Le Corbusier, the modernist

Architecture as a medium started during the Egyptian era, then the Greek and Roman Period followed, after which the development seemed just to have died down. No further design was evident but only reinvention of the three distinct styles from Byzantines to gothic, renaissance to baroque, neo-classicism to art nouveau and art deco. All contributed to designs of sinuous curves and decorations creating an atmosphere of brilliant exuberance (â€Å"Neoclassic†).However at the start of the 20th century a new movement was born – the international style of modern architecture. This is a form of rebellion on the established architectural norms at the time and to basically express in style that is totally different from the past. Coupled with the development of concrete, steel and glass, it became the barometer by which succeeding styles evolved (â€Å"History†).The International Style of ArchitectureThe international style is characterized by three basic principles; the marked influence of volume rather than mass; balance rather than applied symmetry; and the total expulsion of ornaments to the composition of the structure both in the faà §ade and interior spaces. This movement is brought about by the advent of the industrial revolution. Thus, the international style is anchored towards machines, or that structural spaces are â€Å"machines where one can live in† (â€Å"International Style†).One of the pillars of the international movement was Le Corbusier, the Swedish Architect who eventually made a name for himself while in Paris. He was a tireless artisan, through pamphlets, manifestos, magazines, books and even exhibitions he was able to project the merits of the movement not only in Europe but the America’s as well.Part of his (Le Corbusier) design innovation is; the structure is raised on stilts to make it appear light and floating; free flowing plan, so dwellers will have the freedom to rearrange the spaces according to their needs; make the walls independent of the structure – thus curtain walls were developed; provide horizontal bands of windows to keep the light in; and most of all top the structure with a roof garden to bring the natural environment to the structure (Rybczynski).The resulting structure is a study of steel columns and beams, a skeleton devoid of any decorative ornament. It projects an architecture that is harsh and brutal in appearance, but with the application of ground to ceiling plate glass windows it tempered the faà §ade and promotes the functional side of the structure. The walls are no longer planned as load bearing but only as decorative panels devised mainly to protect dwellers from the elements. The elevator shafts are now exposed and part of the design retinue (â€Å"International†).The Villa SavoyeThe most important building that expressed the tenets of the international style is the Villa Savoye, near the suburbs in Paris. This building is memorable since it was designed by one of the movers of the style – Le Corbusier. The Villa Savoye captures the essence of the movement because of its abject simplicity and is considered by many as the climax of Le Corbusier’s work as it virtually expressed the style in its purist form (Sullivan).What make the Villa Savoye the true representative of the international style are the different components that truly define the spirit of the style. The faà §ade is endemic throughout, meaning the design does not distinguish the front, the sides or the rear of the building and it is of plain reinforced concrete that added to its effortless appeal.The Villa Savoye is obviously modular in design and follows the pattern on human proportion; the building seems to float because of the series of â€Å"pilotis† or stilts that raise it from the ground, though it may be a form modern classicism; it does not have any attachment to historical ornament but is actually an expression of a mo dern abstract sculptural composition; and the external faà §ade is pure white that suggests birth, purity, simplicity and health (â€Å"LeCorbusier†).The building has an open interior plan that defines the logic of large spaces; to go up or down between floors is best served by a corkscrew spiral staircase and a reliable ramp system; the windows provides a wealthy interplay of light, reminiscent of industrial architecture; of course the feature that Le Corbusier emphasized is the roof garden at the top of the structure – to promote oneness with the natural environment even when inside the building; and the ground floor has an integral garage (â€Å"LeCorbusier†).All the characteristics of the international style as expounded by Le Corbusier are all incorporated in the Villa Savoye. And owing to the importance of the Villa Savoye to the international style, it has become a relic and a pilgrimage site for students of architecture.ConclusionNever in the history of architecture have a style that truly evolved without the undue influence of the past. Two movements have expressed the sincerity to really deviate from this form of evolution – the modern movement of Frank Lloyd Wright (organic style) and the international style. Both styles have echoed desires for large uninterrupted open spaces and simplicity in design without the use of elaborate ornaments.The development of the skyscraper in the United States put into full use the international style of architecture. The buildings were now constructed according to the new manual on steel construction with reinforced concrete as the material of choice on the walls and foundations. The faà §ade fully utilize the versatility of plate glass as it clad the structure from the ground floor up to the penthouse.The glass curtain walls may have added to the aesthetic appeal of the building, but it also plagued insulation engineers, for it resulted in problems about heating and cooling, particular ly during the cold and warm months. Therefore new standards were set as it increases the energy requirement of buildings.But, even with some negative perceptions, nobody can question the effects of the international style in our modern society. It has revolutionized our ideas of a modern structure.Bibliographyâ€Å"History.† Art Deco Architecture. 15 December 2007. .â€Å"International Style, in Architecture.† The Columbia Encyclopedia sixth edition. 2007. Columbia University Press. 16 December 2007. .â€Å"International.† Realtor Magazine Online. 2001. National Association of Realtors. 16 December 2007. .â€Å"LeCorbusier – Villa Savoye.† Boston College – Fine Arts Department. 12 November 2007. The Trustees of Boston College. 17 December 2007. .â€Å"Neoclassic Art and Architecture.† Microsoft Encarta Encyclopedia. 2001. Microsoft Corporation. 15 December 2007. .Rybczynski, Witold. â€Å"Le Corbusier.† Time. 8 June 1998. Time Inc. 17 December 2007. .Sullivan, Mary Ann. Bluffton University. 2006. 17 December 2007. .

Culture & country Essay

There is no country today whose culture and values are so isolated from the mainstream of the world. The preservation of their thoughts and peculiarities as people has been, not just a social phenomenon, but a proof that no culture is so exact or perfect to any community on earth. Each is tailored-fit to that specific tribe, community, or people. The Philippines was colonized by the United States for more or less half a century. Many Filipinos today, act, think, and work like any American their age. Just consider the fashion and music people from these two nations enjoy. A closer look will reveal that Filipinos prefer the same type of music and clothing just as the same as any American. However, while cultural subjugation may be present, since US has largely dominated the thoughts of Filipinos, striking differences cannot be denied. On Family matters, Filipinos usually ask the permission of their parents before engaging in marriage. The groom’s family pays visit to the bride’s home to discuss matters regarding the wedding. Most of the time, the parents’ have their last say on almost all conceivable aspects of marriage. It is a truism, that Filipinos hold the idea that marriage is not just union of individuals but of families, as well. On the contrary, weddings, American style are commonly planned by the couples themselves and the parents have little or no influence at all in the preparation and ceremony itself. Furthermore, many of Filipino women today are still dependent to their spouses. Largely, their women are more patriarchal in orientation in terms of family life than their American counterparts. On the other hand, American women are more independent and self-actualized individuals, while Filipinos are very family-dependent people. As proof, they would usually live in one house or in one neighborhood together with the clan, very different from American families who usually live far from each other. This reveals the close-family ties of the Filipinos, compared to the independent-minded thoughts of the Americans. While this issue is so simple, the effect is profound and cannot be diminished. The family is a microcosm of the entire society and the mirror of the entire nation. It is where all social contexts are indexed and all values are reflected. Source: Shead, M. T. ed. (2006). Family Structure. retrived May 9, 2006, from Living in the Philippines. Website:http://www. livinginthephilippines. com/philculture/family. html

Adele Laurie Blue Adkins

Adele Laurie Blue Adkins is a young music composer of the 21st century. She is British, American, Seoul, R B and pop music. She is only 25 years old and has won numerous Grammy nominations and awards for her early career. Adel will receive more prizes in his future career. Adele has been hit at least five times since signing at the age of 19. When she entered puberty, she got a lot of inspiration. Adel was born on May 5, 1988 in London, England. Adele Laurie Blue Adkins is a British singer and composer. In 2006, she graduated from Britt Performing Arts Technical Graduate School. Her debut album 19 was released in 2008. This album is a huge success, has received seven Platinum certifications in the UK, and the Double Platinum award in the United States. She appeared on Saturday Night Live at the end of 2008 and improved her career in the United States. In the 2009 51st Grammy Awards ceremony, Adel received the Best New Records Award and the Best Female Pop Music Performance Award. Ad ele Laurie Blue Adkins is a young music composer of the 21st century. She is British, American, Seoul, R B and pop music. She is only 25 years old and has won numerous Grammy nominations and awards for her early career. Adel will receive more prizes in his future career. Adele has been hit at least five times since signing at the age of 19. When she entered puberty, she got a lot of inspiration. Adel was born on May 5, 1988 in London, England. A 29 year old British singer-songwriter, Adele Laurie Blue Adkins, has released three highly rated albums in seven years. Roger Lawson, a 32 - year - old American television advertiser and enthusiastic writer, had three faithful relationships during the same period. Below is a discussion of similarities between Adele 's respective album and Roger' s respective relationship. Adele released her first album 19 in the United States on June 10, 2008. Within three months, Roger is scheduled to meet Mike in the diving bar in the East Village, New Yo rk. Coincidentally, Roger coincidentally dated, and another man named Mike in the fall. The first microphone was inexperienced, confused, and excessive; Roger was looking for something else at the age of 22. Indeed, Roger just left the closet just a year ago, but he was more confident about his needs and the needs of the date. Adel London is a very different hometown from mine. Adele Blue Adkins did not think he was living anywhere in the city I was living when I was 19 at the age of fifteen, but a vibrant division and culture bumped me. Eugene Oregon is a hometown indifferent to me, there is no kinetic energy of the city and the warmth of a small town. Eugene's hometown glory is sports, especially running. My high school is basically a group of light and muscular sprinters who eat protein bars and are taken to the preposs marathon to the university professor. I am tall, my legs are thick, my thighs are full, my ass and small breasts. I step on the sorghum potatoes because this is b ecause my sports friends made me feel unevenly adjusted. A miracle of my hometown, and a small world that makes it confusing us is a girl who is not afraid to take off clothes in the locker room.

