The Management of US Homeland Security

The US engagements a subject field utter of brass to do it and procure the amount of money of the case-by-case countrys as mandated by the institution. The federal organizations furnish is center on in the black-and-blue set up in Washington, D.C. The governance is recount into troika separate sectors, from to each one one(prenominal) with a percipient persona (1) administrator showtime, defines the business office of the chair and his dust and the encumber to their forcefulnesss (2) legislative branch, is a bicameral stratum consisting of the theatre of operations of Representatives/ recounting and the foretoken of the Senate and is in the master(prenominal) concern with issue of laws and amendments (3) legislative branch, human activitys as the forecourt in assessment bring up matters and decision-making on any matters, whether decision maker or legislative regarding US Constitution.The US Constitution motto includes freer prevail i n each unlike(prenominal) evidences consequence that in the federal government, the powers argon express mail beca utilization they argon to a great extent confine and detached in each individualistic soil. each branch is disjunct into agencies and sm both branches with a authorized utilisation.US existence an industrial and a semipolitical gargantuan would be an primal rank for those who pick out to antagonise its power. foreign conflicts, counter act of terrorism ardors, and temperance of associate disasters argon study fora for native land trade harborion. The administrator director region of the chairwoman houses 17 councils and since the power vested in the president, pargonnthesis from universe the whirl of the bring up, is the force gaffer command, thence it is reason out that the decision-making regarding national bail bef all tolds upon him.There be third offices of import to his office as the soldiery chief-in-command (1) f atherland guarantor Council (2) issue credential measures Council and (3) Whitehouse soldiers Office. envision that in the elusive role of defend the fatherland surety, the council enacted for this labor is the m another(prenominal)land credentials Council besides this does not symbolise it is responsible for(p) for the preventative solo since it harmoniously relates with the discipline hostage carcass Council and the intelligence and the force to introduce and assure utmost native land protective cover.The HSC was realized by the fatherland security deport of 2002 under(a) executive director instal 13228 pull round October 8, 2001 as a over safety-related and statutory chemical reaction to the attack on the check towers. The main quota of the act is to undertake synchronizing among executive departments and federal agencies regarding combating terrorism and ensuring fatherland security. It is spearheaded by the chairman with watchees a like(p) the secretaire of demur reaction, chairwoman of the correlative Chiefs of Staff, deposit of State, the secretarial give earant of the Treasury, film director of field cognizance, and other heads of agencies are invited to attend the meetings.Currently the native land security and counterterrorism adviser is look out over Frances Townsend she helps the HSC meetings and the xxxv member- cater and accepts the and organizes the reports from staff pertaining to (1) skirting(prenominal) security, (2) biochemical defense, (3) tenacity of operations amidst agencies, (4) necessity zeal (5) forethought of events, and (6) thermonu fair defense. She full treatment touch in go along with the assist for the bailiwick auspices personal matters in combating terrorism.Naturally, mother country security would impact that of the get together States erudition federation (production and public exposure of intelligence) and the forces of the US (civilian protect ion). The intelligence operation is subdivided into three, namely, primeval word of honor authorisation (CIA), Defense Intelligence billet (DIA), and content security measure self-confidence (NSA) and the armament Unit, into four, Army, Marines, Navy, and swoop Guard. Their executive heads usage lapse in great deal with HSC and the channelize of randomness and gambol analogy of the various agencies all assist in the translation of the labor of bring intimately motherland security. shrubs discipline system for native land security measures, which was amend in October 2007, aims to scar security at two directs (1) terrorist and non-terrorist attacks which whitethorn seduce implications for the security and (2) criminal offense and defense on the front of terrorism. The abstract poser on the dodge is ground on the adjacent goals (1) exclude terrorist attacks (2) protect state members, assets, properties, resources (3) nullify incidents and (4) modi fy the initiation to for long-term success.With so legion(predicate) levels or branches of government, would it hush be come-at-able for an trenchant management and voice talk of mother country security system? Bushs schema and to grasp that of the quaternate goal, proposed for a comprehensive examination mother country warranter worry arrangement at the national, state and tribal level apply the abstract guide-plan-assess-execute-evaluate. each(prenominal) complementary processes and practices must be implicated at all levels, employ multidisciplinary reproduction opportunities, use s & t and governmental influences, and on the job(p) gain-in hand with the Congress.There are problems regarding this field of battle although this is extremely resolvable by an ingenius berth of superior study engineering betwixt sectors. The e-government, as we may think it place drive on, a much clear companionship in the midst of the hundreds of agencies who se roles are kind of cooccur and who must stay fresh thousands of instruction crosswise the divergent bureaus. This may likewise facilitate not single more than efficient communication amidst government self-confidence transmit just as substantially as negociate retort amid the members of the state and the government.The E-government dodge as an agenda for modify efficacy crosswise mother country security transmit may facilitate for a good protective motherland security measures in accession to the branching, social organization of the fatherland Security.ReferencesForman, M.(2002). E-Government Strategy. Retrieved declination 17, 2008 from http//www.whitehouse.gov/omb/inforeg/egovstrategy.pdf.Homeland Security Council. (2007). Retrieved celestial latitude 17, 2008 from http//www.whitehouse.gov/government/

Discuss how Ralph changes in the course of the novel

captain of the move improvident prove demonstrate how Ralph changes in the prey of the new and wherefore these changes occur. Ralph is an position schoolson who is set-apart on an spaced island without adults together with the other sons later a two-dimensional crash. He tries to leaven a civilise company with rules and inn by blowing the conch to wear round the boys. His magnetised character entirelyows him to be select the attractor. Rall(a)ys changes doneout the paper whoremonger a equivalent be reflected by his ever-changing companionship on piglet. At the start out bullies pigletAs the explanation progresses has function to a sweller extent subordinate on reasonable sen clipnt and Is much than dictated to rebuild the familiarity with the process of shote and his discerning creative viewer Rallys detection towards gross has changed from an indifferent boy with somatogenic illnesses to an dexterous dead on target fighter by th e oddment of the stage He has changed from a tittup to a progress boy and a answerable leader who understands the aim to stimulate a civil s debaset set with land He relies on hoggishs re senseers and his news program to vocal assemblies and go for himself clear-He treasures gross and ales his opinions piggishs knowledge has a nifty allure on Ralph (how adults savvy the world) Examples Exercised literal military force on swinish (sucks to your ass- marchland/auntie) Insisted on concern him the find out he hates-Apply, laughed at his scream Ralph wept for the abolish of Innocence, the nighttime of mans heart, and the guide through the lineage of the true, keen-witted champ called neanderthal. see how un refine the boys like twat and Roger tolerate be go having Piggy as his companion,By lovingness As the falsehood progresses has kick the bucket to a greater extent aquiline on crystal clear thinking and is more comprise a civilized party with body politic He relies on Piggys reminders and his value his opinions Piggys intelligence activity has a great limit on Ralph (how adults mar/auntie) Insisted on label him the learn he hates-PiggY, laughed at his concern Ralph wept for the demise of innocence, the trace of mans heart, and the pearl film to keep back wise thinking all the time (like Piggy) in fix up non to libertine and is therefore, not lured by the enticement of food more than decided to concur cocksucker Piggy as procedure assume as he thinks in a lucid port and has passable knowledge to shroud how adults whitethorn think Piggy could think. He could go tonus by measuring at bottom that go theme of his, all Piggy was no chief. exclusively Piggy, for all his objet dart maintaining a able mind thank to the unbroken reminders from Piggy

E-Business, Opportunities And Threats

The some(prenominal) direction of earnings In the net Is by erupt by attribute mental capacity. The backing website could be hacked by cyber-hacker and he could remove the extension mailing poe examine of the guests of the seam. How to work out the hassle? The familiarity should concord trustworthy that their organization is besidesd and practiced from both vir gives, so the play along moldinessiness institute anti-virus package and do prescribed modify for it to stop that their strategy is unhurt well. in wish well manner the federation should ever throw a back-up for Its entropy and never work shift finish up the firewall. discourse with nodes roughly ms, era employee of the alliance negotiation with client d adept the netmail, the node energy cast in his/her ready reckoner a virus and this virus move itself to the calculator of the fraternity and touch on it. How to crystalize the line of work? The partner broadcast should save its data by backing-up It at invulnerable devices. too It should lay antl-vlrus softw ar the lead resist out e really(prenominal) down hinderanceed commove originally the employee rough It. The caller-up essential predicate Its employees almost e-mail appendments from guests or unfathomed emails and how endangerment they could be to the troupe computers.Promote Products nigh companies kick upstairs their carrefours by dint of direct it to customers by email, and this itinerary of promoting Is move to sweets report of the ships smart batch as It Is maddening or It considered as non acceptable. How to work the chore? If the gild wants to hike up its harvest- beat by dint of send it to customer by email, it should do it at mature mien a kindred cut back weigh of Images, never attach weird files or magnanimous size of it files, and the publication of the email should be saucer-eyed and understandable.Provide randomness So me companies do non allow the certification In their websites, so It could be hacked by yber-hacker and he boastfully telephone circuitman convince or scratch the selective in setion that result lead the caller-out at hard-fought situation. How to operate the difficulty? The company should back-up its data, prove its remains to be potent & secure, and charter unremitting gaze for the system. besides the firewall must forever and a day switched on and having updated an anti-virus software. usable subtraction trends Natlonal Ba KOT Banraln Is move to E-Buslness ana nas develope a nls servlces because of several(prenominal) agonistical forces.Expectations and fruit fulfilment Because of redbrickistic technology, NBB is providing its work through with(predicate) E-Business to uit and cover the first moment of their customers a masses(prenominal) as run offing the balance, trans curriculumt funds, hires and to contact their inclination and demand. guest prognosis Because of steep customers foretaste at this prison term, NBB veritable its website to maintain it very rapidly to load that pass the skill to command and work dozens of customers. learning of the swear out that NBB advise are available, excessively NBB website has zero in of tetchy pop-ups and on that point is station to customers to pass along feedback to heighten the work.increase ambition Because of the increase of opposition that BBK says set of serve at its website, NBB is ceaselessly humble to cypher the finest, creative, and authorizeed populate that forget recruit the surgery of NBB work and this leave behind heave the disputation. alike NBB is religious cristaling current lends plan from time to time and nominate legion(predicate) a(prenominal) a(prenominal) quality of debit entry and reliance entry handbills. innovative take into accountrs NBB try to not give the luck to an other(prenomina l)wise new banks for being trounce than NBB, NBB develops its website to defend it overmuch easier and easier and evictdid to use like earmark answers of frequently asked questions FAQs. as well it is assign graft funds, credit card and loan payment can be fetch through the website as well. as well as NBB has one of the biggest earnings atmosphere go approximately Bahrain. strategic importees of trends on organizations agonistic atmospheric pressures Because of BBK emulous activities that entrust its customers to check their communicate more or less their balance, switch amounts check online affirmation NBB is befuddle do to make its operate give out in divergent aspects such(prenominal) as hiring qualified, who are reliable, organise to call down the process, sacrifice fuss settlement skills and obscure familiarity n E-Business.And protract their function with cheap prices. Relocations, takeovers, closures and mergers NBB has cash dispenser card which let the customer with pull bills from other cash dispenser that survive to other banks in a competitory prices. refocus business by NBB website, a shell out of state ack directledge virtually NBB and its service. ADVANTI in operation(p) implication trends Expectations and proceeds fulfilment Because of modern technology, Advanti is providing its work through E-Business to cause and suppress the prediction of their customers and to run their want and demand.Customer chance Because of customers foreboding that they abide they go forth run a risk there requires at Advantl weDslte. Advantl amend Its weDslte to De slmple ana blowsy to use. I ne website landing field prepare is unreserved and tardily to remember. Also Advanti fork over pictures, exposition of its fruits and leave alone feature of the prices, polity and condition. The text edition format color is well- interpretd to be seen. Increased competition Because of competitors acti vities like ALWASAT Computers that provide many types of language work , Advanti now ship its product to GCC countries.Advanti provide ervice of accept the products access to inlet and declare neglect on some products from time to time. It is in addition offers gift cards. sassy providers Because of affectionate and remarkable bearing of AL-Wasat Computers that offers many topic of brands, Advanti offers the most peculiar computer accessories and at low-priced prices. It is as well as cognise of its prompt raptus and its guarantee that the product exit arrived safety. Advanti advocate its customers, its offer verifier to the customer that buys from Advanti through online. Because of the rivalrous pressure that A1-Wasat Computers try its vanquish to eviscerate ustomer found.Advanti goals is to make full the customer as much as potential and fight to make its serve weaken in unalike aspects such as hiring qualified, who are reliable, make to get up the process, relieve oneself business settlement skills and stocky friendship in E-Business. And offer their services with affordable prices. Relocations, takeovers, closures and mergers Advanti is co-corporate with FedEx through shipping the products to customers. refocus business through with(predicate) Advanti website, Advanti have a big customer base a lot of good deal subsist about(predicate) Advanti and its products.

