Financial Aid Essay Example for Free

Financial Aid Essay The role of financial aid in college access and success is immense. Lack of adequate financing of education make many students from low income backgrounds fail to realize their educational aspirations (Reindl, 2007). It is from this premise that obstacles which accompany financial aid to low income students come to fore. The influence of aid on the enrollment persistence of students consists of interrelated factors which include timing, amount and type of aid and how they correlate with persistence among other attributes that relate to students (Pascarella Terenzini 2005) Although it is prudent to consider the positive implications of financial aid to needy students, especially those of the minority groups that have felt sidelined for long, the question of how best to carry out the financing should be looked into. Many a student in higher education fails to achieve high academic performance due to their inability to focus on academics prompted by frustrated efforts to get financing. Financiers of the education of such student need to look into their procedures to be followed by students seeking financing of their education. This is in terms of the conditions to be satisfied by the needy students as well as the length of time the financial assistance will take before the recipient gets his / her college account credited. The reason for this is that not all institutions have provision for late arrival of the aid. The implication therefore if the aid delays is that the student will be forced to be out of the institution for some time, a matter which may make them fail to do their exams, tutorials, researches and vital lessons. In the long run such students will have low aggregate points and consequently failing to achieve their r personal educational and life goals. When the aid delays, or when the procedures to be followed in securing one prove to be too taxing, students get undue stress. This has far reaching implications both in terms of their health and general academic performance. In the long run, assistance will be a problem added to their financial incapacitation (Immerwahr 2003). Literature review Several researches have been undertaken on the problems that students under finance aid scheme face. Most of them point to the fact that financial aid can be an impediment and not a solution to students’ academic issues related to finance especially if the student fraternity is not informed of the availability and procedures In his journal â€Å"With diploma in Hand: Hispanic High School Seniors Talk about Their Future†, Immerwahr, J. (2003) uses interviews to highlight the challenges that these students faced in college as far as financial aid among other things are concerned. He interviewed 50 Hispanic High School seniors in San Antonio, Santa Clara Tucson, Chicago and New York. His findings were that many students on financial aid had difficulties at the end of it all because the aid was unpredictable making the students to be stressed. This is echoed by Stampen and Cabrera, (2007) who used questionnaires and interviews in their quest to know the effects of financial aid packaging on attrition and Pascarella and Terenzini (2005) in their journal How College Affects Students: A Third Decade of Research who use the same methods to expound on what affects students in college. A variety of issues are raised including the moral and social growth for some and despair for those dependent on finance aid which in most cases is unpredictable. Students may also fail to estimate how much in terms of amount of aid they require. The amount they get can be less than what is sufficient for them to complete their education. The aid that they get can be in the form of loans, work study opportunities or grants and scholarships. In the case of work study opportunities, the students may not get sufficient time for their studies as they are required to work also. This creates a lot of stress on the aid beneficiaries according to Voorhees (2005). Voorhees used on campus surveys in drafting his Student finances and campus? based financial aid: a structural model analysis of the persistence of high? need freshmen. Bias in aid allocation translates into variables exhibited by students in terms of their academic performance (Titus, 2006; Rubin, 2004). Using propensity score matching, it was established that there is a significant difference between financially aided and unaided students. Results based on five thousand freshmen at a public university in the US and retention in second year before and after noting their GPA and math experience showed that there is a relationship between aid influence and enrollment persistence (Adelman, 2004; Pascarella Terenzini, 2005) When looking at the issue of aid extension to low-income students, it is imperative that women be also assisted. This is because they are more likely to be affected more than their male counterparts, in most cases being affected by stress when they fail to secure aid in time to enhance their studies. Financial aid influences the retention of students based on their estimated family contribution. The challenge here is that those students whose families’ contribution is less than $4000 have higher chances of getting lower GPA’s (Adelman, 2004; Pascarella Terenzini, 2005) Methodology and Findings Since there are individual disparities that may affect the performance of the students who may be getting the same financial aid, this study used propensity score matching model which cater for the variables that may be of demography nature, or pre-college experiences. The new freshmen were categorized into those that get aid in form of loans or grants and those that do not get any aid at all. The two groups were then subjected to a comparison, that is, those that get aid package vis-a-vis those without any aid in their first year. The group that did not get any aid was called untreated. The methodology used (estimated propensity score) helps in ridding the bias based on self-selection. The effects of aid bias may not be fully accounted for using this method of study (Titus, 2006; Lunceford Davidian, 2004) as other unaccounted for reasons may come into interplay. The amount that the students are able to get from their families affect the outcome of the study. It categorized the students in terms of those who could pay for their education and those who could not. In the findings that have been tabulated, the columns that are unmatched show the effect of aid without making a match of students on propensity for aid assistance. The matched average effect column is used as a control for the bias in aid selection. The matched average untreated and matched average treated give the probable retention results if the aided student(s) had not been aided or if the unaided one had received some financial assistance. Matched students with an