://michellesullivan.ca/2009/07/top-10-qualities-of-a-pr-practitioner-in-the-digital-age/ Michelle Sullivan, ibid This research paper on Public Relation Consultant was written and submitted by user JaneFoster to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Pediatric Dengue Shock Syndrome Essay Example

Pediatric Dengue Shock Syndrome Essay Example Pediatric Dengue Shock Syndrome Essay Pediatric Dengue Shock Syndrome Essay Michelle de Vera,1 M. D. , and Marissa M. Alejandria,2 M. D. ABSTRACT Background: The cornerstone of therapy for dengue shock syndrome (DSS) remains to be the prompt and aggressive restoration of circulating plasma volume. Two common types of intravenous uids currently used in DSS are crystalloids and colloids. The debate is ongoing on whether one is superior to the other in critically ill patients. Objective: This systematic review aims to compare the therapeutic effects of colloids versus crystalloids in reducing the recurrence of shock, the requirement for rescue uids, the need for diuretics, the total volume of intravenous uids given, the hematocrit level and pulse rates, and mortality rates of children with DSS. Search strategy: We searched Medline 1966 to August 2008, the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2008), and the Philippines Herdin database 1964 to 2008. Local journals were handsearched and reference lists were examined. Researchers and experts in the eld were contacted for unpublished or ongoing trials. Selection criteria: The studies included were randomized controlled trials comparing colloids versus crystalloids in children less than 18 years with a diagnosis of DSS. Data collection and analysis: Two reviewers independently did trial selection and assessment of methodologic quality using the Cochrane Infectious Diseases Group criteria. Two reviewers independently extracted the data and analyzed it using Review Manager Version 5. Results: Of eight studies initially reviewed, four studies ful lled the selection criteria (N=694, colloids=410, crystalloids=284). Colloids and crystalloids did not differ signi cantly in decreasing the risk for recurrence of shock (RR 0. 92, 95% CI 0. 62 to 1. 38), the need for rescue uids (RR 0. 90, 95% CI 0. 70 to 1. 16), total volume of intravenous uids given (WMD 0. 80, 95% CI -1. 68 to 3. 28) and the need for diuretics (RR=1. 17, 95% CI 0. 84 to 1. 64). However, there were signi cant improvements from baseline in the hematocrit levels (WMD -3. 37, 95% CI -5. 94 to -0. 0) and pulse rates (WMD -3. 37, 95% CI -5. 94 to -0. 8) of patients who were given colloids. Tests for heterogeneity were not signi cant. Allergic type reactions were seen in patients given colloids. One child died in the colloid group. Conclusion: Colloids decreased the hematocrit and pulse rates of children with DSS after the rst two hours of uid resuscitation. However, no signi cant advantage was found over cr ystalloids in reducing the recurrence of shock, the need for rescue colloids, the total amount of uids, the need for diuretics, and in reducing mortality. KEYWORDS: Meta-analysis, Crystalloids, Colloids, Pediatric, Dengue shock syndrome Department of Pediatrics, The Medical City Department of Clinical Epidemiology, UP College of Medicine 1 2 *Best Paper, The Medical City Interdepartmental Research Forum, 2008 14 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids of lifesaving F luid resuscitation is oneshock thecritically ill cornerstones in managing in patients. Physicians have an array of intravenous uids to choose from, however, the debate continues on which type of uid would be most bene cial. One condition that would bene t most from smart uid choice is dengue shock syndrome (DSS). DSS is the most serious manifestation of dengue hemorrhagic fever (DHF). The burden of disease is greatest in Asia, where in many countries dengue is a leading cause of pediatric hospitalization. An estimated 500,000 patients with severe dengue require hospitalization each year, a large proportion of which are children. At least 2. 5% of patients die, although case fatality could be twice as high. 1 The major pathophysiological event seen in DSS is the acute increase in vascular permeability leading to the loss of plasma from the vascular compartment. Thus, the key to its management is the rapid restoration of the circulating intravenous blood volume. Two common types of intravenous uids currently used in DSS are crystalloids and colloids. Crystalloids are uids based on a solution of sterile water incorporated with electrolytes that are formulated to be hypertonic, hypotonic, or isotonic in com parison to the human plasma. The most common formulations include 0. 