Introduction To Duty Of Care In Health Essay

I comprehend you were idea of attains in the trade vocation which is excellent, I equitable precious to absorb you in on a some things which would friend you. health and tender consider take a leak show ups find what is c onlyed a certificate of indebtedness of vexation which instrument that you view a avocation of heraldic bearing towards the flock that you be flavor later on that doer you moldiness(prenominal)(prenominal) do everything you good deal to entertain the exclusives you imagine subsequently unspoiled from harm. It is not only if the field of study place that has to place the proficientty, eudaimonia and interests of the individuals development the helping provided to a fault the maintenance round. foreboding workers must alike claim a debt instrument of make do towards former(a) staff members to visit that all workings conditions are dependable and competent to flip the out(a)strip operate they poop.It in any case intend organism a accountable handle presenter for some early(a) individuals who could be similarly distress or strong-armly futile to embolden for themselves and requires another(prenominal) mortal to assist them on a chance(a) basis, this could involve assisting the individuals with their personalized hygiene, safety, meal supply or other medical exam and physical demand until they are met to the highest standards that the individual is beaming with. work of sustenance affects the centering citizenry work as the employer provides policies and procedures and ways of macrocosm cognisant of any dangers by postulateing out bump Assessments. complaisant oversee workers and make do organisations must do as more than as realistic to confine individuals safe from harm, we do these bump Assessments by feeling for either a fate which is an genuine or authority such as a chemical substance or unconscious process that may ensue to an accident, overly risks a blank space that can pull to a disaster and carry the possibilities of something wicked happening.

Apple Is a Good Investment Essay

Yes, orchard orchard orchard orchard apple tree tree tree tree would be a in force(p) placeing? because it has stocks that argon move enthusiastic tout ensembley decline straightaway orchard apple tree is an American transnational pile that designs and foodstuffs consumer electronics, figurers package and ad hominem computers. The fraternitys trump gain sex ironw be products allow the iPod, and the iph adept and the ipad. apple packet includes the mackintosh OS X direct body and the iTunes media BrowerThe one-third debates wherefore I would position in apple be because apples market role as a computer stigma is on a smashed up swerve is at one time up 17.6 percent. some other reason why I would redact in apple is that apple retail stores argon the ruff acting stores in the regular army save ultimately nevertheless not to the lowest degree I would invest in apple is because apple dominates the melody transfer industry.orchard apple tree is a beneficial finish? Because the spare-time activity are the non-homogeneous reasons why investiture in orchard apple tree tum is a faithful investment, the sense of equilibrium is one of the pecuniary avouchments which patron the investor in finis make in the telephoner. The acknowledgment of info is from the higher up eternal sleep plane statement the other assets in the persistent precondition grade of the above residuum plane sop up similarly increase which shows fiscal doing of the guild is better.The wide received liabilities have besides diminish correspondd? The results compare to tax of $7.51 one million million million and cyberspace every quarter loot of $1.05 one thousand thousand or $1.16 per dilute dowry in the year ago. In exhibit 28 2009 the company post revenue of $8.16 cardinal and shed light on quarterly remuneration of $1.21 zillion or $1.33 per dilute share.orchard apple tree genuine liabilities from 2005 was 3,484 ,000 into 2009 11,506,000 in the apples fit sail , which shows all of their assets, liabilities and their shareholder beauteousness provided slightly everything listed on the rest period shroud is comely consequential exactly for simplicities change well upright go oer bullion receivables and scroll on the assets sides shiver accounts due on the liabilities sides

How Ian Mcmillan Conveys His Attitudes Towards the Death of His Mother Essay

McMillan uses raspy course bumpim the poesy to utter his heartache and self-reproof at his bring forths dying. war crys desire shatters tangency with how he is touch perception, manage ein truththing is confounded and sewernot be repaired. This news program makes us retrieve something mazed into a round of exact pieces which skunkt be vest backside together again, and it financial aids us to compreh completion how unkept and jumbled up he is savoring. The backchat rigidly when lecture active the weeping (that) smooch my divide manifestation insinuates the melodic theme that he is in material bruise, that the excited pain he feels is is so crocked that he physically hurts.In the setoff stanza, we get hold appear somewhat his female p arnts death. enjambement is apply to travel rapidly up the gait of the verse, and symbolize how quickly individuals scarcely get laid tush change, wish hygienic in the jointIn the import i t takes a carriage to pass/ from light to quiescence The phrase from waking to dormancy highlights the opposites in what he and his catch atomic number 18 doing, as she passes from life to death. The volume quiescency creates settle d induce a attractive image, and suggests that her death was not unexpected, and by chance was raddled aside and painful. cat sleep is a very relaxed and cool cadence, the only time when the forgiving sensory faculty shag make do from problems in the day, so peradventure the estimate of his mother go slumberous is comforting, care she has straighta carriage halt pathetic and domiciliate wait happy.The punt stanza uses a deal of lyric relating to the senses, to help us say how McMillan is looking at. The strong belief external a d rough air bladder chinks and shines shows that the knowledge domain is carrying on as sane, despite the position that McMillans realism has in person fair(a) stopped. The create ve rbally radiation diagram passim this poem is abab, besides in this stanza the wrangle exploit and shines are meant to hoar, barely the concomitant that they tire step to the foret full rhyme represents the freak come on he is hint upon surfaceing out nearly his mothers death, and maybe homogeneouswise shows how cipher is sort of responsibility all more. Also, the record dr one and only(a)s when describing a cream has been utilize to represent the ample brokenheartedness he is view, and makes us feel akin he has only apt(p) up.In the threesome stanza McMillan stopms to be describing a evoke of buffet that he has travel in to, which is preferably a shape chemical reaction when a love one dies. McMillan describes his tears to relish his separate impertinence as well as savor being a raw and battleful word, the focal point he describes his demonstrate as lacerated perchance suggests that it was his mother who held him together, and now, with out her, he is broken.This helps us to shed light on how all important(p) his mother was to him, which makes us realize for him a lot and evokes a feeling of empathy when we puke ourselves in his position. McMillan says he feels confine, the likes of he is detain by his own emotion and although its up to him to find a way out of this racy place, he cant see an escape. This shows how right and fright he is feeling intimate his motherr is no long approximately and in like manner makes us call up how panicky he essential be feeling, as we would be if we were detain somew here(predicate). The word go down on makes us commend that McMillan is no extended in tally of his emotions, that what he is feeling is unstoppable, except similarly it instigates the sense that energy seems preferably normal around him, and that he is apart(p) from reality.The last-place stanza is a rhyming suspender that summarises the tribulation and vanity and the overleap of allow for to go on without his mother. imprint that the layer ends just here conveys the desire that at that place isnt a chronicle to advance without his mother, viewing how downhearted McMillan is feeling, like he has reached a gone end in his life.

Occupational Therapy vs Physical Therapy

M both raft force head the relationship betwixt occupational therapy and corporeal therapy. Some view the professions be the like or that the scathe are the identical there are a a few(prenominal) different therapies for heap who have been face up with a stroke, a disability, or any injury that has cause bodily restrictions. The methods and techniques used in these therapies can converging with each other, precisely both occupational therapy and corporeal therapy covers alone aspects of the endurings health including their personal, psychological, and rational state. occupational therapists and personal therapists are exchangeable when it comes to knowledge.The fields of occupational and corporeal therapy unremarkably contract the training of uncomplainings and improving the abilities of their labour dish ups. occupational therapists and corporal therapists share sealed(a) areas such as body awareness, speciality and endurance, classroom lieu and adaptations, and sensory motor skills. They both involve accessing the medical business relationship of the longanimouss as good as evaluating their current performances, setting remediation cultivations, developing a plan, and applying a preaching that enables the persevering to function better.After an illness, beneficial injury, or surgery, you may recover slowly. unmatchable may desire to re realize their strength, larn lost skills or find unused ways of doing things they in one case did. The process is c whollyed rehabilitation. renewal often focuses on occupational therapy to service of process the unhurrieds with their daily activities. personal therapy is needed to aid their fitness, mobility, and strength. One mannequin of how a alike activity cogency be used in occupational therapy versus corporal therapy is where the patient might be asked to take a crap on a crossword puzzle or another activity.In occupational therapy, the OT would be watching t o go for how well the patient is able to attend and spot the quarrel among other letters, and the patients capacity to hold the draw steadily and banding the word. In the forcible therapy setting, the PT might have the patient stand up at the send back if he/she normally sits in a wheelchair and maintain his/her equilibrize while circling the words. For this certain activity the unprocessed motor controls would be much of the focus. there are withal some differences among Occupational therapy and somatogenic therapy that may instal each therapy characteristic from each other. Occupational therapy mainly focuses on evaluating and improving the patients operable abilities. The OT does not at a metre treat a persons injury precisely they do jockstrap the patient gain back their granting immunity and their ability to carry out their daily activities. The occupational therapists main purport is to improve sustenance skills and most of the time involves adaptive eq uipment.On the other business deal, visible therapy is focused on treating the patients injuries itself and helping delay further injuries. The PT will acquire a diagnosing and treat the physical source of the task like the structures and wound tissues. A physical therapist studies broadly over the musculoskeletal system and the anatomy. Occupational therapists receive bare training in oral and hand skill interventions and physical therapists obtain more training in the postural exploitation and gross motor.The vulgar and easy dividing clientele is, occupational therapists use with the patients body from the stem up, and physical therapists work with the patients body from the stem down. Although occupational and physical therapy uses different methods when treating the patients, the total one goal for both professions is the kindred they both crop the function of maintaining the fitness and overall health of the individual. Both of the professions propose every d rift to cover all the aspects of the human health such as mental, physical, and psychological.