average possibility of receiving aid are more likely to persist into their second year of studies compared to those with low aid chance. This study furnishes separate estimates by EFC in gauging the influence that financial aid has on student retention. An EFC of 4000 dollars and less encompasses students from low- income background eligible for grants. These students got an aid of between $2000 and $ 3000 in their first year while middle income students with $ 4000-10000 receive between $ 800- 900 aids. Those with Expected Family Contribution (EFC) of more than $ 10000 receive less to no aid at all, only relying on merit-based aid. They however show a greater possibility of remaining in college in their next academic year as compared to their aided counterparts who have higher remaining need after using their aids to pay for schooling. There is no correlation between the net persistence of students with $ 4000-$10000 EFC in their GPA or math experience and the aid they receive. Gift aid for those with high EFC increases their persistence by 18% meaning that the more EFC these students have, the better they work towards their academic endeavors (Dowd, 2004). The following are the tabular summaries of the information obtained from the study. Not all parts of the study have been tabulated but only the seminal ones. From the literature analysis and the results of this study, some issues are apparent: Financial aid to low- income students may greatly hamper their studies if we look at the securing of the finances. If the aid delays, the students get stressed up and may therefore not concentrate in class. Those who do not know the whole procedure get more problems because their studies are hampered. The effect of the Expected Family Contribution on the capability of the learner to proceed to the next year has been shown. The less the EFC a student is capable of raising, the lower their performance and possibility of proceeding to the next year. Those with EFC of more than 10000 dollars show no effect if not given an aid but show considerable possibility of proceeding to the next year and also of passing well. References Adelman, C. (2007). Do we really have a college access problem? Change (July? August): 48? 51. Bodvarsson, O. B. Walker, R. L. (2004): Do parental cash transfers weaken performance in college? Economics of Education Review 23: 483? 495. Caison, A. L. (2006): Analysis of institutionally specific retention research: A comparison between survey and institutional database methods. Research in Higher Education 48(4): 435? 451. Dowd, A. (2004): Income and financial aid effects on persistence and degree attainment in public colleges; Education Policy Analysis and Archives, 12(21). Herzog, S. (2005): Measuring determinants of student return vs. dropout vs. transfer: a First-to-second year analysis of new freshmen; Research in Higher Education 46 Immerwahr, J (2003): With Diploma in Hand: High School Senior Talk about Their Future. NCPPHE (8): 883? 928. Lunceford, J. K. , and Davidian, M. (2004): Stratification and weighting via the propensity score

Extended commentary of The Darkling Thrush by Thomas Hardy Essay Example for Free

Extended commentary of The Darkling Thrush by Thomas Hardy Essay On the title: A thrush is a bird; plump, soft-plumaged, small to medium-sized, often inhabiting wooded areas. They feed on the ground or eat small fruit – but aren’t famed for their songs. Examples include a robin. ‘Darkling’ is an archaic word for ‘a creature of darkness’ or ‘in the dark’. Hardy uses it in its latter sense – the bird appears in a very gloomy scene, at the end of the day, at the end of the year (and century, for that matter). It also has negative connotations as well, however – for obvious reasons. Potential other implications: ‘darkling’ is perhaps used to create a diminutive form of the thrush (like a ‘duckling’). Other critics have identified the title as explaining, or preparing the reader for the unexpected advent of the bird half way through the poem, appearing into the scene from nowhere. Perhaps Hardy was attempting to use an antiquitated word to further demonstrate the bird is bringing joy to a dark land, and that there exists an enormous time difference between the new century and the old? Overall Structure: Hardy uses four regular eight line iambic stanzas; in either ‘tetrameter’ or ‘trimeter’, depending on the length of the line. This meter creates a poetic lilt, with alternate stressed feet. It seems very out of place in such a depressing poem we must question why this is. Does it reflect the hope expressed at the end of the poem, or prepares us for it? Or does it tell of an oddity within the persona; is his negative manner actually genuine – perhaps we shouldnt accept the persona’s judgment/emotions to the same extent as hed like us to? His choice of rhyme scheme and meter along with the harsh subject fail to match up. Themes: Time (passing of century), Isolation, Man and the Natural World. Difficult Language Notes: ‘Darkling’ – discussed above. ‘Illimited’ is an archaic form of ‘unlimited’. First and Second Stanza Notes: As usual, Hardy presents us with an image, this time of a landscape – a depressing one, at that. This poem was published at the end of the century – 31st December 1900 (Hardy was one of those people who believe that a century is complete when the hundredth year is over.) It is very cold and frosty and the day is growing to a close. It really is the end of a century. And Hardy presents us with a very clear image of death – he later personifies the Century itself as being dead. The first two stanzas are full of death-language: 1. â€Å"When Frost was spectre-gray†. A clear example of ghost imagery (‘a spectre’). This line is of interest on its own, due to the obvious personification of ‘Frost’. This is a good place to make a key note about the poem itself. Throughout, we discover a distinct Hardy-esque style; the environment is unpleasant and it demonstrates his usual antics in animism. Hardy develops complex (and often deeply personal) symbolic systems which deal almost exclusively with the natural world. The reader is made personal with non-human entities like frost and birds but avoids people – even the persona is a subject avoided in great detail. 1. Back with the ‘death imagery’, â€Å"The weakening eye of day†; a comment on the darkening sky – the day is dying. 1. â€Å"All mankind that haunted nigh† – haunted is clearly a reference to death and ghosts. Hardy is commenting on the lack of human life in his scene; they â€Å"had sought their household fires†. A further indication of the low temperature. Is it a hint that the world is ending? Or is that just a little extreme? In any case, note how the rest of humanity are seeking light in an otherwise dark environment. The second stanza contains an extended metaphor involving the dead century, but we need to examine the first stanza more before moving on. Hardy’s persona is leaning upon a coppice gate – a gate into a small woods or ‘coppice’. It is a highly ambiguous persona (another thing to explore), but he leans nevertheless. The scene is wintry, indeed, along with Frost, Winter is personified equally – â€Å"Winter’s dregs made desolate/ The weakening eye of day.