Patient Diagnosis: Lack of Energy Presentation

Patient Diagnosis: Lack of Energy Presentation Summary This dissertation is based on two patients who presented to medical services with a presenting complaint of a lack of energy?. My first patient, Mrs W, 61 years, has Diabetes Mellitus, type 2 and my second patient, Mr H, 59 years, has severe anaemia from unknown lower Gastrointestinal blood loss. I shall begin by focusing on the clinical aspects and basic medical sciences of their diseases and then go on to discuss psychosocial aspects, management, investigations and the role of professionals involved in their health care. I will then look at research and evidence based trials to explore the scope of their conditions and look at any current research that is being carried out. Throughout my dissertation I aim to reflect and convey what I have learnt and how I felt about my experiences. From writing this report I have developed as an individual and have gained personal advancements that I didnt expect to achieve. I have been able to widen my understanding of diseases and patients experience of their disease. Furthermore, I have gained an appreciation for research and evidence based medicine and developed a respect for other health care professionals. I have learnt the vital importance of taking on a holistic approach when dealing with a patient, rather than just looking at the basic science behind a disease. All in all, writing this dissertation has enabled me to truly understand how a disease can affect a patient and I now appreciate that it is not always about curing a patient, but about treating, advising and working towards a better quality of life for the patient and their family. 1. Introduction In my dissertation I aim to explain, explore and reflect on my experience of the People and Disease course. In particular I will focus on my experience of meeting with two individual patients with the same presenting complaint a lack of energy?. Both patients seem to be concerned with the prognosis of their disease but from very different points of view. My first patient wants to overcome her diabetes and not let it worsen; whereas, my second patient does not wish to know the cause of his anaemia, but is worried about the associated symptoms of his condition and how they will progress. Before contacting my first patient, Mrs. W, I felt apprehensive and quite anxious about the idea of having my own patient. I was worried about what she would think of me, how we would be able to build a rapport and what sort of questions I would ask her. In all honesty, I had naturally stereotyped her as a typical old lady?, but on meeting her, my initial thoughts were soon corrected. From this I have learnt that when given details about a patient you shouldnt necessarily stereotype and categorise them into a certain group in society. When asking her the initial questions that I had prepared I felt that it made the conversation very informal, so to adapt to the situation I just literally let her speak and tell me whatever she wanted to. This was very helpful to me as she had a lot of things she wanted to tell me and talk about. However, I do realise from communication skills seminars that not all patients will be as open as this in the future and therefore I do need to have the ability to speak to patients that are perhaps a bit more reluctant and unwilling to share their problems and thoughts. For example, you can use a lot of open questions to allow the patient to answer what they feel is comfortable for them and just gradually develop the conversation from what they say, rather than chit chatting?, which is what I found with my first patient. After asking Mrs.W about her recently diagnosed diabetes she seemed very unsure how to explain to me what she thought was wrong with her, she seemed to resent the fact she has a disease and questioned what she had done to deserve becoming ill. She said that even though the Doctor had explained everything to her, she was unsure of what to expect in the future and seemed quite worried about the aspect of not being able to care for herself. From telling me all of this, I felt quite overwhelmed and unsure of how to reassure her. Even though I wanted to help, I found myself in a situation where I physically couldnt, which was very frustrating. On my second and third visits I asked a bit more about her family situation, her social activities and her thoughts, ideas and feelings (psychological factors). From taking on this broader approach, I began to realise the true picture of Mrs Ws life and how it contributed to the worries of her illness. She told me about her husband leaving her and h er daughter and son becoming quite distant, she explained that she often felt lonely and at times it made her feel quite depressed. This seemed to be more of a concern to her than her actual illness, but it demonstrated why she is concerned about her diabetes worsening because she has very little family support and would have to cope by herself. From the meetings with Mrs W, I have learnt the vital importance of taking on a holistic approach when speaking to a patient. I have learnt that its not just a biological illness that contributes to the wellbeing of a patient; you have to take into consideration the home/family environment and the social and psychological factors. Not only have I had the opportunity to see an illness in the context of real life but I have greatly improved my confidence and patient communication skills by being able to gather information, take family history and cope in a one-to-one based home environment. However, my experience from meeting my first patient contrasted completely with my second patient experience. Initially I had some difficulties finding my second patient, as the consultant I had contacted only ran morning clinics; so I took the initiative to go into the hospital and find a suitable patient myself. Even though I felt quite nervous, I went onto the haematology ward and simply explained to one of the nurses about my course and what had happened so far with trying to find a patient. She was extremely helpful and understanding, which put me at ease and she more or less found me a patient right there and then (which I hadnt expected). However, even though I hadnt really prepared anything I already felt that I had developed some good skills and awareness of communicating appropriately with patients, both from my first patient and communication skills seminars, to be able to build up a good report with my second patient. Mr. H (my second patient) was very different to my first patient in the sense that he wasnt as open when talking about his illness. He is suffering from severe anaemia and has to have blood transfusions every week (so like my first patient, had the presenting symptom of no energy). However, he didnt seem to recall any dates of his illness and didnt want to explain what had caused the anaemia. However, after reading his medical records and meeting with his consultant, I came to realise that Mr. H had had a bad experience with a doctor and had adamantly refused further investigation, so his severe/worsening anaemia remains an unknown cause. Also, in comparison to my first patient, he had a much more considerable loss of energy, so even though he gave consent for me to talk to him, I felt at times he needed a break so I ensured that I did not stay too long and trouble him during my visits. Nevertheless, I found that meeting a patient in a hospital environment is completely different to meeting them in a home environment. In a hospital environment you need to be very aware of everything around you, how you are acting towards other staff and patients and there is a real need to realise certain cues from the patient (as they are in a more severe situation than a patient in a home environment). Overall, the People and Disease course has been a really enjoyable learning curve. Ive been able to put my communication skills to practice and see how to adapt to different situations, which has boosted my confidence enormously. Even though there is much more to learn, I really look forward to doing so and I hope that I will develop the skills needed to become a good doctor in todays society. 