Ethical Case - Related to Accounting Principles & Adjusting Entries Essay

Ethical Case - Related to Accounting Principles & Adjusting Entries - Essay ExampleIn order to report a higher afoot(predicate) symmetry than the actual value, the companys chief financial officer omitted some items such the accrue salary payable and supplies for the period. Based on the short case, two discussions will be prepared. The first discussion concerns whether failure to make adjustment entries would lead to an progression in the current ratio. The second analysis shows whether it is ethical for such omissions to be made, and the relevant accounting principle involved.The current ratio is utilize to measure the force of the company to meet all the current obligations using the current assets, and without exhausting the available current assets. The current ratio is obtained using the following formula = (current assets/current liabilities). Js Wedding Production required current ratio of 1.5 means that the companys current assets should cover the current liabilities 1 .5 times in front they are exhausted. Similarly, the actual current ratio of the business, 1.4 means that the current assets could cover the current liabilities 1.4 times before they are exhausted. The accrued salary payable and the supplies used during the year are categorized under liabilities and current assets respectively (Kapil, 2011). Their omission reduces the reported core current responsibility and also increases the stated amount of inventories (current assets) for the company. The total current liabilities are a factor of the current ratio. That is, current ratio = (current assets/current liabilities). Therefore, if the current liabilities are reduced by eliminating some liability items (the accrued salary payable) and the current assets increased by included the amount of inventories used during the period, the numerator element is increased while the denominator part is reduced, thus, leading to high current ratio (Kapil, 2011).Various users use the accounting inform ation for different purposes. The user is the investors, the employees,

Alcohol and tobacco use in pregnancy Essay Example | Topics and Well Written Essays - 1000 words

Alcohol and tobacco use in gestation - Essay ExampleA cigarette smoker is prone to withdrawal and nicotine dependance which makes the process of quitting smoking much difficult. Addiction is diagnosed when the smoking victim develops frequent use or compulsive seeking symptoms thus uses the substance without considering its adverse deductive reasoning to health as well as other unwanted consequences. Alcohol on the other hand does not have addictive components in its ingredients. However, it depends with the amiable perception of the person drinking. In this case, alcohol can be addictive in a certain capacity but does not have utmost(prenominal) symptoms such as withdrawal. Therefore alcohol may be easy to quit with the right use of the correct mental and physical therapies.Smoking during pregnancy might result to a raise in future nerve centre risk to the child. Mothers who smoke during the pregnancy period reduce the high-density lipoprotein which is also known as cholestero l in the babys body system. Cholesterol helps in the protection of the body against heart defects such as stroke and various heart diseases. Tobacco smoking and alcohol drinking have negative implication on the growth of the baby before and later on birth. The weight of the baby after delivery is directly proportional to the number of cigarettes smoked during the pregnancy period (Stockman, 2012). The baby of a smoker may have an estimated weight of between one hundred fifty and 250 grams. The infants of smokers experience retardation in all gestation stages. Low birth weight of infants who are depicted to prenatal smoking is connected to low enumerate tissue development and fat-free masses.The use of alcohol by women during pregnancy has negative implications on the growth of the unborn child. Fetal alcohol effects is a model used to refer to the aftermath implication of an infant in reaction to the alcohol in its system which is passed on to it by the alcoholic mother. one(a) of the fetal alcohol effects is developmental delay and retarded

Differentiating Between Market Structures Essay

Differentiating Between Market Structures - Essay ExampleThe attraction of the consumers is ensured through high quality products. The products where the phoner specializes in be not available easily in the securities industry and therefore the company has the opportunity to cement the consumer base. The company can thus figure the bargaining power of the consumers. The needs of the consumers can be readily analyzed and they argon assisted in taking the advantage of the buying opportunities. The clients are operate towards the shops with the help of the discounts offer. The supply chain managers of the company can recognize the importance of the customers in their business. They are aware that attracting more customers will involve more sales which in turn mean more revenue and profits. The customers are retained through the modes of product variety and low costs. The services offered are efficient and ensures that customers do not queue up in the shops of the competitors. The customer loyalty has been gained by the company through the modes of customer retention and widening up more opportunities for the customers which increases the customer sovereignty and the customers have the option to choose the products that suit their preferences. Competitors never got the chance to drive away consumers from Kedler Fine Foods. In order to compete effectively the competitors are forced to make additional expenses in terms of marketing and advertisements. Competitive strategies Branding ensures that the customers associated with the company believe in innovation and quality. The customers want value for cash and so the company engages in providing top quality support to them. The efficient delivery arrangement has paved the way for higher profits while the overleap in innovation can lead to reduced sales and revenue. The company has been able to invent new product styles and effective delivery system upon post of orders. Internet marketing is the strategy that was adopted by the company to promote the products. The website offers information on a variety of products, details on delivery system and some other information that may be necessary for the customers (Porter, 1985). The online customer relationship is an effective way of managing the business and to deal with the customers in prompt fashion. set is a strategy that tends to increase profits. The company enjoys the top position in offering fine quality products to the customers who bring quality with competitive prices. The company targets the pump class customers and focuses to cement the customers base with time. Market Structure The company operates in the market of perfect competition. A large number of small firms comprise the market for perfect competition. Each firm is small compared to the entire market. The comprising firms set the identical products. The customers as well as the firms are well informed about the prices. In the short run the firms can change only the va riable factor namely labor. The other decisions are predetermined. In the long run the firms have the latent to change their scale. In the short run when the existing price is less than the average cost curve it is better for the firm to close down. Several buyers are present in this market. The market offers products that are substitutable. There are no barriers to entry and therefore provides a level playing field for the new entrants (Etro, 2009). The forces of demand and supply determine the prices of the products and since the company under

HR & Communication in Projects - Weekly Discussion Topics Coursework

HR & Communication in Projects - Weekly Discussion Topics - Coursework ExampleAnother important impute that is life-sustaining in the building up of a aggroup is that the project manager should have exceptional organizational skills. A work example of the importance of this attribute is that before and during a project, good organizational skills will help the project manager to plan strategies and objectives that will allow the team members to perform in an optimum manner (Scott, 2014). It is also important for a project manager to display the attribute of confidence in both his and the abilities of his team. In the course of a project, footsure project managers ar secure in the decisions that they make concerning the team.There are also a number of attributes which although they are important to a project manager, they are not quite vital in the building up of a team. One of these attributes is effective negotiation skills. Whereas this skill is important in the resolution of body of work conflicts, it is found to not be as important to project managers in building up of a team. Another attribute that can be considered to not be vital in the building up of a team is empathy. A project example of the relative unimportance of this attribute is that although empathy is important in the everyday management operations, it can be found to not be as important when building up a team.A team process analysis can broadly be described as the process of evaluating the overall performance of a given team. The analysis seeks to try and establish the failures and successes of the team based on its efforts. To conduct an effective team performance analysis, there are a set of four key categories that are analyzed (Thompson. 2008). severally of these categories covers a number of key questions that must be answered before a project manager can be able to know how to plan for the in store(predicate) effectiveness of the team performance these categories areProductivit y In conducting a team performance analysis,

Children of Men Movie Review Example | Topics and Well Written Essays - 500 words - 1

Children of Men - Movie Review ExampleThis essay demonstrates that it is noteworthy that the only hope for the human suffering from sterileness is vested in a black pregnant woman Kee. The latter, in her turn, embodies the European myth of noble savage, the person representing a more authentic interpreting of people surrounded by a natural environment and living according to the rules of temper (Cornea 184). For this reason, human infertility in the film creates the opposition amidst people and nature because while people lose their ability to reproduce animals retain it, which is evident in the examples of farm animals in the immigrant camp. In other words, Kees racial identity symbolizes her return to the natural state of mankind, which is further stressed by her pregnancy as the sign of her close ties with nature. Animals are also hearty in the film because Kee makes her pregnancy known to her protector Theo in the barn standing surrounded by calves. The scene takes on symbol ic meaning because it equates Kee and her unhatched child with the Madonna and child as the only hope of humanity. What is more, the barn scene partially explains the reason for the human-nature opposition and ensuing conflict in the movie. Kee notices that the cows are mutilated to fit the particular types of milking machines serving human needs. In her view, it would have been more reasonable to adjust the machines to nature (Children of Men). Thus, it becomes evident that the denial of nature lies at heart of infertility treated as a broad concept in the film.

Travel and Tourism Industry of London Assignment

Travel and Tourism Industry of London - Assignment ExampleChapter 3 Methodology253.1 Introductions253.2 Quantitative research263.3 Qualitative research273.4 Analysis283.5 London A Haven for Connoisseur30Chapter 4 Questionnaire (Finding and Analysis)314.1 Introductions314.2 Front Office Manager314.3 F&B Manager324.4 Kitchen32CHAPTER 5 CONCLUSION33Bibliography34Appendices 36ALL THE TABLES AND FIGURESTables and figures 1.0 IntroductionThe travel and tourism industry is among the oldest and largest industry in the world, and the industry has been increase significantly faster than most other industries. globalisation has led to the increase in travel across the globe, and to meet additional pick ups for accommodation and food, hotels and motels have uprise up in a big way. The prevalent economic vitality of a country is an important consideration because an indication of its economic condition result be reflected in such(prenominal) factors as consumer demand and prices. In scannin g the economic environment, the following factors deserve consideration1. Gross National Product (GNP). This refers to the total market value of goods and services produced in a country per year and its growth rate. 2. Income distribution refers to the level of consumers income and his/her buying power3. Foreign exchange rates ar an essential component of the traveller, as he/she will have to carry foreign exchange during travel between countries. 4. Monetary and fiscal policies and exchange controls essential be considered, as there are countries that limit the amount of money that can be withdrawn from their country as well as apply large payments for international transactions, like vocalize ventures and entry into a... There are many business tactics that can be employed to bring about operational changes to manage talent effectively, such as identifying role models, eliminating biased policies and procedures, providing equal opportunities, training and development, and cond ucting workshops for employees to increase performance and production (David Pappie, p.103, 2006).The travel and tourism industry is among the oldest and largest industry in the world, and the industry has been growing significantly faster than most other industries. Globalisation has led to the increase in travel across the globe, and to meet additional demands for accommodation and food, hotels and motels have come up in a big way.The general economic vitality of a country is an important consideration because an indication of its economic condition will be reflected in such factors as consumer demand and prices. In scanning the economic environment, the following factors deserve consideration4. Monetary and fiscal policies and exchange controls must be considered, as there are countries that limit the amount of money that can be withdrawn from their country as well as impose large payments for international transactions, like joint ventures and entry into a country.5.

Britain ID Cards Debate Essay Example | Topics and Well Written Essays - 1000 words

Britain ID Cards Debate - Essay ExampleYes, a law was broken. Even though Transport Security Administration Officials argue that they did not violate the Privacy Act of 1974, the fact is that 5 million JetBlue customers had an expectation of privacy and did not admit to their personal information being turned over to a third party. They submitted their information for the purpose of obtaining a specific service and when doing so, did not consent to the base on balls of their information to any other party. Accordingly, in my opinion, both the spirit and the letter of the law were violated.According to several sources, such as CNet, Wikipedia, and DarkNet, the first calculating machine virus struck in the early years of the 1970s and was called the Creeper virus. The exact year of its release is unknown but it is commonly regarded as the first computer network virus.Secure Socket Layer (SSL) is a protocol that Netscape stimulated. In brief, it enables the establishment of a secure connection between web servers and web clients. Generally speaking, SSL employs the earthly concern key cryptology system as a means of ensuring data security during a transmission process. In an SSL session, both client and server create a unique session key which will be used for the encryption of sensitive data during SSL data exchange process.WRAM stands for Windows Random Access Memory. It is a type of RAM developed by Samsung Electronics for the achievement of faster display performance. WRAM is capable of the faster display as it supports two ports, allowing the video adapter to bugger off and display images while new image bytes are being loaded into its memory. It is, thus, much faster than the single port RAM1) Name Netsky.P Description In 2005, PC Magazine published an April Fools story which claimed that the Center for Disease Control had discovered that the Netsky.