† The dregs of the season indicate a very cold atmosphere; one without much colour. Clearly this has emptied the scene of any colourful sight upon which the â€Å"eye of day† weakens. The day is ending; thus dusk darkens the scene. â€Å"Tangled bine-stems scored the sky/ Like strings of broken lyres†. As before mentioned, the persona is standing in woodland, thus â€Å"Bine-stems† are tree branches. Hardy’s comparison of them to broken lyres is interesting. Lyres are a) harmonious in Classical literature and b) belong only in Classical literature. Hardy is clearly stating that the scene is not ‘harmonious’ or perhaps the ‘death-lament’ later mentioned isn’t. Or is it also a reference Hardy’s romantic passion for the past, that it was somehow better than the day in which he writes? Second Stanza Notes: The first four lines of this stanza deal explicitly with Hardy’s ‘dead Century’ metaphor. He imagines the land before him as â€Å"the Century’s corpse outleant.† Quite what ‘outleant’ means, I have no idea, (The OED has confirmed that ‘outleant’ is not, nor ever has been a word) but â€Å"his crypt [becomes] the cloudy canopy† (the cloudy sky) and â€Å"the wind his death-lament†. One need not explain it in any more detail; the implications are quite explicit. Hardy’s persona clearly didn’t approve of the past century, but had yet to indicate an emotional reflection on the future. He imagines England as a rotting corpse, essentially. However, note the use of the verb ‘seems’ – is all as it seems? However, Hardy goes on to write even more damningly of his persona’s scene. ‘The ancient pulse of germ and birth’ – the regenerative power of life, following Winter’s onslaught – ‘was shrunken dry and hard’. Nothing appears to be growing back – is this another indication of the end of the world, or certainly of an era. Hardy appears to be making the simple change of an arbitrary number into something quite different, and more serious. A degeneration of life itself. Indeed, â€Å"every spirit upon earth/ Seemed fervourless than I.† Very negative. Observe how silent the description is up to this point in the poem. There is an implied sound in both the death-lament and of broken lyres, but otherwise, the sound is non-existent. That changes soon. Here comes the VOLTA. Third Stanza Notes: â€Å"At once a voice arose among The bleak twigs overhead In a full-hearted evensong Of Joy illimited;† Hardy emphasizes a sudden change with the words â€Å"At once† – indeed, there are multiple changes which create this volta: * Note the sudden inclusion of sound – the thrush is singing! This breaks the poetic still (of death) which has held the poem so far. * The length of ‘sentence’ also changes. Note the semicolon at the end of these four lines above. Previously, each quatrain had completed with a full stop. Perhaps Hardy is opening up his poetic form to mirror the sudden movement in the lines themselves. The use of enjambment accentuates this. There are perhaps religious connotations with ‘evensong’. Much as Hardy may simply be again referring to the mundane fact that the bird is singing a ‘song’ and ‘eve’, we pray that the man is capable of higher minded comparisons. These vaguely religious nuances are maintained throughout the poem. The crucial fact is that the mood has changed, perhaps. â€Å"Of Joy illimited† suggests a pleasant image, which stands in stark contrast to the surrounding gloom. â€Å"An aged thrush, frail, gaunt, and small, In blast-beruffled plume,† Yet the mood is suddenly plunged back into the red with Hardy’s following lines. The thrush, which is, admittedly, a very odd bird to chose (not famed for their song), is an elderly figure in a storm – hence the ‘blast-beruffled plume’. In this otherwise grim situation, the reader’s immediate concern is whether the bird itself is going to survive at all! The use of â€Å"frail, gaunt, and small† mirrors the ghoulish imagery used in the first two stanzas – the thrush is alive, for certain, but perhaps the persona questions for how much longer? Note how the thrush is NOT personified. Every other element of the natural world takes an animated form, but not the bird! Why does Hardy do this? â€Å"Had chosen thus to fling his soul Upon the growing gloom.† Perhaps desperation is the key word in this stanza, but also hope. There is a powerful message in the face of this ghoulish bird; that, in spite of all the darkness and death, the thrush maintains his song. Stanza Four Notes: â€Å"So little cause for carolings Of such ecstatic sound Was written on terrestrial things Afar or nigh around,† Once again, Hardy’s use of enjambment allows for the lines to ‘bleed’ into each other – in a direct contrast to the poem’s former rigidity. Perhaps he is now gathering momentum for a change in mood? Yet, in terms of sense, Hardy appears to be doing the opposite. He states that the bird has no reason to be singing a joyful song amongst so much desolation. However, perhaps, by even considering such a fact, the persona’s own deep-rooted pessimism is beginning to shift away? On some key language points: * Note more religious emphasis: ‘carolings’ typically sing hymns at Christmas time. Hymns are definitely religious! * Perhaps there is an equally religious connotation which Hardy applies to his comments on the ‘terrestrial things’. If there is not any cause for singing about things on Earth, then perhaps, reciprocally, there is cause for celebrating the sky, or heaven? â€Å"That I could think there trembled through His happy good-night air Some blessed Hope, whereof he knew And I was unaware.† It is a rather ambiguous ending upon which Hardy chooses to conclude, but he achieves a sense of dramatic effect through it. The persona realises the presence of (a perhaps religious) hope, in the fact of utter desperation, but it is unintelligible to him. In an odd way, the reader is forced to consider whether the persona is being entirely accurate: * Can one be unaware of something, yet still able to write about it? * Does this tell us that the persona, as a Modernist, is able to perceive such an uplifting messages but unable to interpret them in such a way as to ‘release’ himself from the ‘dark’? Hardy himself was a modernist and therefore dwells upon an odd lot of ideas. Amongst them was ‘searching for hope/meaning to darkness and cruelty’. Despite being a realist, he was deeply influenced by Romantic notions (look them up) – perhaps this exploration is one of them? * The use of ‘blessed’ again implies a deified presence within the thrush’s message. Is the persona experiencing some divine inspiration?