9% isotonic saline which is designed to approximate closely the human plasma, and lactated Ringer’s solution, almost similar to isotonic saline, but with the addition of lactate. Colloidal uids are also water- and electrolytecontaining solutions, but with the addition of a substance that does not easily diffuse through a semipermeable membrane owing to its high molecular weight. Albumin preparations contain human serum albumin, the largest component of colloid osmotic pressure in the human blood. The hetastarches, which are 6% hetastarch and 10% pentastarch, are derived from a polysaccharide that is incorporated in a uid with different molecular weights. Dextran solutions use synthetically derived dextran proteins. Gelatin solutions have true gelatin component designed to be biologically compatible. 3 The current guidelines in the management of DSS include administration of crystalloid intravenous uids at a rate of 10-20mL/kg over an hour upon presentation of unstable vital signs or manifestations of shock. Shifting to colloidal solution is warranted if there is evidence of hemoconcentration despite administration of about 1 liter of initial intravenous uids, as shown in Appendix 1. Once improvement is seen, colloids should be shifted back to crystalloids. The increased vascular permeability in DSS, combined with the capability of crystalloid uids to seep through easily, predisposes a patient to receive massive volumes until hemodynamic stability is achieved. This led to the belief that colloids, with their higher molecular weight and ability to maintain or improve the colloid osmotic pressure, will require less amount to achieve improvement, and can thus be a better alternative to crystalloids during the early resuscitative phase in DSS. The studies that have investigated the bene ts of colloids over crystalloids in patients with shock are limited. The large, multi-center, double-blind, randomized controlled trial Saline vs Albumin Fluid Evaluation conducted in 2004 compared the colloid albumin and the crystalloid isotonic saline for uid resuscitation in 6,997 intensive care unit patients. In the said trial, albumin and saline were comparable in terms of 28-day all cause mortality. 4 Likewise, a systematic review of the use of colloids and crystalloids for uid resuscitation in critically ill patients found no evidence that colloids, compared with crystalloids, reduced the risk of dying. Despite the increasing numbers of patients with DSS who are mostly children, there are only a few studies that compared the use of colloids and crystalloids in these patients. 6-9 OBJECTIVES The purpose of this systematic review is to synthesize the available data from clinical trials comparing colloids and crystalloids in resuscitating children with DSS. It aims to estimate the effects of colloids compared to crystalloids on the following param eters in children with DSS: Recurrence of shock. Requirement for rescue intravenous uids. Mortality. Total volume of intravenous uid given. 15 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Need for diuretics. Change in hematocrit level. Change in pulse rate. This systematic review aims to compare the adverse effects associated with the administration of colloids versus crystalloids in children with DSS. experts, and researchers in the eld for additional information on unpublished and ongoing trials. There was no language restriction. Methods of the review: Two reviewers independently assessed the eligibility of potentially relevant trials based on the selection criteria. The reviewers independently assessed the methodologic quality of each trial using the Cochrane Infectious Diseases Group criteria. Studies were assessed as â€Å"high quality† if randomization and allocation concealment were adequate, blinding maneuvers were performed, and intent-to-treat analysis was done. Studies were assessed as â€Å"fair quality† if any subtle biases were present: unclear allocation concealment; absence of blinding; and no intent-to-treat analysis. Studies were considered â€Å"low-quality† if any of the following biases was seen: inadequate randomization and allocation concealment and/or signi cant differences between the treatment group and control group in terms of known predictors of outcome; obvious differences in the general quality of care received by subjects in both groups; marked difference in drop-out rates; and outcome detection methods were different for both groups. Two reviewers independently abstracted data from the studies including baseline characteristics of patients, inclusion and exclusion criteria, types of intervention or study uids, and dosing regimen. The information on each outcome measure and the number of affected patients were also obtained. Data were analyzed using the Review Manager (RevMan) Version 5. 