Role of Gluthathione Pathway in Discovering Anticancer...

Cancer cell have different metabolism compare to normal cell and the modification in the metabolism turn normal cell to cancer cell (Akhdar et al 2012, p.137). In the human body, anticancer drug need to pass several metabolism to change it into other form before it will distributed to the target site and will be excreted through bile or urine. There are two different phases of enzymatic system that anticancer drug will become metabolite, namely phase I and phase II (Gonzalez 2005, p. 71). As the glutathione conjugation (phase II) plays main role in metabolism of anticancer compound, this point will be focused on. Glutathione are one of the major mechanisms controlling cellular oxidative balance (Pei et al 2013, p.2). There are three main function of glutathione (GSH) according to Pei et al (2013, p.2) : The role of glutathione can be explained by using example of human acute myelogenous leukemia (AML) cells. By targeting the glutathione pathway, this cancer cell will be stamped out. The primitive leukemia cells, which also known as leukemia stem cells (LSCs), are typically refractory to many forms of therapy.Research has been done to improve strategies for targeting of human AML cells by comparing the molecular mechanisms regulating oxidative state in primitive (CD34+) leukemic vs. normal specimens .By comparing this,,radox state is known as the most prevalent of the cellular properties known to differ in cancer vs.normal cell .From this,it shows that radoxShow MoreRelatedRole of Gluthathione Pathway in Discovering Anticancer Compound793 Words   |  3 Pages(Richard Manrow and Rebecca Chasan, 2013). In order to produce an effective and potent anticancer drug, there are several criteria we have to look into. For instance, the role of metabolism, cell environment and also protein homeostasis should be taken into account in discovering anticancer drug. To obtain the pharmacokinetic profile of an anticancer drug during the discovery process, metabolism plays a crucial role where the metabolic liability and the potential drug-drug interactions have to be determined

Greek Male Sculptures and Todays Advertising Essay

Greek Male Sculptures and Todays Advertising Freestanding sculpture that decorated the early Classical Period of Greek Art consisted of predominantly male nude figures. The male body was used in seeking to create more realistic ways to portray the human figure in painting and sculpture and to place figures in more realistic settings(Stokstad pg 178). This portrayal of young men through freestanding sculpture revealed a sort of obsession with the male body in which society took on as the norm. As opposed to the Greek society, the one of today might associate nudeness with aspects of profanity and vulgarity because of the view that certain parts of the body are not to be seen by public eyes. A nude body of today may also be seen as†¦show more content†¦Unlike the Krytios Boy, there is an inability to see all aspects of the male nude such as the potentially controversial frontal view. The prominent aspects of this ad in relation to the Krytios Boy include the right figure in a contrappasto stance, the inward positioning o f the left shoulder, and the thoughtfully blank expression on the mans face. Along with the two nude men there is a clothed woman wearing the product to be sold. The woman may also be considered a play on Greek Art in that woman were always sculpted as clothed. Like the Krytios Boy who may represent the Athenian hero Theseus standing as a dedication to the goddess Athena(Oliver pg 86), the two men in this ad may be positioned as a dedication to the woman wearing the advertised clothing. This displays the lack of monumentality in the meaning of position in the advertisement as opposed the existence of it in the Krytios Boy. The use of male bodies in advertisement may give more more to the cliche sex sells, as opposed to the athletic young man idea in Greek sculpture. The 460 B.C. sculpture, Statuette of an Athlete Making a Libation portrays a young athlete in the traditional kouroi stance with a reaching, open-handed gesture. These aspects are also prominent in the 1990s Obsession for Men ad. This advertisement displays a young man in a similar kouroi-like stance and the same, though not as elevated, open-handed gesture. While the GreekShow MoreRelatedDemand for Beauty by Society6415 Words   |  26 Pageseveryone (society) wants and demands to see. So therefore, anyone that doesn’t have these ideal and physical beauty that the society demands is considered to be weird, freaks, ugly, or outcasts. Beauty in today’s society is perceived in terms of one’s size and complexion. The notion of beauty in today’s society has been misconstrued to mean slim bodies, flawless skin, etc. Most people think that beauty is just on the surface. This idea is very unhealthy in a sense that it could lead to a very ill judgmentRead MoreMr Abdul Moeed5308 Words   |  22 Pagesthe current inhabitants of the country. Some of the largest groups were the Proto-Indo-Aryans, of which Sindhis and Punjabis descend from and later Iranic peoples which the Baloch and Pashtuns descend from. Other less significant ones include the Greeks, Scythians, Persians, White Huns, Arabs, Turks, Mongols, Buddhists, and other Eurasian groups, up to and including the British, who left in the late 1940s. The region has formed a distinct cultural unit within the main cultural complex of South AsiaRead MoreThe taste of melon by borden deal11847 Words   |  48 Pageswas tolerated, laughed about. The men told great tales of their own watermelon-stealing days, how they’d been set on by dogs and peppered with salt-loaded shotgun shells. Watermelon raiding was a game, a ritual of defiance and rebellion by young males. I could remember my own father saying, â€Å"No melon tastes as sweet as a stolen one,† and my mother laughing and agreeing. But stealing this great seed melon from a man like Mr. Wills lay outside the safe magic of the tacit understanding betweenRead MoreLogical Reasoning189930 Words   |  760 Pagesa tougher job than physical scientists in making scientific advances. Lets consider the special problem of the social scientist. Suppose the newspaper reports on a scientists finding that rich females are more intelligent on average than poor males. The logical reasoner will ask, How did the researcher figure out who is rich and who is intelligent? Lets focus on the term rich. If the researcher merely asked each person whether he or she was rich, the answers are going to be very unreliable