Case Summary On The Effects Of Unstable Angina Nursing Essay

Case Summary On The Effects Of Unstable Angina Nursing Essay Mr AR is a 41 years old male. His calculated BMI was 20.9kg/m2. His presenting complaint was chest pain which has lasted for three days before being admitted into the hospital. His chest pain was of pressing type, it occurred even at rest and lasted for 5-10 minutes each time. It was relieved slightly by rest and it was always accompanied by numbness on his left hand. He had shortness of breath, orthopnea, headache and low effort tolerance. He complained of abdominal discomfort also. He had stopped taking all his medications for the past three days. He had a pacemaker fixed 16 years ago for his atrial fibrillation (AF), but the pacemaker stopped functioning 3 years ago. Due to financial constraint, he did not go for a new pacemaker replacement. He underwent an angiogram last year and was found that he has 2 blocked vessels. He has a history of hypertension too. Before being admitted into the hospital, he has been taking frusemide 40mg twice daily, hydrochlorothiazide 25mg once daily, perindopril 8mg once a day and amlodipine 10mg once a day for his hypertension. For his AF, he has been taking warfarin 5mg once daily and digoxin 125microgram once daily. In addition, he took simvastatin 40mg at night for the prevention of cardiovascular events. Mr AR was found to have poor compliance. He always missed the dose, took the medications at the wrong time and was unsure the reason behind taking all his medications. He was first admitted to the acute and emergency department. ECG was carried out and there was no ST-elevation. His blood pressure was found to be high, 172/126mmHg. No troponin test was done on Mr AR, the only available test results on cardiac enzymes were that of creatine kinase (CK), aspartate amino transferase (AST) and lactate dehydrogenase (LDH). All three were not elevated. Hence, he was diagnosed with unstable angina, gastritis and hypertensive urgency. He was given nifedipine 10mg, aspirin 300mg, Sublingual GTN and plavix 300mg in the acute and emergency department. His management plans were to monitor his vital signs every hourly for two hours followed by every two hourly and to carry out dextrostix test three times daily. He was given 60mg enoxaparin subcutaneously immediately and twice daily thereafter, intravenous ranitidine 50mg three times daily, sublingual glyceryl trinitrate (GTN) one tablet when required and IV frusemide 20mg twice daily. He was restricted to fliud intake of 800mL per day and started on fliud input and output monitoring. He will also be started on low salt diet for the management of his hypertension. On day 2, he no longer complained of chest pain. His potassium level was found to be slightly lower than normal range (3.3mmol/L). His BP was still high throughout the day, fluctuating at around 150/120mmHg. He was started on tablet clopidogrel 75mg once daily. On day 3, IV frusemide was changed to oral frusemide. On day 4 his blood pressure has already dropped to around 120/90 mmHg. He was planned for discharge and enoxaparin was to be stopped on that day. Disease overview and pharmacological basis of drug therapy Mr AR was diagnosed with 3 diseases. Only unstable angina will be discussed. Unstable angina (UA) is categorized under acute coronary syndrome (ACS) which is very common in the UK. According to the hospital episode statistic year 2002-2003, there were 83842 cases of UA in England and 4421 cases in Wales.1 UA happened when there is insufficient myocardial oxygen supply to meet the oxygen demand of the heart. The reduction in the oxygen supply is due to the disruption of artherosclerotic plaque, causing the formation of intracoronary thrombus and hence narrowing of artery. Abnormal vasospasm of the coronary arteries or coronary dissection may also lead to UA. UA is closely related to non-ST elevated myocardial infarction (NSTEMI) as they have the same pathogenesis and both are presented as chest pain. The only difference between them is that in NSTEMI, there is a rise in the cardiac biomarkers such as cardiac troponin or the MB isoenzyme of creatine phospokinase (CK-MB), which indicate s myocardial injury. In UA, the ischemia is not severe enough to cause damage to the myocardial cells and thus releasing these biomarkers in detectible amount. For the diagnosis of unstable, the patients history of anginal symptoms should be obtained. Physical examination like cardiac examination and vital signs monitoring may also be done. Patient with ongoing chest discomfort should have a 12-lead ECG performed within 10 minutes of onset to check if there is any ST-elevation or depression. If there is no ST elevation, STEMI will be ruled out and the level of serum cardiac biomarkers will be used to determine if the patient has UA or NSTEMI. Troponin I or T are normally the biomarker chosen for detecting myocardial cell death as it is detectable in the serum 3-6 hours after a myocardial infarction and remained raised for 14 days. If the serum troponin level is less than 0.01 Ã‚ ­g/L, then the patient will be diagnosed to have unstable angina. CK-MB may also be used when troponin test is not available. In Mr AR case, the results on the cardiac enzymes available, namely AST, CK and LDH are all non specific cardiac biomarkers as those enzy mes can also be elevated in skeletal muscle injury or liver disease. The treatment of UA can be divided into emergency treatment and secondary prevention treatment.2,3 Patients must rest in bed and ECG monitoring should be continued during the early phase of hospital stay. Sublingual glyceryl trinitrate (GTN) tablet or spray should be given for the relief of angina symptoms. GTN is a fast acting coronary vasodilators. Dilatation of veins going to the heart reduces ventricular volume and preload, while dilatation of systemic conductive arteries together with the decrease in ventricular volume causes a reduction in afterload. These effects will all reduce the myocardial oxygen demand.4 GTN also found to dilate collateral vessels, thus the areas of ischemia will receive a higher blood flow. If the chest pain is not relieved by GTN, intravenous morphine sulphate can be given to ensure patient comfort. Patient with ongoing chest pain or high risk patients should be given inravenous beta-blockers followed by oral route if there is no contraindication. Inter mediate or low risk patients can be given oral beta-blockers. If beta-blocker is contraindicated such as the in presence of uncontrolled heart failure, or the chest pain is not relieved by GTN and beta-blocker, nondihydropyridine calcium channel blocker can be given. Antiplatelet therapy should be given immediately by giving aspirin 300mg initially, followed