Histroy Essay Example | Topics and Well Written Essays - 1750 words

Histroy - Essay Example Etruscans played a major role in the development of the Roman state most importantly increasing the trade between the Romans and other societies especially the Greek thereby creating wealth in the state. The group’s seers also taught the Romans how to interpret omens and also enriched the Roman architecture by giving them a distinctive temple architecture that was unique compared to that of the Greeks. The Roman and the Etruscan architecture therefore had better and much deeper porticos and pronounced porches which were supported by colonnades symbolic of their advanced civilization at the time, (Levack, Muir and Veldman 139). The early republic, established by about 600 B.C.E had a well organized social and political system. By this time, they had begun the construction of public buildings which included the first senate house where elders regularly assembled to discuss community matters and the temples, (Levack, Muir and Veldman 139). The republic established at about 500 B.C.E abolished the rule of kingship and establish a state in which political power was wielded by the people and their representatives. The republic had a military and a voting system in which only free male city inhabitants who could afford their weapons were allowed to vote in the citizen assembly. The assembly was responsible for making the important public decisions in consultation with the senate and although poor men could fight to defend the state, they were not allowed to vote, (Levack, Muir and Veldman 139). The assembly was constituted by Rome’s male citizens otherwise known as the Centuriate Assembly and had the responsibility of managing the city’s judicial, legislative and administrative affairs. Two chief executives known as the consuls were elected each year and given the authority to administer the law, although their decisions could be appealed in the assembly, (Levack, Muir and Veldman 139). The senate comprised of about

Companies Go Global Article Example | Topics and Well Written Essays - 500 words

Companies Go Global - Article Example s, the Europeans always criticize the Americans for their lack of knowledge in relation to the culture of the Europeans and this has over the years lead to a build up of animosity between these groups of people. The two groups of business people are faced by a number of disparities in relation to their attitudes to one another plus the differences in the etiquettes of running of the companies in each of the continents plus the relative management approaches of the relative countries. Complications in the management of different traditions and values for the achievement of goals and targets occur when people from differing cultures either from the European or America find themselves running businesses in the opposite continent. Problems are always inherent in the host countries and managers find themselves with problems of internalizing issues making management to be full of complications requiring expatriate knowledge. Due to the disparities in cultures and values of the various societies, the business has to develop and implement advanced and customized tactics which suit the specific countries needs and characteristics. Despite all this management problems and related challenges, the companies need to go global due to the increased competition and advancements in communication. Companies have become multinationals hence the need for globalization that’s related to the characteristics of nations ensuring that they no longer remain in just in one country. Initially companies used to go multinational due to their attempts to diversify, seeking raw materials, increasing their markets, improving of the production efficiency and in some instance attempts to avoid or move away from issues like the political instabilities. However the companies always try and achieve their attempts to act global but unfortunately they find themselves unable to act local and understand the roots of what the local communities like and practice like and hence they are faced with

Hashing Algorithm Research Paper Example | Topics and Well Written Essays - 2500 words

Hashing Algorithm - Research Paper Example In fact, any value or even a single letter is changed in the input; then the values of hash value will also be changed. Additionally, same hash value can be used in calculation in order to find two different inputs; for that reason the hashing algorithms are used to determine the reliability and effectiveness of data (comprising digital signatures, authentication and so on). In some cases, these hash values are also acknowledged as a "message digest". In the past few years, the use of hashing algorithms in every walk of science has increased to massive extent. In fact, hashing algorithms are believed to be the most important technique in data structures and randomized algorithms, within a wide variety of applications and fields like that complexity theory, information retrieval, data mining, parallel algorithms and cryptology (Ostlin & Pagh, 2003). However, hashing algorithms are extensively utilized in the field of information security (Yang, Li, Tan, Yan, & Hou, 2012). In the field of information security, hashing algorithms play a significant role in cryptography and are utilized to achieve numerous security goals. For instance, these algorithms are extensively used to attain reliability and validity, authenticating users of computer systems, implementing efficient digital signatures, putting into practice pseudo random number generators, implementing digital time stamping, creating session keys and sometime for building block ciphers as well. In the history of hashing algorithms a large number of hash functions were created as well as the majority of them were effectively broken and some were to some extent breached, along with it a number of theoretical threats were as well propose (Sobti, Geetha, & Anand, 2012; Algredo-Badillo, Morales-Sandoval, Feregrino-Uribe, & Cumplido, 2012). This paper presents a detailed analysis of hashing algorithms. This paper will discuss the uses and applications of hashing algorithms. This paper will focus on some of the impo rtant hashing algorithms such as digital signatures algorithms, cryptography algorithms and various other techniques. Hashing Algorithms Basically, the process of hashing simplifies the search process by making use of computationally a few operations as compared to any other sequential basic search algorithm. In this scenario, a hash function is a mathematical process in which a number is mapped to a large value range into an additional number with a smaller range. Figure1 demonstrates the process of hashing in the detail. In this diagram, a database that consists of eight specified records (such as addresses in one application) are to be matched in opposition to any received record. In view of the fact that each record contains a huge amount of data as well as the entire database contains a large number of records under actual circumstances, in this scenario scanning all the records and searching through the complete database individually can be unfeasible. However, this problem co uld be resolved if a piece of the record (or on the whole) is chosen and a key is assigned to the target value (normally, this target value is based on a 3-bit value as demonstrated in the figure1) by making use of the hash function (operator). As shown in the figure1, this process has divided a complete database of eight records into smaller groups of records in accordance with their matching hash outputs. In addition, this searching process will be applied to all the searches, in which this

History of American Government Essay Example | Topics and Well Written Essays - 2250 words

History of American Government - Essay Example   James Madison became a student of colonial history and political theory in his search for a solution to the political and economic dilemmas which beset the colonies at the time. Madison felt the Articles of Confederation were too weak to serve the needs of the United Colonies. He reasoned that the state autonomy clause, precluded the perpetuation of a strong central government, which Madison felt was necessary to adequately regulate commerce.This inadequacy left the central government with little ability and left the Confederation coffers inadequate to wage war. Meantime, inflation began to engulf the country; a pound of tea could cost as much as $100. Of course this inflation resulted in a contraction of business activity; some small farmers were arrested for bad debts and many farmers were forced to sell their farms to pay their taxes.Madison solicited the assistance of the elder statesman, general George Washington.. Washington initially found a number of reasons to lay suspec t to the idea proposed by Madison, and was reluctant to accept Madison’s offer for assistance. Washington dealt with the issue of credibility; â€Å" what if the new experiment did not work? What light would be cast upon his reputation? After a considerable amount of soul searching, Washington wrote to Madison. â€Å"Wisdom and good examples are necessary at this time to rescue the political machine from the impending storm†. (Madison)George Washington understood that Madison envisioned a strong central government to provide order and stability.... pay their taxes. Madison solicited the assistance of the elder statesman, general George Washington.. Washington initially found a number of reasons to lay suspect to the idea proposed by Madison, and was reluctant to accept Madison's offer for assistance. Washington dealt with the issue of credibility; " what if the new experiment did not work What light would be cast upon his reputation After a considerable amount of soul searching, Washington wrote to Madison. "Wisdom and good examples are necessary at this time to rescue the political machine from the impending storm". (Madison) George Washington understood that Madison envisioned a strong central government to provide order and stability. Madison responded to Washington with; "let it be tried then whether any middle ground can be taken which will once support a due supremacy of the national authority, and providing state power only when subordinately useful" This was a mighty issue, one which would generate much debate. It became so fervent until the labels of federalist (those who supported a strong central government and anti-federalist (opposed to watering down of state sovereignty), created substantial followings. James Madison and John Tyler served together in the Virginia General Assembly. They devised a plan for a states convention to be held in Annapolis, Maryland3 in September 1786. At this convention the two men proposed that macro commerce be controlled and regulated by the Continental Congress. James Madison and Alexander Hamilton issued a report of the Annapolis meeting. The meeting

Jose Clemente Orozco's Zapatistas Essay Example | Topics and Well Written Essays - 500 words

Jose Clemente Orozco's Zapatistas - Essay Example One can see that interpretation helps a viewer to perceive an artwork from a different angle of view. The artwork consists of different figures (animate and inorganic) in different sizes. To be specific, the rocks and hill in the artwork is symbolic of inorganic objects in different sizes. On the other side, the horses and human figures represent life in different sizes. These objects/figures in different sizes provide proper balancing to the artwork. The upright, parallel, and slanting lines indebted to the figures provide proper rhythm to the artwork as a whole. To be specific, the swords, caps, and dress in the artwork results in wave like rhythm in the artwork. Besides, the painter is deeply interested in the usage of contrasting colors in the artwork. The different shades of dark brown, blue, and yellow are used in the artwork. This is helpful to project the focal point (armed soldiers, captured revolutionaries, and women) as the central figure. In my opinion, the artwork is sym bolic of the artist’s view of human life. The artist considers that vegetative life without intellectual development is wastrel. In addition, one must be ever ready to protect one’s individual rights. Still, the painting portrays how dictators can crush the self-confidence of the mass. Beyond the artistic elements, I like this artwork because the same is symbolic of the social responsibility of art. Summing, Orozco’s artwork is symbolic of the influence of art, which can be used as an innovative medium for social criticism.

It Is Needed to Control Combustible Dusts Hazard Research Paper

It Is Needed to Control Combustible Dusts Hazard - Research Paper Example The explosions develop and then give safety measures to be taken in preventing such occurrences. The paper will also discuss some debatable issues regarding combustible dusts. The paper will then conclude with an overview of the recommendations needed to control combustible dusts hazard. Combustible dusts comprise of fine particles that cause an explosion hazard when suspended in the air and certain conditions (OSHA, 2009). A hazardous product has the capability of being ignited (Willy, 1995). Dust explosions cause tragic loss of life, serious bodily harm and devastating destruction of property. The potential for dust explosions remains unknown to most workers. This calls for the evaluation of potential chemical hazards, and the communication of hazard information to workers. According to OSHA (2009), materials that have the capability of forming combustible dust include wood, paper, sugar, metals such as aluminum & magnesium, coal, dried blood, soap, biosolids, plastics and certain textiles. They are found in a variety of industries and workplaces. Combustible dust can build up within process equipment and/or escape from process equipment settling on surfaces in the general working environment (L & I, 2009). These accumulations are extremely explosive especially when dispersed in the air in the presence of ignition sources like standard electrical switches. The U.S Chemical Safety and Hazard Investigation Board (CBS) identified two hundred and eighty of combustible dust incidences between 1980 and 2005 that led to the death of one hundred and nineteen workers, injured seven hundred and eighteen, and extensively damaged numerous industrial facilities (OSHA, 2009). Massachusetts suffered a similar fate in February 1999, when the deadly fire broke in a foundry investigation in the incidence revealed that a fire stemmed from a shell molding machine and then extended in the ventilation of the system ducts by feeding on  heavy deposits of phenol formaldehyde dusts (OSHA, 2009).  