The Indigo Spell Chapter Six Free Essays

string(50) " became more and more resolved to make the drive\." I FOLLOWED MS. TERWILLIGER’S instructions diligently. I never took the garnet off, not even when I slept or showered. We will write a custom essay sample on The Indigo Spell Chapter Six or any similar topic only for you Order Now When school started the next morning, I wore it under my shirt to avoid any questions. It didn’t exactly scream â€Å"magical amulet,† but it was certainly conspicuous. To my surprise, Ms. Terwilliger wasn’t in her first-period history class, making me wonder if she was doing some investigating of her own. â€Å"Ms. T on some secret mission?† I flinched and realized I’d been lost in my own thoughts. I turned and found Trey Juarez kneeling by my desk. Class hadn’t started yet, and a confused-looking substitute teacher was trying to make sense of the chaos of Ms. Terwilliger’s desk. Trey grinned at my surprise. â€Å"Wh-what?† I asked. Had he somehow found out about Veronica? I tried to keep cool. â€Å"What makes you say that?† â€Å"I was just joking,† he said. â€Å"This is the second year I’ve had her, and she’s never missed a day.† He gave me a puzzled look. â€Å"Unless you really do know something I don’t?† â€Å"No,† I said quickly. â€Å"I’m just as surprised as you are.† Trey scrutinized me a few moments. We were good friends here at Amberwood, with only one teeny-tiny problem hanging between us. His family was tied to the Warriors of Light. Last month, the Warriors had tried to kill Sonya in a barbaric execution ritual. Trey had been one of the contenders for the â€Å"honor† of killing her, though he’d thrown the match at the last minute. I’d tried to appeal to the Warriors to release Sonya, but they hadn’t listened. She and I were both saved when a raiding party of dhampirs showed up and defeated the Warriors. Stanton had helped orchestrate that raid – but hadn’t bothered to fill me in that I was being used as a distraction. It was part of what had fueled my distrust of her and the Alchemists. Trey had been blamed for getting me involved with the ritual, and the Warriors had ostracized his father and him. Just as I had been pressured by the Alchemists, Trey had had Warrior doctrine drilled into him his whole life. His father was so ashamed of the fallout that he would barely speak to Trey now. I knew how much Trey wanted his father’s approval, so this silence was more painful to him than the Warriors’ treatment. Our allegiances made things difficult. When I’d once tentatively hinted to Trey that we still had unresolved issues between us, he’d responded with a bitter laugh. â€Å"You have nothing to worry about anymore,† he’d told me. â€Å"I’m not hiding any secret plans from you – because I don’t know any. They won’t tell us anything. I’m not one of them, as far as they’re concerned. I’ve been cut off forever, and it’d take a miracle for them to ever take us back.† There’d been something in his dark eyes that told me if he ever could find that miracle, he’d jump on it. I’d tried asking about that, but he wouldn’t discuss it any further. â€Å"I want to be your friend, Melbourne,† he had said. â€Å"I like you. We’re never going to resolve our differences. Might as well ignore them since we have to be together every day.† Amazingly, our friendship had managed to survive all that drama. The tension was always there, lurking between us, but we tried to ignore it. Although he knew about my involvement in the vampiric world, he had no idea I was taking behind-the-scenes magic lessons with our history teacher, of course. If he thought I was lying about Ms. Terwilliger’s absence today, he didn’t push the matter. He nodded toward the sub. â€Å"This is going to be a blow-off day.† I dragged my mind away from magical intrigue. After being homeschooled for most of my life, some parts of the â€Å"normal† school world were a mystery. â€Å"What’s that mean, exactly?† â€Å"Usually teachers leave subs a lesson plan, telling them what to do. I saw the one Ms. Terwilliger left. It said, ‘Distract them.'† Trey shook his head in mock sympathy. â€Å"I hope you can handle the wasted academic time. I mean, she’ll probably say something like, ‘Work on homework.’ But no one will.† He was right. I wasn’t sure if I could handle this. â€Å"Why wouldn’t they?† This seemed to amuse him immensely. â€Å"Melbourne, sometimes you’re the only reason I come to class. I saw her sub plan for your independent study, by the way. It said you didn’t even have to stick around. You’re free to run wild.† Eddie, sitting nearby, overheard and scoffed. â€Å"To the library?† This made both of them laugh, but my mind was already spinning with possibilities. If I really didn’t have to stay for my last class, I’d be free to leave campus early. I could go into Los Angeles to look for Veronica and – no. Adrian wasn’t back. For a moment, I toyed with the idea of investigation without his spirit magic, but Ms. Terwilliger’s warnings echoed through my mind. The hunt would have to wait. But I could still look for Marcus Finch. Santa Barbara was two hours away. That meant I had enough time to drive up there, do some investigating of Marcus, and still comfortably make it back by the school’s curfew. I hadn’t intended to go look for him until this weekend but realized now that I shouldn’t waste this opportunity. Ms. Terwilliger’s task weighed heavily on me as well, but I couldn’t do anything about it until Adrian returned tonight. Marcus Finch had been a mystery to me since the moment I’d discovered he was an ex-Alchemist. Realizing that I might actually get some answers today made my heart pound in overtime. It was one thing to suspect the Alchemists had been holding out on me. It was an entirely different matter to accept that I might be on the verge of having those suspicions confirmed. It was actually kind of terrifying. As the day progressed, I became more and more resolved to make the drive. You read "The Indigo Spell Chapter Six" in category "Essay examples" I had to face this sooner or later, and I might as well get it over with. For all I knew, Marcus had simply been sightseeing in Santa Barbara and could be gone already. I didn’t want to repeat the scrying spell if I could help it. Sure enough, when I showed up for what would normally be my independent study at the end of the day, the sub (looking extremely worn out after a day of following in Ms. Terwilliger’s footsteps) told me I was free to go. I thanked her and hurried off to my dorm room, conscious of the clock that was now ticking. I didn’t know exactly what I’d be facing in Santa Barbara, but I planned to be prepared for anything. I changed out of my Amberwood uniform, opting for jeans and a plain black blouse. Kneeling by my bed, I pulled out a large metal box from underneath it. At first glance, the box looked like a makeup kit. However, it had an intricate lock that required both a key and combination. Inside was my Alchemist chemistry set, a collection of chemicals that would probably get me kicked out of school if found since it looked like it was capable of manufacturing illegal drugs. And really, some of the compounds probably were pretty questionable. I selected some basics. One was a formula that was usually used to dissolve Strigoi bodies. I didn’t expect to encounter any Strigoi in Santa Barbara, but the compound could also be used to disintegrate metal pretty handily. I chose a couple other mixtures – like one that could create a spy-worthy smoke screen – and carefully wrapped them all up before slipping them into my messenger bag. Then I locked the box again and slid it back under the bed. After a little consideration, I took a deep breath and produced another hidden box. This was a new one in my collection. It contained various charms and potions I’d made under Ms. Terwilliger’s instruction. Staring at its contents, I felt my stomach twist. Never in my wildest dreams had I imagined I’d have such a kit. When we’d first met, I’d only created charms under duress. Now I had several that I’d willingly made, and if what she’d said about her sister was true, I’d need to start making more. With great reluctance, I picked a variety of these as well and packed them up with the Alchemist chemicals. After a moment’s consideration, I put a couple in my pocket for quick access. The drive to Santa Barbara was easy this time of day December had cooled off some of southern California’s weather, but the sun was still out, making it seem warmer than it really was. And, as I drove up the coast, the desert gave way to more temperate conditions. Rain increased in the middle and northern parts of the state this time of year, making the landscape lush and green. I really did love Palm Springs and Amberwood, but there were times I wouldn’t have minded if Jill’s assignment had taken us up here. Finding the Old Mission Santa Barbara wasn’t difficult. It was a well-known tourist attraction and pretty easy to spot once you were nearby. The sprawling church looked exactly as it had in my vision save that it was lit by mid-afternoon sunshine rather than twilight. I pulled off to the side of the road in a residential neighborhood and gazed up at the beautiful stucco and terra-cotta masterpiece. I wished I had the time to go on a tour, but, as they so often did, my personal desires had to take a backseat to a larger goal. Now came the more difficult part – having to figure out where the studio I’d seen might be. The neighborhood I parked in provided a view that was similar to the one I’d observed in the spell. The angles weren’t exact, however, and this street only contained houses. I was almost certain the studio I’d seen had been in an apartment building. Keeping the mission in view, I drove a few more streets over and found what I’d hoped for: several blocks containing apartment complexes. One looked too nice to have what I’d seen. The studio had seemed pretty bare bones and run down. The other two buildings on the street looked like more likely candidates. I drove to each one and walked around their grounds, trying to imagine what the angle might be when viewed from a higher window. I wished I’d had a chance to actually look down to the parking lot in the vision. It would have given me a better idea of the floor. After much thought, I finally deduced the studio had been on the third or fourth floor. Since one of the buildings only had two floors, that gave me a pretty positive hit on the correct place. Stepping inside the building made me glad I’d packed hand sanitizer in my bag. The halls looked like they hadn’t been swept in over a year. The walls were dirty, their paint chipped. Bits of trash sat on the floor. Cobwebs hung in some of the corners, and I prayed spiders were the only creepy-crawly inhabitants. If I saw a roach, I was probably going to bolt. The building had no front desk I could make inquiries at, so I flagged down a middle-aged woman as she was leaving. She paused, regarding me warily. â€Å"Hi,† I said, hoping I looked non-threatening. â€Å"I’m trying to find a friend of mine, but I don’t know which apartment he lives in. Maybe you know him? His name is Marcus. He has a blue tattoo on his face.† Seeing her blank look, I repeated the question in Spanish. Comprehension showed in her expression, but once she’d heard my entire question, her only response was a brief headshake. I didn’t even have time to show her Marcus’s picture. I spent the next half hour doing the same thing whenever I saw residents going in or out. I stayed outside this time, preferring a brightly lit public area to the dingy interior. Some of the people I talked to were a little sketchy, and a couple of guys looked me over in a way I definitely didn’t like. I was about to give up when a younger boy approached me. He appeared to be about ten and had been playing in the parking lot. â€Å"I know the guy you’re looking for,† he told me in English. â€Å"But his name’s not Marcus. It’s Dave.† Considering how difficult Marcus had been to find, I wasn’t entirely surprised he’d been using another name. â€Å"You’re sure?† I asked the boy. I showed him the picture. â€Å"This is the guy?† He nodded eagerly. â€Å"That’s the one. He’s real quiet. My mom says he’s probably doing bad things.† Great. Just what I needed. â€Å"Do you know where he lives?† The boy pointed upward. â€Å"At the top. 407.† I thanked him and went back inside, heading up to the fourth floor on stairs that creaked the entire way. The apartment was near the end of the hall, next to one that was blasting obnoxious music. I knocked on 407 and didn’t get a response. Not sure if the occupant had heard me, I knocked more loudly and received the same result. I eyed the doorknob, considering melting it with my Alchemist chemicals. Immediately, I dismissed the thought. Even in a disreputable building like this, a neighbor might be concerned to see me breaking into an apartment. I didn’t want to attract any attention. This situation was getting increasingly frustrating, and I couldn’t spend all day here. I ran through my choices. Everyone said I was so smart. Surely there was some solution here that would work? Waiting around in the hall wasn’t an option. There was no telling how long it could take for Marcus or â€Å"Dave† to show up. And honestly, the less time spent in the dirty hall, the better. If only there was some way to get inside that didn’t involve actually destroying – That’s when the solution came to me. I groaned. It wasn’t one I liked, but it would get the job done. I went back outside and waved hello to the boy as he practiced jumping off the steps. â€Å"Was Dave home?† he asked. â€Å"No.† The boy nodded. â€Å"He usually isn’t.† That, at least, would be helpful for this next crazy plan. I left the boy and walked around the side of the building, which was mercifully deserted. There, clinging to the outer wall, was the most rickety fire escape I’d ever seen. Considering how rigid California safety standards were, I was astonished that this hadn’t been reported. Of course, if it had, it didn’t seem likely this building’s owner would’ve been quick to act, judging from the rest of the conditions I’d seen. Double checking that no one was around, I stood in the fire escape’s shadow, hoping it more or less concealed me. From the messenger bag, I produced one of my charms: a necklace made of agate and crow feathers. I slipped it over my head and recited a Greek incantation. I felt the warmth of magic run through me but saw no ostensible changes. Theoretically, I should be invisible for those who didn’t know to look for me. Whether that had actually happened, I couldn’t say. I supposed I’d find out if someone came by and demanded to know why I was climbing into an apartment via the fire escape. Once I stepped onto it, I nearly terminated the plan. The entire fire escape squeaked and swayed. The scaffolding was so rusty, I wouldn’t have been surprised if it disintegrated beneath my feet. I stood frozen where I was, trying to work up the courage to go on. I reminded myself that this could be my one chance to find Marcus. The boy in the parking lot had confirmed he lived here. I couldn’t waste this opportunity. I gulped and kept going, gingerly moving from floor to floor. When I reached the fourth, I stared down in amazement, unable to believe the fire escape was still intact. Now I had a new problem. I’d figured out where Marcus’s studio was, and it was one window over from the fire escape’s landing. The distance wasn’t that great, but on the narrow ledge between them would feel like miles. Equally daunting was the fact that I’d have to get through the window. It was shut, which made sense if he was in hiding. I had a couple magical amulets capable of melting glass, but I didn’t trust myself to be able to use them on the narrow ledge – which meant I had to see just how good my aim had become in PE. Still conscious of the precarious fire escape, I took out a small pouch of powder from my messenger bag. Sizing up the distance, I threw the pouch hard toward the window, reciting a spell – and missed. The pouch hit the side of the building, throwing up a dusty cloud, and began eating away at the stucco. I winced as the wall dissolved. The spell eventually burned itself out but left a noticeable hole behind. It hadn’t gone all the way through, and I supposed given the state of the building, no one would probably even notice. I had one pouch left and had to make it count. The pane was fairly big, and there was no way I could miss this time. I threw hard – and made contact. The powder smashed against the window. Immediately, a reaction spread out and began melting the glass. It dripped down like ice out in the sun. Now, watching anxiously, I wanted the reaction to go on for as long as possible. I needed a big enough hole to get through. Fortunately, when it stopped, I felt confident I could make it inside – if I could get over there. I wasn’t afraid of heights, but as I crept along the ledge, I felt like I was on top of a skyscraper. My heart was in my throat, and I pondered the logistics of surviving a four-floor drop. My palms began to sweat, and I ordered them to stop. I wasn’t going to come all this way just to have my hands slip at the last minute. As it turned out, it was my foot that slipped. The world spun, and I frantically flung my arms out, just barely grabbing the inside of the window. I pulled myself toward it, and with a surge of adrenaline-fueled effort managed to hook my other leg inside. I took a deep breath and tried to quiet my pounding heart. I was secure. I was going to make it. A moment later, I was able to pull myself up and swing my other leg around the ledge, tumbling into the room. I landed on the floor, my legs weak and shaky as I worked to steady my frantic breathing. That was close. If my reflexes had been a little slower, I would’ve found out exactly what four floors could do to the human body. While I loved science, I wasn’t sure that was an experiment I needed to try. Maybe being around dhampirs so much had helped improve my physical skills. Once I’d recovered, I was able to assess my surroundings. Here I was, in the exact same studio I’d seen in my vision. Glancing behind me, I sized up the mission, verifying I had the same vantage. Yup. Exactly the same. Inside, I recognized the mattress on the floor and the same meager belongings. Across the room, the door leading out had a number of very new, very state-of-the-art locks. Dissolving the outer doorknob wouldn’t have done any good. â€Å"Now what?† I muttered. I’d made it inside. I didn’t have Marcus, but I theoretically had his apartment. I was unsure what I was looking for but might as well start somewhere. First, I examined the mattress, not that I expected much. It couldn’t hide belongings like mine could. It could, however, hide rats and God only knew what else underneath it. I gingerly lifted a corner, knowing I must be grimacing, but there was nothing underneath – alive or otherwise. My next target was a small, disorderly pile of clothes. Going through someone’s dirty laundry (because I assumed it was dirty, if it was sitting on the floor) wasn’t much better than looking at the mattress. A whiff of fabric softener told me that these clothes were, in fact, recently washed. They were ordinary guy clothes, probably a young guy’s clothes, which fit with Marcus’s profile. Jeans. T-shirts. Boxers. As I sifted through the pile, I nearly started folding them and had to remind myself that I didn’t want to leave any sign of my passing. Of course, the melted window was kind of a dead giveaway. A couple of personal items sat nearby, a toothbrush and deodorant with a scent inexplicably called as â€Å"Ocean Fiesta.† Aside from a rickety wooden chair and the ancient TV, there was only one other form of comfort and entertainment in the barren room: a battered copy of The Catcher in the Rye. â€Å"Great,† I muttered, wondering what it said about a person who owned no other personal possessions. â€Å"Marcus Finch is pretentious and self-entitled.† The studio’s bathroom was claustrophobic and barely had enough space for a single shower stall, toilet, and dripping sink. Judging from the mildew on the floor, a good deal of water sprayed out when the shower was used. A large black spider scurried down the drain, and I hastily backed out. Defeated, I went to investigate a narrow closet door. After all my work, I’d found Marcus Finch but hadn’t actually found him. My search had revealed nothing. I had limited time to wait for him, and honestly, if I were him and returned home to a melted window, I would promptly walk out the door and never return. If he ran, I’d have no choice but to keep scrying and – â€Å"Ahh!† Something jumped out at me as I opened the closet door – and it wasn’t a rat or a roach. It was a man. The closet was tiny, so it was a miracle he had even fit inside. I had no time to process the spatial logistics, however, because his fist shot out and clipped me on the side of the face. In my life, I’d been slammed up against brick walls and bitten by a Strigoi. I’d never been punched, however, and it wasn’t an experience I wanted to repeat. I stumbled backward, so surprised that I couldn’t even react right away. The guy lunged after me, grabbing my upper arms and shaking me as he leaned close. â€Å"How did you guys find me?† he exclaimed. â€Å"How many more are coming?† Pain radiated through the side of my face, but somehow, I managed to gather my senses. Last month, I’d taken a self-defense class with a slightly unstable Chihuahua breeder who looked like a pirate. Despite Malachi Wolfe’s unorthodox behavior, he’d actually taught us some legitimate skills, and they came back to me now. I kneed my attacker in the stomach. His blue eyes went wide with shock as he released me and fell to the ground. It didn’t keep him down for long, though. He scrambled back to his feet and came after me, but by then, I’d grabbed the chair and was using it to keep him at bay the way a lion tamer would. â€Å"Back off,† I said. â€Å"I just want to – â€Å" Ignoring my threats, the guy pushed forward and grabbed one of the chair’s legs, pulling it away from me. He had me backed into a corner, and despite some tricks Eddie had taught me, I wasn’t confident in my own ability to throw a punch. Nonetheless, I put up a good fight when my attacker tried to grab me again. We struggled and fell to the floor. I kicked and clawed like crazy, making things as difficult as possible. It was only when he managed to pin me with his entire body that my flailing got stifled. I had enough freedom to reach a hand into my pocket, however. â€Å"Who sent you?† he demanded. â€Å"Where are the others?† I didn’t answer. Instead, I pulled out a small vial and flipped the cap off with one hand. Immediately, noxious yellow vapor with the consistency of dry ice spilled out of it. I thrust it toward the guy’s face. He recoiled in disgust, and tears sprang into his eyes. The substance itself was relatively harmless, but its fumes acted as a kind of pepper spray. He let go of me, and with strength I didn’t even know I had, I managed to roll him over and hold him down. I drove my elbow into his wrist, and he made a small grunt of pain. With my other arm, I waved the vial with as much menace as I would a machete. This wouldn’t fool him for long, but hopefully it’d buy me some time to reassess my situation. Now that he was still, I was finally able to get a good look at him and was relieved to see I’d at least achieved my goal. He had a young, handsome face with an indigo tattoo on his cheek. It was an abstract design that looked like a latticework of crescent moons. A faint silver gleam edged some of the blue lines. â€Å"Nice to meet you, Marcus.† Then, the most astonishing thing happened. Through his watering eyes, he’d been trying to get a good look at me too. Recognition appeared on his face as he blinked me into focus. â€Å"Sydney Sage,† he gasped. â€Å"I’ve been looking for you.† I didn’t have any time to be surprised because I suddenly heard the click of a gun, and a barrel touched the back of my head. â€Å"Get off him,† a voice demanded. â€Å"And drop the smoke bomb.† How to cite The Indigo Spell Chapter Six, Essay examples