by 75mg once daily for long term secondary prevention. In addition, clopidogrel 300mg should be given initially and 75mg daily thereafter for 3 months. Aspirin works by inhibiting the cyclooxygenase (COX) 1 enzyme on the platelet, thus preventing the production of thromboxane which stimulates platelet aggregation.5 Clopidogrel is an antiplatelet which acts by inhibiting adenosine diphosphate (ADP) from binding to its receptor, hence blocking the activation of ADP-mediated glycoprotein GPIIb/IIIa complex, a step involved in aggregation of platelets.6 Unfractionated heparin (UH) or low molecular weight heparin (LMWH) is an important antithrombotic agent in the management of UA. LMWH is normally preferred over UH as it can be given subcutaneously and no coagulation monitoring is needed. LMWH like enoxaparin should be given for 2-8 days. Heparin binds to antithrombin and the complex formed deacti vates a series of enzymes involved in the coagulation process. Thus thrombus formation will be inhibited.7 Patients with high risk of MI or death should also be given glycoprotein IIb/IIIa antagonist such as eptifibatide, tirofiban or abciximab. For the secondary prevention treatment, in addition to aspirin and clopidogrel, beta-blockers should be continued indefinitely. Statins can be started regardless of the patients cholesterol level for the preventing cardiovascular events. Statins are 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, which act by inhibiting the biosynthesis of cholesterol.8 Angiotensin converting enzyme (ACE) inhibitors are useful in patients with UA also. They work by inhibiting the production of angiotensin II which is a potent vasoconstrictor and reducing the breakdown of bradykinin which is a potent vasodilator.9 Evidence for the treatment of the conditions When the patient was admitted to the acute and emergency department, he was given clopidogrel 300mg, aspirin 300mg immediately and was then continued with long term treatment of 75mg of clopidogrel. The use of clopidogrel for the long term treatment of unstable angina was supported by two large trials. First, the CAPRIE trial which compare the beneficial effect of clopidogrel versus aspirin in patients at high risk of ischaemic event.10 In this trial, patients were either given 75mg clopidogrel once daily or 325mg of aspirin once daily. The clopidogrel group has a marginally lower risk of ischaemic stroke, myocardial infarction, or vascular death (5.32%) compared to the aspirin group (5.83%). The side effects reported were similar in both groups, indicating that clopidogrel has a comparable safety profile to that of aspirin. The second trial is the CURE Trial which investigate the beneficial effect of adding clopidogrel to aspirin therapy in patients with non-ST elevation acute coronary syndrome.11 In this trial, 12,562 patients were given either 300 mg clopidogrel innitially, then 75 mg once daily or placebo plus aspirin for 3 months to a year. It was found that there was a lower rate of death from cardiovascular causes, nonfatal MI or stroke in the clopidogrel group. However, the risk of major bleeding was significantly higher in clopidogrel group. Hence, it can be concluded that long term clopidogrel should be used in patients with acute coronary syndrome in addition to aspirin. In addition, according to a meta-analysis done by the Antithrombotic Trialists Collaboration, long term treatment of aspirin in the range of 75-150mg was found to be beneficial in patients with acute coronary syndrome. In cases where antithrombotic effect is needed immediately such as during acute attack of MI or UA, aspirin at a dose of 300mg should be given.12 In Mr AR case, only 300mg of aspirin was given in the acute and emergency department, no long term treatment of aspirin was given. This might be due to his newly diagnosed gastritis. NSAIDs were found to cause or worsen gastritis.13 According to the AHA/ACC guideline, clopidogrel will be the alternative for patients intolerant to aspirin due to gastrointestinal problems. According to a study done by Harker LA et al. where the tolerability and side effects of aspirin and clopidogrel were compared using the results from the CAPRIE trial, it was found that the group of patients receiving clopidogrel has a lower percentage of gas trointestinal side effects, with a rate 27.1% compared to 29.8% in those taking aspirin (p < 0.001).14 This finding support the reason behind clopidogrel being the only antiplatelet given to Mr AR. However, The difference in the incidence of side effects between the two treatment group was small and higher rate of occurrence of gastrointestinal problem in aspirin group might be due to the high dose of aspirin used (325mg). The policy of the ACC/AHA guideline of using clopidogrel instead of aspirin in patient with a history of GI complication was also refuted by Chan and colleagues.15 In this study, 320 patients who had recovered from aspirin-induced upper GI bleeding were given either 75 mg of clopidogrel daily or 80 mg of aspirin daily together 20mg of proton-pump inhibitor esomeprazole twice daily. When the patients were followed up after one year, it was found that patients in the aspirin group has a lower rate of recurrent upper GI bleeding compared to those receiving clopidogrel plus esomeprazole (8.6% versus 0.7%, P=0.001). No protective effect was conferred by esomeprazole in aspirin-induced lower GI bleeding. Hence, low dose aspirin is still deemed appropriate in Mr ARs case if given with a proton pump inhibitor or H2-antagonist like ranitidine. On day 1 Mr AR was given 60mg of enoxaparin immediately and twice daily thereafter. A comparison between the efficacy of UH and LMWH was carried out in the ESSENCE trial.16 In this trial, patients were allocated either subcutaneous enoxaparin plus placebo bolus and infusion or bolus and infusion unfractionated heparin plus placebo subcutaneous injection. In addition, they were all given oral aspirin. It was found that the enoxaparin group has a lower rate of recurrent angina, MI or death and also the need of revascularization process. Hence it was concluded that enoxaparin is more advantageous than UH, as there is little protein binding, longer plasma half life and more resistant to neutralisation by platelet factor IV as compared to UH. The dose given to Mr AR is justified according to a trial where the dose of enoxaparin was adjusted according to the weight of the patients. 