2. Clinical Features In this section I aim to discuss clinical features of my patients diseases and differential diagnoses. My first patient was diagnosed with Type 2 Diabetes Mellitus and my second patient suffers from severe anaemia; both of these conditions have similar clinical features and the same presenting complaint of a lack of energy and fatigue. Both of my patients recorded symptoms of lethargy, dizziness, fainting and shortness of breath; exploring these similar symptoms demonstrates the importance and accuracy needed for a diagnosis, as these symptoms could be indicative of a variety of other diseases. It is also vital to have a correct diagnosis, as a misdiagnosis would lead to unnecessary grievance, treatments or investigations which would cause a patient a lot of stress. Fatigue is the common presenting complaint in both of my patients and is clinically difficult to define; it is related to tiredness, exhaustion and a general lack of energy. Fatigue is a very common health complaint and around 20% of people in the United Kingdom claim to have fatigue intense enough to interfere with them having a normal life. Physical causes are estimated at 20-60%, and emotional causes are the other 40-80% (1).The fact that fatigue alone can disrupt ones life so severely indicates the important role of a doctor to be able to make a correct diagnosis for the cause of it. However, my individual patients described their fatigue in very different ways. Mrs W described her lack of energy in relation to feeling lethargic and very tired all the time, whereas Mr Hs fatigue was very much to do with a sudden onset of shortness of breath and chest pain. The symptoms that patients with anaemia normally present with are highlighted in the image below: (2) Mr. H has anaemia with haemoglobin levels often as low as 3.2gm/dL; with the normal range being 13 18 gm/dL for a male and 12 16 gm/dL for a female (2); indicating that his anaemia is very severe and therefore explains why he would experience fainting, chest pain and angina as shown in the image above. And in comparison to Mrs. W, highlights the difference in their experience of their clinical presentation of a lack of energy. Type 2 diabetes was previously referred to as adult onset diabetes and is related to insulin resistance and a relative, rather than an absolute, deficiency of insulin secretion (3). Due to the fact that this type of diabetes is concerned with gradual insulin resistance/deficiency means that individuals do not always (or initially) require insulin to achieve satisfactory diabetic control. The common symptoms associated with Type 2 Diabetes are (4): Polyuria: the need to urinate more often due to the body trying to excrete the extra glucose that is in the blood and in turn creating an osmotic gradient resulting in more urine production. Polydipsia: feeling thirsty more often than usual, due to the loss of fluids (increased urine production). Weight loss: this is due to the fact that glucose is not being taken up by cells due to insulin deficiency/resistance, so the body starts to burn up fat instead, which results in weight loss due to fat storage depletion. The majority of diabetic patients experience lack of energy because the cells in the body are not getting the glucose that they need, resulting in lethargy and tiredness. As type 2 diabetes progresses, patients may also experience blurred vision, yeast infections and prolonged time for wound healing. Mrs W was diagnosed with type 2 diabetes in February 2007; initially only experiencing a lack of energy. Over the months that I met with her she also started to experience polyuria and polydipsia. She was concerned as to how much her diabetes would progress and worsen because it had not been made very clear by her Doctor. This demonstrates the important need for a Doctor to be aware of patients concerns and level of understanding of their disease process. However, when speaking to Mr H about his clinical presentation and symptoms he had a very nonchalant attitude towards the cause of his disease. I later discovered that his anaemia was in fact due to unknown lower Gastro-intestinal (GI) blood loss and on questioning Mr H about this; he explained that he refused investigation to find the cause of the blood loss due to dissatisfaction with the way he was treated. He explained that during a scheduled procedure for a colonoscopy, the doctor carrying out the investigation was extremely rough and caused him a lot of distress and discomfort. And even though Mr H asked for the procedure to be stopped, the doctor proceeded against the patients wishes; this aggravated Mr H and led to violent behaviour towards the doctor and the dispute was later taken to court. I was very shocked to hear of his experience and also felt deeply concerned that he refused future investigations as his symptoms and anemia are very severe and have lead to angina and disabling conditions; with him being unable to walk and get out of bed unassisted due to such severe lack of energy. This emphasizes the crucial need for a good doctor-patient relationship, as shown in this case, without it, a doctor may be unable to make a proper diagnosis and prescribe ideal treatment.   Differential Diagnosis:- Diabetes:- The process of looking at a differential diagnosis involves weighing the probability of one disease against the possibility of other diseases accounting for a patients illness. For example, Mrs W presented with a lack of energy for her diabetes mellitus, but this complaint could have been diagnosed as any other kind of condition such as, hypothyroidism or Cushings disease as they can also present with fatigue. Differential diagnosis to Diabetes Type II:- Why is the condition considered to be a differential diagnosis How to make the correct diagnosis:- Hypothyroidism Also results in a lack of energy and fatigue. Often diagnosed via a blood test, examining the levels of T3,T4 and TSH in the blood. Cushings Disease Polyuria (and associated polydipsia); insulin resistance (especially common in ectopic ACTH production) (5)which can lead to hyperglycaemia (high blood sugar levels), which can in fact lead to diabetes mellitus. Dexamethasone suppression test or/and a 24hour urinary measurement of cortisol(6). Hyperglycaemia High circulating blood glucose levels this is a symptom of diabetes, but could also be due to physiological stress, critical illness or certain drugs. Blood test which indicates a glucose level of 10+ mmol/L (180mg/dl) also a test for diabetes, therefore, need drug/medical history. Anaemia:- The differential diagnosis of anaemia would be any condition relating to the presenting complaint of a lack of energy?, or any other condition relating to the symptoms of anaemia, as discussed in the clinical features section. In particular relation to Mr Hs lower gastrointestinal bleeding the differential diagnoses are as follows: Differential diagnosis for lower GI bleeding:- Why is the condition considered to be a differential diagnosis? How to make the correct diagnosis:- Haemorrhoids Swelling/inflammation of veins in the rectum commonly due to straining in constipation. These can often rupture and bleed. Physical examination of external haemorrhoids, digital rectal examination for internal haemorrhoids. Colorectal Cancer Cancerous growths in the colon (thought to be adenomatous polyps) can rupture, thus causing a bleed. Digital rectal examination, Fecal occult blood test (testing for blood in the stool), endoscopy (7). Ulcerative Colitis A form of Inflammatory Bowel Disease, includes ulcers and open sores which lead to constant diarrhoea mixed with blood. Endoscopy; involving both colonoscopy and sigmoidoscopy. From exploring the differential diagnosis of my patients conditions it has made me more aware of the vital importance of making the correct diagnosis; as there are a number of conditions that certain symptoms could be caused by. Furthermore, considering Mr Hs anaemia it does highlight the fact that his condition could be a number of quite serious conditions, which shocks me even more as he has chosen not to find out the cause of his worsening anaemia due to his troubled experience with a doctor. 