Cuban Missle Crisis Essay Research Paper Cuban free essay sample

Cuban Missle Crisis Essay, Research Paper Cuban Missile Crisis When given the chance to compose a research paper on any struggle or conflict during recent American History, one has a figure of options: World War Two, the War in Vietnam, and the Korean struggle to call but a few. However, I have chosen a brief period of two hebdomads during which the really being of the United States was earnestly threatened. To most of my coevals the Cuban missile crisis is nonexistent. No 1 tends to look at non-physical actions as 1s of any importance. However, if the successes and failures of past coevalss are non decently looked at we will be blind as to what should be done in the hereafter. The anxiousness and emotions felt by 200 million Americans as the U.S. was on the threshold of atomic war has since been forgotten. The Cuban missile crisis is an of import aspect of American history for many grounds. We will write a custom essay sample on Cuban Missle Crisis Essay Research Paper Cuban or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page When Eisenhower yielded the presidential term to Kennedy the gross output of all U.S. arms likely equaled about one million times that of the bomb that had obliterated Hiroshima. We must pay close attending to these figures because, in October 1962 the United States was on the threshold of a atomic war with the Soviet Union ; we must recognize merely how close we came to decease if it was non for the speedy actions of many brave work forces and adult females in charge of intelligence. The blast of an atomic bomb is measured in 1000s of dozenss of TNT, in contrast the blast of a H bomb, which is measured in 1000000s of dozenss of TNT. The Hiroshima bomb was 10 pess long, weighed about 5 dozenss, and required a crew of experts yearss to lade. In contrast, by the clip of the missile crisis, bombs 20 times more powerful were three pess long and could be strapped to an ordinary bomber. The populace learned how toxic atomic arms were when Strontium-90 generated by trials in Nevada showed up in milk in New Jersey. The Cuban missile crisis began on October 14, 1962 when CIA U2 undercover agent planes took aerial exposure of Cuba and revealed the worst frights of some members of Congress: that the Soviet Union had been carrying arms in Cuba. On October 16, it was revealed that non merely had the Soviets been carrying arms, but they were hive awaying 40 medium-range-ballistic-missiles ( MRBM ) in Cuba that, with the aid of decommissioned Soviet aircraft could be launched up to 1,100 stat mis and were hence within easy range of the United States. The menace of a atomic war with the Soviet Union had placed fright in both Americans and Russians for both sides knew that neither could win a atomic war. Although the United States might militarily win such a war, losingss would be in the 10s of 1000000s and it is dubious that we could last the atomic winter that would follow. Between October 16th and 22nd Kennedy spoke with his National Security Advisors so that he might come to the best determination as to what to make in such a atomic confrontation. One suggestion was that the U.S. should occupy Cuba but this was overturned due to the losingss and media frenzy that The Bay of Pigs invasion had caused. Another suggestion was that the U.S. should bomb the sites where it was determined that atomic payloads were located. This determination, excessively, was overturned as Kennedy felt that if the Soviets were willing to set payloads in Cuba they might revenge if the United States bombed these payloads and the 1000s of technicians in Cuba needed to guarantee their smooth operation. In 1962 although both the Soviet Union and the U.S. had MRBM s neither had the capableness to stop the oppositions # 8217 ; , go forthing it so that if the U.S.S.R launched a payload on the U.S. within seconds the U.S. would establish one at the U.S.S.R and within proceedingss both of our states would be destroyed. The Navy was ordered to quarantine ( a euphemism to avoid the diplomatic term encirclement ) Cuba, turning back all ships transporting violative arms at that place. The President made it clear that any atomic arm launched from Cuba would ensue in a full revenge by the United States on the Soviet Union. One can theorize that the Soviet Union placed arms in Cuba non to assail the U.S. but to give the feeling that they could if they wanted to. In making this, the Soviet s purpose was most likely to transfuse fear into the American thickly settled and authorities. Expecting the U.S. to take the affair to the U.N. , the Kremlin may hold placed violative arms in Cuba entirely to be used as a bargaining bit within the U.N. so that the U.S. would hold to a Berlin and German colony on Soviet footings. The Kremlin has been historically bad at judging other states responses to its actions and did non recognize that the American authorities would non see this a mere menace, but a menace to the American manner of life. The Kremlin erroneously believed that the United States would digest its ain methods of foreign policy being used upon it. President Kennedy took the menace imposed by the Kremlin as a echt menace mentioning that when Soviet purposes are non known it is better to take any menaces at face value. Taking the Soviet menace as echt, Kennedy himself threatened world-devastation by informing Premier Khrushchev that the United States had every purpose of making whatever is necessary to guarantee the American manner of life. In one missive on October 28th, 1962 Khrushchev agreed to retreat the missiles if the United Sates pledged neer to occupy Cuba. The containment policy that the U.S. had implemented against the Soviet Union had worked once more. The bear was back in its den. There are those who believe that the United States should hold bombed out the missile sites and the Castro authorities. The simpleness of such a class is attractive, but the consequences would hold been questionable. The missiles would hold been removed but 1000s of Soviet technicians might hold been killed. Because it sometimes reacts instinctively, the Kremlin might hold responded with a direct military counterblow. Khrushchev failed in his mission to negociate a Russian colony of the Berlin and German state of affairss. His error was in non recognizing that the U.S. excessively could play tough and that Americans would non let their manner of life to be threatened under any fortunes. On Monday, October 29, 1962 the Soviet missiles were being withdrawn and the Cuban crisis was over. President Kennedy had non flinched under the two greatest force per unit areas of a presidential term the menace to national security and the danger of a atomic war. His commixture of limited, but definite, military action-the quarantine-with the strongest possible diplomatic language-the menace to eliminate the Soviet Union was -masterful. President Kennedy non merely prevented a atomic war but besides resolved the state of affairs without a individual hurt or decease. Bibliography Bohlen, Charles E. , Witness to History, 1929-1969. New York: Norton, 1973. Collier, Peter and Horowitz, David The Kennedys: An American Dream. New York: Acme Books ( Simon A ; Schuster ) , 1984. Detzer, David The Brink: Narrative of the Cuban Missile Crisis. New York: Crowell, 1979 LaFeber, Walter The American Century. Boston: McGraw-Hill, 1988. May, Ernest R. and Zelikow, Philip D. explosive detection systems. The Kennedy Tapes. Cambridge MA: Harvard University Press, 1997.