17 It was found that giving 1mg/kg of enoxaparin to patients with UA or non-Q wave MI resulted in a lower ris k of major bleeding compared to giving a dose of 1.25mg/kg (6.5% versus 1.9%). Mr ARs weight was 59kg, thus a dose of 60mg is appropriate and evidence based. Sublingual GTN was given to Mr AR for the relief of his chest pain. According to the British Medical Journal evidence centre, no good evidence was found on the angina. There is one randomized placebo controlled study done by Karlberg et al. where they compared the effectiveness of intravenous GTN versus placebo in reducing ischaemic attack in unstable angina.18 In this trial, they found that patients given GTN have a fewer new onset of chest pain compared to placebo group. No trial was done to investigate the effectiveness of sublingual GTN in preventing ischaemic attack. However, according to a methodological study done by G Nyberg to determine the time of onset of sublingual GTN, it was found there was a significant reduction in the intensity of exercise induced chest pain and an improvement in the ST-depression when 0.5mg of GTN was given sublingually at the onset of chest pain.19 Hence, there is a consensus that sublingual GTN can be used for symptomatic control of unstable angin a. Mr ARs previous medications were continued during the hospital stay. Among those medications, perindopril, an ace-inhibitor, is also proved to be beneficial in the prevention of MI. There are two well known studies done on the effect of ace-inhibitors in preventing cardiovascular event in patients with cardiovascular disease, namely the HOPE trial and the EUROPA trial.20,21 In the HOPE trial, ramipril was chosen as the treatment drug. As for the EUROPA trial, perindopril was chosen to investigate if there is any beneficial effect in preventing MI, cardiac arrest or mortality in patients with stable coronary disease. It was found out that in the group of patients receiving perindopril, there was a 20% relative risk reduction in the primary end point as compared to the placebo group. Hence, it was concluded that perindopril should be given to all patients with coronary heart disease, including Mr AR who has unstable angina. In addition, Mr AR was continued with 40mg simvastatin once daily at night. According to a trial on simvastatin, it was found that giving simvastatin to high risk patients lowers their cholesterol level and reduces the incidence of cardiovascular events.22 In this trial, 20536 adults in the UK with high risk of getting cardiovascular event were given simavastatin 40mg daily or placebo. It was found that the simvastatin group has a lower percentage of all cause of death (12.9%) and major vascular event (19.8%) compared to the placebo group (14.7% and 25.2% respectively). There was a difference of about 1.0mmol/L in the LDL cholesterol level between the two groups after treatment regardless of the initial cholesterol level. This indicates that there is a reduction in the LDL cholesterol level in the simvastatin group which is independent on the initial cholesterol level. For patient given simvastatin, the risk reduction of the first major vascular event is similar no matter the patient s were taking ace inhibitors, aspirin, beta blockers or antihypertensive drugs or not. This shows that simvastatin provides additional benefits when added to the existing treatment with these drugs. Thus, it can be concluded that simvastatin will be beneficial to Mr AR who was taking ace inhibitor and antihypertensive drugs concurrently. Mr Ar was newly diagnosed with gastritis and was commenced on IV ranitidine. In a double blind clinical study, patients diagnosed with gastritis were given 300mg ranitidine daily for 4 weeks or placebo only.23 It was found that patients from the ranitidine group improved significantly faster than the placebo group and 80% of the patients had their symptoms completely resolved. Only 45% of the patients from placebo group achieved improvement in their symptoms while the remaining showed no change in their gastritis. Hence, it was concluded that ranitidine is an effective treatment option for gastritis. However, this trial only involved 52 patients and this small sample size renders the finding from trial inconclusive. In another trial where the effectiveness of ranitidine and sucrafate was compared, it was found out that both have a similar activity in relieving the symptoms of gastritis.24 77.6% of the patients receiving sucralfate and 79.4% from the ranitidine group had their symptom s completely resolved at the end of the study period (8 weeks). However, ranitidine was found to act faster in relieving pain compared to sucralfate. Hence, it can be concluded that the management of Mr ARs gastritis with ranitidine is justified. Mr AR was given nifedipine 10mg for the treatment of his hypertensive urgency. Even though nifedipine was found to be effective in reducing blood pressure within 20 minutes, this fast release, short-acting calcium channel blocker are not recommended in this case as Mr AR did not receive any beta-blocker before. According to the results obtained from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT), monotherapy with nifedipine in patients with unstable angina naà ¯ve to beta blockers was associated with a higher risk of recurrence ischaemic attack or MI.25 The event rate ratio compared to placebo for beta blocker naà ¯ve, nifedipine only group was 1.15. As for the group receiving both nifedipine and metoprolol, the ratio was lower (0.80). Patients who were already receiving beta blockers and were added with nifedipine also showed lower rate ratio (0.68). Hence, it was concluded that nifedipine was only beneficial in patients who were treated with beta blocker at the sa me time. Moreover, it was found from the Trent study that nifedipine does not show any beneficial effect in patients with MI.26 In this trial, the death rate for patients receiving nifedipine 10mg four times daily and placebo was similar. When the number of death and MI were compared among patients taking beta blocker and not taking beta blocker among admission, it was found that the latter group has a higher rate of death and MI. This result is comparable to those from the HINT trial. Hence, the use of nifedipine in treating Mr ARs hypertensive urgency is not justified, other drug should be chosen. Conclusion The immediate treatment of UA with high dose of antiplatelet agent aspirin and clopidogrel together with the antithrombotic agent LMWH are justified as they help preventing the progression of UA to MI. Sublingual GTN on the other hand helps relieving his chest pain. As for his previous perindopril and simvastatin that were continued, these help in preventing recurrent angina also. Choosing clopidogrel for the long term prevention treatment of UA due to the presence of gastritis might not be the best option for Mr AR. Once his gastritis has resolved, life-long aspirin at the dose of 75mg should be added in with oral ranitidine 300mg twice daily prescribed as prophylaxis against NSAID induced gastritis. However, the use of