Asthma Research Paper Example | Topics and Well Written Essays - 1000 words

Asthma - Research Paper Example An individual finds it extremely strenuous to take air in and out of the lungs during an asthma attack. This is because the inner layer of the tubes conveying air between the throat and lungs become swollen to some extent closing the airway (5). There is also increased secretion of mucus, which further serves to narrow the airway. The inflamed airway is sensitive to a number of substances, which causes asthmatic patients to be extremely allergic to various substances. The precise cause of asthma is unknown; however, researchers believe that there is an interaction of some genetic and environmental factors, which bring about asthma. This usually happens during the early stages of development. Statistics show that about 23 million Americans have asthma, 7 million of them being under the age of eighteen years (Murphy 7). The genetic and environmental factors that cause asthma include atopy, childhood respiratory infections, contact with airborne allergens, having asthmatic parents, and contact with some viral illnesses during infancy or early childhood as the immune system is developing (What Is Asthma? - NHLBI, NIH). Atopy is the hereditary propensity of developing asthma. The Hygiene Hypothesis tries to explain the causes of asthma by suggesting that reduced exposure to various childhood ailments due to the highly hygienic Western lifestyle affects children’s immune systems, making them more prone to atopy and asthma. There is no known cure for asthma and the ailment can erupt at any time despite the patient feeling fine. It is, therefore, imperative to treat symptoms as soon as one notices them to prevent the progression of a mild attack into a strong attack. Consequently, one needs to know asthma symptoms to recognize them. The most common signs of asthma are wheezing, coughing, shortness of breath, and chest tightness (What Is Asthma? - NHLBI, NIH). However, possessing these signs does not always mean that a person has asthma. Hence, a person displayin g these symptoms needs to see a doctor for proper diagnosis using the lung function test and a physical examination. Many things set off or aggravate asthma conditions including allergens derived from dust, mold, pollen, animal fur, and cockroaches. Cigarette smoke, dust, and sprays also contain irritants that can spark asthma attacks. Viral infections of the upper respiratory tract, for example, colds, some medications (nonsteroidal anti-inflammatory drugs and nonselective beta-blockers), and sulfites present in foodstuffs and beverages also trigger asthma attacks (What Is Asthma? - NHLBI, NIH). Vigorous physical activity such as exercises may also worsen the symptoms of asthma. Other health conditions e.g. â€Å"a runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea† make the management of asthma more challenging and ought to be treated, as well (What Is Asthma? - NHLBI, NIH). The identification of asthma relies on medical and family histories , test results, and a physical examination. The establishment of medical and family histories involves determining the frequency and severity of asthma symptoms. It is also imperative to determine the exact periods of the attacks, for example, certain times of the day or seasons of the year. Physical examination involves the doctor looking out for asthma signs such as â€Å"wheezing, a runny nose, swollen nasal passages and allergic skin conditions such as eczema†

Child and young person development Essay Example for Free

Child and young person development Essay Task 2 – Explain the difference between sequence of development and rate of development and why the difference is important. The sequence of development is the order in which development takes place. Although some stages of development may be missed (for example some babies do not crawl and go straight from shuffling to walking) the sequence is usually followed by children and the order usually remains the same. The rate of development is the time-frame given for the average development of a child expected at a certain age, i. e. at one has started to walk. All children are unique and will develop at their own rate. The rate of development is just a guideline. For example: some babies start teething from 6 months and some of them start at 9 months. Some babies can start making sentences at around 1 year; others can only speak few broken words. Read more: Rate of development  essay The sequence of development generally remains the same. The rate of development can change considerably and many other factors such as individual growth patterns, social background, health and nutrition, disability and learning difficulties can have an effect on it. It is important to know the difference between the sequence and rate of development as it helps to meet the children’s individual needs. It helps you recognise if any children have special educational needs and helps you plan to make sure they are getting the help and support they may need. Practitioners must have a good understanding of the child development rates. Practitioners should: †¢Carry out assessment and observation effectively. It is required for practitioners to make development comparisons between a child’s actual development stage and expected development rates. †¢Offer appropriate activities and experiences. This will be informed by  observation, monitoring and assessment of individual children. †¢Anticipate the next stage of a child’s development. This allows the practitioner to provide activities and experiences that will challenge and interest children, therefore, stimulating the child’s learning development. †¢Notice when children are not progressing as expected. Although children develop at different rates, significant delays in one area or many delays in several areas can be an indication that children need intervention and extra support.