Caring for Filipino Patients with Cancer Essay Example | Topics and Well Written Essays - 500 words

Caring for Filipino Patients with Cancer - Essay ExampleThe problem with the American health care practices lies behind the fact that most of the American physicians are practicing paternalistic decision-making and enduring autonomy (Schmit, 2005). In line with this, most of the American physicians are non aware that the practice of too much paternalistic decision-making and patient autonomy can lead to Filipino crabmeat patients dissatisfaction with regards to the health care services they go from the U.S.-based hospitals.The problem with the use of pure American health care system is that the American physicians may sometimes tend to forget about knowing how a Filipino cancer patient would prefer to discuss their discourse and care (Harle et al., 2007 Schmit, 2005). For example It is possible that most of the Filipino cancer patients would prefer to have at least one of their family members to be present while discussing the patients health diagnosis including the recommended treatment or medication that can enable the cancer patient to alleviate pain. Since American physicians are trained to practice patient autonomy and confidentiality, most of Filipino cancer patients are not able to be with their family members at the time the physician would discuss about their diagnosis.By nature, Filipinos are not confrontational. For this reason, nurses should assure the patients that it is good to ask them questions whenever they have doubts about the care and treatment they are receiving from the hospital and health care professionals (Schmit, 2005).For example In case a cancer patient is given a new medication, nurses should make the patient know that they have the right to know about the name of drug and purpose of the medication given to them by the nurses. In line with this, cancer patients or patients in general will ceaselessly have the right to refuse to take the medication.Despite the cultural differences between the American nurses and Filipino cance r patients, nurses should always build a

Under Armour Essay Example | Topics and Well Written Essays - 500 words

Under Armour - Essay ExampleThe fact that Under Armour has fewer sell stores it means that it has fewer powerful buyers who can often dictate terms. In terms of competitive rivalry, the two companies do not pose a earnest threat since Under Armour itself offers unique products. However, all the competitors father allocated a sizeable budget on research, meaning that they are likely to offer consistent products and services that may reduce attractiveness of Under Armour. Under Armour doesnt pose the threat of new entry since the other two corporations have the advantage of the economies of scale, and considering their budgetary allocations on marketing, Under Armour is less likely to capitalize on the threat of substitution.Under Armour has a major authority of manufacturing the most unique brand in the market. However, the weakness of fewer retail stores and the threat posed by other corporations like Nike and Adidas Group gives it a lesser advantage in the market.Broadening the companys product offering to all athletes and increasing its sale, designing kits that can be worn under distinct weather conditions, marketing and product promotion (Thomson, 2012).All the three companies are engaged in sponsorships and endorsements for product promotion and marketing. They have also allocated sizeable amounts of resources on research and development of new products. On one hand, Under Armour has the advantage of its unique products in the market, and on the other hand, it has a disadvantage of inauspicious competition in terms of capital against the other two.He needs to address the issue of the growing number of individual items produced, uncertainties surrounding consumer demand that affects hi-fi projections of items to order (Thomson, 2012), and how to acquire the lions share of the market.Carrying out proper survey in

Business Ethics Essay Example | Topics and Well Written Essays - 1500 words - 6

Business Ethics - Essay ExampleThe most straightforward definition of an honorable predicament is a clash between two goods. If we accept the notion that respectable teaching directs ones actions towards doing that which benefits the good of the majority, rather than that of the minority, then we get out begin to comprehend the concept of ethical dilemma as referring to instances wherein two alternate, and even conflicting, decisions may lead to equally good consequences. Diversity comprises an ethical dilemma because support for its realisation implies support for and the empowerment of marginalised groups. Objection to it, as in principles disputing its ethical base, are equally ethical because of their predication on the concept of merit, or the hiring of employees based on theory qualifications, irrespective of ethnicity, race, religion, gender or age. As either of the two positions is, arguably, ethical, a final determination of which of the two is more ethical rests upon th e analytical assessment of both perspectives from within the framework of ethics theory. A review of the literature on workplace diversity reveals that numerous scholars dispute the argument regarding a direct relationship between ethics and the attainment of employee diversity.

Managing Homeland Security Essay Example | Topics and Well Written Essays - 1250 words - 1

Managing Homeland Security - Essay ExampleEmergency managers, in their pursuit of tackling diminutive problems, need to make the best use of available resources, and act efficiently during disaster situations. Although the role of an emergency manager is magnified only during problematic conditions, his action is nevertheless an on-going process. The department of emergency management is required to prepare in advance for potential disasters, respond effectively during disasters, and ensure the well-being and settlement of residents aft(prenominal) the disasters are over. Emergency Management departments try their best to make sure that the opportunity cost of emergency management actions such as emergency prep and hazardare less than the long-term losses incurred from maximum credible disasters.As the Emergency Management Coordinator, it is my job to have proper hazard and photograph analysis of the city conducted frequently, and facilitate training to task-forces, as well as citizens to ensure that the city is prepared to handle catastrophic situations at all times. These trainings cannister be done in the form physical exercises and drills, or dissemination of safety instruction. Also included as part of my duty is the creation of impudent positions and policies for the innovative and initiated minds, redefining responsibilities and considering budget requirements. Moreover, I shall endeavour to form coalitions with banks, insurance companies, local government agencies, and other forms of community groups so as to reduce disaster losses to the city and its residents.When a situation arises, it is important that emergency managers work in collaboration with other public service and safety departments like the police force, turn on department and paramedics. To achieve unanimity of purpose, an emergency manager can work towards ensuring that public safety departments are in frequent contact with each other, and information flows through them without barriers of

Developing YORKLAB HR strategy Essay Example | Topics and Well Written Essays - 3250 words

Developing YORKLAB HR strategy - Essay ExampleThe company tries to retain its customers by ensuring timely delivery of goods which in turn enables to run across growth for the company throughout the year. Yorklab follows a flat organisational structure, which ensures a wide span of control with fewer direct of management. The structure allows the company to be slight costly, with less management levels. This structure will ensure a better and quick flow of decision within the organisation. Moreover, it will have a dissipated and clear communication of messages from the management ensuring timely and quality product. This structure helps the company to keep a proper track of the sales and the services provided. The HR indemnity of the company facilitates in employing people who have knowledge regarding the process and are friendly and ready to work in team. Satisfying the customer is the primary motive(prenominal) of the company and this is the core reason for the success of the organisation for years. The company is in the need to expand its business into new areas of the market. In this context, the management realises that the current HR system or management structure will not be able to sustain the market growth. The HRM concept used is to bind the employees and the management to get the goal of the company. It entails the planning, controlling and organising the employees to add value to their service and arrive at the desired objectives. In this regard, the objective of the paper is to explore the efficient structure requirement of the company, to relieve the issue related with the market expansion. The upgraded HR strategies are required to be implemented by the Yorklab in order to attain profit and growth in the market. HR Strategy Content Human resource management is a strategic approach on managing employment and relation in order to achieve competitive advantage. The competitiveness of a business depends on the manager, employees and the knowl edge and training provided. Yorklab in this regard followed the flat structure of management, with a few number of employees and a wide span of control. This structure had various advantages such as the fast communication of information and quick decision regarding the process improvement. The fewer strata of management in like manner help Yorklab to have a better recurrent communication between the higher level of authority and the staff. The purpose of the company is to expand its business property in view the quality and the level of customer satisfaction. This was not possible with the current flat HR strategy used by the company. As the level of guidance and coordination between the management and the employee was less there was no proper co-ordination. With the expansion of business, the current number of employee would not suffice the need of the company. With the increase in the business activities, the complexities would increase and the current flat structure would not s upport the requisite. The flat strategy with wider span of control renders less amount of time to centering on the individual decisions. This can thus be of a great disadvantage for taking significant strategic decisions which will have a long-run impact on Yorklab (Education-Portal,

How to get a Grant up and Running Essay Example | Topics and Well Written Essays - 500 words

How to get a Grant up and Running - Essay Examplea Seriousness, the co-chairperson of the Grants Committee said that, We need to use this give up money to fund studies and to create pilot programs which can become self sustaining with regard to prevention and education concerning the conundrum of underage drinking in the job Force. Jack Notso, the co-chair of the grants committee was briefer in his dictation when he said, We finally got the money. Lets see who deserves it.This is likely to be an important question since on that point are individuals within the placement who have presented their own ideas with regard to what could be done with the money for the grant. A poster and media campaign targeting the argument Force had been suggested to begin with but was turned down on account of being too broad. Another plan for implanting experimental medical monitoring chips within the bodies of underage Air Force officers was also turned down when ethical and privacy related ques tions came into play.The grants committee is looking for workable solutions which will have the least impact on the lives of Air Force officers while giving them awareness about the issue and teaching them the idea of responsibility with regard to underage drinking. This is certainly a problem which needs a solution but no quick fix or partial solution will be acceptable to the organization. It is clear that the organization is looking at the long term when it comes to solving the problem of underage drinking in the Air Force and that the projects or studies conducted under the grant should be self sustaining after the initial funding has been provided.More information about the grant and the application forms are available from the website or the offices of the organization. The grant request statement has to explain why the grant is being requested as well as give a detailed outline of what the money would be employ for. Practical solutions that can sustain themselves for a numbe r of years are to be given priority over studies and research

Self Assessment (Final Portfolio) Essay Example | Topics and Well Written Essays - 750 words

Self Assessment (Final Portfolio) - Es formulate ExampleTo put it simply, I must say that I lacked a direct human relationship with the voice communication. However, after joining this class, in the course of time I contrive developed a true love and appreciation for the English language. My approach towards learning English language is no more than, dry, but is marked by lot of emotion, enthusiasm and interest. One otherwise important thing that I learned in this class is the importance of making mistakes, as far as the task of learning a language is concerned. In the initial stages I somely got disheartened by the number of mistakes I made. Sometimes I strongly felt that I will never be able to have a good grip over the English language. However, later on I realized that every time I made mistakes, I learned many new things, which correctd my English a lot. So slowly I got over the fear of making mistakes. With the musical passage of time my writing skills began to improve. On the basis of the things I learned by making mistakes, I began correcting and improving my previous drafts. No wonder, these corrections made my drafts more grammatically correct and meaningful. I realized that I could express my views and emotions in a much better way than before. I know I equable have a lot to learn. But, now I take this challenge with much enthusiasm and hope. The most important thing that this class did for me was to allow for a direct exposure to the concepts of culture and identity by making us read the stories written by famous writers. This class also allowed me a get hold to watch three global films. Both these experiences of reading stories and watching films helped me improve my communication skills and made me better at expressing and conveying my views and feelings. Out of the three international films I watched, the film that impacted me most was the Iranian film The Color of Paradise. This film was about the story of a blind boy Mohammed, who is disliked and spurned by his father because of him being blind. His father felt that his blind son Mohammed would spoil his plans of getting a new wife and leading a intellectual and prosperous life. What particularly impressed me in this film was Muhammads ability to enjoy the beauties of nature, despite his being blind. I was touched by his sadness and his intuitive feeling in himself and God. I believe that all of us have a little Muhammad inside us. All of us may be not be blind. Still, many a times many of us are unable to convey to others what we think and feel due to many problems like not wise to(p) a language or not knowing how to phrase what we intend to say. In that sense I identified with Muhammad. Watching this film encouraged me to improve my communication skills and my ability to interact with others. Out of the stories that we read, the whizz that interested me most was Bloomington, Fall 1971. Though I found the story to be very interesting, the one thing that i mpressed me most was the mastery of the writer over the art of writing. This story showed to me how language can be used to communicate and convey the most deep seated emotions and feelings. This story made me respect the power of writing. It motivated me to work hard to improve my writing skills and to be able to communicate with others in a much better way. Overall, I must say that this class has led me on to a journey towards improvement and ambition. Whatever I have learned in this class will surely make a good foundation for further improving my writing and communication ski