nifedipine in the management of his hypertensive urgency is not justified. Instead, he should be given labetalol, atenolol or clonidine which were found to be better alternatives to nifedipine in treating hypertensive urgency.27 PATIENT MEDICATION PROFILE Patient details Name: AG Consultant: General Practitioner: Address: Gender: Male Weight: 59kg Height: 168cm Community pharmacist: Age: 41 Known sensitivities: NKDA Social history: Non-smoker, No alcohol abuse. Patient hospital stay Reason for admission Admission date: Chest pain. Discharge date: Relevant medical history Relevant drug history Date Problem description Medication Comments 1994 Pacemaker fixed Warfarin 5mg OD Atrial fibrillation 2007 Pacemaker not functioning, did not go for replacement due to financial constraint T digoxin 125mcg OD Atrial fibrillation 2007 Angiogram, 2 blocked vessels T frusemide 40mg BD Hypertension Hypertension Perindropil (coversylƒ’) 8mg OD Hypertension T amlodipine 10mg OD Hypertension Hydrochlorthiazide 25mg OD Hypertension T simvastatin 40mg ON Prevention of cardiovascular event Prescribed medication Route of administration Start Stop Nifedipine (adalat) 10mg PO Day 1 Aspirin 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 75mg OD PO Day 2 Enoxaparin (Clexaneƒ’) 60mg stat, BD subcutaneous Day 1 GTN 1 tablet PRN sublingual Day 1 Simvastatin 40mg ON PO Day 1 Amlodipine 10mg OD PO Day 1 Hydrochlorothiazide 25mg OD PO Day 1 Warfarin 5mg OD PO Day 1 Furosemide (Lasix) 40mg stat, BD IV Day 1 Day 3 Furosemide 40mg BD PO Day 3 Perindopril (Coversylƒ’) 8mg OD PO Day 1 Ranitidine (zantac) 50mg tds IV Day 1 Digoxin 125mcg OD PO Day 1 Clinical/ Laboratory Tests Date Results Potasium (3.5-5.0 mmol/L) Day 2 3.3 BP Day 2 150/118 Day 3 134/100 Day 4 122/86 Pharmaceutical Care Plan Care Issue Action Actual output/ Desired output Long term treatment with aspirin. Patient should be given 75mg of aspirin for the secondary prevention of UA. Patient has gastritis. He should be started on long term treatment of aspirin once his gastritis has resolved and ranitidine should be prescribed as prophylaxis against NSAIDs induced GI complications. Long term treatment with beta blockers. Beta blocker should be given to the patient as the secondary prevention treatment. Patient should be started on labetalol 100mg twice daily and titrate up to 200mg twice daily. Inappropriate use of nifedipine for the management of hypertensive urgency. Nifedipine should be substituted with labetalol 200-300mg every 3-4 hours when required. Not taken. Interaction between digoxin and diuretics when hypokalaemia occur. Potasium level should be monitored. Inform the patient on signs and symptoms of digoxin toxicity. Patients potassium level was lower than the normal range on day 2. He should be given potassium sparing diuretics or potassium supplement if the potassium level keeps going down. Monitoring should be continued. High risk of bleeding due to warfarin, aspirin, clopidogrel and enoxaparin. Bleeding tendency should be monitored. Patient should be told to inform the GP if there is any unusual bleeding like blood in the stool. Patients INR and prothrombin time were within the normal range. Monitoring was continued. Changing of IV ranitidine to oral ranitidine. Patient should be switched to oral ranitidine150mg twice daily after being discharged. Not taken. GTN for relief of angina symptoms. Patient should be prescribed GTN spray or sublingual tablet for the relief of chest pain shoul the patient has another angina attack. GTN sublingual tablet was prescribed as discharge medication. Poor patient compliance Patient should be informed on the reason behind taking his medication, the importance of compliance. Compliance aid should be given. Patient was counselled on the importance of compliance. Side effects of simvastatin -muscular side effects -liver disease Patient should be advised to report immediately any unexplained muscle pain, weakness nor tenderness. Regular LFT monitoring should be done. No monitoring of cholesterol level. Cholesterol level should be monitored suring the hospital stay so that the dosage of simvastatin can be adjusted accordingly. Cholesterol level should be maintained below 5.2mmol/L. Patient education on healthy lifestyle. Patient should be told on the importance of low salt diet for his HT and encouraged to exercise more. Patient was counselled on the importance of healthy lifestyle before being discharged.

continent :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  The muses sing of the greatest battle ever to occur in Olympian history. It started when Zeus, the king of the gods, sitting atop Mt. Olympus felt a strange presence. He stood up and looked across the great realm that was Earth. After concentrating for what seemed like millennia he spotted a rainbow. But, this was not Iris. No, it was something else. An even greater rainbow that housed a great home, it housed other gods! Zeus concentrated even harder, and he finally saw that someone†¦was looking back at him! It was Odin! Father of the Norse gods and greatest of all Asgardians! They finally looked at each other and smiled like two foxes. They now knew what had to be done next. A battle! But not just any battle, the greatest of all battles to ever occur in Earth’s history. The outcome would proclaim which pantheon was the greatest, of all Midgard. The rules were simple: Each king would choose three other gods or goddesses to fight. When one fell, the fi ght was over. Zeus and Odin immediately began searching for which god would best represent the power of each realm.   Ã‚  Ã‚  Ã‚  Ã‚  Zeus thought long and hard over whom to choose. He did not know exactly whom Odin would choose so he had to choose wisely. Immediately he thought of the wisest of gods, Athena. He knew that her power and tactics would be most valuable for the coming battle. Zeus also chose his son, Apollo. His power of the sun and healing abilities would be needed in the heat of combat. Finally Zeus had to one more slot to fill. But who to pick? Should it be the ferocity and bloodlust of Ares? Or, the skill and vigor of Artemis. He knew that unyielding viciousness would be needed for combat, but calm and critical judgments would also be a key to victory. In the end Zeus chose Ares over Artemis, hoping that his savagery would be enough to put down the Asgardians. Zeus had chosen his warriors, Athena, Apollo, Ares, and himself. The best of Olympus chosen, all that was left was for Zeus’s soldiers to train and prepare for the coming fight. Now it was Odin’s turn.   Ã‚  Ã‚  Ã‚  Ã‚  Odin sat in his great hall, pondering which of Asgard’s great warriors would be chosen to represent the greatest of the Nine Worlds. He already knew that Thor was going to be amongst his soldiers.