The Importance Of Wastewater Treatment Environmental Sciences Essay

The Importance Of Wastewater Treatment Environmental Sciences Essay Water scarcity is the major problem that is faced all across the world. Although 2/3rd of the earths crust is made up of water but all this water is not available for drinking and for other human activities as either it is locked in the form of ice or present in the form of vast saline oceans and seas. It has been found out that 97% of the total water is salty that is of no use to human and animals (except marine animal) and the remaining three percent is available as freshwater. More than half of this three percent is locked in glacier and less than 0.01% is available as fresh water. So water resources are less as compare to human demand for water. Above this, the major part of water that can be consumed is getting polluted because of human activities. This polluted and untreated water is causing abundant water borne diseases. Then the world is facing a huge climatic change which is further aggravating the water problem. Some of the regions are getting more rain water than earlier and some are getting almost negligible. Experts even believe that the next World War would not be for oil or land but it will be for water. Also because of improper use of water and lack of water treatment, the problem of water crisis will further increase where 884 million people are already not getting easy access to safe drinking water. And a further 2.5 billion people are getting difficult access to water for disposable and sanitation. Agriculture is also overusing and polluting the ground water thus depleting the natural source of water. So here water treatment plants will play important role. Water crisis at present is the biggest problem according to the United Nations. Almost 25 countries of Africa, parts of China, Peru and Brazil in Latin America, some parts of Middle East like Iran, Chile, Mexico, and Paraguay are some of the countries that are facing the water crisis. Even other parts of the world are facing the varied levels of the water crisis. Because of acute shortage of water, the food problems are getting aggravated. About 40 million people in Africa are facing the problem of food shortage. It is expected that if the similar conditions will persist then there will be 500 million till 2025 who will suffer from these problems. Nature has its role but the major water problem is arising because of its increasing consumption and faulty usage. Major chunk of the problem can be solved if the wastewater treatment is taken very seriously and precautions at every step are taken to improve the water quality. The supply and demand The demand for fresh clean water delivered to our homes is ever increasing as more and more residential homes are being established. Although 70% of the world is covered with water, only 1% is fresh water and thus raises a need to recycle waste water to satisfy our needs. Efforts to continuously recycle waste water are always stressed upon as a shortage would mean a disaster in heavily populated areas. Governments have committed billions towards research and development to such projects. Fresh water is also needed in agriculture. The demand for water in this sector is very high as farmer need fresh water for crops and cattle. Therefore, stresses the demand for sewage water treatment plants to be built. Water from rivers and lake are inadequate to provide water for farm and residences alike. The supply of sewage water treatment facilities are slowly dwindling. A crisis may arise from a lack of sewage water treatment plants as this would greatly reduce the supply of fresh water. Governments are desperately trying to keep up with the pace of development of the population but are slowly lagging behind. The supply of fresh water will be adequate for the next few years but if the development of sewage water treatment plant continues at its current pace it without a doubt a shortage would take place. Furthermore, the agriculture industry will be greatly impacted and the supply of food will go down as well leading to famine due to a shortage of water. The prospects of this industry The wastewater treatment industry most probably will be successful in future due to presence of new wastewater treatment technologies. Advanced Immobilized Cell Reactor technology is one of the new technologies which immobilize the organisms such as bacteria in the pores of the carbon matrix. This process can avoid the immobilized organisms from shock load application as the diffusion of the pollutants from bulk fluid phase to organisms follows Ficks law. Through conventional biological wastewater treatment, infinite electrical energy and vast land area are being consumed. Besides that, a huge investment in electromechanical equipment is involved which will bring about a huge total cost of operation. Generally, the total cost of operation for new technology is lowered compared to the convention technology. By using the new technology, the total cost of operation can be cut down to approximately 50 percent of the total cost of conventional treatment. Furthermore, the biological oxygen demand and chemical oxygen demand are reduced by 94 percent and 90 percent respectively. Oxygen consumption in the new technology is lower than in conventional technology. The oxygen gas is supplied in the form if compressed air from the bottom of the reactor. Both liquid and gas streams are in counter-current direction which facilitates the oxidation of dissolved organics and desorbs the converted products. This is to make sure the activated carbon keep up its activity throughout the process. Moreover, with all those new wastewater technologies such as Advanced Oxidation Process, NERV (Natural Endogenous Respiration Vessel), Wet oxidation and many others processes, wastewater treatment can be done efficiently. For instant, through the new technologies less land is required to use to build plant; the power consumption is lowered. Besides that, the requirement for electrical and mechanical equipment is lower compared to conventional technology. In a conclusion, wastewater treatment industries have a good prospect in the future with the help of new technologies. By using all those new technologies, waste water treatment can be done efficiently with lower overall lifecycle costs, lesser energy and equipment needed. We are sure that there is more new technologies will be invented in order to improve the wastewater treatment. The impact on the environment When the waste water is mixed with the waste materials such like garbage, household waste, toilets liquid and disposable things, the resulting product called sewage or waste water. This sewage water is normally will undergo a few process before it is release to the environment but there are still some impact on the environment. One of the impacts on the environment is agricultural impacts. The sewage water contains salts which is soluble that may accumulate in the root zone with possible harmful effect on soil health and crop yield. The physical and mechanical properties of the soil, such as dispersion of particle, stability of aggregates, soil structure and permeability are very sensitive to the types of exchangeable ions present in irrigation water. Thus, when effluent use is being planned, several factors related to the soil properties must be taken into consideration. On the other hand the effect of dissolved solids in the irrigation water on the growth of plants is also another aspect of agriculture which we have to concern. Dissolved salts increase the osmotic potential of soil water and increase the osmotic pressure of the soil solution which increases the growth and the yield of most plants decline progressively as osmotic pressure increases. In addition the one of the environment impact is ecological impact where the drainage water from waste water irrigation schemes drains particularly into small confined lakes and water bodies and surface water, and if phosphatesin the ortho phosphate form are present, the remains of nutrients may cause eutrophication. Here the overloading organic materials resulting in decrease in dissolved oxygen may lead to changes in the composition of a aquatic life such as fish deaths and reduced fishery. The eutrophication potential of waste water irrigation can be assessed using biological indices, which in turn can be qualified in monitory units using economic valuation techniques. The hidden impact on the environment is the increase on the production of green house emissions. The large agriculture reuse project might cause to the environmental externalities associated with pumping water uphill which emits greenhouse gas. Another impact is on the health. The sewage water contains pathogenic microorganisms like bacteria, viruses, protozoans and parasitic worms, the diseases and signs related with such infection are also diverse including typhoid,dysentry and cholera, diarrhea and vomiting. the concentration of he pathogens in waste water is dependent on the source population and the susceptibility to infection varies from one population to another. So basically he waste water is actually harm for the nature even though its treated and release to the environment so as a human being we should not dispose the waste into the water thus our water will be clean and the cost of the treatment can be reduced. The Processes involved in this industry Pre-Treatment(prepared by Brian Lee CL, 0902669) Pre-treatment consists of three sub-stages which are Screening, Grit Removal and Fat and Grease Removal. Pre-treatment is done to remove materials which are easily collected such as debris, leaves and trash which would damage or clog up pumps and skimmers of the primary treatment. Screening is used to remove large objects such as leaves, twigs and cans in the sewage stream. This is normally done with a giant mechanical rake bar which is automated. The rake bar revolves around a central axis at a rate varying on the accumulation and flow rate of the sewage stream. The screens vary in sizes to optimize solid removal. Objects accumulated are collected and disposed in landfills. Grit is minute granules such as sand or stone. The wastewater is channeled to a chamber where to velocity of the water is adjusted so that the grit would settle at the bottom of the chamber. Grit may cause damage to the pumps or other equipment. Grit removal may not necessary in smaller plant. Fat and grease are groups of compounds which are generally insoluble in water. The fat and grease are normally found floating on the surface of the water. In some plants, the fat and grease are removed by using skimmers to collect the fat and grease on the surface of the water in a small tank. However this can also be done in the Primary treatment stage in the same manner. 2) Primary treatment (prepared by Tan HY, 0903497) Primary wastewater treatment is the second step in the wastewater treatment process ahead of the preliminary treatment of a headworks, involves the physical separation of suspended solids from the wastewater flow using primary clarifiers. The objective of primary treatment is the removal of settle able organic and inorganic solids by sedimentation, and the removal of materials that will float (scum) by skimming. Approximately 25 to 50% of the incoming biochemical oxygen demand (BOD5), 50 to 70% of the total suspended solids (SS), and 65% of the oil and grease are removed during primary treatment. Some organic nitrogen, organic phosphorus, and heavy metals associated with solids are also removed during primary sedimentation but colloidal and dissolved constituents are not affected. The effluent from primary sedimentation units is referred to as primary effluent. On the other hand, primary treatment is the minimum level of reapplication treatment required for wastewater irrigation. It may be considered sufficient treatment if the wastewater is used to irrigate crops that are not consumed by humans or to irrigate orchards, vineyards, and some processed food crops. However, to prevent potential nuisance conditions in storage or flow-equalizing reservoirs, some form of secondary treatment is normally required  in  these countries, even in the case of non-food crop irrigation. It may be possible to use at least a portion of primary effluent for irrigation if off-line storage is provided. Primary sedimentation tanks or clarifiers may be round or rectangular basins, typically 3 to 5 m deep, with hydraulic retention time between 2 and 3 hours. Settled solids (primary sludge) are normally removed from the bottom of tanks by sludge rakes that scrape the sludge to a central well from which it is pumped to sludge processing units. Scum is swept across the tank surface by water jets or mechanical means from which it is also pumped to sludge processing units. 2) Secondly treatment (prepared by Harintharan S, 1101379) The secondary treatment in this sewage treatment is one of the most important part in this process. This process is basically designed to remove the waste product from the sewage. This system is also classified as fixed-film  or suspended-growth  systems. The secondary treatment contain a few processes, the 1st process is activated sludge. This activated sludge is majority from the plants which encompass the variety of mechanisms and processes that use dissolve oxygen  to promote the growth of biological flock that substantially removes organic material. This process basically change the ammonia  to  nitrite  and  nitrate  and ultimately to  nitrogen  gas. The 2nd process is this treatment is the Surface-aerated basins also known as Lagoons. This process basically removes the BOD from the sewage water. In an aerated basin system, the aerators provide two functions: they transfer air into the basins required by the biological oxidation reactions, and they provide t he mixing required for dispersing the air and for contacting the reactants (that is, oxygen, wastewater and microbes).However, they do not provide as good mixing as is normally achieved in activated sludge systems and therefore aerated basins do not achieve the same performance level as activated sludge units. The biological oxidation in the Surface-aerated basins is sensitive to the temperature and the rate of reaction increase with the temperature. The suitable temperature for this process is in between  0  °C and 40  °C. Besides that the constructed wetland is one of the process also. This process is a process which cleans the drainage of animals and used to recycle the waste water. The constructed wetland are known to be highly productive systems as they copy natural wetlands, called the Kidneys of the earth for their fundamental recycling capacity of the hydrological cycle in the biosphere and they provide a high degree of biological improvement but depending on design. T he next process is the filter beds which is knows as oxidizing beds are used where the settled sewage liquor is spread onto the surface of a bed made up of  coke, then liquor is typically distributed through perforated spray arms, then distributed liquor trickles through the bed and is collected in drains at the base, and the  biological films of bacteria, protozoa and fungi to reduce the organic content. The next process is the Biological aerated filters are a combine filtration with biological carbon reduction,  nitrification  or denitrification. Its a dual processer in purpose of to support highly active biomass that is attached to it and to filter suspended solids. Carbon reduction and ammonia conversion occurs in aerobic mode and sometime achieved in a single reactor while nitrate conversion occurs in  anoxic  mode. This process is operated either in up flow or down flow configuration depending on design specified by manufacturer. In addition the Rotating biological contactors are the next process in this secondary treatment. This is actually a secondary mechanical treatment system which is capable  of withstanding surges in organic load. The rotating disks support the growth of bacteria and micro-organisms present in the sewage, which break down and stabilise organic pollutants. Oxygen is obtained from the atmosphere as the disks rotate. As the micro-organisms grow, they build up on the media until they are sloughed off due to shear forces provided by the rotating discs in the sewage.   Effluent from the system is then passed through final clarifiers where the micro-organisms in suspension settle as sludge. The sludge is withdrawn from the clarifier for further treatment. After that the membrane bioreactor combine activated sludge treatment with a membrane liquid-solid separation process. The component on this system uses low pressure for microfiltration or ultra-filtration membranes and eliminates the need for clarification and tertiary filtration.   The elevated biomass concentration in the system process allows for very effective removal of both soluble and particulate biodegradable materials at higher loading rates. The final process in this secondary treatment is the secondary sedimentation where the process is to settle out the biological flock or filter material through a secondary clarifier and to produce sewage water containing low levels of organic material and suspended matter. 4) Tertiary treatment (prepared by Raiminder S, 0904743) The main purpose of the tertiary treatment is to ensure that the treated water which is to be released on to the environment is biologically accepted by all other fresh water organisms such as weeds and algae. This part of the treatment includes processes like physical water treatment, lagooning, and excessive nutrient removal processes.to ensure that the discharged water is raised in effluent quality before proceeding to the final stages. In physical water treatment, much of the residual suspended matters are removed using only physical processes such as sedimentation  method and the infamous filtration method. In the sedimentation  method, the water is place in a certain tank to allow all the remaining heaver objects to sink down to the bottom of the container. After few hours went most of the dense object are separated from the water, the cleared effluent or waste stream is removed. Sedimentation is one of the most common methods, quite often used at the beginning and the end of many water treating processes. Another physical method that is commonly used in the sewage water treatment system is the filtration method. In filtration, the water is allowed to pass through filters to separate the contaminating solids from the water. Sand filter is a common filter used in this process. In a number of wastewater treatment methods, semi-solid contaminants like grease and oil are allowed to float on the surface of the wat er, and then they are physically removed. Besides the in lagooning where lagoon is a stationary system having a continuous flow: several ponds working in parallel in which the inlet flow and the outlet flow are equals form lagoon plants. The lagooning technique is a natural and very efficient technique that consists in the accumulation of wastewater in ponds or basins, known as biological or stabilization ponds, where a series of biological, biochemical and physical processes take place. In these ponds or lagoons, certain types of the microorganism are actually supported as these biological agents help in treating the water further by removing the fine particulates. These types of biological ponds are usually classified as anaerobic ponds or oxidation ponds depending on the shape, depth, organic rate, level of treatment of that particular lagoon itself. The excessive nutrient removal is the most viral step in the last stages of the water treatment before the water is released to the environment. When the previously treated water comes to this area of the system, the nutrients level mainly nitrogen and phosphorus in the water is checked. Where when found in excess, the excessive nutrient removal step is carried out. This is because if the unchecked water supply is to be released into the natural water system (river, pond, etc.) it will cause a sudden increase in the native microorganism population of that certain water system. Some of the native microorganisms which are commonly found in ponds today are usually weeds, algae, and cyanobacteria. Therefore, after the sudden rapid grown in the population of these microorganisms, the number of algae for example, becomes unsustainable which causes most of them to die and eventually decay. The following decay process would substantially increase the biochemical oxygen demand (BOD) in that p articular pond, which would cause the other fresh water living organism such as fishes to die as well. Firstly, the nitrogen removal process is carried out. There are various methods of removing nitrogen, each with advantages and disadvantages. However, the biological treatment method is used most commonly. With this method, organic nitrogen and ammonia nitrogen is converted into nitrous and nitrate nitrogen in an aerobic environment, and is dispersed into the atmosphere as anaerobic nitrogen gas. Therefore the gas is removed from the water and released to the atmosphere. And as there is no secondary pollution, this can be called an effective method. In the removal of phosphorus is usually carried out using a method called enhanced biological phosphorus removal (EBPR). The first process in EBPR is the mainstream biological treatment process. Where the utilizing of aerobic and solids separation zones and the provision of return activated sludge are carried out. The next is a first side stream process for anoxic/anaerobic selection of desirable BPR organisms such as the polyphosphate accumulating organisms (PAOs). Finally, a second side stream process serves to ferment organic material in some of the return activated sludge to produce food utilized in the first side stream selection process. The system permits the three processes to be separated from each other by creating two side streams, allowing all three processes to be controlled separately and optimized in satisfying their own specific goals. Besides this biological method, the removal of phosphorus can also be done via chemical precipitation, usually with salts of iron, alu minum, or lime. Chemical precipitation is usually more reliable, easier to operate, and requires smaller equipment footprint than biological removal. But the main back draws of this chemical method is that it may form excessive sludge production as hydroxides precipitates and the chemical used in this method might be considered expensive. 5) Disinfection (prepared by Lim CS, 1001012) The main purpose of disinfection in the wastewater treatment is to provide a degree of protection from contact with infectants and pathogen organisms which will cause waterborne diseases such as cholera, dysentery and hepatitis. Disinfection is also used to reduce the load of microorganisms in the wastewater to be discharged to the environment. Primary, secondary and even tertiary treatments do not fully remove the incoming waste load and microorganisms in the water stream and as a result, many microorganisms still remain in the wastewater. Therefore, various methods of disinfection are introduced such as chemical methods, physical methods and biological methods. The effectiveness of disinfection depends on different factors including the quality of wastewater being treated, disinfectant dosage, type of disinfection being used and others. For instant, cloudy wastewater will not be treated efficiently due to less contact time between ultraviolet light and microorganisms. These microorganisms are shielding by those solid matters in wastewater stream and it reduces the contact time. Generally, long contact times, high concentration of disinfectant and optimum temperature and pH value will increase the effectiveness of disinfection. Chlorination is one of the chemical methods which is commonly used for disinfection in the wastewater treatment. It is widely used through the world due to its low cost and long-term history of effectiveness. Chlorine can be applied in two general ways, liquid and gas. Chlorine in gaseous form is generally added to the wastewater stream rather than liquid form which is also known as hypochlorite because the former costs lesser than the latter. When chlorine dissolves in pure water, hypochlorous acid is formed followed by hypochlorites which are known as free residual chlorines Chlorine is an extremely active oxidizing agent which will react with many other substances in the water stream. For instant, it reacts rapidly with such compounds as hydrogen sulfide, ferrous iron and manganese which found in industrial wastewater. However, if all of the chlorine is consumed in these reactions, no disinfection will result. Hence, to accomplish disinfection, sufficient chlorine is added into wastewater stream to satisfy the chlorine demand and produce residual chlorine which will destroy bacteria. There are few factors which will affect the effectiveness of chlorination. Among the factors are pH, temperature, turbidity, control system and many others. However, chlorination brings some disadvantage to environment. Chlorination of residual organic material can generate chlorinated-organic compound which may be harmful to the environment. Those residual chlorines are toxic to aquatic species; therefore, dechlorination is needed, adding to complexity and cost of treatment. However, chlorination becomes less favoured as disinfectant due to rising cost and it had found to be toxic to aquatic species. As a result, ozone and ultraviolet begin to be used as disinfectant. Ultraviolet (UV) light is more environmental friendly to be used as no chemicals are used and leave no toxic residual. Ultraviolet radiation and damages the genetic material of microorganisms, destroying their ability to reproduce. Before pass through the UV disinfection unit, the wastewater must pass through an advanced pretreatment component. Wastewater flows in the stream parallel to the UV light in a thin film in order to increase the contact time. To increase the effectiveness of the UV light, the UV radiation must come in direct with pathogen organisms and other microbial in the wastewater stream. The effectiveness of a UV disinfection system is affected by few factors including characteristics of the wastewater, the contact time, intensity of UV radiation and many others. Turbidity, flow rate of water stream and suspended solids are also play an important roles in UV disinfection. These factors must be kept at low levels to ensure proper treatment. Disinfection of wastewater, primarily by chlorination, has played an important role in the reduction of waterborne disease. However, there are more new disinfection processes are being developed in order to maximize the effectiveness of disinfection. Role of engineer in this industry The Chemical Engineering is the profession that combines chemistry and engineering concepts that help to solve problems related to world hunger, pollution of our environment, creating new materials, or meeting demands for energy. Chemical engineers develop low cost processes for useful chemical products, which make it possible for both poor nations and the United States to manufacture important fertilizers. The roles of a chemical engineer in waste water treatment have to minimize the waste across the plant or reduction of waste loading to the treatment plant. Other than that, chemical engineer need to state whether its systems for the treatment and reuse of wastewater, process water treatment for industry, high-purity water for sensitive medical or scientific applications, or systems to supply clean drinking water to people and their families. Besides that, as a chemical engineer also responsible for providing expertise in their respective discipline as it applies to the hazard analysis of the process being studied. Therefore, we also in charge for attending the initial hazard analysis kick-off meeting. On the other hand, we are also required to be available to the team as required with the understanding that the team leader will give adequate advance notice when their expertise is required. Lastly we are necessary to provide documents of any existing safeguards and procedures. Skills/ knowledge required Many types of skills and knowledge are required for chemical engineer in waste water treatment. They required intensive knowledge in wastewater treatment technologies, so that they will more easy to solve the problems when they face the difficulty. On the other hand, they also need expertise in equipment design, influent water treatment, effluent monitoring, and wastewater recycling. In addition, proficiency in computer, programming, modeling and data analysis, for example AutoCAD, Microsoft Office, FOTRAN, Origin, Maple, Polymath, and other software are also the knowledge needed for chemical engineer. Moreover, strong technical writing, presentation, and project management skills are also useful skill for chemical engineer in order to present the researches after they have completed. Besides the skills at above the hazard and operability study (HAZOP) technique also needed for a chemical engineer working in industry. The HAZOP technique is most popular in most industry because that is technique which is structured and systematic examination of a planned or existing process or operation in order to identify and evaluate problems that may represent risks to personnel or equipment, or prevent efficient operation. Otherwise, HAZOP as well a qualitative technique based on guide-words and is carried out by a multi-disciplinary team (HAZOP team) during a set of meetings.