0. For dichotomous data, the risk ratio, or the probability that an event will occur, was determined for each comparison. The need for diuretics, need for rescue uid, and recurrence of shock were all considered dichotomous outcomes. For continuous data, the weighted mean differences were determined. The decrease in hematocrit and pulse rate from baseline and the total volume of intravenous uids administered were all analyzed as continuous data. Missing data such as standard deviations were derived using the 95% con dence intervals provided. SEARCH METHODOLOGY Criteria for considering studies for this review: Studies included in this review were randomized controlled trials in which children less than 18 years of age were given either colloid or crystalloid intravenous uid within the rst 2 hours after being diagnosed with DSS. The diagnosis of DSS was based on the World Health Organization (WHO) criteria, as shown in Appendix 2, which included hemoconcentration associated with the characteristic plasma leakage, presence of circulatory compromise as evidenced by narrowing of pulse pressure, hypotension, decreased perfusion, and decreased urine output. The primary outcome measures included the number of episodes of shock, the requirement for rescue intravenous uids, and mortality. The secondary outcome measures included the change from the baseline in pulse rate, the change from the baseline of hematocrit, the need for diuretics, the total volume of intravenous uid given, and adverse effects. Search strategy: We searched the following databases for relevant studies: Medline 1966 to June 2008; the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2008); and the Herdin database of the Philippines 1964-2008. The search strategy combined the terms â€Å"pediatrics†, â€Å"child†, â€Å"children†, â€Å"dengue†, â€Å"dengue hemorrhagic fever†, â€Å"dengue shock†, and â€Å"intravenous uids† with the Cochrane Highly Sensitive Search Strategy phases one and two as contained in the Cochrane Reviewer’s Handbook, as shown in Appendix 3. Conference proceedings and local journals were handsearched for potentially relevant trials. The reference lists of articles were examined to identify additional relevant studies. We also searched institutional libraries, including libraries in universities, hospitals, and pharmaceutical companies. We contacted colleagues, 16 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Study Flow Diagram Potentially relevant randomized controlled trials identified through Medline, Herdin, and CENTRAL searches (n=4) Trials excluded (n=2) Included patients with septic shock (n=1) Assessed difference between clinical and laboratory diagnosis of dengue (n=1) Articles obtained from colleagues (n=2) Trial excluded (n=1) Used both colloids and crystalloids in a single patient (n=1) Links to related articles and other references examined (n=2) Trial excluded (n=1) Compared colloid with blood plasma (n=1) Randomized controlled trials comparing colloids and crystalloids in pediatric dengue shock (n=4) The formula for grouping data and imputing group means and group standard deviations were obtained from the Cochrane Handbook of Systematic Reviews. 0 We assessed heterogeneity using the chi-square test for heterogeneity (P value 50% indicated moderate degree of heterogeneity; a value of 75% indicated large degree of heterogeneity across trials. For outcome measures with signi cant heterogeneity, the sources of heterogeneity were explored by doing sensitivity analysis according to methodologic quality. excluded two trials: one trial was on the assessment of the differences between the clinical and laboratory diagnosis of dengue, and the other trial included patients with septic shock. On review of the reference lists of relevant articles, two more trials were identi ed: one ful lled the selection criteria while the other was excluded since it used both colloids and crystalloids for each study participant. We obtained two additional studies from colleagues. One trial was excluded because it compared a colloid with blood plasma. Included studies: Four randomized controlled trials on the use of colloids and crystalloids in children with DSS were included with a combined sample size of 694 (colloids=410, crystalloids=284). -9 All the trials used WHO criteria for the diagnosis of DSS. 2 Participants: The patients were under 18 years old, with ages ranging from 1-15 years. All patients were Asians: 655 were Vietnamese and 39 were Indonesian. In all the studies, none of the patients received any intravenous uids prior to the study. 