2/11/99 Essays - Essays By George Orwell, George Orwell,

2/11/99 Engl. 108 Final Essay Society's Influence Throughout time society has played a major role in determining what are to be the expected and appropriate actions of a person. Social pressure is common in every facet of life. It influences our every decision in some way, be it positive or negative. Sometimes we are pressured into doing something that we would not normally do even though we know it's wrong. In the short stories "Salvation" by Langston Hughes and "Shooting an Elephant" by George Orwell, there are strong examples of society pressuring people into doing something that they would not normally do and that they don't want to do. The short story "Salvation" is about a twelve year old boy who is forced to lie to his family and the members of a church because of the pressure put on by the people around him. One of the first sentences in the introduction says: "That night I was escorted to the front row and placed on the mourners bench with all the other young sinners, who had not yet been brought to Jesus(Hughes 177)." The author's choice of diction in this sentence is extremely meaningful. His use of the phrase "I was escorted?" is a definite sign that he was not going willingly or was not happy about going. He says that he was "?placed on the mourners bench with all the other young sinners." To a young child the thought of being "...placed?with all the other young sinners" is probably a scary and degrading one. These are both evidences of negative pressure put on just by his surroundings, not by people or what they are expressing verbally. Langston, the main character, was sitting next to another young boy named Westley. He was a rounder's son. A rounder is a minister who travels around preaching at different churches. This is evidence that Westley was brought up around church and probably has a good idea as to what is right and what is wrong. Even though he has this knowledge he still gets pressured into lying, which is an action he probably knows is wrong. He says to Langston: "God damn! I'm tired o'sitting here. Let's get up and be saved (Hughes 178)." This is an obvious attempt to appease the people around him and end a stressful situation. Some might call his actions covertly sacrilegious, but the expectations of the people around him were so great that he put his knowledge of right and wrong aside to do what everyone wanted him to do. Towards the end of the service Langston finds himself alone on the mourners bench and that all the other young children had already gone up and been saved. He says: "Now it was getting late. I began to feel ashamed of myself, holding everything up so long (Hughes178)." The congregation was praying for him and calling him to come forward. The combined pressure of him being the one holding things up and the people calling him to come and be saved was enough to get him to lie in order to do what the congregation expected him to do. He says, "So I decided that maybe to save further trouble, I'd better lie, too, and say that Jesus had come, and get up and be saved (Hughes178)." The fact that the pressure put on caused him to do something as bad as lying in church about seeing Jesus and being saved is terrible. The short story "Shooting an Elephant" by George Orwell contains some vivid examples of societal pressure. The main character, a police officer, is subjected to negative pressure when he is faced with the possibility of him having to kill an elephant. The main character states: "The people expected it of me and I had got to do it: I could feel their two thousand wills pressing me forward, irresistibly (Orwell 240)." This quote shows that he police officers will is being bent by the combined will of the crowd surrounding him. This is an obvious example of the power that a large group has in effecting a person's judgement. The diction used in this sentence not only encompasses the feelings brought up in the story but also spells them out, word for word.

Childhood Is the Happiest Time of a Persons Life Essay Example

Childhood Is the Happiest Time of a Persons Life Essay Example Childhood Is the Happiest Time of a Persons Life Paper Childhood Is the Happiest Time of a Persons Life Paper Essay Topic: Life Of Pi Good afternoon ladies and gentlemen. The topic for our debate is that childhood is certainly not the happiest time of your life. We the negative team believe that this statement is false. RECAP Our first speaker has already stated everything is possible in children’s life. This mean the ARGUMENTS Today I will be talking to you about childhood is certainly the happiest time of your life Now to my first point, children spend their time mostly with their parents in childhood than in later life.The reason for this is parents take care of children every minute and devote themselves to children. I am sure that there is nothing that can have more value for a human than that. If children are ill they have person to look after them, to give a piece of advice if children have a fight with their friends, in the long run there is a person to turn to in any time. However children may not have these chances in their later life. It is a life and one day that can pass away even though sometim es these occasions happen without warn us.So, we should enjoy life with our parents that would be a great memory in our minds. Now to my second point, children expectations are simple and limited compare to adults. This is because to be happy, children only need friends, toys and place to play. It is different with adults who are always not satisfied with all they have had. They always expect more than all are already in their hands. For example, having a small house is still not enough so that they want a bigger one. Also, after they could buy a car, they also want to buy another car. In career,

Seminar in Criminology- classmate response 12 Essay

Seminar in Criminology- classmate response 12 - Essay Example The grouping of inmates according to their age, background and chances of being more violent was also seen to improve the situation according to the study results given by Fuller and Orsagh (Wooldredge & Thistlethwaite, 2014). Based on the recommendations that Maurice provides in his discussion, it is evident that they can easily be implemented even on a low-budget. Nonetheless, Maurice also says that re-organizing the prison populations would also be helpful in eliminating the cases of prisoners who get assaulted, whether it is based on age or a person’s race. Lastly, Maurice has not only discussed some of the most useful things that the prison staff could do to reduce cases of assault, but he has also organized his work in neat paragraphs. In addition, his sentences are well spaced and there is no paragraph that has inconsistently spaced paragraphs. The discussion is also not too lengthy, which makes the reading of each paragraph easy. Maurice also persuades the reader that more supervision in prisons is important when he uses illustrations that are simple. For example, he says that getting prisons to have more supervisors in each floor is not possible since the economy today is not too

A Critical Review and Comparison of Physical Education Studies Essay

A Critical Review and Comparison of Physical Education Studies - Essay Example The paper looks into the reason why this model is popular among the teachers as well as students. The holistic approach of this paper is to analyse physical education in general terms. And try to see how it has contributed towards better literate athletes. Towards the end, a brief discussion of pros and cons of certain models clears the situation and summarizes the whole debate. There are certain recommendations given in the conclusion based on the whole debate. The recommendations are not definite because there is no one-size-fits-all model. This report makes a conclusion that there are many models that can be incorporated in sports education. As time progresses and with the advancement in technology there will be better and more effective models in the future. Be it the cooperative learning model or formal old school model, the inherent goal of making the students think independently and make better decisions is the key. From the debate it is evident that any model or curriculum design that promotes social-based learning is more successful than competitive ones, especially in sports education. However, more research is needed to figure out how the teachers interpret the sports education and how they teach through a curriculum model. The research does not intend to support cooperative learning. There is no single study that creates a complete knowledge base. But the pros and cons offered by this model makes it a favourite among teachers and students.

Questions Essay Example | Topics and Well Written Essays - 500 words - 9

Questions - Essay Example According to Goldman, the qualitative approaches to assessment needs is more clients involves and is based a lot more on the standardised or objective tests. a) Quantitative Approaches of Assessments: This form of assessment includes self – efficacy measurements. Here the individual’s judgement to judge the ability to perform a task at a level. â€Å"These self – efficacy cognitions mediate action with the result that individuals avoid tasks or activities they believe are beyond their capabilities and instead engage in those they judge themselves capable of performing†. b) Qualitative Approaches of Assessments: These assessments are based on two major philosophical positions, post modern and logical positivism. The major practical differences between each of the perspectives are mainly in the assessment area. The logical positivists have relied a lot on the traditional measurement devices. These include interest and personality inventories while the postmodern theories do not include the above mentioned factors. a) Quantitative Approaches of Assessments: These assessments include Scholastic Aptitude Tests and other similar tests that are progressed to through school. This is a relatively common and most common to all the readers. b) Qualitative Approaches of Assessments: These assessments include techniques like repertory grid, reptest. These are relatively very complex and require extensive training before they can be used in career counselling. The post modern assessments are easy to use and a few of the strategies and tests used here include Career – O – Gram, role play, card sorts, and genograms. Special needs are a term that is used to refer to clinical diagnostic and functional development to describe individuals who need assistance for disabilities that may include mental, psychological and medical assistance. Disability has been defined by WHO as, â€Å".. is any restriction or lack