3. Pathophysiology It is quite complex to discuss the aetiology of both my patients conditions as the exact cause of type 2 diabetes is not fully understood, although clear risk factors have been identified. Furthermore, Mr H refused investigation into his GI bleeding, which results in the cause of his anaemia remaining ambiguous. Diabetes Mellitus Type 2:- Diabetes Mellitus is a group of metabolic disorders characterised by chronic hyperglycaemia (high blood glucose concentration), due to insulin deficiency, insulin resistance, or both. There are two main types of diabetes; type 1 and type 2. They can clearly be distinguished by their epidemiology and probable causation, but not always so easily separated clinically. Type 1 diabetes is due to autoimmune destruction of insulin-producing beta cells of the pancreas therefore, causing an increase in fasting blood glucose. However, diabetes type 2 is a disorder that is characterised by high blood glucose due to insulin resistance and relative insulin deficiency (8). Since diabetes is a disease that affects your bodys ability to utilize glucose, it is important to understand what glucose is and how your body would normally control it. Glucose is a monosaccharide (simple) sugar that comes from the food we eat, cells take in glucose from the blood and break it down for energy; brain cells and red blood cells rely solely on glucose for fuel. The Pancreas:- The pancreas (where Insulin is synthesised) has both endocrine and exocrine functions. The exocrine function involves the secretion of digestive enzymes that are secreted from acinar cells and released into the small intestine via a system of ducts. Additionally, the endocrine part of the pancreas consists of millions of clusters of cells called Islets of Langerhans that produce hormones. Within the islets there are four main cell types; cells secrete glucagon, cells secrete insulin, cells secrete somatostatin, and PP cells secrete pancreatic polypeptide (9). Glucagon and Insulin are hormones secreted from the pancreas that work concomitantly to control the level of glucose in our blood. Glucagon is released when blood glucose levels fall, therefore resulting in stored glycogen being converted to glucose and thus increasing blood glucose levels, preventing a hypoglycaemic state. Insulin is a hormone that causes cells to take up glucose from the blood and store it as glycogen, thus a deficiency or resistance of this hormone will result in a high concentration of glucose in the blood. Insulin Release:- Beta cells release insulin via the following process; The glucose uptake takes place through a specific transporter protein called GLUT-2. The pancreatic ?-cell membrane contains several K+ channels, and two of them are directly involved, the K+-ATP channel and the maxi-K+ channel. The hyperglycaemia (high blood sugar level) accelerates the glucose uptake and metabolism and thus increases the ATP/ADP ratio. Increased ATP closes the K+-ATP channels, so the cell depolarises. During deploarisation from the normal resting membrane potential of -70 mV, a threshold is reached at 50 mV, resulting in the opening of Ca2+   channels. The Ca2+ influx triggers exocytosis of insulin and C-peptide containing granules following vesicular fusion with the cell membrane. ne. This process is demonstrated in the diagram below (10): However, in an insulin resistant individual normal levels of insulin that are released (via the process described above), do not have the same effect on muscle, adipose and liver cells, therefore resulting in glucose levels staying higher than normal. Increased levels of glucose in the bloodstream over a sustained length of time result in damage to blood vessels. Poorly controlled glucose levels can lead to complications such as nephropathy, retinopathy, neuropathy and cardiovascular diseases. Even though these complications may take a while to develop, it is important to realise that type 2 diabetes is often diagnosed at a relatively late stage. From looking at the pathophysiology of diabetes, Mrs Ws main symptom of lack of energy/tiredness can be explained. Due to her slow progression of insulin resistance means that more glucose remains in the blood and is not utilised by certain cells, such as muscle cells. Therefore, due to the fact that her cells are not able to use the glucose, she experiences weakness and tiredness. This lack of energy will progressively become worse and she may develop other complications if her diabetes is not controlled appropriately. Anaemia:- Anaemia occurs when there is a decrease in the level of haemoglobin in the blood and occurs when the production rate of red blood cells does not match the loss rate. It is a common condition in which all forms can be defined on the basis of physiological mechanisms. There are three broad categories: decreased/defective red blood cell production; increased destruction of red blood cells; and a mixture where both mechanisms operate simultaneously (11). Haemoglobin:- Haemoglobin is a substance contained within red blood cells and is responsible for their colour. It is composed of haem (an iron-containing porphyrin) linked to a protein, globin (12). Adult haemglobin consists of two and two globin chains. The iron containing porphyrin in the haem group is bound to each globin chain and a ferrous atom that can reversibly bind one oxygen molecule (as shown below (13). The biconcave shape of red blood cells enables a large surface area for the uptake and release of both oxygen and carbon dioxide. Haemoglobin becomes saturated with oxygen in the pulmonary capillaries where the partial pressure of oxygen is high and haemoglobin has a low affinity for oxygen (therefore, binds easily). Oxygen is then released in the tissues where the partial pressure of oxygen is low and haemoglobin has a low affinity for oxygen (therefore, oxygen offloads easily). The haemoglobin molecule itself exists in two conformations, relaxed (R) and tense (T). The tense state is characterized by the globin units being tightly held together by electrostatic bonds; when oxygen binds to the haemoglobin these bonds are weakened and broken, resulting in the relaxed conformation. The binding of one oxygen molecule leads to an increased affinity for the remaining binding sites, this is known as co-operativity, and is the reason for the sigmoid shape of the oxygen dissociation curve (below (14)). The binding of oxygen to haemoglobin can also be influenced by secondary effectors (as seen in the above image) i.e. hydrogen ions, carbon dioxide, and 2-3 diphosphoglycerate. The binding of 2, 3 DPG stabilizes the tense state and therefore, reduces haemoglobins affinity for oxygen (15). In conditions with lowered haemoglobin/oxygen levels, such as anaemia or hypoxia the concentration of 2, 3 DPG increases to raise oxygen availability for tissues. Haemoglobin Synthesis:- Haemoglobin is synthesised in a series of complex steps, it takes place in the mitochondria of the developing red blood cells. The major rate limiting step is the conversion of glycine and succinic acid to ?-aminolaevulinic acid (ALA), this occurs via ALA synthetase. Two molecules of ?