17 RESULTS Search results: As shown in the study ow diagram, we identi ed four potentially relevant randomized controlled trials on the use o f colloids and crystalloids through Medline and CENTRAL searches. We Philippine Journal of Microbiology and Infectious Diseases Vol. 9, Issue 1, January-June 2010 Colloids Table 1. Characteristics of Included Studies Author, Year Nhan 2001 7 Study Population 230 Vietnamese children clinically diagnosed DHF DHF grade III = 222 DHF grade IV = 8 1-15 years old Intervention Study uids Lactated Ringer’s solution, isotonic saline, dextran, gelatin Fluid rate DHF grade III: 20mL/kg for 1 hr DHF grade IV: 20ml/kg for 15min, then 20mL/kg over the following hour Study uids Lactated Ringer’s solution, starch, dextran Fluid rate 15mL/kg for 1 hr, then 10mL/kg for the 2nd hr Outcomes Data presented are those of DHF grade III patients only: PPRT, reshock rate, time to 1st episode of reshock, change from baseline of hematocrit and pulse rate, volume of uid infused, requirement for rescue uid, volume of rescue uid used, requirement for diuretic, mortality Change from baseline of hematocrit; total volume of rescue uid used after initial resuscitation, total volume of uid given, requirement for further uid resuscitation, requirement for diuretic, mortality, length of hospital stay; depth of pleural effusion, new bleeding after study entry, clinical uid overload, volume of ascites Change from baseline of hematocrit, cardiac index, pulse rate and pulse pressure, requirement for further uid resuscitation, requirement for diuretic, duration of shock, episodes of reshock, mortality Change from the baseline of hematocrit, hemoglobin, pulse rate and pulse pressure; total volume of uid given, episodes of reshock, mortality Adverse Reactions None stated Wills 20056 51 2 Vietnamese children with clinical DSS Moderate shock = 383 Severe shock = 129 2-15 years old Allergic type reactions, transient high fever and rigors without cardio-respiratory compromise; urticarial rashes Dung 19998 50 Vietnamese children with clinical DSS 5-15 years old Study uids Lactated Ringer’s solution, isotonic saline, dextran, gelatin Fluid rate 20mL/kg for 1 hr, then 10mL/kg for the 2nd hr Study uids Lactated Ringer’s solution, gelatin Fluid rate 20mL/kg as initial volume of uid resuscitation None stated Prasetyo20089 39 Indonesian children with clinical DSS 1-13 years Adverse reactions in coagulation, liver and renal functions and acid-base equilibrium; severe allergic type reactions DHF: dengue hemorrhagic fever DSS: dengue shock syndrome PPRT: pulse pressure recovery time One study included both DHF grades III and IV patients9, while two studies presented data on DHF grade III patients only. 7-8 The study by Wills (2005) grouped patients into those with moderate and severe shock. The subset of patients with severe shock was not given the chance to receive crystalloid uids and was not included in this review. Children were excluded in the study if they had severe hemorrhagic manifestation for which transfusion was likely7, chronic disorders7, malnutrition9, and heart, renal, liver, and lung diseases. 9 Interventions: The colloids used were dextran 706-8, gelatin7-8, and hydroxyethyl starch. 6,9 The crystalloids used were lactated Ringer’s solution69 and isotonic saline. 7-8 In three studies6-8, the study uids were administered initially at 20mL/kg for 1 hr for DHF grade III patients and 20ml/kg for 15min. Subsequently, uids were given depending on each study’s protocol: 20mL/kg over the following hour for DHF grade IV patients7; 15mL/kg for 1 hour, then 10mL/kg for the 2nd hour6; and 20mL/kg for 1 hour, then 10mL/kg for the 2nd hour. The study by Prasetyo9 administered an initial volume of 20mL/kg to all patients. Table 2. Characteristics of Excluded Studies Author, Year Hung 2006 Martinez-Vega 2006 Tatura 2008 Upadhyay 2005 Reason for Exclusion The study used both colloids and crystalloids in all patients with DSS. The study did not compare colloids and crystalloids; it was based on the assessment of the difference between clinical and laboratory diagnosis of dengue. The study compared gelatin solution with blood plasma. The study participants were children with septic shock. 18 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Table 3. Methodological Quality of Included Studies Author Year Dung 19998 Randomization Adequate Allocation Concealment Adequate-treatment pack numbers contained in opaque envelopes Adequate-treatment pack numbers contained in opaque envelopes Computer generated random numbers, treatment packs prepared by independent staff Not stated Blinding Double-blind each treatment bottle covered in black tape Double-blind Double-blind Intent-to-treat Analysis Not stated Nhan 20017 Wills 20056 Sequential randomization Adequate, strati ed by pulse pressure Random assignment, strati ed to DHF 3 or 4 Yes Yes Prasetyo 20089 Not stated Not stated Outcomes: The outcomes measured included the following: changes from baseline of hematocrit6-9 and pulse rate7-9; total volume of rescue uid used after initial resuscitation6,7 and requirement for further uid resuscitation6-8; total volume of intravenous uids given6,7,9; requirement for diuretics6-8; and number of patients with recurrences of shock. -9 Other parameters evaluated were the following: change in hemoglobin9, pulse pressure8,9 and pulse pressure recovery time7; cardiac index8; duration of shock8; time to rst episode of reshock7; length of hospital stay in days6; and mortality. 