3-Year Marketing Plan Essay Example for Free

3-Year securities industrying Plan EssayIntroductionIn order that we continue our companionships monetary growth, we pauperism to branch out into new product lines. A study was performed to consider our entrance into the front-runner supply market. We flummox true a new single product for that purpose. It is a Cordless Automatic Nail Trimmer for dogs and cats. The findings of this study be in this presentation. Our numbers ar conservative. The say-so for success is high. We ar Comp all G are always looking forward to find and implement new lines that pass on complement our Mission statement, and our stooge line. This is our next opportunity introduces Company G and the product or product line that you are writing this marketing plan somewhat.Mission StatementWe change consumers to improve the quality and convenience of their lives by providing innovative electronics solutions.See moreMasters of Satire John Dryden and Jonathan Swift Essay ingathering Description an d categorizationThe Cordless Automatic Nail Trimmer for Dogs and cats exit be our first entry into the world of pets. This product uses a sensor to find the quick (the squeeze of nerves and blood vessels) on a pets nail, then adjusts to a spot just below it. It turn offs the nail, rotates to the next nail, and repeats the process, until trimming each nail on the paw. manifestly remove the paw, and continue on each paw until done. Our trimmer depart avoid the pain of cutting the quick with bleeding. It will not cause self-consciousness for the animal associated heat build up from electric nail trimmers. This product will allow anyone from novice to professional to trim a dog or cats nails to perfection. Rather than making an appointment, going to the local pet groomer, paying $7 to $25 (before tip), or big box, a pet owner can trim their pets nails at home. If the owner would rather have the nails done, they can have their groomer use our tool, giving the pet owner peace of mi nd, knowing their pet will not suffer any pain.Consumer Product ClassificationConsumer FactorsPlanning time involved in purchasePurchase frequencyImportance of cheerful locationComparison of price and qualityConsider suitableInfrequentImportantConsiderableShopping ProductsSpecialty ProductsShopping ProductsShopping ProductsMarketing Mix Factors expenseImportance of sellers image dispersion channel lengthNumber of sales outletsPromotion relatively highVery importantRelatively shortFewPersonal selling and advertising by producer and sellerShopping ProductsShopping ProductsShopping ProductsShopping ProductsShopping ProductsTarget MarketThe target market is between the ages of 30 and 45 with busy lives, looking to save time and money. Their incomes would be greater than $60K. This will include professionals, as salutary as working couples. We will target both existing dog or cat owners, as vigorous as new entrants to pet self-control. competitive Situation psychoanalysisAnalysis o f Competition development Porters 5 Forces ModelCompetitive RivalryToday are no post competitors. We are entering an existing market, with a completely new technology. The closet rivalry is the electric trimmer, produced by Dremel Tools and Oster Company. These products do NOT have the features we have. They do not comparability in experience. thither is no threat at this time.Threat from New EntrantsWe have the threat from two outside entrants to create a flush off version of our automatic nail trimmer. The two companies that could attempt to enter the market are Dremel Tools and Oster Company. The threat to us is medium for a few reasons. We will patent our trimmer, which means that they will have to start with our product, and then develop modifications, to avoid patent infringement. Both companies current products use a different sweet of technology. They are grinders and do not have any quick detection apparatus. While Dremel Tools has been in the pet trimming market for s ome time, they but modified the grinder used for woodworking and other craft projects. This would be a departure from their core competency. This is the only venture by Oster Company. They a relatively new to the market, It isnt likely that they will put more R and D dollars into a second pet product at this time.Threat from BuyersThere is no threat to us from vitiateers. Pets must have their nails trimmed on a regular basis, or they can suffer pain and / or wellness issue. The owners of these pets are responsible to maintain their pets nails. With the addition of our safe, reliable, easy to use product added to the market, buyers have all of the options they could want. At our price point, they would not consider creating a sympathetic product. It is an infrequent purchase for them. We will also establish a blog site to give our customers an opportunity to help us determine if they desire any additional features.Threat from SuppliersThere is very gnomish threat to us from our t wo suppliers. Vendor A is supplying us with the heat-sensing component to our trimmer. The device they are producing for us helps to expand their bottom end line of heat sensors. This represents a 10 percent addition to their offering. The main customers for Vendor A is the Armed forces, who buy heat sensing devices for airplanes, tanks, and vision goggles for ground troops. They do not have the infrastructure to build a product such as ours. They would not take on the capital expense to enter this type of manufacturing. They do not have any retail, on-line, distribution experience, or presence. Vendor B who supplies us with the stainless steel blades are in a similar situation. Their main customer is the medical, surgical industry. Vendor B manufacturers high end surgical blades, knives, as well as blades for mens razor blades. Our product represents a new product in between in quality. It is not significant equal for Vendor B to start an entirely new type of product for themThrea t from SubstitutesIn the current market, there are threats from substitutes.People not using our product can use manual nail clippers, grinders, or pay someone else to trim their pets nails. The threat to us does not exist. All pet owners are currently using one of these venues today. With the quality, ease of use, time and money savings, and cruelty free aspect of our trimmer, virtually nobody will revert to these substitutes.SWOT AnalysisBefore we risk our profits or our blemish value, we took a critical look both internally, and externally. The intent is to consider how we can leverage the positives, improve on our weaknesses and prepare for outside threats. Here are the findings.STRENGTHS *indicates core competencyFinancial health*Efficient manufacturingBrand Reputation*WEAKNESSESLack of trainingLack of Distribution networkNever advertised pet productsOPPORTUNITIESPet ownership on steady risePersonal time on decreaseEconomy is change magnitude expendable incomeTHREATSPossible newer technologyEconomic downturnHeat sensor supply issueStrengthsFinancial health is one of our core competencies. We have a very low debt-to-equity ratio, combined with a credit rating. This gives us the flexibility to create initial inventory and cover the typical start-up costs related to a new product line. Brand reputation, another core competency, means that we are already in the homes of many of our targeted customers. They know we produce high quality, well designed, products. Our brand is a trusted name nationally. Efficient manufacturing is another of our strengths. It allows up to produce our goods at a lower total cost compared with competitors. We run our production lines quickly, with little waste, or re-work. This helps for reliable batch production, and very few quality / defects issues in the field.WeaknessesLack of training for our production line associates is a potential issue. Production will be slower, risks quality compliance, and will cost more per unit comp ared to our established lines. Lack of advertising relationships within the pet market is another weakness. We do not advertise at all aimed at pet owners. We do not understand what the costs are, compared to our other product lines. We will not be able to bundle the new lines advertising with our other lines, for a volume discount. Our sales force is not equipped to demonstrate our new product line. We will need to higher trainers, and new sales pile that are specialists specific to the new line.OpportunitiesThe economy is on an upward trend. As wages increase, so does expendableincome. This allows people to purchase pets, supplies, and services. This applies for either new or existing pets in the household. Personal time is on the decrease. Wage earners are spending more time working. Parents are spending more time driving their school-aged children to sports, music lessons, and dance classes, etc. These parents will also attend the events surrounding the activities. Taking Fido to the groomer and picking him up ulterior is another time eater. Being able to trim nails effortlessly, in your own home, on your own schedule has a good deal of appeal. Pet ownership is on the rise. In 2013, there were 82.5 million pet owners in the United States. This number is expected to rise to 92 million by 2018. In 2013 $4.4 one thousand million dollars were spend on grooming and boarding. In 2014 sales rose to $4.7 billion, a 7% increase. This is a growth industry.ThreatsEconomic downturn could croak a viable threat. As expendable income dwindles, pet owners could potentially purchase less expensive nail trimmers. They could also choose to go to a groomer, but do so less often as a money saver. A supply issue could threaten our ability to produce our product. A shortage of the heat sensors could become an issue. If our vendor chooses to increase the price of the sensors could become an issue as well, reducing our margin to an unacceptable level. Development of a newer t echnology is a threat. A competitor, on a new company could start making the next generation of automatic trimmers. Dependent on the features, or price, we could lose market share.Market purposesProduct ObjectiveSell 100K units by 12/31/2016.Price ObjectiveAchieve a profit of $500K by 12/31/2016.Place Objective arrive at our product on the shelves of 2 national chains, and in 200 independent retail pet supply stores by 9/15/2015. Have an on-line presence by 9/1/2015.Promotion ObjectiveOur objective is to have 250K hits on you-tube demonstration by 1/1/2016 and 100K hits on our website specific to the new product line by 6/1/2016.Marketing StrategiesThis section will introduce you to the particular strategies, which will assure that we strive our objectives. You will find them well thought out and comprehensive. We took the necessary time to be confident that they are inter-related and logical, using previous maneuver which have been winning here at Company G.Product StrategiesPac kaging use our trusted XG logo and recognized style of packaging. Great Warranty offering a two-year warranty, this is better than current electric trimmers in the market. This is in line with our warranty for other product lines in our assortment. Dedicated Help Line have a 24/7 help line specific to this product line. It will give advice, answer questions, and take care of issues that arise for customers.Price StrategiesMarket set Skimming pricing of $89.99.Good Terms we will give 2% net 30 days pricing to our distributers. Advertising Allowances $5 per unit sell for preapproved advertising campaigns. We will require proof of sales and give credit within 30 days of campaign end date/ Place Strategies sell Stores 2 National chain stores and 200 local pet stores based on their sales. Web presence We will sell through Amazon.com, as well as on our web site. Quick shipping We are going to use Amazons distribution Centers to ship to retail stores and directly to customers. Th is will be the most efficient use of our finished goods inventory.Promotion StrategiesPersonal selling We will provide demonstrations at dog shows. Social media We will have a You-tube presence, and a Face book presence. Discount / Donation We will give customers a $5 discount and donate $5 to the Humane social club for the first 50K units sold.Explanation of StrategiesThese strategies are a combination of approaches. We are going to use our strong brand name and recognition to take advantage to the consumers trust.If they compare our product to Dremel or Osters trimmer, they will see we give them a superior warranty. We will get our product in front of millions of potential customers at dog shows. There are dog shows of various types happening every week across the United States. The retailers that we target will get good financial terms, along with our strong brand name. Our you-tube presentation will prove to customers just how easy and safe our trimmer is. We will also appea l to the good temperament of pet owners will our donation to the Humane Society.Tactics and Action PlanIn order to assure our success we need to put specific tactics in place. They need a due date and responsible party, so anyone in the process can see if we are adhering to our timeline. We know whom to ask about any given tactic as well.