Social Determinants of Health (SDOH) | Essay

Social Determinants of Health (SDOH) | Essay Introduction The Social determinants of health (SDOH) are a group of factors that impact health and wellbeing of an individual. Child development is influenced by various aspects starting from birth, biology, genetic characteristics, gender, culture and family values. The Family provides adequate support systems by various means such as socioeconomic resources, ideal family environment and effective parenting skills. A community’s health and social development depends on healthy living and health services available to them (McMurray Clendon, 2011). The health burden of disease and causes of major health inequalities arises from the environment in which an individual is born, raised, grown and worked. Theses factors are referred to as SDOH. SDOH consist of a number of structural conditions. The model representing cascade of bubble demonstrates how SDOH are interrelated to each other. It is observed that if there are any political or environmental changes, all structural determinants are affected (Wilcox, 2007 as cited in McMurray Clendon, 2011). Primary health care (PHC) is aimed to create healthy communities. PHC approach is best described by multi-level health promotion model. Primary prevention is attained through upstream actions which are aimed to promote and maintain health. This is achieved through providing a healthy environment, health services and education for healthy living. Secondary prevention/midstream actions are providing treatment for illness and further prevention of disability. Tertiary or downstream actions are basically rehabilitation services or educating the community to cope with disability conditions (McMurray Clendon, 2011). This essay outlines the effect of housing on health of the community. Improving the housing condition is primary prevention through upstream actions. To improve health and reduce inequalities, a coordinated approach is required to address SDOH which has direct effects on structural determinants. House designs should be made by taking into account health and well being. The infrastructure planning for housing designs which should include insulation, ventilation, sewage system, public spaces as well as community’s participation in their health development project should be encouraged. The health of an individual, families and the community can be improved by well designed, insulated houses and community health services. (WHO, 2011; Chapman Bierre, 2008). The US Centres for Disease Control and Prevention also emphasised on approach to promote health by improving housing and living conditions. The visits to emergency and stay in hospital with serious acute medical illness is shorter with improved living conditions as opposed to those who lives in poor housing (Thomson, Thomas Petticrew, 2009; Sadowski, Kee, VanderWeele Buchanan, 2009). The research study has indicated that people migrated to better housing has improved health outcomes and are also exposed to less substance abuse, violence and less neighbourhood problems as compared to their original living conditions. Government generated social and health policies directly affect the quality of life and living conditions of the community, and also the economical status of the family significantly influence an individual’s health. A co-ordinated action is required from the Policy makers, health service providers and leaders from various sectors to utilise their knowledge to enhance better living conditions bringing the best population health outcomes (Williams, Costa, Odunlami Mohammad, 2012). The importance of living and working conditions, indoor environment, safe neighbourhood, healthy lifestyles in general and respiratory health in particular is a major concern these days. The predominant factors increasing the risk of asthma and respiratory problems are moisture damage in the house and bacterial growth. The studies have shown a close association between mould, dampness and asthma in children. Damp houses resulting in mould and microbial growth are the predisposing factor resulting in wheezing in adults and infants. In a survey carried in NZ homes reported 35 % of moulds clearly visible in the living area or bedrooms. NZ has been reportedly having higher asthma rates in the world, which is contributed by poor living conditions. Damp and cold houses support the bacterial growth, providing favourable media for mould, bacteria and dust mites. Young children spend more time at home as compared to adults, There is a significant effect of damp houses on respiratory system, t hus the incident rate of bronchitis and wheezing illness is more common in children. It is suggested, if people will be provided with better housing and insulation, respiratory symptoms will reduce by 33% (Keall, Crane, Baker, Wickens, Chapman Cunningham, 2012). It has always been stated that population of health is largely impacted by quality of housing where they live. If people living in substandard housing or poor living conditions could be provided with better housing, insulation and ventilation, It could potentially prevent ill health. There was a cluster randomised trial for housing, insulation and health study of insulating houses of communities with low socioeconomic status. A Community based approach is effective mean of improving health rather than an individual focused e.g. Insulating houses are more effective than providing people with more clothes. Older aged, infants and children spend more time in houses, thus they have to bear the physiological stress due to their weaker immune system. This research also reports an association of cold, damp houses likely to get bacterial and mould growth, eventually causing respiratory problems. Several international report highlight poor insulation, damp, cold and mouldy houses leading to p oor health. People with insulated houses and better living conditions were less likely to be admitted to acute wards with pulmonary and obstructive airway diseases. The results interpreted in studies of the insulated housing affecting health were significant with improved outcome measures, except for the use of medical facilities. This study was conducted in uninsulated old houses with cold and dampness, where at least one member has respiratory problems, Increased warmth and decreased humidity brought improved health conditions. Population living in well designed and insulated houses reported significantly less cold and dampness however People in insulated houses also reported that their houses felt significantly less damp and mouldy, however this study does not determine essential determinants involved. Although this study greatly emphasise the effect of living in cold and damp houses resulting in pulmonary conditions such as asthma, cough and wheezing (Chapman et al., 2007). A study conducted by Kearns, Smith and Abbott on Pacific population showed substandard living conditions as compared to Maori and European population. Pacific people are at a great risk of developing asthma, cold and flu (as cited in Butler, Williams, Tukuuitonga Peterson, 2003). Studies have reported a close relationship between cold, damp houses and respiratory diseases. Researchers also highlighted the association of poor housing with mental health and maternal health. Statistical analysis showed cold/damp houses a potential risk factor for asthma and postnatal depression. The pathophysiology of the respiratory symptoms is triggered by an allergic reaction to fungi or dust mites (Butler, Williams, Tukuuitonga Peterson, 2003). A major British cohort study has reported an evidence of poor living/housing conditions are growing over the life, of course, and can impose serious health effects on an individual and family. Thus, interventions to improve housing could measure better effects. Providing insulation for houses for the community with low economic conditions is a cost effective intervention to promote health and well being. It should be widely accepted by the community for their own health, policy makers and leaders to make strategy for healthy measures (Chapman et al., 2007). Conclusion The health of the community is greatly influenced by SDOH more than medical care. As above stated, quality of life is significantly affected by the society and the environment in which they live and work. The burden of disease and ill health can be reduced by improving the housing environment. Medical care and accessing physician is not affordable to all, however better housing conditions can effectively reduce the financial burden on the health sector. Hence, the individual and the community should be encouraged to participate in health programmes for the promotion of their health and wellness. Reference List Butler, S., Williams, M., Tukuionga, C., Paterson, J. (2003). Problems with damp housing among pacific families in New Zealand. The New Zealand Medical Journal, 116 (1177), 1-8. Retrieved from https://researchspace.auckland.ac.nz/bitstream/handle/2292/4653/12861308.pdf?sequence=1 Chapman, P. H., Bierre, S. (2008). Reducing health inequalities by improving housing. In Dew, K., Matheson, A. (Eds.), Understanding health inequalities in Aotearoa New Zealand (pp. 161-173). Dunedin, New Zealand: Otago University Press. Chapman, P. H., Matheson, A., Crane, J., Viggers, H., Cunningham, M., Blakely, T.,Davie, G. (2007). Effect of insulating existing houses on health inequality: cluster randomised study in the community. BioMedical Journal. doi: 10.1136/bmj.39070.573032.80 Keall, M. D., Crane, J., Baker, M. G., Wicken, K., Chapman, P. H., Cunningham (2012). A measure for quantifying the impact of housing quality on respiratory health: a cross sectional study. Environmental Health, 11 (33), 1-8. Retrieved from http://www.biomedcentral.com/content/pdf/1476-069X-11-33.pdf McMurray, A., Clendon, J. (2011). Community health and wellness: Primary health care in practice (4th ed.). Sydney, Australia: Elsevier. Sadowski, L, S., Kee, R. A., VanderWeele, T. J., Buchanan, D. (2009). Effects of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of American Medical Association, 301 (17), 1771-1777. doi: 10011/jama.2009.561 Thomson, H., Thomas, S., Sellstrom, E., Petticrew, M. 92009). The health impacts of housing improvement: A systematic review of intervention studies from 1887 to 2007. American Journal of Public Health, 99(3), 681-691. doi: 10.2105/AJPH.2008.143909. Willimas, D. R., Costa, M. V., Odunlami, A. O. Mohammed, S. A. (2008). Moving upstream: How interventions that address the social determinants of health can improve health and reduce disparities. Journal Public Health Manag Pract, 14, S8-17. doi: 10.1097/01.PHH.0000338382.36695.42 World Health Organization. (2011). Closing the gap: Policy into practice on social determinants of health: discussion paper. Retrieved from https://extranet.who.int/iris/restricted/bitstream/10665/44731/1/9789241502405_eng.pdf 1

Why Do The Terrorists Hate Us? :: Terrorists, Terrorism

"We have met the enemy and he is us." -- Walt Kelly   Ã‚  Ã‚  Ã‚  Some politicians view ISIS as a snake and â€Å"If you cut of the head of the snake the rest will wither.† I view ISIS as more of a hydra than a snake, in that cutting one head off will only cause another to grow in its place. And while destroying ISIS would be welcomed by the American people it would hardly be the end of our problems. That action would just inspire more religious fanatics. They also love martyrs; it would only had fuel to the fire.   Ã‚  Ã‚  Ã‚  Ã‚  Why do they hate us? What is the reason for thousands of lost lives and millions of dollars in destruction? It can be broken down into 5 different reasons. Wealth, Power, viewed as the world police, our freedoms, and our Middle East policy. Why should hate be put upon a country with wealth? Success is a short step to wealth and with that comes jealousy. In our economic development we have worked with a small frame growth, in that, we use the economy to work for us and rarely include other countries. If we showed other third world counties to develop an economic system, like we did to China, they would also enjoy the feeling of wealth. With that though would come completion to America? Our power is hated. Our power in the military, our power in the culture we have and our power in the economy we use. This is the main reason we are hated. We are seen as a goliath that bosses around other countries, taking out governments we don’t like and putting others in. We did that to Iran, Saudi Arabia, Chilly and Panama. We pulled out of the Keocto proto call because it was not in our economy frame. We are seen as a country that only thinks about our self’s and has no concern for other countries. Our freedom to talk, dress, act, and worship as we please is seen in some areas of the Middle East as a weakness. We are â€Å"ungodly† and our women are viewed as sluts. We are considered a great Satan of the world. Our fore fathers died to make this country free of religious percussion and fought on the idea of freedom. These deaths and ideals are falling on deaf ears in parts of the Middle East.   Ã‚  Ã‚  Ã‚  Ã‚  Our Middle East policy is viewed as one sided.