-ALA condense to form a pyrrole ring, called porphobilinogen. The pyrrole rings are then grouped together   in fours, to form protoporphyrins. Iron is then inserted into the rings to form haem and then finally, haem is attached to the globin chains to form haemoglobin. Production and removal of red blood cells:- Red blood cells are formed and develop in the red bone marrow of large bones; the process by which they are produced is called erythropoiesis. The organ responsible for turning on the faucet of red blood cell production is the kidney. The kidneys can detect low levels of oxygen in the blood. When this happens, the kidneys respond by releasing a hormone called erythropoietin, which then travels to the red bone marrow to stimulate the marrow to begin red blood cell production. Within the bone marrow there are many stem cells from which red blood cells can be formed. As these cells mature, they extrude their nucleus and fill with haemoglobin, forming reticulocytes which can circulate around the body. After 3/4 months, approx 120 days, red blood cells begin to weaken and their cell membranes become very fragile. The red pulp of the spleen allows mechanical filtration and removal of red blood cells, and any leftover components i.e. iron from the haemoglobin are recycled to form new red bl ood cells (16). There are several different types of anaemia such as B12 deficiency, iron deficiency, diseases of the bone marrow and in relation to Mr H, chronic loss of blood. His severe loss of blood has subsequently led to his anaemia as there is a mismatch in production of red blood cells and loss of blood. Due to his deficiency in circulating reticulocytes, oxygen, via haemoglobin is insufficiently supplied to his body, resulting in severe lack of energy. Complications of his condition have led to shortness of breath and angina.   Angina Pectoris:- Angina pectoris literally means a choking sensation in the chest?. It is an episodic pain that is usually felt in the centre of the chest, often radiating to the neck and left arm. Angina occurs because myocardial oxygen requirement is greater than what it is supplied with. This results in a buildup of metabolites, causing pain (17). Classic angina occurs after exertion, excitation or emotion and is caused by insufficient oxygen supply to meet its demand; however, the pain normally subsides with rest. Due to Mr Hs chronic blood loss, there is insufficient blood supply to the heart and subsequent stress is placed on the organ which has led to his angina. 4. Psychosocial aspects of Illness and Disease The impact of chronic illness and disability is far reaching, extending beyond the patient to all those whom the individual has contact. Illness and disability affects all aspects of life, including social and family relationships, economic status, activities of daily living, and recreational activities. Even though several factors influence the extent of impact, every illness or disability requires some adjustment to everyday life. The extent of the impact can depend on (18): The nature of the condition Individuals pre illness/disability personality The meaning of the illness to the individual Individuals current life circumstances The degree of family/social support With reference to my patients, they each had different outlooks on their illnesses as mentioned previously. However, they do have certain similarities when considering the psychological aspect of their diseases. Both patients were shocked to find out their conditions as neither of them had expected to be diagnosed with a lifelong illness. This is known as biographical disruption, which is a key sociological concept as it identifies severe illness or disease as a major disruptive and unexpected experience. The illness/disease leads to a biographical shift from a perceived normal trajectory to an abnormal one, with the development of a new consciousness of the body, fragility of self and grief for a former life. For instance, Mrs W had future intentions to look after and care for her grandchildren and Mr H wanted to carry on working as a HGV driver; but due to their conditions they cannot achieve these former life plans and now have to adapt to a new ones. Additionally, they both explained to me how they experienced the feeling of facing stigma. Stigma refers to the identification and recognition of a negatively defined condition, attribute, trait or behaviour in a person or group of persons (19) . There are different types of stigma, such as enacted or felt. Mr H explained how he felt shunned from his friends and some relatives which refers to enacted stigma; the real experience of prejudice, discrimination and disadvantage as the consequence of his illness. Whereas, Mrs W spoke about her fear of being discriminated against and what people would think/say, which falls under a felt stigma; a fear of enacted stigma, also encompasses a feeling of shame associated with being diabetic?. I feel that this notion of facing stigma is perhaps underestimated in health care because it is not necessarily something a Doctor would automatically think about and therefore, perhaps wouldnt advise the patient on how to deal with such feelings. However, from talking to my patients about how they feel about having an illness they both stressed how psychologically disruptive it is, and how the feeling of being categorised as an ill individual has often led to depressive moods and anxiety. Therefore, from this experience I have learnt the importance of considering the patients thoughts and feelings rather than just focusing on how to treat their disease. Biological-psychosocial Model (Engel, 1977):- This is a model that incorporates psychological, sociological and biological factors in contribution to well being and health of an individual (20). It suggests that all three of these factors together and individually play an important role in relation to health and emphasises the importance of taking on a holistic approach when caring for a patient. The obvious factor of health is the biological factors of disease, the process of the disease and the individuals genetic make-up. Sociological factors include individuals family and friend support network as well as financial status and social class. Psychological factors include peoples disposition, their emotional status, whether they are stressed, depressed or anxious all contribute to ill health. From learning about this model it is important to note what factors affect a patient and how to deal with them accordingly when it comes to management and treatment of their disease. Both of my patients spoke of their psychological and social aspects and how they thought these factors had affected their illness. Mrs W, for example often felt quite depressed and lonely as she recently divorced her husband, and due to her illness often felt too tired to see her grandchildren. She also explained how she felt useless?, as she would get tired grocery shopping and house cleaning and she would get frustrated with herself, which often made her feel worse. This highlights how illness can be affected by more than just a biological aspect, and as a Doctor it is important to recognize other factors that affect a patients life. In comparison to Mrs W, who quite openly spoke about her psychological and social problems, Mr H was much more reluctant to tell me how he felt about his illness and how it was affecting him. However, over time I felt that he became much more comfortable talking to me and we were able to build a good rapport. He later went on to explain how he felt he had to keep a bravado about himself, being an ex army sergeant and that he was embarrassed that he often felt severely depressed and stressed about his worsening condition, but felt that by standing his ground and refusing investigation he Mechanisms Of Granule Formation: Pharmaceutical Industry Mechanisms Of Granule Formation: Pharmaceutical Industry For the production of solid oral dosage forms most fine pharmaceutical compounds require granulation to improve their flowability and processing properties prior to tabletting.    