6-9 The study by Prasetyo further determined disorders of blood coagulation, liver and renal function parameters, and acid-base equilibrium. 9 The study by Wills reported depth of pleural effusion, new bleeding after study entry, clinical uid overload, and volume of ascites. 6 Two studies determined severe allergic type reactions after intravenous uid infusion. 6,9 The characteristics of the included studies are summarized in Table 1. Excluded studies: Trials that did not compare rystalloids and colloids or were not used on pediatric patients with DSS were excluded from this review. 11-14 The characteristics of the excluded studies are summarized in Table 2. Methodological quality of included studies: Two studies were assessed as â€Å"high quality. †6. 7 The study by Prasetyo had unclear alloc ation concealment and did not mention blinding or intent-to-treat analysis, as shown in Table 3. The study by Dung also did not state whether intent-to-treat analysis was done. Both were rated as fair quality. Despite randomization, the study of Nhan had unequal distribution of more severely ill patients: dextran group had fewer patients with very low pulse pressure, but had patients with lowest mean pulse rate at presentation. Primary outcomes: The meta-analysis of the trials showed no statistically signi cant difference in reducing the risk for recurrence of shock (3 trials, RR 0. 92, 95% CI 0. 62 to 1. 38) and the need for rescue colloids (2 trials, RR 0. 90, 95% CI 0. 70 to 1. 16) after the initial resuscitation. Test for heterogeneity was not signi cant for both outcomes, as shown in Figures 1 and 2. Figure 1. Number of Patients Who Had Recurrence of Shock After the Initial Fluid Resuscitation Study or Subgroup Dung 1999 Nhan 2001 Prasetyo 2008 Total (95% CI) Colloid Crystalloid Risk Ratio Events Total Events Total Weight M-H, Fixed, 95% CI 2 31 1 25 111 19 155 2 32 3 25 5. 4% 111 86. 7% 20 7. 9% 156 100. 0% 1. 00 [0. 15, 6. 55] 0. 97 [0. 64, 1. 47] 0. 35 [0. 04, 3. 09] 0. 92 [0. 62, 1. 38] Risk Ratio M-H, Fixed, 95% CI Total events 34 37 Heterogeneity: Chi? = 0. 82, df = 2 (P = 0. 66); I? = 0% Test for overall effect: Z = 0. 40 (P = 0. 69) 0. 005 0. 1 1 10 200 Favours colloids Favours crystalloids Favours experimental Favours control 19 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Figure 2. Number of Patients Who Needed Rescue Colloids After the Initial Fluid Resuscitation Study or Subgroup Nhan 2001 Wills 2005 Total (95% CI) colloid crystalloid Risk Ratio Events Total Events Total Weight M-H, Fixed, 95% CI 32 74 111 255 366 37 40 111 41. 0% 128 59. 0% 239 100. 0% 0. 86 [0. 58, 1. 28] 0. 93 [0. 7, 1. 28] 0. 90 [0. 70, 1. 16] Risk Ratio M-H, Fixed, 95% CI 77 Total events 106 Heterogeneity: Chi? = 0. 08, df = 1 (P = 0. 78); I? = 0% Test for overall effect: Z = 0. 81 (P = 0. 42) 0. 01 0. 1 1 10 100 Favours colloids Favours crystalloids Favours experimental Favours control All study participants recovered fully, ex cept for one child in the colloid group (starch) who died of profound shock and gastrointestinal bleeding. 6 Secondary outcomes: There was no signi cant difference between patients who received colloids and crystalloids in terms of the total volume of intravenous uids given during resuscitation (WMD 0. 80 ml/kg, 95% CI -1. 68 to 3. 8) and the need for diuretics (RR=1. 17, 95% CI 0. 84 to 1. 64). The test for heterogeneity was not signi cant, as shown in Figures 3 and 4. Hemodynamic variables: On the other hand, there was a signi cant improvement in hematocrit levels from the baseline after the rst two hours of uid resuscitation (WMD -7. 87, 95% CI -8. 52 to 7. 22), but with a large degree of heterogeneity, as shown in Figure 5. Sensitivity analysis removing the study of Wills (2005), which used median instead of mean, removed the heterogeneity and a statistically signi cant reduction in hematocrit levels remained (WMD -3. 37, 95% CI -5. 94 to -0. 80), as shown in Figure 5a. The study of Wills (2005) also showed a signi cant reduction in the median hematocrit levels two hours after the initial resuscitation (25% for the dextran group versus 9% for the Ringer’s lactate group, p 35% Improvement IV therapy by crystalloid, successively reducing the ow from 10 to 6, 6 to 3ml/kg/hr Discontinue after 24-48 hrs Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 25 Colloids Appendix 2. World Health Organization Criteria for the Diagnosis of Dengue Fever and Dengue Hemorrhagic Fever DF/DHF DF Grade* Symptoms Fever with two or more of the following signs, headache, retro-orbital pain, myalgia, arthralgia I Above signs plus positive tourniquet test Above signs plus spontaneous bleeding Laboratory Leukopenia occasionally. Thrombocytopenia, may be present, no evidence of plasma loss Thrombocytopenia 100,000, Hct rise 20% Thrombocytopenia 100,000, Hct rise 20% Thrombocytopenia 100,000, Hct rise 20% DHF DHF II DHF III Above signs plus circulatory failure (weak pulse, hypotension, restlessness) Profound shock with undetectable blood pressure and pulse DHF IV Thrombocytopenia 100,000, Hct rise 20% *DHF Grade III and IV are also called as Dengue Shock Syndrome (DSS) 26 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Appendix 3. Search Strategy Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 27