Factory Farming Essay Essay

Factory farming is one of the most controversial topics talked about around the world. Most people just believe their perfectly packaged meat from the supermarket comes from a normal farm. Little do they know, it’s much more than that. Consumers have no idea what animals go through just for them to have a great chicken or steak dinner. Jessica Leader of the Huffington Post states, 99% of the meat in the United States comes from factory farms. (Leader, paragraph1). Factory farming according to Webster’s Dictionary is a farm on which large numbers of livestock are raised indoors in conditions intended to maximize production at minimal cost. This doesn’t sound so hurtful or damaging, but according to the Huffington Post, these operations cause distress for the animals that live there, and they are given chemicals, antibiotics and sometimes they even have diseases (Paragraph 2). Factory farming, in my opinion is really animal savagery and there is nothing healthy or positive about it. There are actually many health and environmental problems associated with industrial farming. For example, Jonathan Foer in his book, â€Å"Eating Animals† states â€Å"These animals are genetically engineered, restricted in mobility and fed unnatural diets.† (Page 34) Anything unnatural obviously can’t be healthy for the animals let alone the people who are being fed these animals after they are packaged and sent away to markets. In addition, factory farms are not healthy for the environment. A farm with 10,000 hogs produces as much fecal waste as a small city with 40,000 people, says Robert Martin of the Johns Hopkins Bloomberg School of public health. (Kristof, Nicholas, page 2). Food people are consuming and fecal waste should not even be in the same association with each other. The hogs in a single country of North Carolina produce half as much waste as all of the people living in New York City. That fact right there clearly shows that factory farms are usin g very unsanitary conditions just to harm these animals, as well as the environment. Although not intentional, these farms hurt the animals without a care because people need to eat. Mass amounts of waste is a perfect example of air pollution. Soil used for vast crops as well as the manure are  the largest contributors to air pollution from the farms. Another big health risk of factory farming is the use of chemicals/antibiotics. Antibiotics are medicine prescribed from a doctor to humans or animals to kill infections and more then 80% of antibiotics was produced in 2011 to be fed to livestock. (Leader, #2) Factory farmers are giving these to the animals who aren’t sick. Routinely they are given antibiotics, in order to help them grow quicker in small living conditions. Infections can also be given because of antibiotics, which puts Americans at risk everyday because of overuse (Paragraph 13). The animals are fed the medicines to fight disease that they don’t have, pretty much infecting the humans as well. People could be getting sick because of the f oods their eating everyday without even knowing it. Taking antibiotics not prescribed to you sometimes allows unwanted bacteria to grow causing a person to get sick when they weren’t going to be in the first place. Although there seems to be no positive reasons as to why factory farming could benefit anyone, the only benefit besides people not starving really is it’s efficiency. Because it’s a fast and organized system, these farms have no choice but to make a lot of money for themselves and the government. Consumers are obviously buying all things that are being made mainly because they don’t really know what’s being put into the meat they are buying. Because there are not enough reasons to convince me why factory farming is positive to anyone at all, I think that it’s a very negative way to get our food. Kristof states in his article â€Å"Is That Sausage Worth This?† that animals, â€Å"Live out their adult lives without exercise or meaningful social interaction; it’s like a life sentence of solitary confinement in a coffin†¦Ã¢â‚¬  (Kristof, Nicholas, Paragraph 7). In no way, shape or form is that fair to an innocent animal. Animals shouldn’t have to be kept prisoners in small places just to be poisoned, killed and eaten. All of the various drugs and chemicals are harming the animals and humans that it touches. More animals are being slaughtered and fed different chemicals that aren’t safe for people to be eating all the time. If the government truly cared about societies health, they would try to stop unsanitary and unhealthy conditions such as this. In 1906, a situation just as similar to this had risen with the meat packing industry. In that year, Upton Sinclair a reformer/socialist released his book The Jungle which told a horrible story of Chicago’s meat packing industry. Because of this book, society started to change severely. The issue of the unsanitary and unfair working conditions got to the president and he knew he had to make a change. President Theodore Roosevelt had a bill signed on June 30th of that same year, called The Meat Inspection Act. This banned packers from using unhealthy dyes, chemical preservatives and adulterants. By studying what happened to improve the industry in the 1900’s I believe that our food system could then make some changes. This act should still be in effect, but the way it’s been worked around, it seems as if factory farming really isn’t harming people at all. It’s an undercover system. Obama already started trying to fix these problems by undertaking a push beginning in 2010 to strengthen antitrust of the meat industry. Kristof, Nicholas, Paragraph 4). I still believe that overtime they could find better products to give the animals that are safer and healthier for both them to live a little longer, and us to be healthier. Personally, I believe that if people including myself start to buy more healthier, organic foods, and less meat, producers will start to realize that maybe people are seeing the truth. Organic foods are just made in a safer way, without really harming animals and they’re also more nutritious as well. Also, in some way people need to be informed of what’s really being put into their food and actually try to make a difference instead of sitting there and watching themselves be harmed by things that should be giving them a better well being. Over time, hopefully factory farms die out and there will be a better system to produce our foods. Analysis of Sources Form Give the following information for each source that you use in your research paper. Source 1) Title of Source 9 Facts About Factory Farming that Will Break Your Heart . Name of Author Jessica Leader . Date of publication March 17, 2014  . Publisher: The Huffington Post . Where did you find the source? Online . Type of Source (Is your source a book, magazine, newspaper, journal, etc?) The source is an online article from a newspaper. Credentials of the author: Check your source for information about the author or google his/her name) Jessica Leader is the Huffpost Green associate editor. Publisher: How long has the publisher been in business? What other publications does the publisher publish?____Not sure how long the publisher has been in business, but she wrote several articles in the Huffington Post . Reasons why this source is reliable:____Real information and real live pictures to show how gruesome factory farming is. Reasons why this source may be unreliable: There may be some opinions listed, not all people may be heart broken from this. Source 2) Title of Source Eating Animals . Name of Author Jonathan Safran Foer . Date of publication 2009 . Publisher: Little, Brown and Company . Where did you find the source? I was told to read this novel last semester in English 12. Type of Source (Is your source a book, magazine, newspaper, journal, etc?) Source is a book . Credentials of the author: Check your source for information about the author or google his/her name) Foer is most known for his two novels Everything is Illuminated and Extremely Loud and Incredibly Close. Known especially for his storytelling in non-traditional ways . Publisher: How long has the publisher been in business? What other publications does the publisher publish? His first novel was published in 2002, and he’s written many other books as well. Reasons why this source is reliable: first hand source, someone who has experienced and studied factory  farming on his own. Reasons why this source may be unreliable: The novel includes a lot of his opinion and a reader may interpret those things as facts. Source 3) Title of Source Is That Sausage Worth This? Name of Author Nicholas Kristof . Date of publication February 19, 2014 . Publisher: The New York Times . Where did you find the source? CUNY online library . Type of Source (Is your source a book, magazine, newspaper, journal, etc?) Online, newspaper article. Credentials of the author: Check your source for information about the author or google his/her name) Columnist for The New York Times since 2001, writes op-ed columns that are in the paper twice a week. Mr. Kristof won the Pulitzer Prize two times, in 1990 and 2006. Publisher: How long has the publisher been in business? What other publications does the publisher publish? He joined the Times in 1984, and as well as columns in the paper he is the author of a chapter in a book on George W. Bush. Reasons why this source is reliable: He has been in the business for a very long time, so he is clearly smart and speaks facts. Reasons why this source may be unreliable: Newspaper columnists can too make mistakes when writing. Source 4) Title of Source The Unhealthy Meat Market . Name of Author Nicholas Kristof . Date of publication March 12, 2014 . Publisher: The New York Times . Where did you find the source? CUNY online library . Type of Source (Is your source a book, magazine, newspaper, journal, etc?) Online, newspaper article. Credentials of the author: Check your source for information about the author or google his/her name) Columnist for The New York Times since 2001, writes op-ed columns that are in the paper twice a week. Mr. Kristof won the Pulitzer Prize two times, in 1990 and 2006. Publisher: How long has the publisher been in business? What other publications does the publisher publish? He joined the Times in 1984, and as well as columns in the paper he is the author of a chapter in a book on George W. Bush. Reasons why this source is reliable: He has been in the business for a very long time, so he is clearly smart and speaks facts. He wouldn’t continue to be working with the Times if he wasn’t knowledgable. Reasons why this source may be unreliable: Sometimes there are errors in breaking news. WORKS CITED Leader, Jessica. â€Å"9 Facts About Factory Farming That Will Break Your Heart (GRAPHIC PHOTOS).† The Huffington Post. TheHuffingtonPost.com, 17 Mar. 2014. Web. 14 Oct. 2014. http://www.huffingtonpost.com/2014/03/17/factory-farming-facts_n_4063892.html Foer, Jonathan Safran. Eating animals. New York: Little, Brown and Company, 2009. Print. Kristof, Nicholas. â€Å"Is That Sausage Worth This?.† The New York Times. The New York Times, 19 Feb. 2014. Web. 15 Oct. 2014. http://www.nytimes.com/2014/02/20/opinion/kristof-is-that-sausage-worth-this.html Kristof, Nicholas. â€Å"The Unhealthy Meat Market.† The New York Times. The New York Times, 12 Mar. 2014. Web. 15 Oct. 2014. http://www.nytimes.com/2014/03/13/opinion/kristof-the-unhealthy-meat-market.html

Editorial Essay High Persuasive School

Editorial Essay High Persuasive School Editorial Essay High Persuasive School Editorial Essay High Persuasive School: Cope with It with Our Help Editorial essay high persuasive school is rather difficult task to be completed without having professional assistance while writing; that is why if you have received a task to write editorial essay high persuasive school and you are puzzled with this task, we are waiting for you at our custom writing site to give you professional help. Editorial essay high persuasive school presupposes from you presenting your own ideas on the subject of your essay writing; rewriting someones thoughts is considered to be plagiarism and is strictly punished by professors. That is why all the thoughts you are going to present in your editorial essay high persuasive school should be unique ones. However, it is not enough only to share your opinion with the readers; in order to succeed in editorial essay high persuasive school writing, you have to persuade the readers that your point of view is relevant one. Solid arguments and evidence are those to help you in your editorial essay high persuasive school writing: Editorial Essay Needs Strong Arguments Sometimes it becomes rather difficult to present solid arguments in favor or against some thought, which will be able to convince the readers; that is the main problem students face while trying to cope with their editorial essay high persuasive school writing. If you are going to suffer from the same difficulties while trying to write your editorial essay high persuasive school, or if you are going to have some other problems with your writing, you are welcome to make use of our custom writing site, where you are going to receive professional consultation and immediate help with any problem you have. We offer a full range of servicing to our customers from creating captivating editorial essay high persuasive school and supporting with creative ideas to writing editorial essay high persuasive school for you or editing your own writings. Our team consists of highly qualified specialists with years of experience that is why all the works we deliver to our customers are brilliant writings, which are awarded A+ grades. Do You Need Help With Editorial Essays? That is why if you need help with editorial essay high persuasive school you are welcome to get it at our custom writing site and for rather a moderate price, which is also considered to be one of the advantages our servicing offers to our customers. It is really simple to get rid of problems with editorial essay high persuasive school writing with our help. Read also: Draft Essay Rough College Essay Editing Pay For Essay Need a Professional Essay Help Assignment