http://www.pharmamanufacturing.com/articles/2008/096.html http://www.scribd.com/doc/6601180/Tablet-Granulation Tablets are the most common drug dosage form today, and thus granulation, which allows primary powder particles to adhere and form granules, is one of the most important unit operations in drug manufacturing. Understanding granulation grows more complex each year. This article reviews the most current methods and mechanisms of pharmaceutical granulation, including factors that can lead to improved control. Particle-bonding Mechanisms a) Adhesion and cohesion forces in immobile films. If sufficient liquid is present in a powder to form a thin, immobile layer, there will be an increase in contact area between particles. The bond strength between particles will increase, as the Van der Waals forces of attraction are proportional to the particle diameter and inversely proportional to the square of the distance of separation [1]. b) Interfacial forces in mobile liquid films. During wet granulation, liquid is added to the powder mix and distributed as films around and between the particles. There are three states of water distribution between particles. At low moisture levels, the pendular state, particles are held together by surface tension forces of the liquid/air interface and the hydrostatic suction pressure in the liquid bridge. ADVERTISEMENT On Pharma Blog Get the latest analysis and commentary on manufacturing and the drug industry at our editors blog. On Pharma looks at the drug industry with a special focus on manufacturing, which is coming into its own as a strategically important area. When all the air has been displaced from between the particles, the capillary state is reached, and the particles are held by capillary suction at the liquid/air interface. The funicular state represents an intermediate stage between the pendular and capillary states. Moist granule tensile strength increases about three times between the pendular and the capillary state. These wet bridges are, however, a prerequisite for the formation of solid bridges formed by adhesives present in the liquid, or by materials that dissolve in the granulating liquid. Solid bridges can be formed in two ways: Hardening binders. When an adhesive is included in the granulating solvent it forms liquid bridges, and the adhesive will harden or crystallize on drying to form solid bridges to bind the particles. Crystallization of dissolved substances. The solvent used to mass the powder during wet granulation may partially dissolve one of the powdered ingredients. When the granules are dried, crystallization of this material will take place and the dissolved substance then acts as a hardening binder. c) Attractive forces between solid particles. In the absence of liquids and solid bridges formed by binding agents, there are two types of attractive force that can operate between particles in pharmaceutical systems, electrostatic forces and Van der Waals forces. Van der Waals forces are about four orders of magnitude greater than electrostatic and add to the strength of granules produced by dry granulation. Mechanisms of Granule Formation a) Nucleation. Granulation starts with particle-particle contact and adhesion due to liquid bridges. A number of particles will join to form the pendular state. Further agitation densifies the pendular bodies to form the capillary state, and these bodies act as nuclei for further granule growth [2]. b) Transition. Nuclei can grow in two possible ways: either single particles can be added to the nuclei by pendular bridges, or two or more nuclei may combine. The combined nuclei will be reshaped by the agitation of the bed. This stage is characterized by the presence of a large number of small granules with a fairly wide size distribution. c) Ball Growth. If agitation is continued, granule coalescence will continue and produce an unusable, over-massed system, although this is dependent upon the amount of liquid added and the properties of the material being granulated [1]. There are four possible mechanisms of ball growth, which are illustrated in Figure 1 [3]: Coalescence. Two or more granules join to form a larger granule. Breakage. Granules break into fragments which adhere to other granules, forming a layer of material over the surviving granule. Layering. When a second batch of powder mix is added to a bed of granules, the powder will adhere to the granules, forming a layer over the surface and increasing the granule size. Abrasion Transfer. Agitation of the granule bed leads to the attrition of material from granules. This abraded material adheres to other granules. Granulation Methods  [4] Dry Granulation. This requires two pieces of equipment, a machine for compressing the dry powders into compacts or flakes, and a mill for breaking up these intermediate products into granules. The dry method may be used for drugs that do not compress well after wet granulation, or those which are sensitive to moisture. Wet Granulation. In this method, the wet mass is forced through a sieve to produce wet granules which are then dried. A subsequent screening stage breaks agglomerates of granules. Organic solvents are used when water-sensitive drugs are processed, as an alternative to dry granulation, or when a rapid drying time is required. Because direct compressing is not the best technology for many active substances, wet granulation is still a preferred method. Even if the active substance is sensitive to hydrolysis, modern equipment (e.g., a fluidized bed) eliminates all problems in wet granulation [2]. http://www.investopedia.com/terms/l/leptokurtic.asp Dawar Qhoraish (k0920236) Nazmul Islam (k) Introduction Granulation can be used to For the production of solid oral dosage forms most fine pharmaceutical compounds require granulation to improve their flowability and processing properties prior to tabletting.    Method and Materials The experiment was carried out as explained in PY2020A practical booklet, without any amendments. Paracetamol (25g), lactose (265g) and sodium starch glycollate (2.945g) and PVP solution 15% (30ml) was used. 1 Erweka AR402 oscillating granulator with the finer sieve was used to granulate the drug without too much force with variables of turns (rpm) and time (minutes). The machine had an emergency switch off button and safeguard on top which turns off machine when you put your hand in. Sieve shaker used was Retsch A5 200 basic was used to separate the particles into different sizes by vibration with variables of amplitude and speed. The top sieve was fixed by parallel bars with screws and bottom of sieves contained rubber bands to control any overflow and stability. Discussion Modal: Low so most particles are fine. (low) Relate to flow rate. Better flow rate. Small IQR-data close to each other. Positive skewness means more particles with finer particles, so flow rate is better. What Does Leptokurtic Mean? A description of  the kurtosis in a  distribution in which the  statistical value is positive. Leptokurtic distributions have higher peaks around the mean compared to normal distributions, which leads to thick tails on both sides. These peaks result from the data being highly concentrated around the mean, due to lower variations within observations. Limitations: 7.9% MC was lost after 45 minutes in 75oC oven compared to 9.51% in 130oC heater balance. Tray was exposed to air for different amount of periods each time, errors as tray was allowed to cool down. Not dried properly Granulators normally used for large quantities. If lubricant used, particle size would be higher. Improvements: More repeats, heat for longer and at high temperature.