Overview of Animal Cruelty

Overview of Animal Cruelty The term animal cruelty gets thrown around a lot, but an animal activists definition of animal cruelty may be very different from that of a hunter, a vivisector or a farmer. There is also a legal definition of animal cruelty that varies by state in the U.S., to confuse things further. Essentially, though, animal cruelty boils down to inhumane acts against animals of all walks of life, including starving domesticated pets, torturing any creatures and excessive killing of animals for sport. Animal Cruelty Law in the United States In the United States, there is no federal animal cruelty law. While some federal laws, like the Animal Welfare Act, the Marine Mammal Protection Act or the Endangered Species Act restrict when or how certain animals in certain situations may be harmed or killed, these federal laws do not cover the more typical case, such as the person who intentionally kills the neighbors dog. Every state has an animal cruelty statute, and some offer stronger protections than others. Hence, the legal definition of animal cruelty will vary according to which state you are in, and some places have very large exemptions. For example, most states have exemptions for wildlife, animals in laboratories, and common agricultural practices, such as debeaking or castration. Some states exempt rodeos, zoos, circuses and pest control. However, some states may also have separate laws banning practices like cockfighting, dog fighting or horse slaughter - activities observed as inhumane by the majority of Americans. Where the legal definition is lacking, at least for animal rights activists, is in protecting all creatures from unnecessary suffering at the hands of mankind.   In any case, if someone is found guilty of animal cruelty, penalties also vary by state. Most states provide for the seizure of the animal victims and reimbursement for expenses for the animals care, and while some allow counseling or community service as part of the sentencing, twenty-three states have felony penalties of over a year in prison for animal cruelty. For more information, the Animal Legal and Historic Center provides an excellent, detailed overview of animal cruelty statutes in the U.S. To find your states animal cruelty statute, go to the Centers site and choose your state from the drop-down menu on the left. The Common Understanding Animal cruelty cases make headlines around the country every day, whether its the person who kills the neighbors cat, the hoarder of sick and dying animals, or the family whose starving, freezing dog is tied up outside in the middle of winter. These acts would likely constitute animal cruelty under any states animal cruelty statute, and would also fit with the publics common understanding of the term. However, when it comes to animals other than cats and dogs, peoples concept of the term animal cruelty varies greatly. Most animal activists would say that traditional agricultural practices such as debeaking, tail docking, castration, and confinement on factory farms are animal cruelty. Although some people do agree, as evidenced by the passage of Prop 2 in California, factory farmers and most other states animal cruelty laws havent yet adopted these same values. While some might base their definition of animal cruelty on how much the animal suffers or feels pain during death, the amount of suffering is not relevant for animal rights activists because the animals are deprived of their right to live and exist free of human use and abuse. Some may also base their definition on which type of animal is involved or how intelligent they perceive that animal to be. The slaughter of dogs, horses or whales for meat may be the epitome of animal cruelty to some, while the killing of cows, pigs, and chickens are acceptable to those same individuals. Similarly, to some, the killing of animals for fur or cosmetics testing may constitute unacceptable animal cruelty while the killing of animals for food is acceptable. Among the general public, the more culturally beloved the animal is and the more unusual the harm is, the more likely they are to be outraged and label the harm to that animal as animal cruelty. To animal activists, a much wider range of harms is called animal cruelty. Animal rights activists would argue that cruelty is cruelty, regardless of how common or legal the harm is.