Boldwoods Christmas party Essay Example for Free

Boldwoods Christmas party EssayBathsheba Everdene is the main character in a Thomas Hardy novel called Far From the Madding Crowd. Which is set in Wessex. Bathshebas character is along with many other things decisive, brisk, vain, businesslike, and independent. However you get a line her evolve throughout the book, mainly as a result of her marriage to click Troy. At the antecedent of the story Hardy seems to focus on her bad qualities, though you still see great deal wishing to be married to her. Some correct qualities are sh experience as well like her thoughtful response to save Gabriels life. Her first fault is vanity.This trait is mentioned in chapter one, almost everything else follows on from this. Vanity affects the look she be absorbs in a powerful way. Her vanity makes her annoyed and angry at not attracting Boldwoods attention. When she meets Frank Troy he plays up to her vanity by compensable her compliments and showing her flirtatious affection. By the end of the story she shows that she has grown out of or overcome her vanity. Instead of wanting to stand out and mystify everyone looking at her, at Boldwoods Christmas party, she dresses down and wants to merge into the background.You tin also see she is not vain because when Boldwood praises her beauty the comments have no effect. Her life experiences have caused this change in her. The main life experience is her marriage to Frank Troy which affected her the most. She transforms from a confident character to a submissive and introvert figure she becomes less and less like her usual self. The first sign you see of independence is fairly near the beginning in chapter three, when we see her move the horse.Instead of doing it the conventional ladylike way we see her lie flat on her back on top of the horses back. This could be showing her independence and improper behaviour, this would tie in with an independent spirit too wild. She likes to have independence so later on in the story when this is taken away from her we see her rely on Gabriel Oak. She always had her own independence, but when she got married she lost that independence and we see her seek advice and help from Gabriel Oak.At one point in the story she rejects Gabriels advice, but later on in chapter fifty four she asks for it. This shows a big change in her personality. She once would have done her own thing and maybe even sacked Gabriel for his advice whereas she now determine both him and his opinion. Her independence continues to be shown throughout the rest if the story, even after her marriage to Frank Troy. Independence along with assertion is showed when she goes to the corn market and is the only woman there. Another characteristic shown is confidence with businesslike skills.An example of this would be when she takes it upon herself to sack her bailiff. I have formed a resolution to have no bailiff at all. Bathshebas confidence continues to be shown with her decision to pay the workers herself in chapter ten. Bathsheba has a lot of confidence in herself. In short I shall astonish you all. This is said shortly after her decision to have no bailiff when she is convincing the staff that she give the bounce manage. The barbarism shows her self-confidence shining and her belief in her own ability.Towards the end of the novel we see her find an even balance between the overconfidence which she showed through the beginning of the novel which made her appear full of herself, compared with when she had little or no confidence and relied on Frank Troy, to finally become a person who can cope on her own but realises she cannot do everything to the best of her ability without assistance. Before we see her lose her self confidence she shows she believes in herself by deviation to the Corn Market, making her the only woman present.One thing bothers Bathsheba the fact that Boldwood is the only person who does not take notice of her. This lack of attention shows us how she cra ves to be the centre of attention you could even go as far as calling her an attention seeker. She will do silly antics in an guarantee to attract peoples attention. For example the Valentines Day control board. Bathsheba tries to make herself popular with everyone especially men this seems to be her biggest desire. In chapter thirteen she mischievously sends a Valentine card to Boldwood to attract his attention. This starts Bathshebas change.She wants people to notice her and does not sit around waiting she takes action for herself. The sending of the Valentines card shows her vain characteristic. A big characteristic she shows throughout is impulsiveness, she does things without thinking. The Valentines Day card is an example of this another example of this earlier in the book is when she chases Gabriel Oak after he had been wrongly informed that many men wanted her mess in marriage though she did not want to accept his proposal. She did not think that her actions would show th is until after the conversation her and Gabriel had.Many of her actions are on propensity she doesnt think things through first. Later on however she takes time to think about Fannys grave and she decides to clean it up and replant the bulbs on it. This also shows she can be selfless. When Gabriel gives her advice early in the novel she decides she doesnt like what he has to say. She sacks him whilst she was angry and acting highly impulsively. This demonstrates how she doesnt want to face the truth even though she values his opinion later in the novel after the drowning of Frank Troy she relents asking him for his thoughts.

Impact of Crystal Meth Addiction

Impact of Crystal Meth AddictionBy the time you be in elementary you already read some k immediatelyledge on medicines. They affect us in various ways, former(prenominal)s even personally. For Luke it became a personal issue.At first he began sustentation in the house of a quartz glasslisation ice rink addict to research the medicate and experience first-hand how it affected others. Originally he had no intention of winning the drug, exactly after some time he fell into temptation. Since the house he was living in was full of lechatelierite meth and crystal meth addicts its not surprising that this ending up happening. At first he would only use it occasionally/recreationally. He felt that he could bring through more while victimisation it and that non-user were weird for not using it. According to him it was cheap, it helped him lose weight, and it was really fun. I felt creative, confident and productive. (Luke Williams)But after sometime this recreational drug became something he could not live without. Luke then became an addict and began to experience psychotic episodes and aggression. Because of crystal meth he felt that e genuinelyone was out to nonplus him and wanted to kill him. This is when he realized that he needed to stop. He went to a hospital, but they offered him pretty much no help and were very unsympathetic. The discount where he used to live kicked him out and finding a place to stay became a difficult task. He lived with other crystal meth addicts but they began to flip out on him, leaving him with no choice, but to return home. His parents were very kind and took him in and helped him with his habituation. Learning to cope with the after effects of crystal meth was hard, but with the help of his parents he is now living a normal healthy lifestyle. Although he no longer has that many friends he feels better, because now he doesnt relieve oneself bad influences around him. He realizes how dumb he was for taking crystal met h and encourages others to never set about it (Williams).But where did this drug that destroys so many homes and lives come from? This drug is a man-made stimulant that has been around for a long time. Crystal meth was originally made by the government during World War II to help soldiers stay awake. But after realizing the after affects it had on the soldiers the government decided to ban it. Most of the crystal meth in the United States comes from Mexican super labs. Although people still make it here in the U.S. its usually inside their homes. Its very dangerous to make because of the chemicals involved which are very explosive. Crystal meth comes in clear chunky crystals resembling ice and is most commonly smoked.You can advert Crystal Meth addicts by certain characteristics/behaviors that they exhibit. One of the first things that you will start to notice is that they do not care about their personal carriage or hygiene. They continually pick at their hair and skin which cau sing themselves nasty looking sores. And they get pimples that are hard to get rid of. They are also more likely to steal to pay for their addiction. Angry outbursts and mood swings are very common in crystal meth addicts. Other affects it has on the body is raising the body temperature to an abnormal level, so high that the user could pass out or even die. They lose appetite and weight dramatically. Dilated pupils, quick eye movement, anxiousness, confusion, insomnia, unsafe sex, violent outbursts, and twitching are some of the after effects of crystal meth. Users can become paranoid and hear and see things that arent actually there (hallucinations). (Ratini)But why do people take this drug? What makes it so addictive? The powerful gripe people get from using crystal meth makes a lot of people get hooked right from the start. When its used, a chemical called dopamine (chemical in the brain that floods parts of it that get feelings of pleasure). Users also feel confident and ener getic. A user can become addicted quickly and soon finds he will do anything to have the rush again. As he continues to use the drug, he builds up a tolerance. That means he needs higher doses to get the same high. The higher the dosage of crystal meth, the higher the risks.How do you get clean from such a powerful drug? How do you liberate yourself from its iron grasp? Since most people who try crystal meth are immediately addicted to it, its very hard to get clean from it. Actually its one of the hardest drug addictions to beat. muckle who are addicted to crystal meth usually cannot beat the addiction on their declare and require overlord help. They either need a professional counselor or drug treatment program. For the first few weeks their bodies will go into withdrawal and they will only be able to eat and calmness because their mind and body are too tired to do anything else. They will feel anti-social and may have violent outbursts. During the whole withdrawal your body i s shriek for meth. This is the hardest part of getting clean. Then they go through a honeymoon phase where they feel super confident. Most people have a reverting during this moment because of how over confident they are. Then comes more depression and boredom after this. Finally they move into the adjustment phase where they begin to adjust to troupe and life in general. Staying clean is a daily choice so its an ongoing recovery.But how does this drug affect your spiritual life? dissolve you still have a close relationship with God while doing Crystal Meth? No, you cant Of course the Bible never in a flash talks about drugs but thats because they were not around during those days. But it does talk about addictions. All of the apostolic exhortations to remain sober-minded and alert are knowing to remind us that we must be vigilant against the snares of the Devil who seeks to ensnare us through deception. (1 Peter 58) (1 Corinthians 1534 1 Thessalonians 54-8 2 Timothy 45 1 Pete r 113 47 58) All of these texts talk about world sober and how can you do that if youre so high you dont even know your name? Sobriety is also important for plea (1 Peter 47). As Christians, our bodies are not our own, we have been bought with a price which is the blood of Christ (1 Peter 117-19) (1 Corinthians 619-20). Having bought us with His own life if we pollute or harm our bodies we desecrate the House of God (1 Corinthians 316-17). So I guess all this answers the question if you can or cant be high and still consider yourself a devoted Christian.In the beginning I mentioned that Luke began to use the drug because he was nave of its effects on the human body and what crystal meth actually was. After reading all of this information I feel like he would think twice before trying the drug. People dont usually think about the effects drugs have on your body and never stop to consider the after effects. But if it is all written out for you and personal testimonies are added then its a lot easier to stop and be informed about the drug. This type of information would have saved Luke from a lot of pain, hardship, and danger. And all though he wasnt a Christian, the texts from the Bible can be very helpful to Christian youth who are experimenting with different things. Many people are ignorant and think that just trying a drug once will not affect them later on and that they are just going to do it once recreationally. Unfortunately this is not the suit of clothes 99% of the time. Because crystal meth is so strong people get addicted to it the first time they try it and it is really hard to stop the addiction that is why Luke had such a hard time. To prevent things like this from happening we need to direct out against drug abuse and inform people on what Crystal meth and drugs in general do to your body. We need to let them know that they take control of your life and leave you worse than you ever were before. And battling drug addiction is a lifelong thing because your body will always crave the drug. Crystal meth ruins hundreds of lives, families, relationships, and homes each year that is why we must speak out against it now. Luke didnt have people in his life to inform him, but think about the people you know that are messing around with drugs have you taken the time to inform them? Dont let them go through all the things Luke went through.Works CitedPetit, Aymeric. J Addict Res. Methamphetamine Addiction A Review of the Literature (2012) http//omicsonline.org/methamphetamine-addiction-a-review-of-the-literature-2155-6105.S1-006.php?aid=3893.Ratini, Melinda. crystal meth what should you know. 16 september 2014. 6 may 2015. .Williams, Luke. life as a chrystal meth addict. The saturday Paper 2 8 2014 2.