Conformity and Censorship on Society Essay

â€Å"Fahrenheit 451†, by Ray Bradbury, is a story about a society where the government controls the thoughts, and actions of the citizens. Bradbury’s futuristic society has no past and is completely empty. The works and knowledge created in the centuries before, banished and burned. His world contains no beauty, no love, and is completely monitored and controlled by an overbearing and cruel government. Through the depiction of this society, Bradbury comments on the horrific effects of censorship on the souls of human beings. As well as the loss of humanity at the hands of a government that enforces mass conformity. In â€Å"Fahrenheit 451†, all pieces of writing are considered unnecessary and illegal because they supposedly cause unrest in the general public. Similarly, individualism is also discouraged and the mind is meant for mundane and boring acts of repetition and routine. Bradbury’s future world is emotionless and blinded to the fact that the civilization is rapidly progressing toward complete destruction. Bradbury is a skilled storyteller and intricately parallels his fictional world with modern day society. â€Å"Fahrenheit 451† is a carefully constructed warning about the potential future of the world if it continues to misuse censorship, technology, and enforce conformity. The story of â€Å"Fahrenheit 451† was based on the current events in United States during the 1950s. Jack Zipes, in Mass Degradation of Humanity and Massive Contradictions in Bradbury’s Vision of America in â€Å"Fahrenheit 451†, explains â€Å"â€Å"Fahrenheit 451† is discussed in terms of the world’s problems at large when it is essentially bound to the reality of the early 1950s in America, and it is the specificity of the crises endangering the fabric of American society which stamp the narrative concern† (182). The second world war prompted many writers to turn from fantasy fiction to works that dealt with the more serious issues of the time. This was a time when scientists had just discovered and used the atom bomb. For the first time the citizens of the world had to take seriously that idea that with a single technology the entire planet could be destroyed (56). Bradbury’s hatred for such technology can be seen in the novel. Technologies are often described as â€Å"chilling, impersonal gadgets of mechanized anti-culture† (141). In addition, the television was now a common household item used not just for entertainment but also as a means of communicating the daily news. The obsession of mindless entertainment irritated Bradbury, and the citizens of his fictionally world are equally as mindless. As the popularity of the television increased the reading of books decreased. Bradbury, in â€Å"Fahrenheit 451† shows what would happen in a world where literature ceased to exist. The United States was also suffering through misinformed McCarthyism which persecuted supposed communists who wanted to overthrow the government (McGiveron 283). The governmental actions were illegal and unconstitutional and yet they continue to destroy lives with paranoia and power (Zipes 189). Therefore, Bradbury used the forum of a science fiction novel to voice his concerns about the world. He believed that censorship in any form was wrong and the burning of books was really the destruction of knowledge, ideas, and individuality. Bradbury forewarns that if society is to become docile and submissive the government could easily manipulate minds and lives. George Slusser, in Coordinates: Placing Science Fiction and Fantasy, writes â€Å"Although librarians and teachers fought back, the pressure for censorship increased. † (Slusser, Rabkin, and Scholes 104). Oddly enough, â€Å"Fahrenheit 451† has been banned from books shelves and schools since it’s publication. In Bradbury’s futuristic world, the burning of books is normal and the citizens accept this reality without question. People have become mindless, empty beings, at the sole control of their government. Captain Betty reflects â€Å"[Fire’s] real beauty is that it destroys responsibility and consequences. A problem gets too burdensome, then into the furnace with it† (115). He represents the typical citizens in this world that is forced into conformity so long that he is happy to comply. Conformity is seen as the solution to the world’s problems. Keith Booker, in Dystopian Literature: A Theory and Research Guide, observes â€Å"throughout â€Å"Fahrenheit 451† he emphasizes the voluntary participation of the populace in the oppressive policies of the government. â€Å"(89). If there are no differences then there is no conflict, no war, and unfortunately no variety. The unfortunate consequence is that in a world with no pain there can not be happiness. Manipulation through fear is not a fictional concept that Bradbury created. It was real in the 1950s when this novel was published and it is real today (Booker 82) . Just six years ago, the citizens of the United States were manipulated by the government. An act was created in the dark days following the terrorist attacks against the United States on September 11, 2001. It was created to allow the agencies of law enforcement and intelligence to have more authority in order to prevent any future attacks by terrorists on the United States. Additionally, it made available monitoring tools within the United States to aggressively address the Bush administration’s domestic war on terrorism. The draft title of the act was â€Å"Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001†. However, today it is better known as the USA Patriot Act. The Patriot Act was responsible for drastic changes in over 15 important government and constitutional statues. All which lead to the increased ability of the government and law enforcement to secretly monitor, conduct surveillance, and investigate anyone at anytime. The fictional world of Bradbury and out modern society reacted in the same way to violence – handing over our freedoms for a bit of pseudo-safety. The use of propaganda is also used by the government to control it’s citizens. Eric Rabkin, in No Place Else: Explorations in Utopian and Dystopian Fiction, asserts â€Å"The mass of humanity is subjected to the labor process for the purposes of those who control it rather than for any general purposes of ‘humanity’ as such† (123). The incident in the subway is an excellent example of this control. There is a commercial on the subway speaker system for ‘Denham’s Dentrifice’ and as it plays, everyone one the subway is reciting the commercial from memory and the â€Å"words was recreated on the passengers’ lips† (78-80). Censorship is central theme in â€Å"Fahrenheit 451†. Censorship leads to the hiding of the truth. Symbolic of this censorship is the flamethrower which is used to burn books and the houses that contain them ( Slusser, Rabkin, and Scholes 105). It is a way in which the government great rid of individuality and what is considered â€Å"dangerous thought. † The flamethrowers are used by the firemen who are mindless government agents who destroy people’s most valuable possessions each and everyday. It is a weapon of fear used to control individuals in this society. It is this type of technology that Bradbury is most afraid of. He describes their power by explaining â€Å"With the brass nozzle in [Montag’s] fists, with this great python spitting its venomous kerosene upon the world, the blood pounded in his head, and his hands were the hands of some amazing conductor playing all the symphonies of blazing and burning to bring down the tatters and charcoal ruins of history. † (3). Bradbury is quick to mention that the knowledge and literature that took centuries to acquire can easily be destroyed by technology in minutes (Rabkin 127). While Bradbury might have been commenting on the use of the television which seemed to dumb down the intellectual capacity of Americans, his warning is just as useful in the 21st century. The pervasive use and misuse of the Internet has created a new non-tangible world which allows users to communicate but not connect. The Internet has contributed to the lack of individual and unique thought in literature, art, and music. The World Wide Web is also place of anonymity where individuals can hide behind user names, partake in unethical acts, and accept no responsibility for their actions. Rafeeq McGiveron, in â€Å"To Build a Mirror Factory: the Mirror and Self-Examination in Ray Bradbury’s â€Å"Fahrenheit 451†,† explains â€Å"in â€Å"Fahrenheit 451† Ray Bradbury creates an unthinking society so compulsively hedonistic that it must be atom-bombed flat before it ever can be rebuilt. â€Å"(282) . In â€Å"Fahrenheit 451†, Ray Bradbury, warns the general public to the importance of uniqueness and individuality. He urges the audience to fight the government ideals of censorship and forced societal conformity. He asked readers to reflect on their own societies and make changes before it is too late. In Bradbury society written language is forbidden and forgotten about. Citizens are no longer able to think for themselves and holds only the views of the government. Citizens are controlled by fear and degradation of their humanity producing shelled human beings who have no purpose. This story of destruction and hope was created to mirror out own society and to warns modern citizens that human rights need to be fought for, held on too, and cherished. In a time of the rampant evolution of technology we must be vigilant in holding and expressing out rights to be human. If not, out fate is that of the Bradbury’s society, succumbs into to the advancements in technology and being wiped from existence. Works Cited Booker, M. Keith. Dystopian Literature: A Theory and Research Guide. Westport, CT: Greenwood Press, 1994. Bradbury, Ray. â€Å"Fahrenheit 451†. New York: The Ballentine Publishing Group, 1953. McGiveron, Rafeeq O. â€Å"To Build a Mirror Factory: the Mirror and Self-Examination in Ray Bradbury’s â€Å"Fahrenheit 451†. † Critique 39. 3 (1998): 282-287. Questia. 28 Nov. 2007 . Rabkin, Eric S. , Martin H. Greenberg, and Joseph D. Olander, eds. No Place Else: Explorations in Utopian and Dystopian Fiction. Carbondale, IL: Southern Illinois University Press, 1983. Slusser, George E., Eric S. Rabkin, and Robert Scholes, eds. Coordinates: Placing Science Fiction and Fantasy. Carbondale, IL: Southern Illinois University Press, 1983. Zipes, Jack. â€Å"11 Mass Degradation of Humanity and Massive Contradictions in Bradbury’s Vision of America in â€Å"Fahrenheit 451†. † No Place Else: Explorations in Utopian and Dystopian Fiction. Ed. Eric S. Rabkin, Martin H. Greenberg, and Joseph D. Olander. Carbondale, IL: Southern Illinois University Press, 1983. 182-198. .