Biology - Wood Frog Essay Example | Topics and Well Written Essays - 1000 words

Biology - Wood Frog - Essay Example For example, it has a moderate size up to two inches or two to three inches long ("Wood Frog - Rana Sylvatica: Minnesota DNR" ), and it has a smooth, moist and reddish skin. Moreover, it is cold blooded and can tolerate a large temperature and saves the water inside the body for the later usage for example, in some cases, up to 65% of the whole body water. Additionally, wood frog has webbed feet just as other amphibians but it does not have fully webbed feet. Moreover, it has a vertebra that is why it is usually identified as vertebrates; it also has notochord which identifies for the Chordates. It can live in water as well as in soil and it can lay eggs in water as well as in the soil. Furthermore, its eggs does not have any membrane which makes them amphibians, males and female frogs gather in ponds for reproduction, skin coloration is brown, and they also go to ponds and water lands for breeding. Moreover, its sound can be heard in the first periods of the spring and they have dar k pitch under their eyes The relationship between the wood frog and other organisms can be reflected by the fact that wood frog belongs to Kingdom Animal which is the broadest category of classification. This is because of the fact that most of the animals that are categorized as â€Å"animals† have some specific characteristics which are common to them. For example, organisms that are characterized as â€Å"animals† are eukaryotic i.e. the animals that have developed cell membrane and complex cell structures, for example plants, fungi etc. Moreover, organisms in Kingdom Animal are â€Å"motile† which means that they can freely move from one place to the other. The examples include snack, lion, deer etc. These are all animals and have common characteristics with the wood frog because they are all under Kingdom Animal. The second category of classification is the Phylum which is Phylum Chordates in case of the wood frog. Furthermore, the animals in Phylum Chordat es are identified with their Notochord which they have at least for some period of their lives, a hollow dorsal nerve chord, and an anal tail etc. Besides this, notochord is the flexible and rod shaped body which is found in the early embryos and, in some cases, becomes the axial support of the body. Similarly, the animals in Phylum Chordates include Hagfish, Star fish and lancelet etc. and these animals have the common characteristic with the wood frog that they all have notochord, a hollow dorsal nerve chord and an anal tail. In this way, wood frog is more closely related and associated with the animals of Phylum Chordates because they have many common characteristics. The third category of classification includes Class which is Amphibians in case of wood frog. The basic characteristics of amphibians are that their eggs are not surrounded by membranes, they have four limbs and they are cold blooded. For example, toads, salamanders etc. are the vertebrate chordates that have same c haracteristics as wood frog. In this way, wood frog is far more linked and has similarity with animal chordates such as salamanders, toads because they are in the same class and have similar characteristics. Similarly, wood frog is also associated with many other amphibians due to their order which is anura and family which is Ranidae. Moreover the common genre and species

The Art and Craft of Rap Music Essay Example | Topics and Well Written Essays - 3000 words

The Art and Craft of Rap Music - Essay Example Then, the four most infuential rap albums of all time are discussed, chosen primarily based upon their influence in redefining the genre as it existed prior to the album. Some of the largest names in the rap music business are discussed and analyzed with particular respect to their technical and artistic merits, as well as their social impact upon the world. Since its conception in the early seventies, rap music has been more than just a genre of music. It has become a street culture with elements that promote self expression and participation. Whether you call it rap or hip hop, it is the medium for urban-based creativity and expression of culture. This paper discusses the history and influence of rap, offering insight into a genre that is highly publicized on a global level but often ignored. The beginning of hip hop has often been discussed and debated among those in the music scene. On one hand, it seems to be widely accepted that the birth date of rap was 1979, when Sugar Hill Gang released Rappers Delight, but the hip hop scene more likely began to form in the Bronx in 1971. The founder of hip-hop was rapper and first break-beat deejay Kool Herc. Sugar Hill Gang seem to be used as a starting point as they hold the title for the introduction of rap music on vinyl, the youth cult for rap music had established itself many years prior to 1979. Soon after the conception of rap as an idea, Grandmaster Flash invented scratching; spinning a record back and forth creating a scratching sound. These innovations made by Kool Herc, Grand Wizard Theodore, Grandmaster Flash, Afrika Bambaataa and other like- minded DJs of the era were the spearhead of an underground cultural movement that is now