Chronic Obstructive Pulmonary Disease (COPD) Literature

Chronic Obstructive Pulmonary Disease (COPD) Literature This essay focuses on the search and exploration of three pieces of literature related to Chronic Obstructive Pulmonary Disease (COPD). This includes one government guideline and two research articles covering different nursing angles of the condition. An analysis of how the search was conducted, the main findings and rationale for the chosen articles. Finally, a demonstration of understanding with the use of additional literature to analyse, identify and explore how it will influence the nursing care of patients with COPD. Search Strategy. PubMed was the chosen search database as supposed to other databases like Cumulative Index to Nursing and Allied Health Literature (CINAHL) because PubMed presented more articles with clear and precise titles, therefore enabling the writer to identify its significance (Macnee and McCabe, 2008). The writer firstly chose a topic, which was ‘self-management for people with Chronic Obstructive Pulmonary Disease’. Harvard (2007) further suggests that when conducting an effective and valid literature search it is important to identify a topic to enable the search results to be applicable and relevant. In-order to be more specific the writer identified key words from the chosen topic, and implemented Boolean operators, which concluded to ‘Self-Management AND COPD’, this was inserted and resulted to 1127 hits. According to Barker, Barker and Pinard (2011), Boolean operators such as ‘AND, OR, NOT, AND NOT’ are simple words used to join or exclude key wor ds in a search. PubMed included search options such as full text and abstracts available, language, age range, gender and publication dates which were utilised to enable the user to narrow the search to an optimal amount (refer to Appendix 1 and 2). The search was narrowed from 1127 hits to 95 hits, from which this article was selected, titled ‘Self-management support for moderate-to-severe chronic obstructive pulmonary disease’. This article was chosen because the authors used current evidence to support and justify the outcomes and findings of their study. Boswell and Cannon (2011) suggest that a research study that incorporates current and relevant evidence to analyse their study is more likely to be reliable. The second research article was selected using different key words, which was ‘Pulmonary Rehabilitation AND COPD’. The writer retained the same search options used to find the first article, this narrowed the search to an ideal amount, from 479 to 38 hits (refer to Appendix 1and 2). This article was selected because it identified the importance of pulmonary rehabilitation in connection to improving quality of life and reduced hospital admissions. The authors validated their aims by analysing current evidence that supports the need to promote pulmonary rehabilitation for COPD patients following a discharge from hospital. United Kingdom. National Institute for Health and Care Excellence. (2010). Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. London: NICE. The National Institute for Health and Care Excellence (NICE, 2011) released a guideline titled ‘Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease for Adults in Primary and Secondary care’. The writer was able to find this Guideline simply by inserting ‘Chronic Obstructive Pulmonary Disease’ into the NICE database, which resulted to 138 hits. The writer then narrowed the search by selecting ‘Guidance’, which is an option provided; this further narrowed the hits to 37, from which this guideline was selected. This guideline defines COPD as a chronic disorder caused by frequent airflow obstruction with symptoms like persistent and progressive breathlessness, chronic cough and limited exercise ability. It is estimated that COPD is UK’s fifth biggest killer with 3.2 million people living with the condition, this support the importance of delivering high quality care, which NHS England (2014) defines as providing a positive experience of care that is clinically effective and safe. The National Institute of Health (2013) further suggest that there is yet to be a cure for this disease. The aim and objectives of this guideline is to offer the best professional practice advice on a patient centred approach to caring for COPD patients. The British Lung Foundation (2013) additionally suggests that this guideline will help the health care professionals such as the nurses to identify the types of care COPD patients should be receiving, as they are frequently the first point of contact and are involved in all aspects of care. NICE (2011) guideline also defines the symptoms, signs and investigations required to establish a diagnosis. Bellamy and Smith (2007) support that the key to early diagnosis is recognising the signs and symptoms such as frequent coughs, chronic sputum production, breathlessness and a history of exposure to tobacco smoke to aid in diagnosing the patient. The guideline also looks at the necessary factors to assess the severity of the disease and guide best management in both acute and community settings so that it is applicable to all settings and professionals. This guideline was chosen because it considers most issues that are important in the management of people with COPD, integrates published evidence in areas of uncertainty that could possibly need further research and is useful to all professionals involved in the care of COPD. According to British Lung Foundation (2013) the management of COPD is challenging, as the patients have complex health and social needs requiring long-life monitoring and treatment, Fletcher and Dahl (2013) go further to explain that nurses in comparison to other health professionals are more involved in the care and management of patients with COPD. Therefore, this guideline positively influences the nursing care of patients with COPD by providing information about the basic level of care required and empowering COPD patients to make decisions over their health and care needs (DOH, 2013). Taylor, S., Sohanpal, R., Bremner, S. A., Devine, A., McDaid, D., Fernanded, S. L., et al. (2012). Self- Management Support for Moderate-to-severe Chronic Obstructive Pulmonary Disease. British Journal of Medical Practice, 62. (603), 687-695. The authors study is focused on the importance of self-management education and its contribution to a better quality of life and reduced hospital admission. According to The Health Foundation (2014), self-management education is aimed at improving how people with COPD are supported and empowered to self-manage. The authors aim was to explore the cost effectiveness of self-management programmes and education for COPD. The author’s findings suggest that COPD patients feel useless and helpless to self-manage their condition, therefore the programmes plays a vital role in improving the patient’s quality of life, exercise tolerance and empower them to take control over their health which in turn will reduce exacerbations and rapid deterioration. The outcome of this study has a good chance to meet the UK National Health and Clinical Excellence (2010) criteria on cost-effective approaches to managing COPD. This information could be useful to nursing patients with COPD by underlining the importance of Self-management education, which may include working closely with primary care teams and educating the patients on self-management techniques, like learning to control breathing, being mindful of tiredness due to over exertion on daily activities and eating a well-balanced diet. This would contribute towards living better with the condition (COPD Education, 2014). The authors recognise that nurses play an important role in educating, equipping and supporting the patients to merge their everyday life to suit their long term condition, such as dealing with an altered view of the future and the frustration and depression that may result (Redman, 2004). Part of the nursing care, with patient participation includes creating a short-term personalised action plan, which would be closely monitored to enable the nurse to identify the strengths and areas of development. Fletcher and Dahl (2013) ackn owledges that the purpose of self-management education is to empower patients to improve their health and to restore the highest level of function regardless of the disease stage or following an exacerbation. Cosgrove, D., MacMahon, J., Bourbeau, J., O’Neil, B. (2013). Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation, 13. (50), 13-50. The author’s presentation of their study, based on the importance of facilitating education in pulmonary rehabilitation was clear and precise as the reader was able to gain a good understanding of the study. Galin and Ognibene (2012), go further to support that a good clinical research study should not be full of medical terminologies, and should be presented with clear and accurate information enabling the reader to grasp the key elements. The author’s aims of the study were to adapt a self-management programme which was Living Well with COPD (LWWCOPD) through pulmonary rehabilitation and then to evaluate its impact. They identify that pulmonary rehabilitation administered after an exacerbation can reduce hospital re-admission and improve the patient’s quality of life as supported by Seymour et al (2010). The author’s findings suggested a positive outcome for the patients, as they felt they were in a friendly and supportive environment to be empowered to manage their condition, especially coping with breathlessness. The British Lung Foundation (2013) supports this evidence as they additionally suggest that pulmonary rehabilitation programmes are designed to help people with COPD to cope with breathlessness and to feel stronger to manage with activities of daily living such as walking, personal care and eating, as they often feel disempowered to self-care. This information could be beneficial to nursing patients with COPD by emphasizing on the importance of evidence based nursing practice to enable accurate and useful information when recommending relevant programmes, which contributes to their on-going care (Deutschman and Neligan, 2010). It is estimated that most patients with COPD will experience at least one hospital admission due to an exacerbation of their condition within three months (DOH, 2012). Therefore based on the information from the Study which suggests that pulmonary rehabilitation reduces hospital re-admission, the nurse plays an important role in encouraging the patients to join the programme which is designed to suit the individual. British Lung Foundation (2013) goes further to suggest that the course will teach the individuals how to increase their exercise tolerance, cope with breathlessness and manage periods of stress and panic. Additionally pulmonary rehabilitation can be beneficial to COPD patients socially, a s it involves interacting with trained professionals and other COPD patients, as due to the nature of the condition social interaction may be difficult (Bellamy and Booker, 2011). In conclusion, this essay has explored three pieces of literature related to COPD with additional evidence to analyse identify and explore how it will influence the nursing care of patients with COPD.