Research Proposal Writers Options

Research Proposal Writers Options Proposals help you estimate the magnitude of an undertaking. Writing a proposal might be a tedious and complicated undertaking, especially if asking for a grant. The Research Proposal Template is a template that will help you the way to make an exemplary research proposal. It is the type of document which is used to propose the research project. Research proposal depending on the size needs and. If you wish to obtain a research proposal, visit our main page and produce the purchase. You are able to use a research proposal example to aid in designing your own template. If you have to compose your research proposal and you've got a strict timeframe, research paper proposal writing service is here to aid you. If you order a custom made research proposal, it's understandable that you could have many questions regarding the approach. It is possible to always reach out to your writer to supply more information or request information concerning the order's progress. A lot of investigation has to be conducted in the particular locale where the project being researched on will be run. When you get research proposals from a trustworthy provider like us, you can be sure that your project is going to be completed punctually, to the highest quality standards possible. You are going to have a chance to converse freely with your writer throughout the procedure, helping make sure th at the finished product appears exactly the direction you would like it to. The Fundamentals of Research Proposal Writers That You Will be Able to Benefit From Beginning Immediately Research proposal writing is an ambitious job and deciding on the perfect topic usually means a good deal in your paper. Because proposal essays are a form of argumentative essay, you would like to be certain the essay is worthy of an argument. Now you have a notion about what a proposal essay is and the way to select the ideal topic to compose your own essay, here are a few examples of proposal essay topics. You might even require research writing help to receive your A. Staying in contact with the writers may also help the students know the job in progress. Our writers are also professional researchers that are in a position to access not simply the academic resources that are readily available to the general public but also other specialized resources which aren't as widely offered. They ensure that the abstract is well detailed to represent the entire research process. Our top writers from the other side of the world make certain you will acquire well-researched proposal either it's about the sciences, academic, general, and for another subject line. The War Against Research Proposal Writers Proposal writing is valuable to your pursuit of a graduate level. In other words, a proposal essay identifies an issue and suggests a remedy to that issue. An introduction is similar to an attention getter. Generally, writing a research proposal determines a total success of an upcoming masterpiece. Research Proposal Writers Explained In case you have any questionnaires for your research proposal or some other documents linked to your investigation, include all of them in the appendices. Specify the question your research will answer, establish the reason it is a substantial question, show how you're likely to answer the question, and indicate what you expect we'll learn. A research proposal is a rather standardized document which has a particular structure and is anticipated to include specific content sections. The research proposal format is comparable to analysis essays. Definitions of Research Proposal Writers You've got to supply a quick overview of your first research. You also need to document how to execute the research. A research paper is generally the very first step for students to acquire funding for their project, so it's critical to create a thoughtful and deep paper. A good research paper should start out with a strong research proposal. You might be asking yourself how you are able to write the research proposal results whenever you haven't actually conducted the research yet. The proposal should incorporate the vital points about the research like research questions, cost and time necessary for research, the advantages of research and earlier research on exactly the same topic. A written research proposal is a fundamental part of planning your research but can be rather sizeable. You can be certain that you will get the ideal PhD research proposal from our professional writers!

Childhood Obesity A Condition Of Being Grossly Fat And...

Childhood Obesity. Childhood Obesity is a condition of being grossly fat and overweight. When someone exceeds a certain weight for a given height they are considered obese. Lifestyle issues such as too little activities and too many calories from drinks are main contributors of childhood obesity. People eat for two reasons and those are either comfort eat or appetite eat. A study have shown that kids who go without breakfast before school are more likely than classmates to be inactive, unfit and obese. Girls who skip breakfast are 92% more likely obese than female classmates who eat before school, the equivalent figure in boys was 62%. This was notified as a key reason because the kids who didn t eat breakfast snacked throughout the day and ate late at night as this became more and more of a daily routine, eating disorders become a factor. Some of the causes of childhood obesity are greater availability of unhealthy foods, little to no daily exercise, No safe place in many communities to play or be ac tive. Plus companies are coming together to make their food be able to be more visualized and make people want to buy their food. Also it becomes harder to jump, hop, or even stand on one leg and they will become clumsier. More effects of being obese are Blount’s Disease, Flat Feet, Diabetes, and Asthma. Blount’s Disease is where a growth disorder in the lower leg cause it to go inward, Flat Feet is where one’s feet has no arch which makes it painful to walk long distance,Show MoreRelatedObesity Is A Major Problem1234 Words   |  5 Pagesfour decades, the rate of obesity in America has been on the increasing end; two out of three Americans are either obese or overweight. The obesity epidemic has become a major problem in the United States which caused many serious effects on individual and society. It is an indiscriminate problem that negatively affect everyone from adults to children; which is a significant threat to the health of humanity that needs to be e liminated. First, we need to know what obesity is. According to OxfordRead MoreHow Does Obesity Impact Children? Essay1602 Words   |  7 Pagesdeciding it finally came to me, â€Å"In what ways does obesity impact children?† Obesity is defined as, the condition of being â€Å"grossly† fat or overweight. As a teen we have stopped trying to figure out how obesity really works and why does it matter so much. As children we are told that we should a certain weight at this age and this height, Like that is how the world is set, these are their standards. This got me think, what effects does obesity have on one s body and is it really a bad thing? SomeRead MoreObesity : Obesity And Obesity1242 Words   |  5 Pages Obesity and Nutrition More than one-third (34.9%) (The State of Obesity) of the American population is overweight. 