recognized as hip-hop. Hip hop quickly became recognized as a form of urban based creativity and expression of culture, the turntables enabled artists to be creative with musical sounds. The turntable is an instrument that gives artists control over mainstream music, by proffering a "simple tool to make their art," (Byi, 1998) constituting a sense of rebellion through scratching and distorting a track. Not only does deejaying give artists a sense of upheaval, but also liberation and freedom, the DJ, Q-Bert explained this phenomenon in an interview, "the art of scratching is like a miracle- how you grab any recorded sound and manipulate it to say whatever you wantI wanted to speak the universal language of music, so I chose the musical instrument of the future: the turntable" (Byi, 1998) In the beginning, hip-hop was mainly seen at parties where a DJ would loop samples from records and allow people to battle over these tracks; from here hip-hop culture grew. Deejays often used a microphone to engage the crowd. Over time, individuals other than the Deejay joined in, delivering a message in a catchy rhyme form. By drawing attention not only to the message itself, but also how the message was conveyed, these individuals became performers in their own right, taking a place alongside Deejays and B-Boys; the emcee was born. People were rapping on the streets, and battles could be seen in warehouses on a Saturday night where budding rappers would get on the stage and rap against each other in a knock out style competition. It was the lack of financial resources that prevented this music from being

A Retrospect of the Hong Kong Handover Essay Example for Free

A Retrospect of the Hong Kong Handover Essay Slide 2 Hong Kong’s handover to the Chinese government after 150 years of British colonial rule is a major historical event My paper analyzes whether or not China handled Hong Kong well 10 years after the Handover occurred. It also aims to look at the changes that have taken place since the Handover, and how they have affected the situation in Hong Kong. Important questions regarding this issue are:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   After 10 years, did China handle Hong Kong well?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Has China fulfilled its promise to maintain Hong Kongs status quo as a leader in Asian economy?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Have the policies and changes that the Handover has brought been beneficial to the people of Hong Kong? My position is that China did a good job in the sense that they did not do harm to Hong Kong and was able to preserve the liberal economic and political spirit of the place. My conclusions are based on the following parameters: One, the economic situation of the territory, and two, the political situation of the territory. Slide 3 Background of the Issue Why was the Handover a source of anxiety to Hong Kong citizens?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Hong Kong way of life is different than that of Mainland Chinas   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   China is under a Communist System while Hong Kong adopts a free market economy The Impact of the Hong Kong handover can be brought to light with the following facts: Geography Hong Kong is a small piece of coastal island below Mainland China. Its strategic location made it an important port for the trading of goods and is regarded as an ideal base for military and tactical operations. When it comes to its economy, Hong Kong is a force to contend with. Hong Kong: Is one the modern world’s most important financial hubs Enjoys one of the world’s highest gross domestic products Provides jobs to millions in Mainland China as well as in neighboring countries Slide 4 Aftermath of the Handover Accounts of life in Hong Kong right after the Handover were promising. Generally, it was â€Å"life as usual†. The general consensus is that the Handover did not cause the major political and economic upheavals that many feared it would. While there was a slowing down in the economy, it was not at the level expected. The changes were milder and subtler than expected The reaction of the business community to the Handover reflects the reaction of the locals: Businesses were able to ride the change without much difficulty. Multinational companies based in Hong Kong have been loyal, and were able to transcend political upheavals. Slide 5 The most important policies implemented after the Handover included â€Å"One country, two policies† and â€Å"Hong Kong people administering Hong Kong†. China also increased public spending and reduced tax. These policies have allowed Hong Kong’s Special Administrative Region (SAR) government a free hand to implement decisions with respect to Hong Kong’s political and economic environment. Such a moves also proved to be effective because it kept businesses in Hong Kong. Hong Kong’s Performance under China’s rule has been on the large part, successful. The following are evidence of China’s good handling of the Hong Kong Handover: Hong Kong was one of the least affected during the Asian economic depressions Hong Kong was one of the first to bounce back from the depression. Hong Kong survived the health problems of SARS, bird flu and mad cow disease.