Molieres the Imaginary Invalid :: essays research papers fc

Moliere's "The Imaginary Invalid" Moliere's "The Imaginary Invalid" is a farcical play about a hypochondriac who is so obsessed with his health and money that he ends up neglecting his family. The story involves several different themes and plots within one family. A new interpretation of this 17th century play is now being performed at the Arts Club Theater; it incorporates some new changes and modernizations in addition to the traditional improvisation. Morris Panych has definitely succeeded in delivering a new, more comical version of Moliere's final play. Moreover, the dominant theme of this play is body versus mind. The play is about a wealthy, but stingy man who believes that he is constantly sick (Argan). However, there is an obvious doubt to whether he is really sick or if he is just imagining his illness. Therefore, the primary theme is Argan's internal struggle of body vs. mind. This theme is developed throughout the play into smaller themes such as masculinity versus femininity, greed versus love, and death versus life. Two of the major changes from the text to the play are Argan's degree of illness and his death. In the text, there are very few elaborate descriptions of Dr. Purgon's treatment. However in the play by Panych, there is no shortage of enemas and other "bathroom" related scenes. I originally thought this change was for comical purposes, but after some additional thought I questioned whether Argan was imagining his illness or if he really was ill. In the text, by not having too many bathroom scenes, Argan seems to be imagining his illness (thus, he is the imaginary invalid). In Panych's stage version, Argan shows several symptoms of being ill; this definitely confuses the original play by Moliere. One of the original purposes of the play was to criticize, among other things, the medical profession in Moliere's time. Now, if Argan really was sick, does that mean that the doctors were correct in their analysis? No, it doesn't. I believe that Panych intended to show that it was the doctors' treatments that made Argan ill and eventually killed him. Another major change from Moliere's version is Beralde's gender and role in the play and in the family. Beralde is transformed into Argan's sister, instead of his brother. Panych saw male versus female as a major theme. If you look at the structure of the original play, all the people who truly love Argan and mean him well are female, except for Beralde. In fact out of all the different characters who take advantage of Argan, only one of them is female-

The Disease that Infests The District Essay -- Essays Papers

The Disease that Infests The District There is a disease that is sweeping across this country. From this disease, no one person has immunity. It strikes the poorest of families and the richest of families. It has the ability to harm the old and young, male and female. It does not care what your sexual preference is, if it wants to infect you, it will. What is this disease that does not care who it harms? It is the acquired immune deficiency syndrome, better known as AIDS. Even the capital of the most powerful country in the world has a problem with AIDS. In fact, Washington, DC has a major problem with this disease. The rate of new AIDS cases in the District and its surrounding areas is twelve times higher than the national average. â€Å"By the end of 1998, [†¦] there are 19,086 cases of AIDS in the DC greater metro area and 10,750 deaths from the disease (Whitman-Walker Clinic). One of the groups that is most heavily affected by this disease in Washington, DC as well as across the country is homosexual men, though in recent years that trend seems to be changing. It is for this reason that concern was growing in the District about the AIDS problem amongst the homosexual community. This is where the Whitman-Walker Clinic steps in. Located in the Northwest area of Washington, DC, this clinic has been serving the community as early as 1973. The clinic has an array of services mainly for the homosexual population that include testing for HIV and AIDS, support groups, legal services, the list goes on and on. One of the major aspects of the Whitman-Walker Clinic is providing prevention education to those who have not yet contracted the disease. One of the divisions ... ...ed their services to different areas not just here in The District. Primary care clinics are also located in Northern Virginia and most recently Maryland. â€Å"One of the biggest things we just accomplished was expanding primary care to a new Maryland facility. Every here [at the Whitman-Walker Clinic] is happy to see it happen, notes Chip Lewis. The hours that the clinic is open is also changing. â€Å"We realize that people have lives outside of having HIV and AIDS. We are working to expand the hours that all of our clinics are open. Convenience is always an issue; we want to serve as many people as possible† (Chip Lewis) It is about time that â€Å"as many people as possible† are being provided with service to combat AIDS, because too many people have been neglected from services for too long simply because they did not fit the nation’s stereotype of who contracted AIDS. The Disease that Infests The District Essay -- Essays Papers The Disease that Infests The District There is a disease that is sweeping across this country. From this disease, no one person has immunity. It strikes the poorest of families and the richest of families. It has the ability to harm the old and young, male and female. It does not care what your sexual preference is, if it wants to infect you, it will. What is this disease that does not care who it harms? It is the acquired immune deficiency syndrome, better known as AIDS. Even the capital of the most powerful country in the world has a problem with AIDS. In fact, Washington, DC has a major problem with this disease. The rate of new AIDS cases in the District and its surrounding areas is twelve times higher than the national average. â€Å"By the end of 1998, [†¦] there are 19,086 cases of AIDS in the DC greater metro area and 10,750 deaths from the disease (Whitman-Walker Clinic). One of the groups that is most heavily affected by this disease in Washington, DC as well as across the country is homosexual men, though in recent years that trend seems to be changing. It is for this reason that concern was growing in the District about the AIDS problem amongst the homosexual community. This is where the Whitman-Walker Clinic steps in. Located in the Northwest area of Washington, DC, this clinic has been serving the community as early as 1973. The clinic has an array of services mainly for the homosexual population that include testing for HIV and AIDS, support groups, legal services, the list goes on and on. One of the major aspects of the Whitman-Walker Clinic is providing prevention education to those who have not yet contracted the disease. One of the divisions ... ...ed their services to different areas not just here in The District. Primary care clinics are also located in Northern Virginia and most recently Maryland. â€Å"One of the biggest things we just accomplished was expanding primary care to a new Maryland facility. Every here [at the Whitman-Walker Clinic] is happy to see it happen, notes Chip Lewis. The hours that the clinic is open is also changing. â€Å"We realize that people have lives outside of having HIV and AIDS. We are working to expand the hours that all of our clinics are open. Convenience is always an issue; we want to serve as many people as possible† (Chip Lewis) It is about time that â€Å"as many people as possible† are being provided with service to combat AIDS, because too many people have been neglected from services for too long simply because they did not fit the nation’s stereotype of who contracted AIDS.

Henry Fleming In Red Badge Of Courage Essay -- Red Badge Of Courage

Henry Fleming in Red Badge of Courage The Civil War forced many young boys out of childhood and into adulthood. Most of these young boys were not prepared for war, and Henry Fleming was one of these boys. Henry Fleming's life in New York was routine. He had his normal share of friends and lived on a farm. When Henry got up in the mornings, he always knew exactly what the day had in store for him. This simple and boring life drove Henry to enlist. Henry wanted some excitement and to be seen by everyone as a hero. He wanted to be a man. However, his mother was strictly against his joining the Union Army. She thought that the Army was for rough and uncivilized heathens. His mother's greatest fear was that these heathens would influence Henry to start drinking and swearing. Despite his mother's concerns, Henry enlisted in the Army. But being in the Army wasn't enough, Henry was anxious to go to battle. All along the way to his station he and his fellow recruits were treated kindly. Old men patted them on their backs and young boys admired them when they stopped for rest. This warm feeling faded when they reached the camp. Here life was boring for Henry. The only thing his company did was drill day in and day out. All of the experienced soldiers told war stories every night by the campfire. Henry could only listen because he was still 'wet behind the ears'. He felt left out and often sat alone wondering about battle. War was like an illusion to him....