Summary:Cage Aquacultures Environmental Effects :: essays research papers fc

Cage aquaculture in the ocean ouputs large amounts of waste into the surrounding environment. The effluent from the cages has elevated levels of nutrients, waste feed, feces and by-products such as medications for the fish. The effluent has a negative impact on the local environment. The degree of impact depends on the water movement around the cages, the assimilation capacity of the environment around the cages and the rate at which the effluent is produced. The effects of effluent on the environment is considered inconsequential to the inputs from industry and agriculture however. That being said, the ocean floor around the cages tend to be hypereutrophic and completely anoxic up to the surface. They release sulfides and other toxins into the water as a result of reduction in the anoxic conditions of the excess organics in the sediment. The long term effects of these conditions are not known. There are no standards by which to compare internationally the effects of the cages and i t is hard to determine the effects, if any, on areas away from the immediate area surrounding the cages. There needs to be work done on how to reduce feed waste, and how to quantify the effects of the cages on the surrounding environment. To complete this project, more information is needed on operations other than cage salmon in Norway. Bibliography: Record 1 ASFA: Aquatic Sciences and Fisheries Abstracts Organic enrichment of sediments from salmon farming in Norway: environmental factors, management practices, and monitoring techniques Carroll, ML*; Cochrane, S; Fieler, R; Velvin, R; White, P Aquaculture [Aquaculture]. Vol. 226, no. 1-4, pp. 165-180. 31 Oct 2003. Record 2 ASFA: Aquatic Sciences and Fisheries Abstracts The environmental impacts of marine fish cage farms in the eastern Adriatic. Katavic, I Ribarstvo [Ribarstvo]. Vol. 61, no. 4, pp. 175-194. 2003. Record 3 ASFA: Aquatic Sciences and Fisheries Abstracts The degradation of fish-cage waste in sediments during fallowing McGhie, TK*; Crawford, CM; Mitchell, IM; O'Brien, D Aquaculture [Aquaculture]. Vol. 187, no. 3-4, pp. 351-366. 20 Jul 2000. Record 4 ASFA: Aquatic Sciences and Fisheries Abstracts The environmental impact of an offshore aquaculture system in the Gulf of Gaeta: a first approach. Ceccarelli, R; Saluzzi, A; Fiore, V; Salerno, A; Barbera, G Biologia marina mediterranea. Genova [Biol. Mar. Mediterr.]. Vol. 6, no. 1, pp. 294-297. 1999. Record 5 ASFA: Aquatic Sciences and Fisheries Abstracts On the impact of a sea bass (Dicentrarchus labrax L.) cage farm on water quality and macrobenthic communities

Population: The Growing Problem Essay -- Science Biology Papers

Population: The Growing Problem History of Earth's Population From the beginning of time until 1850, the world population had been steadily growing until it finally reached the point of one billion people. Hurray for our species, we are successful and have been able to make adaptations in order to survive! Then, only 80 years later, the world population doubled to a whopping 2 billion citizens. After that, the doubling time was sliced once again. By 1960, just thirty years later, three billion people called Earth "home." Seventeen year later, in 1977, the world population hit four billion people. In 1986, nine short years later, we reached a population of 5 billion inhabitants. Sometime in the next few years, we are looking at crossing the 6 billion mark (Davidson 1995). The notion, debate, and warning behind overpopulation is nothing new. The theologian Tertullian, in 200 CE, wrote, "What most frequently meets out view (and occasions complaint) is our teeming population." He continued by exclaiming that "[the global population] numbers are burdensome to the world, which can hardly support us." At the time of this statement, the global population totaled a mere 190 million people (Lambert 1995). In 1798, Thomas Robert Malthus, possibly one of the best-known writers and debaters of overpopulation, wrote an essay entitled "Principle of Population." In this composition, Malthus suggested that humankind was, currently and forever more, playing a hopeless game of population vs. natural resources. This game, he continued, would end with a vast number of humans losing the battle. Malthus presented this doomsday scenario of global overpopulation as closely connected with famine and starvation. His belief was that human po... ...9). World population and development. New York: Syracuse University Press. "Ireland." The 1996 grolier multimedia encyclopedia. CD-ROM. Danbury: Grolier, 1996. Lambert, T.A., Olin, J.M, Abernethy, V.D., Barroso, C., Sen, G. (1995). Women and population. Environment, 37, 3. Sanger, M. (1931). My fight for birth control. New York: Maxwell Reprint Company. Sax, K. (1955). The world's exploding population. Boston: Beacon Press. Scanlon, M. (1997, September). The new population bomb. Mother Earth News, 163, 48. Wattenberg, B.J. (1997, November). The population explosion is over. The New York Times Magazine, 60-63. Wilson, E.O. (1992). The diversity of life. Cambridge: The Belknap Press of Harvard University Press. World-wide web 1: "United nations population fund moves day of six billion based on new population esitmates." 30 October, 1998.

Is Technology a Boon Essay

Technology is very much a part of modern life. Many people see technology as a force that has escaped from human control. Others feel that technology has improved the quality of life. Do you think that the contribution technology has made to modern life has been positive or negative? State your position on this issue and support it with appropriate examples. Technology has become a part of our lives. The issue of decide if this part is or not good for life is a controversial one. Many believe that contribution technology has made to modern life improve the quality of life in different aspects. Others believe that technology is out of human control and they see adverse effects in modern life. After careful analysis of different fields such as daily life, medicine, and education, I feel that contribution technology has made to modern life has been really positive and help to improve the quality of human lives. The first reason for me to believe contribution technology made to modern life is just the daily life to unprecedented levels. Houses’ security systems, for example, connected to the police, is more powerfully because is build on technologies developed in the last years. As women increase their roles in society in the last times, daily homework such is cook, make laundry or vacuum take less time to do it than before, and its permits women to dedicate this time to other activities such is study, working, and other activities. Not only the daily live is benefited by advances of technology, another field is medicine. Thanks to advances in technology, many diseases that before was the cause of massive death, now is a past true, with the advances in technology, scientific and doctors find different vaccines to help people be healthier. The medical equipment’s advances help process such as surgery in a way that was never possible before. Nowadays, it is routine to get a heart replacement, which in the past such situations was simply impossible. Most importantly, we can see how scientific are in the process of looking for the solution to current diseases, and this will be possible, with the use of advanced medical technology. The best reason for me to applaud contribution technology made is in the field of education. I see how the advances in technology help students in their learning. For instance, the use of projectors and video conferences help in important amount in the process of learning; by using these approaches, different kinds of students’ intelligence can be addressed. Computers are another example of contribution that technology made to educational field. The use of well equipped computer lab is truly helpful for students because they have the chance to learn computer skills that are very important in almost all the work environments. Nowadays, teachers can find information they can use in their daily lessons. For instance, in a math class, teachers can use updated statistical information finding in computers (by just a click), and they can infuse these information into a lesson, making the lesson related with real life situations for students. In the final analysis, I think the benefits technology offer to improve the quality of life outweigh the deficits. I do not think technology is out of human control and by the exposed in lines above we can easily see how technology helps and improves the quality of human live in the daily routine, Medical advances allow humans to live longer and more healthy lives than ever before and technological advances make the learning more easy. Ultimately, Technology is developed by people to help improve quality of human lives and all of us are using technological advances in many different ways, also to indicate that it is incontrollable.