The Three Different Types of Hatred and Discrimination Essays

The Three Different Types of Hatred and Discrimination Essays The Three Different Types of Hatred and Discrimination Essay The Three Different Types of Hatred and Discrimination Essay Shakespeare gives us the example of that in his book of Romeo and Juliet. In this book, there are two families who hate each other due to past conflicts. The Montague and the Caplet family. In this book, the son of the Montague falls in love with the daughter of the Capsules. A love so deep that they get married In privacy. Because them getting married biblically, would cause their parents to greatly punish them. One night, Juliet tells Romeo Deny thy father and refuse thy name; or If thou will not, be but sworn my love, and Ill no longer be a Caplet. (Shakespeare 34-36. Her father wants her to get married to a man who she does not want to marry. The day of her marriage, she fakes her death. Romeo believing she is dead kills himself out of grief of losing her. All this hardship because the parents hate each others names and cannot bear their kids being together. This is Just one example of misjudging one by the name. In this case judging one by his name has resulted in death. Osama is another example. This name is stereotyped because Osama Bin Laden the most wanted man in the world carries it. It does not signify a lion jumping on its prey. And et that is how It Is seen In todays society around the world. And so if a boy or a man were to carry this name, he would have much difficulty In getting a Job. Just for carrying that name. Therefore Judging one by his name affects everyone In one way or another. In Harper Lees book To Kill a Mockingbird, the author puts in evidence the amount of racism that was present in the southern Alabama state of America; back in the sass. In this book, the most part of the white community of Macomb mistreats the black community by firstly by calling them Negroes and secondly by accusing one of them falsely. In this case, the accused is Tom Robinson. A black man accused of violently abusing and raping a white woman. Although his lawyer Tactics Finch defends him with strong evidence, the jury goes against him by Judging him guilty. The white society did not stand up for him, but Just let It pass. They forgot all about this case within two days. After his death due to a failed escape from Enfield Prison Farm, a member of the white community Judges him as Typical of a Niger to cut and run. Typical of Ruggeris mentality to have no plan, no thought for the future. Just run blind the first chance he saw. (Lee page 24) Lee just shows us one example of racism. Still today In southern part AT ten USA tanner are groups AT ten ASK won are still advocating white supremacy. This causes many deaths of non-white people. The Arab race is another example. Arabs are now stereotyped as terrorist ever since the 911 incident. If one person of any race is wrong, it does not mean that all the people of that race are wrong as well. One should not be Judged by his race but by his character. Racism causes many problems to individuals that are part of a stereotyped race or people that are simply discriminated due to their skin color. Therefore racism must take a stop. Often, people with physical disabilities or differences are misjudged or underestimated by those who have none. Either if they have an extra toes, half a finger or are shorter than average. That can cause not getting hired at a Job. Gender can also be a problem. For instance if a girl would want to work in construction, she would be made fun of and greatly under estimated because she might not have the physical strength for the work or the roughness of a man. In todays society in North America, gender has become a minor problem. Men get to work in fashion and girl tortes, Just as women can work at a garage or as police officers. However physical disabilities are still discriminated. In John Handsaws book The Chrysalis, he talks about a girl named Sophie who is believed to be a blasphemy or deviation of some kind because she has six toes. The inspector in the story warns David (the main character) not to be friends with Sophie because she is made by the devil. She has no soul. David is forced to report her to the authorities so they can send her to Finchs land. Muff know, David concealment of a Blasphemy not reporting a human aviation is a very very serious thing. People go to prison for it. It is everybodys duty to report any kind of offence to me even they arent sure so that I can decide. Its always important, and very important indeed is it is a Blasphemy. And in this case there doesnt seem to be any doubt about it unless young Ervin was mistaken. Now he says she has six toes. Is that true? (Yamaha page 51) Those who are physically disabled could be very qualified for something. For instance many people who see a physically disabled person would most likely Judge him as mentally ill. And that is a problem in our society. Employers could miss the chance of having a top quality employee such as a sales manager Just because he is in a wheelchair. The fact of discriminating on physically disabled people can cause us to lose chances of meeting very valuable people. They should not be underestimated and should be considered. Therefore ignoring them can affect many people. The various aspects of misjudging, discriminating or underestimating one by his name, race or physical ability can truly affect everyone in various ways. One must learn to accept others the way they are. And if one would Judges someone else, he should Judge him by his character and not by his appearance. This goes for the same with the famous expression Dont Judge a book by its cover. Shakespeare, Harper Lee and Yamaha have each covered one of these aspects and put it in a scenario. The examples are set and so are the lessons. Now all one can do is read and learn. Bibliography I en occasionally. London: a Penguin KICK, BIBB, pup SSH William. Romeo and Juliet. Toronto: Harcourt Shakespeare series, 1999, IPPP LEE, Harper. To Kill a Mockingbird. New York: Warner Books Edition, 1982, IPPP

Film Journal Essay Example | Topics and Well Written Essays - 250 words - 1

Film Journal - Essay Example Moreover, there is Gorge, who has shown the interest of marrying Tracy. Moreover, we have the family of Tracy, and that is; Margaret, Dinah and Seth Lord. Also, there is the boss of the Spy magazine by the Kidd among other characters featured in the film. However, the primary objective of this study is to examine the plot Philadelphia story critically as well an analysis of the principal characters in the film. The director of the film introduces us to the Main characters by showing us their character traits. For instance, the director presents Cary Grant as a violent character in the play. His violence features are seen when he pushes Tracy down in their time of divorce. Moreover, Cary is seen to gullible for Kidd blackmails him to sneak Ruth and Jimmy ( Liz and Mike) to the mansion impersonating to be Junius, the son of Seth. On the other hand, Katherine is presented to be a violent and temperamental individual. Her characters are clearly seen when she smashes Dexter’s suitcase at the doorway during their separation. Besides, Catherine is seen to be arrogant towards other people’s weakness. On the other hand, Ruth is introduced as a secretive because of her silence on her last divorce and at the same time she is presented as a loving parson. Costume changes in the film have contributed a lot towards the presentation of the real characters, more so the ladies. The designer of costumes in Philadelphia story (Adrian) has a lot of positive comments as well as an excellent reputation for his great influence in the female fashion industry. For instance, provision of men’s wear to Katherine was the first most revolutionary thing that he did in the introduction of the film. Therefore, putting on means’ wear depicted Katherine to be a strong woman who can handle any challenge before her. Therefore, the designer designed Katherine’s’ clothes in that, they can show her braveness.

Disucssion Board 5-1 Assignment Example | Topics and Well Written Essays - 250 words

Disucssion Board 5-1 - Assignment Example The leader must ensure getting substantial information about the members during the screening stage before the actual beginning of the group. For instance, a group leader of adolescent school students should identify with the dynamics of the members and demonstrate sufficient knowledge of the psychological issues concerning adolescents. As a leader of an adolescent group, I would consider songs as the opening exercise in the beginning of a group. I would ask the adolescent students to sing their favorite songs in whichever language they like. The reason for avoiding the use of specific language is to remove restrictions in the initial stages of meeting, which might work to derail effective group processes in the future. In addition, opening language for use in singing by individual members is to help everyone express his/her beliefs while demonstrating how they cherish certain cultures. The messages and tone of the songs considered favorite can also help members develop slight understanding of one another alongside appreciating differences as exhibited by different songs. Once members begin to appreciate differences and gain slight understanding of one another, they can start developing friendship and openness, which can help establish and build trust (Lerner, McLeod & Mikami, 2013) Another opening exercise may involve diving members into groups of three people and asking the different group to engage in games of counter pulling of ropes. This game is usually interesting and requires willingness and commitment to emerge winner as contestants need to use a lot of energy. To win, members of a group will require to coordinate and arrange themselves in the manner can ensure productivity. This act of coordinating and then reaching to agreement is an important tool for building trust as they have to talk and exchange ideas on how to win the game. Once members

Foundation Degree Hospitality Management Essay Example | Topics and Well Written Essays - 750 words

Foundation Degree Hospitality Management - Essay Example In simple definition, ration analysis refers to the process by which the figures are quantified in order to understand business performance in terms of financial and operational management. Ratios analysis can be conducted to compare trends in the inter year performance of the organization. It can also be done to compare financial performance of several companies in the same industry. Similarly, the result of the analysis is comparable with that of the industry to which the company belongs. There are five main ratios that are applicable in this scenario. These include Profitability ratios, sales ratios, liquidity ratios, efficiency ratios, and financial ratios. Based on this brief introduction, ratio analysis of the Brown Sugar Cafe will follow in the next part... Identify appropriate techniques used to assess business performance, analysing data by applying selected techniques. Internal verifier: †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..date:†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. RATIO ANALYSIS Case of the Brown Sugar Cafe The assessment of financial and operational performance of an organization can be accomplished through the use of ratio analysis. This is achieved by evaluating the relationship of different figures generated from the company’s financial statements. A number of performance indicators are derived from these figures. In simple definition, ration analysis refers to the process by which the figures are quantified in order to understand business performance in terms of financial and operational management. Ratios analysis can be conducted to compare trends in the inter year performance of the organization. It can also be done to compare financial performance of several companies in the same industry. Similarly, the result of the analysis is comparable with that of the industry to which the company belongs. There are five main ratios that are applicable in this scenario. These include Profitability ratios, sales ratios, liquidity ratios, efficiency ratios, and financial ratios. Based on this brief introduction, ratio analysis of the Brown Sugar Cafe will follow in the next part The Brown Sugar Cafe Ratio Analysis 1. Gross Profit Margin (%) Gross profit margin is a profitability ratio that helps in examining the ability of the company to control costs associated with the acquisition of raw materials (Ratios Workbook, 2013). It is calculated using the formula below: Gross Profit % = (Gross Profit/ Sales) x 100 Using Brown Sugar Cafe