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay

The Lung Chronic unhealthiness Bronchopulmonary Dysplasia Nursing EssayBronchopulmonary dysplasia or BPD is a form of chronic lung disease that move ups in preterm neonates and is tradeed with type O and confirming- thrust airing (PPV). In this paper I will discuss exactly what bronchopulmonary dysplasia is, its pathophysiology, the etiology, its clinical presentation, and any differential diagnosis of the disease. I will as well as present in my research the preaching and worry for the disease, its prognosis, and the sequelae.Bronchopulmonary dysplasia formerly known as Chronic Lung Disease of Infancy is a chronic lung disorder that is more than prevalent in nestlingren who were born prematurely with low birthweights, and whose lungs energisent had the time to fully develop. White male infants take sustainment to be at a greater pretend for development, and genetics whitethorn contri yete to nigh of these cases. It is also really common in those who entertain cur rent prolonged automatonlike ventilation to treat respiratory distress syndrome (RDS). It is ironic that the treatment for RDS is considered to be the prime ca white plague of BPD. With the treatment of RDS the patient is treated with eminent pressures and high FiO2 over a period of time. Its the high pressures of type O delivery that rear end result in necrotizing bronchiolitis and alveolar septal spot this action supercharge compromises the oxygenation of line of products. Bronchopulmonary dysplasia is characterized by inflammation and scarring in the lungs. The signs and symptoms to watch out for ar the oxygen demands of the infant not diminish as they should, in some cases even increasing. steady breathing, a fast heart rate, fl ared nostrils, retractions, poor weight gain, and coarse crackles may be heard upon auscultation.The pathophysiology of BPD is linked to four factors. These factors are oxygen toxicity, barotrauma, the presence of a PDA ( unmixed ductus arterio sus), and fluid overload. Exposure to high concentrations of oxygen tooshie lead to edema and the thickening of the alveolar membrane. When you have prolonged exposure it causes the alveolar tissues to release and become necrotic. As the disease progresses the interstitial spaces will become fibrotic. When the lung tries to heal itself, all of the new cells are scathed by the same factors as before, and it continues in a cycle. All of this digest interfere with alveolarization and lead to alveolar simplification with a reduction in the pop out area for accelerator pedal transposition. Any damage to the lung during a critical stage of growth will result in significant pulmonary dysfunction. With patients who have left-to-right shunting through the PDA it is more likely that they develop pulmonary congestion and worsening compliance. With this problem the patient will need higher ventilatory pressures and oxygen percentages to sponsor with ventilation and oxygenation therefore they have a higher risk of BPD.Bronchopulmonary dysplasia develops as a result of an infants lungs becoming nettled or inflamed. The lungs of premature infants are very fragile and arent fully developed, and therefore they can become easily irritated. Ventilators are used to help with the breathing by using pressure to blow air into the air hoses and lungs. However it is the pressures used that can irritate and harm a premature infants lungs, so they are used only when absolutely needed. Sometimes oxygen therapy is given to make sure that the infants brains, hearts, livers, and kidneys get seemly oxygen to work right. However in some cases high levels of oxygen can inflame the lining of the lungs and injure the respiratory tracts, it can also slow lung development. some other cause is infections that can inflame the underdeveloped lungs of premature infants. With this problem it causes narrowing of the skyways and makes it harder for infants to breathe. Lung infections can al so increase the need for extra oxygen and breathing raise which in turn leads to the ventilation and extra oxygen requestments. There are some studies also show that heredity plays a role in causation BPD.Infants with bronchopulmonary dysplasia will have ab expression findings on physical exams, chestx-rays, pulmonary function testing, and histopathologic examinations. Initial findings observed shortly afterwards birth are consistent with respiratory distress syndrome (RDS). Persistence of these abnormalities can be associated with an increased risk of bronchopulmonary dysplasia. Physical examination may reveal tachypnea, tachycardia, increased work of breathing, including retractions, pinched flaring, and grunting, as headspring as frequent de saturations and significant weight loss during the first 10 long time of life. Infants with yucky bronchopulmonary dysplasia are often extremely immature and had a very low birth weight. Their requirements for oxygen and ventilatory s upport often increase in the first 2 weeks of life. At weeks 2-4, oxygen supplementation, ventilator support, or two are often increased to maintain adequate ventilation and oxygenation.Dif DX Atelectasis refers to collapse of part of the lung. It may include a lung subsegment or the entire lung and is al just about forever a secondary phenomenon, with no sex or race proclivities however, it may occur more frequently in younger children than in older children and adolescents. The exact morbidity from atelectasis is transient hypoxemia due to telephone circuit flowing through the lung, which does not have normal air flow. The blood does not pick up oxygen from the corresponding alveoli. This shunting results in transient hypoxemia.HypertensionPatent ductus arteriosus (PDA) is one of the more common congenital heart defects. The presentation widely varies. Depending on the size of the patent ductus arteriosus, the gestational age of the neonate, and the pulmonary vascular resistan ce, a premature neonate may develop life-threatening pulmonary overcirculation in the first few days of life. Conversely, an adult with a small patent ductus arteriosus may present with a newly discovered murmur well after adolescence. During fetal life, the ductus arteriosus is a normal structure that allows most of the blood leaving the right ventricle to bypass the pulmonary circulation and pass into the descending aorta. Typically, only about 10% of the right ventricular output passes through the pulmonary vascular bed.Pneumonia and other lower respiratory tract infections are the leading causes of death worldwide. Because pneumonia is common and is associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly recognizing any complications or underlying anatomys, and appropriately treating patients are important. Although in developed countries the diagnosis is usually made on the basis of radiographic findings, the World Health Organization (WHO ) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and on timing of the respiratory rate. (See clinical Presentation.) Pneumonia may originate in the lung or may be a focal complication of a contiguous or systemic inflammatory process. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. These derangements often significantly alter gas exchange and dependent cellular metabolism in the many another(prenominal) tissues and organs that determine survival and contribute to quality of life.Subglottic stenosis (SGS) is a narrowing of the subglottic airway (see human body below), which is housed in the cricoid gristle. The subglottic airway is the narrowest area of the airway because it is a complete, nonexpandable, and nonpliable ring, unlike the trachea, which has a posterior membranous section, and the larynx, which has a posterior muscular section.Tracheomalacia is a struc tural freakishness of the tracheal cartilage allowing collapse of its walls and airway obstruction. A deficiency and/or malformation of the supporting cartilage exists, with a change magnitude in the cartilage-to-muscle ratio.Immaturity of the tracheobronchial cartilage is thought to be the cause in type I, whereas degeneration of previously healthy cartilage is thought to produce other types. Inflammatory processes, extrinsic compressing from vascular anomalies, or neoplasms may produce degeneration.Diffuse malacia of the airway of the congenital origin improves by age 6-12 months as the structural integrity of the trachea is restored little by little with resolution of the process.Treatment and management Treatment in the NICU is designed to limit stress on infants and meet their basic involve of quickth, nutrition, and protection. Once doctors key BPD, some or all of the treatments used for RDS will continue in the NICU. Such treatment usually includes exploitation radian t warmers or incubators to keep infants warm and reduce the chances of infection. Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies bodies. Using sensors on fingers or toes to check the amount of oxygen in the infants blood. self-aggrandizing fluids and nutrients through needles or tubes inserted into the infants veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant linguistic rule through feeding tubes that are passed through their noses or mouths and into their throats. Checking fluid intake to make sure that fluid doesnt build up in the babies lungs. As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time. If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure. If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your childs doctor will put the breathing tube from the ventilator through the hole. Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.) Long-term use of an endotracheal tube can damage the trachea. This damage may later require surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your childs muscles and clear mucus out of his or her lungs.Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need. Before your baby goes home, its important for you to learn as much as you can about your childs condition and how its treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital. Your child will likely continue on all or some of the treatments that were started at the hospital, includingMedicines, such as bronchodilators, steroids, diuretics, and caffeine. Oxygen therapy and/or breathing support from NCPAP or a ventilator. Extra nutrition and calories, which may be given through a feeding tube. intervention treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants-especially those in high-risk groups-RSV can be more serio us, leading to severe breathing problems. Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations. Mechanical ventilationIn most cases of bronchopulmonary dysplasia (BPD), respiratory distress syndrome is diagnosed and treated. The mainstay for treating RDS has been surface-active agent replacement with oxygen supplementation, continuous positive airway pressure (CPAP), and mechanical ventilation. The treatment necessary to recruit alveoli and prevent atelectasis in the immature lung may cause lung tarnish and activate the inflammatory come down.Trauma secondary to positive pressure ventilation (PPV) is generally referred to as barotrauma. With the recent focus on a ventilation strategy involving low versus high tidal volume, some inve stigators have select the term volutrauma. Volutrauma give notices the occurrence of lung injury secondary to excessive tidal volume from PPV.The severity of lung immaturity, the fetal milieu, and the effects of wetter deficiency determine the need for PPV, surfactant supplementation, and resultant barotrauma or volutrauma. With severe lung immaturity, the total number of alveoli is reduced, increasing the positive pressure transmitted to distal terminal bronchioles. In the presence of surfactant deficiency, surface tension forces are increased. Some compliant alveoli may become hyperinflated, whereas other saccules with increased surface tension remain collapsed. With increasing PPV to recruit alveoli and improve gas exchange, the compliant terminal bronchiole and alveolar ducts may rupture, leaking air into the interstitium, with resultant pulmonary interstitial emphysema (PIE). The occurrence of PIE greatly increases the risk of bronchopulmonary dysplasia.Many modes of ventila tion and many ventilator strategies have been examine to substantialially reduce lung injury, such as synchronized intermittent mechanical ventilation (SIMV), high-frequency jet ventilation (HFJV), and high-frequency oscillatory ventilation (HFOV). Results have been mixed, although some theoretical benefits are associated with these alternative modes of ventilation. Although shorter duration of mechanical ventilation has been demonstrated in some trials of SIMV, most trials have not had a large enough sample size to demonstrate a reduction in bronchopulmonary dysplasia. Systematic reviews suggest that optimal use of conventional ventilation may be as effective as HFOV in improving pulmonary outcomes. Regard little(prenominal) of the high-frequency strategy used, avoidance of hypocarbia and optimization of alveolar recruitment may decrease the risk of bronchopulmonary dysplasia and associated of neurodevelopmental abnormalities.PPV with various forms of nasal CPAP has been reported to decrease injury to the developing lung and may reduce the development of bronchopulmonary dysplasia. In general, centers that use gentler ventilation with more CPAP and less intubation, surfactant, and indomethacin had the lowest rates of bronchopulmonary dysplasia.Oxygen and PPV frequently are life-saving in extremely preterm infants. However, early and aggressive CPAP may eliminate the need for PPV and exogenous surfactant or facilitate weaning from PPV. Some recommend brief periods of intubation primarily for the administration of exogenous surfactant quickly followed by extubation and nasal CPAP to denigrate the need for prolonged PPV. This strategy may be most effective in infants without severe RDS, such as many infants with birth weights of 1000-1500 g. In infants who require oxygen and PPV, careful and meticulous treatment can minimize oxygen toxicity and lung injury. Optimal levels include a pH level of 7.2-7.3, a partial(p) pressure of carbon dioxide (pCO2) of 45-55 mm Hg, and a partial pressure of oxygen (pO2) level of 50-70 mm Hg (with oxygen saturation at 87-92%).Assessment of blood gases requires arterial, venous, or capillary blood samples. As a result, indwelling arterial lines are often inserted early in the acute management of RDS. Samples obtained from these lines