Managing a Holistic Marketing Organization for Long Run

CHAPTER 22 Managing a Holistic Marketing organization for Long Run Trends in Marketing Practices Reengineering: Appointing teams to manage customer-value-building processes and break down walls between departments. Outsourcing: Greater willingness to buy more goods and services from outside domestic or foreign vendors. Benchmarking: Studying â€Å"best practice companies† to improve performance. Supplier partnering: Increased partnering with fewer but better value-adding suppliers. Customer partnering: Working more closely with customers to add value to their operations.Merging: Acquiring or merging with firms in the same or complementary industries to gain economies of scale and scope. Globalizing: Increased effort to â€Å"think global† and â€Å"act local. † Flattening: Reducing the number of organizational levels to get closer to the customer. Focusing: Determining the most profitable businesses and customers and focusing on them. Accelerating: Designing the organization and setting up processes to respond more quickly to changes in the environment. Empowering: Encouraging and empowering personnel to produce more ideas and take more initiative. Internal MarketingOrganizing the Marketing Department Functional Organization Geographic Organization Product or Brand management organization Some of the tasks that product or brand managers may perform include: ? Developing a long-range and competitive strategy for the product. ? Preparing an annual marketing plan and sales forecast. ? Working with advertising and merchandising agencies to develop copy, programs, and campaigns. ? Increasing support of the product among the sales force and distributors. ? Gathering continuous intelligence on the product's performance, customer and dealer attitudes, and new problems and opportunities. Initiating product improvements to meet changing market needs. This organization has some disadvantages too: ? Product managers and specifically brand managers are not given enough authority to carry out their responsibilities. They have to rely on persuasion to get the cooperation of other departments. ? Product and brand managers become experts in their product area but rarely achieve functional expertise. They vacillate between acting as experts and having to defer to real experts. ? The product management system often turns out to be costly.One person is appointed to manage each major product or brand and soon managers are appointed to manage even minor products and brands. ? Brand managers normally manage a brand for only a short time. Short-term involvement leads to short-term planning and plays havoc with building long-term strengths. ? The fragmentation of markets makes it harder to develop a national strategy from headquarters. ? Brand managers must increasingly please regional and local sales groups, resulting in a transfer of power from marketing to sales. Product and brand managers cause the company to focus on building market shar e rather than building the customer relationship. Yet the customer relationship, not the brand, may be the primary lever for value creation. MARKET-MANAGEMENT ORGANIZATION ? When customers fall into different user groups with distinct buying preferences and practices, a market-management organization is desirable. ? A market manager supervises several market managers (also called market-development managers, market specialists, or industry specialists). ? The market managers draw on functional services as needed.MATRIX-MANAGEMENT ORGANIZATION ? A matrix organization would seem desirable in a multiproduct, multimarket company. ? This system is costly and often creates conflicts. ? There is the cost of supporting all the managers. ? There are also questions about where authority and responsibility should reside. Relation with other departments Building a Creative Marketing Organization ? Developing a company-wide passion for customers. ? Organizing around customer segments instead of around products. ? Developing a deep understanding of customers through qualitative and quantitative research.Socially Responsible Marketing Corporate Social Responsibility Legal behavior ? Society must use the law to define, as clearly as possible, those practices that are illegal, antisocial, or anticompetitive. ? Organizations must ensure that every employee knows and observes any relevant laws. ? For example, sales managers can check that sales representatives know and observe the law, such as the fact that it is illegal for salespeople to lie to consumers or mislead them about the advantages of buying a product. Ethical behaviorCompanies must adopt and disseminate a written code of ethics, build a company tradition of ethical behavior, and hold its people fully responsible for observing ethical and legal guidelines. Social Responsibility Behavior Sustainability The importance of meeting humanity’s needs without harming future generations. Socially Responsible Business Mo dels ? The future holds a wealth of opportunities for companies. ? Technological advances in solar energy, online networks, cable and satellite television, biotechnology, and telecommunications promise to change the world as we know it. At the same time, forces in the socioeconomic, cultural, and natural environments will impose new limits on marketing and business practices. ? Companies that are able to innovate new solutions and values in a socially responsible way are the most likely to succeed. Cause-Related Marketing ? Cause-related marketing is marketing that links the firm's contributions to a designated cause to customers' engaging directly or indirectly in revenue producing transactions with the firm. ? Cause marketing has also been called a part of corporate societal marketing (CSM) which Drumwright and Murphy define as marketing efforts â€Å"that have at least one on-economic objective related to social welfare and use the resources of the company and/or of its partners . † ? They also include other activities such as traditional and strategic philanthropy and volunteerism as part of CSM. CAUSE MARKETING BENEFITS AND COSTS A successful cause marketing program can produce a number of benefits: ? Improving social welfare ? Creating differentiated brand positioning ? Building strong consumer bonds ? Enhancing the company's public image with government officials and other decision makers; ? Creating a reservoir of goodwill Boosting internal morale and galvanizing employees; and driving sales Choosing a cause Many companies choose to focus on one or a few main causes to simplify execution and maximize impact. One of the more focused cause marketers is McDonald's. Ronald McDonald Houses in more than 20 countries offer more than 5,000 rooms each night to families needing support while their child is in the hospital. Ronald McDonald House program has provided a â€Å"home away from home† for nearly 4 million family members since its beginning in 1974. Social MarketingCognitive campaigns ? Explain the nutritional value of different foods ? Explain the importance of conservation. Action campaigns ? Attract people for mass immunization. ? Motivate people to vote â€Å"yes† on a certain issue. ? Motivate people to donate blood. ? Motivate women to take a pap test. Behavioral campaigns ? Demotivate cigarette smoking. ? Demotivate hard-drug usage. ? Demotivate excessive consumption of alcohol. Value campaigns ? Alter ideas about abortion. ? Change attitudes of bigoted people. Evaluation and Control Annual plan control Sales AnalysisMarket Share Analysis Needs to track its market share in one of three ways Overall market share/Served market share/Relative market share A useful way to analyze market share movements is in terms of four components: Overall market share=Customer penetration (% of all the customers who buy from the company)XCustomer loyalty X Customer selectivity (average customer purchase from the company co mpared to average company)X Price selectivity(Average price of the company with others) Marketing expense to sales analysis Financial analysis Profitability ControlMarketing Profitability Analysis Step: 1: Identifying functional expense Step: 2: Assessing functional expenses to marketing entities Step: 3: Preparing a profit and loss statement for each marketing entity Determining corrective actions Direct versus full costing Efficiency control Strategic control The Marketing audit Comprehensive The marketing audit covers all the major marketing activities of a business, not just a few trouble spots. It would be called a functional audit if it covered only the sales force, pricing, or some other marketing activity.Systematic The marketing audit is an orderly examination of the organization's macro-and micromarketing environments, marketing objectives and strategies, marketing systems, and specific activities. The audit indicates the most-needed improvements, which are then incorporat ed into a corrective action plan involving both short-run and long-run steps to improve overall effectiveness. Independent A marketing audit can be conducted in six ways: self-audit, audit from across, audit from above, company auditing office, company task force audit, and outsider audit.Self-audits, in which managers use a checklist to rate their own operations, lack objectivity and independence Periodic Typically, marketing audits are initiated only after sales have turned down, sales force morale has fallen, and other problems have occurred. Companies are thrown into a crisis partly because they failed to review their marketing operations during good times. A periodic marketing audit can benefit companies in good health as well as those in trouble. THE MARKETING EXCELLENCE REVIEWCompanies can use another instrument to rate their performance in relation to the best practices of high-performing businesses. The Future of Marketing In these ways, modern marketing will continue to ev olve and confront new challenges and opportunities. As a result, the coming years will see: ? The demise of the marketing department and the rise of holistic marketing. ? The demise of free-spending marketing and the rise of ROI marketing. ? The demise of marketing intuition and the rise of marketing science, ? The demise of manual marketing and the rise of automated marketing. The demise of mass marketing and the rise of precision marketing. Proficiency will be demanded in areas such as: ? Customer relationship management (CRM). ? Partner relationship management (PRM). ? Database marketing and data-mining. ? Contact center management and telemarketing. ? Public relations marketing (including event and sponsorship marketing), ? Brand-building and brand-asset management. ? Experiential marketing ? Integrated marketing communications ? Profitability analysis by segment, customer, channel.