International Business Entry Case Study Essay Example for Free

International Business Entry Case Study Essay High turnover. Small companies tend to have a small structure, then job opportunities are few, which force employees to change job. Poor customer service. Distributors mostly only care about selling off a product, then they direct customers with Microsoft. The main problem is that Microsoft Customer service is focused on developed countries, where the needs and tools are greatly different. In some cases the technical service is non-existent, heavily hurting the image of the company, not the distributor. Poor input for further developing products. If all the deployment and input is being done and received by a distributor, then it is most likely that the information will never reach Microsofts engineering department. Without that knowledge products will stall for that particular market in a short period of time, inflicting loses in the long run for the company. 2. Are there countries where Microsoft’s strategy might not work? Why? Small countries with an unique language possibly are the toughest. Microsoft strategy mean that while local partners are relied to market the products, Microsoft is still in charge of the code and language. In that regard Microsoft is very vulnerable to small IT companies that develop solutions for their language. With small partners, it is easy for local developers to attract those distribution channels for their own product, therefore using Microsofts resources and know-how to make profit out of other products, making Microsoft lose money. 3. What other kinds of businesses might find Microsoft’s strategy to be effective? Please explain. Car manufacturers. They basically operate the same scheme with distributors. When a cars manufacturer enter a new country most times they give the concession to sell the cars to a local person or company. Almost entirely those distributors operate in a very small area. The manufacturer covers Marketing and promotion, while the distributor has to develop their sales only in their area. 4. How might Microsoft need to change its strategy once it has established a strong position in a foreign market? They need to deploy a strong services net. They need to be in constant contact with customers in order to assure that they meet their current and future needs. They need to deploy training facilities for their products in order to have a strong pool of expertise from where enterprises can nurture in order to keep fidelity with the products. They need to partner with high profile local companies to develop solutions in order to gain traction in the country. 5. Describe how host governments might react to Microsofts entry strategy? Governments usually react in a good way. The way Microsoft do business benefit host countries a lot, since it creates a lot of jobs for the locals. Nonetheless there might be some countries who could think that Microsoft is a danger for their local IT industry. In those cases their strategy also soften their position a lot, since the entry in indirect. Reference Glusing, J. (2006, June 1). The third world goes high-tech: The dirt road to the information superhighway. Spiegel. Retrieved from http://www. spiegel. de/international/spiegel/the-third-world-goes-high-tech-the-dirt-road-to-the-information-superhighway-a-419034. html

Diagnosis and Assessment: Patient Presenting Knee Pain

Diagnosis and Assessment: Patient Presenting Knee Pain Stephen Chiang Presenting Complaint Mr X is a 72 year old man who presented to the GP clinic with worsening right knee pain for the past 3 weeks. History of Presenting Complaint Pain has worsened over the past 3 weeks. Pain is around the patella with no radiation of pain. Described as a constant dull ache that worsens at the end of the day after activities. Not relieved by any pain medication. Previous trial on NSAIDs and panadolosteo. Pain and movement does not improve during the day. Denies any morning stiffness. Complains of knee being swollen and restricting the range of movement. Denies any locking or catching of the knees. Pain has restricted his movement causing him to lose balance. No history of falls. Denies any recent injury or trauma to the knee. Past Medical History Abdominal aortic aneurysm2014 Pulmonary Fibrosis2014 COPD infective exacerbation2012 GORD Medications Metoprolol 50mg Panadol Osteo SR665mg Vytorin10mg/20mg Rabeprazole10mg Prednisolone25mg Allergies/ Adverse Reactions Penicillins skin rash Immunisation -VAXIGRIP provided Family History nil known Social History Lives alone in Collie. No support services required. Non-smoker. 1 standard drink several times a week. Limited physical activities No history of substance abuse Examination Pleasant looking elderly man. Not in any obvious distress. Alert and oriented to time, place and person. Good mobility Vitals BP 155/88 mmHg, HR 78bpm and regular, RR 17, afebrile Cardiovascular Heart sound dual, nil added. JVP not elevated, all peripheral pulses are palpable Respiratory symmetrical rise and fall of chest with respiration, bibasal crepitations heard, no wheeze. Not in respiratory distress Abdomen – no scars noted, abdomen soft, non tender, bowel sound present Knee – no deformities, swelling or muscle wasting noted. No obvious signs of effusion. Bulge test and patellar tap negative. No erythema and not warm. Crepitations heard with movement of knee. Not tender on palpation. Full range of movement with active and passive movement with pain. (extension, flexion, rotation). Ligament stability test NAD Investigations Ordered Bilateral Knee X-ray Murtagh’s Diagnostic Model Factors in initial history / examination supporting diagnosis Factors in initial history / examination NOT supporting diagnosis Factors in subsequent history / examination / investigation influencing diagnosis PROBABLE diagnosis Osteoarthritis Swelling of the knee Age, Chronic Pain, Asymmetrical, Weight bearing joint, Worse with movement, Crepitus on movement Ligament strains No previous injuries or trauma Asymmetrical knee pain Serious disorders not to miss Neoplasia primary in bone metastases No night sweats, no weight loss, no indication of previous X-ray constant ache day and night Severe infections septic arthritis No fever, no redness, warmth or swelling of joint. No hx of trauma Vascular disorders deep venous thrombosis superficial thrombophlebitis No long periods of immobilisation No previous hx of clots Nil tenderness around muscle unilateral pain Pitfalls Gout/ pseudogout No previous hx of gout Referred pain back or hip Denies any pain of the back and hip Masquerades Diabetes No polyuria, polydipsia, Normal Fasting BSL Spinal dysfunction Another agenda? Depression Lives on his own, poor supportive relationship, Management Plan (Whole person) 1. Knee pain RICE therapy, Weight loss knee X-ray Adequate pain management Referral to orthopaedic surgeons for review Referral to physiotherapist – strengthen quadriceps 2. Pulmonary Fibrosis/ COPD Prevent infective exacerbations Continue follow up with respiratory physicians in Perth Yearly influenza vaccination/ 5 yearly pneumovax Referral to chest physiotherapist 3. Abdominal Aortic Aneurysm Yearly monitoring of AAA Continue follow up with vascular surgeon in Perth Preventative Health Activities 1. Nutrition – patient education on maintaining healthy diet. Referral to dietician 2. Weight – review 6 monthly to ensure BMI 2 3. Physical activity – education on appropriate exercise routine. Referral to physiotherapist 4. Alcohol intake – reduction of alcohol intake 5. General – monitor BP 6 monthly, yearly monitoring of FBC UEC Lipid profile 6. Cancer screening – colorectal every 2 years 7. Vision, hearing and fall risk assessment Unable to follow up with patient as patient returned to GP in Collie while I was based in Bunbury. No access to patient’s result from Bunbury. Clinical Evidence Base In patients with osteoarthritis of the knee (OAK), is intra-articular steroid injection more effective compared to other pharmacological treatment such as NSAIDs and glucosamine in terms of efficacy and managing pain? Osteoarthritis is the most common joint disease affecting adults older than 65 years old. In Australia alone, osteoarthritis affects more than 1.3million adults.1 Osteoarthritis can significantly impact the quality of life because of the restriction in mobility caused by the pain. In osteoarthritis of the knee (OAK), the main form of treatment remains partial or total knee replacement.4 However, there are still a large number of patients who are unable to undergo such intervention. In such patients, treatments are limited to safer alternatives such as NSAIDs, opioids, glucosamine supplements and intra-articular steroid injection. The OneSearch UWA library database was searched and keywords used were â€Å"osteoarthritis†, â€Å"knee†, â€Å"pharmacological†, â€Å"NSAIDs†, â€Å"steroid†. Other related terms were included in the search. One study was identified, â€Å"short term efficacy of pharmacotherapeutic interventions in osteoarthritis knee pain by Jan Magnus Bjordal, Atle Klovning, Anne Elisabeth Ljunggren and Lars Slordal.2 The study is a meta-analysis of randomised placebo controlled trials with a sample study size of 14,060 patients in 63 trials measuring pain intensity within 4 weeks of treatment and at 8-12 weeks follow up using the visual analogue scale (VAS).2 Results Within 4 weeks oral NSAIDs, pain relief measured 10.2mm on the VAS (95% CI8.8-11.6). Steroid injection showed 14.5mm (95% CI9.7-19.2), paracetamol 3.0mm (95% CI1.4-4.7), glucosamine 4.7mm (95% CI 0.3-9.1), chondroitin sulphate 3.7mm (95% CI0.3-7.0).2 8-12 weeks follow up – oral NSAIDs and steroid injection showed decline in efficacy 9.8mm. Paracetamol did not show change in efficacy. Glucosamine showed 3.8mm efficacy and chondroitin sulphate showed an increase in efficacy of 10.6mm.2 Strength and Weaknesses of this study: 1. Level 1 evidence based on NHMRC 2. Outcome and methods of measure was clearly explained and defined. 3. Inclusion and exclusion criteria were clear. 1. Measuring of pain intensity with the visual analogue scale (VAS) is very subjective. 2. Bias in terms of NSAIDs users selection in certain trials. 3. Comparing different treatment options by assessing separate meta-analyses for each treatment may have different baseline data and prognostic factors. 4. All steroid injection trials were performed in a fixed setting limiting their application into primary care context. Duration of trial of 4 weeks may be too short to analyse efficacy of some treatments. Findings showed that there is better short term pain relieve when using steroid injection compared to the other treatment options. However, steroid and oral NSAIDs have the same efficacy in long term. Chondroitin sulphate also showed a minimal pain relieve in the long term. Application – This study was done in Norway and it showed that there is minimal pain relieve by using current treatment options such as steroid injections, oral NSAIDs and supplements. Further studies should be performed to compare patients in Australia. Patients should be educated about the efficacy of such pharmacological treatment to lower their expectations. We should start reconsidering the role of these treatments in future pain management of osteoarthritis. This patient was started on many treatments that did not offer any pain relieve that corresponds to the results of the study stated above. Hence, he was referred to an orthopaedic surgeon for further review and management plan. References 1. Australian Institute of Health and Welfare. A Picture of Osteoarthritis.Department of Health and AgeingOctober 2007; Arthritis Series Number 5 2. Jan Magnus Bjordal a,*, Atle Klovning a , Anne Elisabeth Ljunggren a , Lars Slà ¸rdal b. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials.European Journal of Pain8 May 2006; 11, 125-138 3. Carlos J Lozada, MD Director of Rheumatology Fellowship Training Program, Professor of Clinical Medicine, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine.Osteoarthritis. http://emedicine.medscape.com/article/330487-overview (accessed 17/06/2015) 4. S.P. Krishnana, , J.A. Skinnerb. Novel treatments for early osteoarthritis of the knee.Current OrthopaedicsDecember 2005; Volume 19(Issue 6), Pages 407-414