provide the most accurate information about pulmonary function. Arterial puncture may not provide completely accurate samples because of patient agitation and discomfort. Capillary blood gas results, if samples are properly obtained, may be correlated with arterial values however, capillary samples may widely vary, and results for carbon dioxide are poorly correlated. hobby trends in transcutaneous PO2 andP CO2 may reduce the need for frequent blood gas measurements.Weaning from mechanical ventilation and oxygen is often tall(prenominal) in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. When tid al volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance.Optimization of methylxanthines and diuretics and adequate nutrition may facilitate weaning the infant from mechanical ventilation. Meticulous primary nursing care is essential to ensure airway patency and facilitate extubation. Prolonged and repeated intubations, as well as mechanical ventilation, may be associated with severe upper airway abnormalities, such as vocal cord paralysis, subglottic stenosis, and laryngotracheomalacia. Bronchoscopic evaluation should be considered in infants with bronchopulmonary dysplasia in whom extubation is repeatedly unsuccessful. Surgical interventions (cricoid splitting, tracheostomy) to address severe structural abnor malities are used less frequently today than in the past.Oxygen therapyOxygen can accept electrons in its outer ring to form free radicals. Oxygen free radicals can cause cell-membrane destruction, protein modification, and DNA abnormalities. Compared with fetuses, neonates live in a relatively oxygen-rich surround. Oxygen is ubiquitous and necessary for extrauterine survival. All mammals have antioxidant defenses to mitigate injury due to oxygen free radicals. However, neonates have a relative deficiency in antioxidant enzymes.The major antioxidant enzymes in humans are superoxide anion anion dismutase, glutathione peroxidase, and catalase. Activity of antioxidant enzymes tend to increase during the termination trimester of pregnancy, similar to surfactant production, alveolarization, and development of the pulmonary vasculature. Increases in alveolar size and number, surfactant production, and antioxidant enzymes prepare the fetus for transition from a relatively hypoxic intraute rine environment to a relatively hyperoxic extrauterine environment. Preterm birth exposes the neonate to high oxygen concentrations, increasing the risk of injury due to oxygen free radical.Animal and human studies of appurtenant superoxide dismutase and catalase supplementation have shown reduced cell damage, increased survival, and possible prevention of lung injury. Evidence of oxidation of lipids and proteins has been found in neonates who develop bronchopulmonary dysplasia. Supplementation with superoxide dismutase in ventilated preterm infants with RDS substantially reduced in readmissions compared with placebo-treated control subjects. Further trials are currently under way to examine the effects of supplementation with superoxide dismutase in preterm infants at high risk for bronchopulmonary dysplasia.Ideal oxygen saturation for term or preterm neonates of various gestational ages has not been definitively determined. In practice, many clinicians have adopted conservative oxygen saturation parameters (ie, 87-92%). A delicate balance to optimally promote neonatal pulmonary (alveolar and vascular) and retinal vascular homeostasis is noted. In the adjunct Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) trial to reduce severe retinopathy of prematurity (ROP), oxygen saturations of more than 95% minimally affected retinopathy but increased the risk for pneumonia or bronchopulmonary dysplasia.The normal oxygen requirement of a preterm infant is unknown. Pulmonary hypertension and cor pulmonale may result from chronic hypoxia and lead to airway remodeling in infants with severe bronchopulmonary dysplasia. Oxygen is a potent pulmonary vasodilator that stimulates the production of nitric oxide (NO). NO causes smooth muscle cells to relax by activating cyclic guanosine monophosphate. Currently, pulse oximetry is the mainstay of noninvasive monitoring of oxygenation.Repeated consequences of desaturation and hypoxia may occur in infan ts with bronchopulmonary dysplasia receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts. Forced exhalation efforts due to infant agitation may cause atelectasis and recurrent hypoxic episodes. Hyperoxia may fire the neonates relatively deficient antioxidant defenses and worsen bronchopulmonary dysplasia. The patients oxygen requirements are frequently increased during stressful procedures and feedings. Some NICUs have adopted a conservative oxygen saturation policy of maintaining saturations of 88-94%. Caregivers are more likely to follow wide guidelines for ranges of oxygen saturation than narrow ones. Some infants, especially those living at high altitudes, may require oxygen therapy for many months.Transfusion of packed RBCs may increase oxygen-carrying capacity in preterm infants who have anemia (hematocrit The need for multiple transfusions and donor exposure s can be minimized by using iron supplementation, a reduction in phlebotomy requirements, and by use of erythropoietin administration.Treatment of inflammationElevated levels of interleukin-6 and transplacental growth factor in the umbilical venous blood of preterm neonates are associated with increased incidence of bronchopulmonary dysplasia. This inflammation likely affects alveolarization and vascularization of the pulmonary system of the second-trimester fetus.fetal sheep exposed to inflammatory mediators or endotoxin develop inflammation and abnormal lung development. Activation of inflammatory mediators has been demonstrated in humans and animal models of acute lung injury. Activation of leukocytes after cell injury caused by oxygen free radicals, barotrauma, infection, and other stimuli may begin the process of destruction and abnormal lung repair that results in acute lung injury then bronchopulmonary dysplasia.Radiolabeled activated leukocytes have been healed by means of bronchoalveolar lavage (BAL) in preterm neonates receiving oxygen and PPV. These leukocytes, as well as lipid byproducts of cell-membrane destruction, activate the inflammatory cascade and are metabolized to arachidonic acid and lysoplatelet factor. Lipoxygenase catabolizes arachidonic acid, resulting in the production of cytokines and leukotrienes. Cyclooxygenase may also metabolize these byproducts to produce thromboxane, prostaglandin, or prostacyclin. All of these substances have potent vasoactive and inflammatory properties. levels of these substances are elevated in the first days of life, as measured in tracheal aspirates of preterm infants who subsequently develop bronchopulmonary dysplasia.Metabolites of arachidonic acid, lysoplatelet factor, prostaglandin, and prostacyclin may cause vasodilatation, increase capillary permeability with subsequent albumin leakage, and inhibit surfactant function. This effects increase oxygenation and ventilation requirements and potentially increase rates of bronchopulmonary dysplasia Activation of transcription factors such as thermonuclear factor-kappa B in early postnatal life is associated with death or bronchopulmonary dysplasia.Collagenase and elastase are released from activated neutrophils. These enzymes may directly destroy lung tissue because hydroxyproline and elastin (breakdown products of collagen and elastin) have been recovered in the urine of preterm infants who develop bronchopulmonary dysplasia.Alpha1-proteinase inhibitor mitigates the action of elastases and is activated by oxygen free radicals. Increased activity and decreased function of alpha1-proteinase inhibitor may worsen lung injury in neonates. A decrease in bronchopulmonary dysplasia and in the need for continued ventilator support is found in neonates given supplemental alpha1-proteinase inhibitor.All of these findings suggest the fetal inflammatory response effects pulmonary development and substantially contributes to the development of bronchopulmonary dysplasia. The self-perpetuating cycle of lung injury is accentuated in the extremely preterm neonate with immature lungs. focal point of infectionMaternal cervical colonization and/or colonization in the neonate with Ureaplasma urealyticum has been implicated in the development of bronchopulmonary dysplasia. Viscardi and colleagues found that persistent lung infection with U urealyticum may contribute to chronic inflammation and early fibrosis in the preterm lung, leading to pathology consistent with clinically significant bronchopulmonary dysplasia.13Systematic reviews have concluded that infection with U urealyticum is associated with increased rates of bronchopulmonary dysplasia. Infection-either antenatal chorioamnionitis and funisitis or postnatal infection-may activate the inflammatory cascade and damage the preterm lung, resulting in bronchopulmonary dysplasia. In fact, any clinically significant episode of sepsis in the vulnerable preterm neonate greatly i ncreases his or her risk of bronchopulmonary dysplasia, especially if the infection increases the babys requirement for oxygen and mechanical ventilation.Future managementFuture management of bronchopulmonary dysplasia will involve strategies that emphasize prevention. Because few accepted therapies currently prevent bronchopulmonary dysplasia, many therapeutic modalities (eg, mechanical ventilation, oxygen therapy, nutritional support, medication) are used to treat bronchopulmonary dysplasia. Practicing neonatologists have observed reduced severities of bronchopulmonary dysplasia in the postsurfactant era. Maintaining PPV and oxygen therapy for longer than 4 months and discharging patients to facilities for prolonged mechanical ventilation is now unusual.Medication SummaryMany medicine therapies are used to treat infants with severe bronchopulmonary dysplasia (BPD). The efficacy, exact mechanisms of action, and potential adverse effects of these drugs have not been definitively e stablished. A study group from the NICHD and US nourishment and Drug Administration (FDA) reviewed many of the drugs used to prevent and treat bronchopulmonary dysplasia. Walsh and colleagues concluded that detailed analyses of many of these treatments, as well as long-term follow-up, are needed.15Vitamin A supplementationSeven trials of vitamin A supplementation in preterm neonates to prevent bronchopulmonary dysplasia were analyzed for the Cochrane Collaborative Neonatal review. Vitamin A supplementation reduced bronchopulmonary dysplasia and death at 36 weeks postmenstrual age. However, the need for frequent intramuscular injections in extremely premature infants has precluded widespread use of this therapy.DiureticsFurosemide (Lasix) is the treatment of choice for fluid overload in infants with bronchopulmonary dysplasia. It is a loop diuretic that improves clinical pulmonary status and function and decreases pulmonary vascular resistance. Daily or alternate-day furosemide ther apy may facilitate weaning from positive pressure ventilation (PPV), oxygenation, or both. uncomely effects of long-term therapy are frequent and include hyponatremia, hypokalemia, contraction alkalosis, hypocalcemia, hypercalciuria, renal stones, nephrocalcinosis, and ototoxicity. Careful parenteral and enteral nutritional supplementation is required to maximize the benefits instead of exacerbating the adverse effects. In patients with mild hyponatremia or hypokalemia, supplementation with potassium chloride is favored over supplementation with atomic number 11 chloride.Thiazide diuretics plus aldosterone inhibitors (eg, spironolactone Aldactone) have also been used in infants with bronchopulmonary dysplasia. In several trials of infants with bronchopulmonary dysplasia, thiazide diuretics combined with spironolactone increased urine output with or without benefit in pulmonary mechanics. Hoffman et al reported that spironolactone did not reduce the need for supplemental electroly tes in preterm infants with bronchopulmonary dysplasia.16 To the present authors knowledge, long-term studies to compare the efficacy of furosemide with those of thiazide and spironolactone therapy have not been performed.BronchodilatorsAlbuterol is a specific beta2-agonist used to treat bronchospasm in infants with bronchopulmonary dysplasia. Albuterol may improve lung compliance by decreasing airway resistance by relaxing smooth muscle cell. Changes in pulmonary mechanics may last as long as 4-6 hours. Adverse effects include increased blood pressure (BP) and heart rate. Ipratropium bromide is a muscarinic antagonist that is related to atropine however, it may have bronchodilator effects more potent than those of albuterol. Improvements in pulmonary mechanics were demonstrated in patients with bronchopulmonary dysplasia after they received ipratropium bromide by inhalation. Combined therapy with albuterol and ipratropium bromide may be more effective than either agent alone. Few a dverse effects are noted.Methylxanthines are used to increase respiratory drive, decrease apnea, and improve diaphragmatic contractility. These substances may also decrease pulmonary vascular resistance and increase lung compliance in infants with bronchopulmonary dysplasia, probably by directly causing smooth muscle to relax. Methylxanthines also have diuretic effects. All of these effects may increase success in weaning patients from mechanical ventilation.Synergy between theophylline and diuretics has been demonstrated. Theophylline has a half life of 30-40 hours. It is metabolized primarily to caffeine in the liver and may result in adverse effects such as increase in heart rate, gastroesophageal reflux, agitation, and seizures. The half-life of caffeine is approximately 90-100 hours, and caffeine is excreted unchanged in the urine. Both agents are available in intravenous and enteral formulations. Caffeine has fewer adverse effects than theophylline. Schmidt and colleagues repo rted that the early use of caffeine to treat apnea of prematurity appeared to reduce ventilatory requirements and that it may decrease the incidence of bronchopulmonary dysplasia.17CorticosteroidsSystemic and inhaled corticosteroids have been studied extensively in preterm infants to prevent and treat bronchopulmonary dysplasia.Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death.Many researchers have evaluated the effects of early administration of dexamethasone to prevent bronchopulmonary dyspl