Rheumatoid Arthritis The Problem Health And Social Care Essay

Rheumatoid arthritis is an ague, systemic inflammatory upset that causes chronic redness of the articulations. It is besides known as an autoimmune disease, the status such that the organic structure ‘s immune response sends out incorrect signals to assail the organic structure itself. It may impact other variety meats like eyes and lungs every bit good. It progresses in three phases. ( 1 ) The first phase is the puffiness of the joint ; the 2nd phase is the rapid division and growing of cells which causes synovial membrane to be thickened and the last phase is the loss of motion. Figure 1: Normal joint vs. articulation affected by Rheumatoid Arthritis The loss of motion is caused by the enzymes that released by the inflamed cells that may digest the bone and gristle causes the involved articulation to lose its alliance and form. ( 2 ) The swelling in the articulations of the custodies and carpuss is normally the first symptom to be noticed. ( 3 ) Figure 2: Joint malformations caused by rheumatoid arthritis hypertext transfer protocol: //www.google.com.sg/imgres? imgurl Until now, the cause of the disease is still an unknown. However, there are scientists who believe that the immune system, gender, familial and infection may be the factors of the disease. ( 4 ) . Prevalence is more common in adult females than in work forces in the ratio of 3:1. Figure 3: Arthritis / Rheumatism prevalence: by age and sex, GB, 2003. ( hypertext transfer protocol: //www.statistics.gov.uk/cci/nugget.asp? id=1331 ) Temporary, there is no remedy for this disease. So, what are the current interventions that are available to relieve the symptoms of this disease? I will discourse about them in this study.A Possible SolutionDisease Modifying Anti-Rheumatic Drugs ( DMARDs )DMARDs are a combination of drugs normally used to handle patients with arthritic arthritis. They interfere with the devising or working of immune cells that cause joint redness. ( 5 ) By and large, biological DMARDs are non used in combination with other biological DMARDs because several of these combinations have shown increased toxicity. There are besides some agents that are synthesised through familial technology such as tumour mortification factor alpha ( TNF I ± ) blockers and Interleukin 1 ( IL-1 ) blockers. ( 6 ) The consequence is different and may be more delayed in oncoming than other medicines which are why sometimes they are called slow moving anti-rheumatic drugs ( SAARDs ) . So, I think it is rather of import to g et down DMARD agents every bit early as possible one time RA has been diagnosed and confirmed. ( 7 ) DMARDs could be one of the possible solutions because there are a batch of beginnings saying that its early usage is effectual in alleviating the symptoms as the quotation mark shown: ( 8 )Surveies have shown that early debut of these drugs may be good, with betterment in hurting, joint tonss, and disablement.( hypertext transfer protocol: //www.arthritis.co.za/dmard.html )In malice of its effectivity, there are several factors need to be considered included phase and badness of the joint status, the balance between possible side effects and benefits, and patient penchant ( 9 ) while doing the pick of which DMARDs drugs need to be taken. From my point of position, the patients need to seek a assortment of combinations of drugs to cognize that which combination give themselves the best consequence and the lowest hazard of side consequence with the aid of rheumatologist. Sometimes, mer ely one DMARD is used. However, there are many beginnings demoing that combination of DMARDs works better for the patients as the quotation mark and table below shown:Current grounds suggests that combinations of DMARDs are more effectual, and likely less toxic, than monotherapy. ( http: //www.patient.co.uk/doctor/Disease-Modifying-Antirheumatic-Drugs- ( DMARDs ) .htm )Figure 7: Comparison of combination therapy with individual drug therapy in early RA ( hypertext transfer protocol: //images.google.com.sg/imgres? imgurl=http: // ) From Figure 7, the consequences shown that the combination of drugs was approximately two times more effectual than the individual drug therapy for those who got remittal after one twelvemonth and two old ages of the intervention. Even though DMARDs plays a critical function in arthritis intervention, nevertheless, some of them are used more common than the others. For illustration, amethopterin ( MTX ) is the most normally used DMARD due to its higher efficaciousness but lower toxicity. ( 10 ) Figure 2: The construction of the metrothexate ( hypertext transfer protocol: //en.wikipedia.org/wiki/Methotrexate ) Metrothexate ( MTX ) , acts by suppressing an enzyme involved in the metamorphosis of folic acid, dihydrofolate reductase ( DHFR ) which is involved in the synthesis of tetrahydrofolate. They act by changing the organic structure ‘s usage of folic acid, which is a sort of vitamin and is needed for cell growing. Higher affinity of MTX to DHFR inhibits the transition of dihydrofolate to the active tetrahydrofolate, which means the synthesis of DNA, RNA and proteins are inhibited. It is to believe that this intervention with folic acid makes methotrexate benefit in arthritic arthritis as it inhibits the proliferation of the inflammatory cells in the articulation of the patient. Etanercept aims to command the redness and to retard the patterned advance of terrible RA as good but it is for RA patients which non wholly antiphonal to other drugs. It works by barricading the receptor for TNF-alpha. However, for most RA patients, amethopterin ( MTX ) is now considered the most first line DMARD agent. It is even more effectual when used in combination with other drugs such as Infliximab or Etanercept. ( 11 )Social & A ; Economic DeductionsBased on a research by Dickens and Creed in 2001, the people with RA are twice every bit likely to endure from depression. ( 12 ) Sometimes, they get upset because they merely do non experience the betterment in their organic structures even though they have taken the medical specialty prescribed. In my sentiment, their household members have to be supportive and be able to give them audiences when they need it. An probe in 1993 even found out that some patients need to take 5 old ages for themselves to accommodate to their statu s. In some instances, the disease may even interfere with their day-to-day activities, limit their occupation chances or interrupt the joy and duties of household life as the quotation mark below suggested: ( 13 ) The people with arthritic arthritis ( RA ) have been described as a ‘tightrope between freedom and a life sentence ‘ . ( 14 ) — Maycock, 1988. There are about 20000 new instances of arthritic arthritis in UK every twelvemonth and there are around 400000 grownups in the UK with this disease. From an economic point of view, this brings economic impact on the people today as the life cost presents is high and if they lost the occupation due to inability to travel around easy so their life disbursals including their medicine cost will be a large job for them. The transit fees to hospital on a regular basis, holding food markets delivered and the demand to purchase particular apparels and places add disbursals to their life cost. Extra money is besides spent on the complementary intervention and auxiliary merchandises. ( 15 )â€Å" If other members are acquiring sick, they may desire to pull resources off from the arthritic arthritis patient. † — Alan Mozes ( hypertext transfer protocol: //www.medicinenet.com/script/main/art.asp? articlekey=116607 )When there is a pick needed to be made, RA patients in a household will be given up doing them non be able to go on their intervention as the quotation mark above shown. Figure: Age-specific mortality rates ( per 100,000 ) for adult females with arthritic arthritis in 2009 hypertext transfer protocol: //arthritis-research.com/content/11/3/229/figure/F3? highres=y The mortality rate has non decreased steadily over the past 30 old ages. I think authorities should take this affair earnestly and take some stairss to turn this status better. Here, I unfeignedly hope that authorities can be financially stable and subsidy for those hapless patients who are non low-cost to travel through the intervention to the full. This could take down the mortality rate for arthritic arthritis patients.Benefits and HazardsI think the displacement to sing DMARDs as the new front line intervention is rather good as it may cut down the demand for other medicines as the quotation mark shown below:A DMARD may besides profit the patient by cut downing the demand for other medicines, e.g. corticoids and NSAIDs, which may hold a greater potency for toxicity than the DMARD. ( hypertext transfer protocol: //medsafe.govt.nz/profs/PUarticles/dmards.htm )This may cut down the intervention cost and increase the efficaciousness at the same clip. Methotrexate ( MTX ) has been sho wn to be the most effectual drug used in decelerating down the patterned advance rate of the eroding and devastation of the joint compared to the others DMARDs as the abstract below shown: ( 16 )Methotrexate outperformed other DMARDs in a meta-analysis of surveies comparing efficaciousness with toxicity, and more patients remained on amethopterin after five old ages than on other DMARDs.( hypertext transfer protocol: //medsafe.govt.nz/profs/PUarticles/dmards.htm )Besides, in footings of long periods, it has been shown to be safe and even can be applied on kids. ( 17 ) Normally the good effects from these agents merely last for a few old ages so I suggest that a good planning or scheme of utilizing them consecutive or even in combination is needed. However, several possible inauspicious reactions are at that place which needed to be taken attention of including timeserving infections, oral cavity ulcers and tummy jobs. Figure: Opportunist infections caused by Etanercept and Infliximab ( DMARDs ) hypertext transfer protocol: //images.google.com.sg/ Other than this, liver harm is another side consequence of this drug if this drug is taken orally every twenty-four hours. Alternatively of making so, from my point of position, the drug should be taken intermittently one time a hebdomad so the liver has adequate clip to retrieve. The existent status is nevertheless, the benefits of taking the drugs outweigh its hazards. So, I think this intervention should still go on but at the same clip, the patients who are taking the drugs need to be monitored on a regular basis. Some steps can be taken such as taking folic acid to cut down the side consequence of amethopterin as many beginnings have suggested.The usage of folic acid with the drug is used to cut down side effects.( hypertext transfer protocol: //www.arthritis.co.za/dmard.html )Alternate SolutionsNon-steroidal Anti-inflammatory Drugs ( NSAIDs )Nonsteroidal anti-inflammatory are besides known as ‘first line ‘ medicine in the instance of RA. Examples of drugs including acetylsalicylate ( acetylsalicylic acid ) , ibuprofen ( Advil, Medipren, Motrin ) and etodolac ( Lodine ) . I choose NSAIDs as an alternate solution because they can cut down the symptoms and thereby bettering maps. However, these drugs entirely do non alter the class of the disease or prevent joint devastation. ( 18 ) There are two chief types of Nonsteroidal anti-inflammatory: selective and non-selective. They work by suppressing enzymes, called Cox, COX-1 and COX-2 which participate in the production of prostaglandins. Even though the prostaglandins cause redness and hurting but they besides have critical functions in care of normal organic structure maps. So, the COX-2 inhibitors act by selectively block the prostaglandins produced through the COX-2 which have involved in redness. ( 19 ) Since the drugs merely aim to cut down the hurting and puffiness, so I suggest that they need to be combined with the other agents in DMARDs to do certain the disease is under control.SurgeryAno ther sensible attack that I suggest is to transport out surgery. Its primary intent is to cut down hurting, better the affected articulation ‘s map, and better the patient ‘s ability to execute day-to-day activities. However, from my point of position, a surgery is merely carried out when the medicine can non repair the structural harm or the disease does non react to the physical therapy. As any surgery is serious and involves complications, it is normally delayed until it is necessary. Furthermore, surgical intervention may non be an option for all of the affected articulations. ( 20 ) There are plentifulness of factors need to be considered such as the patient ‘s overall wellness, the status of the joint or sinew that will be operated on, and the ground for, every bit good as the hazards and benefits of, the surgical process. Cost may be another factor. Surgery picks:ChoicesFunctionsFinger and manus surgeries To rectify joint jobs in the manus. Arthroscopy To take dust or inflamed tissue in a joint through a little lit instrument. Synovectomy To take inflamed joint tissue. Arthroplasty To replace portion or all of a joint in the hip or articulatio genus. Cervical spinal merger To handle terrible cervix hurting and nervus jobs. Resection of metatarsal caputs To take distorted bone in the pess. Figure: The articulatio genus cap and the damaged portion are removed and the bipartite prosthetic device, which is normally metal is implanted during surgery as the diagram shown.hypertext transfer protocol: //arthritis.about.com/od/rheumatoidarthritis/ss/pictures_photos_6.htmEvaluationKate Lorig, the writer of the book The Arthritis Helpbook, who is besides the Director of the Stanford Patient Education Research Center and Professor of Medicine in the Stanford School of Medicine. She is a really reputable research worker in the field of developing self-management classs for patients with chronic diseases and she had published several books sing this rubric. So, I think there would be no biased in the fact that stated in the book about the intervention of DMARDs drugs should be commenced every bit early as possible which is besides supported by the quotation mark from the article of the web site & lt ; hypertext transfer protocol: //www.medscape.com/viewarticle/406508_5 & gt ; : The current intervention scheme hence involves the early usage of DMARDs to restrict joint harm and preserve map. Methotrexate is proved to be more effectual when used in combination with other drugs such as Infliximab or Etanercept than itself entirely from the web site & lt ; hypertext transfer protocol: //arthritis.about.com/cs/mtx/a/mtx.htm & gt ; . This beginning is said to be dependable as many other beginnings agree with this statement every bit good such as the web site & lt ; hypertext transfer protocol: //www.medicalnewstoday.com/articles/74289.php & gt ; and the undermentioned infusion: Study leader Dr Cornelia F. Allaart commented: â€Å" Our findings indicate that clinical remittal from RA is accomplishable provided effectual intervention – such as the Remicade amethopterin combination we used in the 4th arm of this survey – is administered early in the class of the disease. † Besides, the informations collected was at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain. The European League against Rheumatism ( EULAR ) , which is a trust able organisation that represents the patient, wellness professional and scientific societies of rheumatology of all the European states. This statement is besides supported by the abstract: The efficaciousness of combination therapy with a biological agent is superior to methotrexate monotherapy for remittal. from the web site & lt ; hypertext transfer protocol: //ard.bmj.com/content/69/7/1298.abstract & gt ; .