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In the last couple decades it was estimated that theRead MoreObesity : The Condition Of Being Grossly Fat Or Overweight2264 Words   |  10 PagesObesity: the condition of being grossly fat or overweight. I know.. One word: HARSH. How many times a day do you see an over weight or obese person walk right past your eyes? How often do you see a really overweight person actually doing something about it as in trying to overcome it? Scientifically speaking, the BMI (Body Mass Index) of an overweight person starts at 25, once you’ve reached 30, you are considered obese. More than twenty-five million of adults are diagnosed with diabetes, while oth erRead MoreObesity And Its Effects On Today s Society2252 Words   |  10 Pagesis one’s health that is at stake. Scientist’s and medical professionals suggest that obese people have a higher risk of developing coronary heart disease and other conditions such as high blood pressure, diabetes, stroke, sleep apnea, and the list just keeps going on. Some of the reasons that more and more people are becoming overweight in today’s society is for starts, the prices of unhealthy foods at supermarkets and fast food restaurants. The healthier food options are much more expensive thanRead MoreObesity Is The Condition Of Being Grossly Fat Or Overweight ( Google Search )1534 Words   |  7 PagesThe definition of obesity is the condition of being grossly fat or overweight (google search) The government really started fighting obesity in 2010, when the surgeon general and the first lady of the United States Michelle Obama started combating obesity and trying to lower it al l across the country. Obesity is not only a issue of a person cannot stop eating. It has number of relations such low income families who cannot afford healthy food but instead go to a number of fast food restaurants around

Death in Stopping by Woods on a Snowy Evening Essay

Stopping by Woods on a Snowy Evening - A Stop for Death Everyone feels burdened by life at some point. Everyone wishes they could just close their eyes and make all the problems and struggles of life disappear. Some see death as a release from the chains and ropes with which the trials and tribulations of life bind the human race. Death is a powerful theme in literature, symbolized in a plethora of ways. In Stopping by Woods on a Snowy Eve Robert Frost uses subtle imagery, symbolism, rhythm and rhyme to invoke the yearning for death that the weary traveler of life feels. When the speaker in Stopping by Woods on a Snowy Eve pauses for a moments rest, he does not do so on a simple evening, but on the darkest evening†¦show more content†¦Winter is a time of cold, when forests die and animals hide from the shrieking winds and biting cold. Winter is a time for survival against the odds. How apt that the speaker is struggling against the lovely, dark and deep woods to remember that he has miles to go before [he] sleep[s]. The easy wind calls to him, and the downy flake beckons him to a comfortable sleep. If the speaker had paused on a bright summer day, the sleep might be just a short rest, but the poem is set on the darkest evening of the year while the woods fill up with snow, and any rest taken in the lovely, dark and deep woods would result in the eternal sleep of death (474). Sleep is another common symbol for death, and Stopping by Woods on a Snowy Evening is filled with the essence of sleep. Every element of the poem works together to create a lullaby effect, calling the speaker and reader to a lovely, dark and deep sleep (474). The gentle imagery of the downy soft snow and easy wind, combined with the cadence and meter of the poem creates a lulling, rocking, soothing effect. The AABB rhyme scheme and the iambic quatrameter create a lullaby feeling, easing the reader in to a comfortable sleep. The last two lines act as a slap in the face. Every element works toward death, and the speaker almost slips into eternal rest. One can see him, putting theShow MoreRelatedStopping By Woods On A Snowy Evening1556 Words   |  7 Pagesis present in Frost’s poem, â€Å"Stopping by Woods on a Snowy Evening,† from the 1928 collection, West-Running Brook. Here, Frost creates a good example of a Rubaiyat stanza that is broken into four sections totaling sixteen lines. From the moment we meet the narrator, we are aware that his persona is suspicious, from his inspections of the winter surrounding, to the focus on his odd behavior and the final reminder of a plan. What â€Å"Stopping by Woods on a Snowy Evening† deeply concerns is found inRead MoreAnalysis of Acquainted with the Night and Stopping by the Woods on a Snowy Evening1471 Words   |  6 Pagespoems â€Å"Stopping By Woods on a Snowy Evening† and â€Å"Acquainted with the Night† written by Ro bert Frost are very similar to each other because of the simplistic form of language used and the uses of metaphors. When we first read the poem, it looks like an ordinary poem but once we go in depth and understand the meaning, it becomes so much more. Both of the poem has a very dark, gloomy and lonely setting with a really mysterious tone. There are different metaphors used in each poem to symbolize death; â€Å"Sleep†Read MoreStopping By Woods On A Snowy Evening And Desert Places922 Words   |  4 PagesRobert Frost’s Stopping by Woods on a Snowy Evening† and â€Å"Desert Places† are complementary works which coincide with the naturesque elements most commonly ascribed to Frost. The two poems were published over a decade apart in a period after the first World War where feelings of lack of community and self-worth had grown in precedents amongst the general public. The early years of Frost’s literary career were spent on his poultry farm in De rry, New Hampshire as he toiled his land. Although FrostRead MoreStopping By Woods On A Snowy Evening1415 Words   |  6 Pagesminutes, there is a life lost in the United States due to suicide. This killer that accounts for over 38,000 deaths per year is often triggered by feelings of helplessness and the inability to cope (Suicide Facts). Many people who suffer from feelings of self-despair mistakenly believe that ending their lives is the antidote to their pain. Robert Frost’s poems, â€Å"Stopping By Woods on a Snowy Evening,† â€Å"The Road Not Taken,† and â€Å"Acquainted with the Night† each have distinct moods and messages, but theyRead MoreLife Choices in Robert Frosts The Road Not Taken and Stopping by Woods on a Snowy Evening970 Words   |  4 Pagesand â€Å"Stopping by Woods on a Snowy Evening† both portray weighing of choices in life. The former is about youth and experiencing life and the latter is about old age, or more probably, a n old spirit wearied by life. In both poems the speaker is in a critical situation where he has to choose between two paths in life. In â€Å"The Road Not taken† the speaker chooses the unconventional approach to the decision making process, thus showing his uniqueness and challenging mentality while in â€Å"Stopping by WoodsRead MoreAnalysis Of Stopping By Woods On A Snowy Evening By Robert Frost1405 Words   |  6 Pagesdarkness; â€Å"Stopping by Woods on a Snowy Evening,† a seemingly simple glimpse into the beauty of a winter night, is in both content and form a metaphor for the contemplation of suicide. The title of the poem suggests a familiarity, with the narrator â€Å"stopping by† the woods, a neighborly phrase that suggests that he has been in this place before (Saunders). The woods symbolize death and oblivion, and as such, it’s implied that this is not the first time that the narrator has considered death and takingRead MoreThe Use of Literary Devices in Robert Frosts Stopping by Woods on a Snowy Evening800 Words   |  4 PagesThe Use of Literary Devices in Robert Frosts Stopping by Woods on a Snowy Evening In Robert Frosts poem. â€Å"Stopping by Woods on a Snowy Evening.† the speaker uses literary devices to show the reader the poems meaning. Symbolism plays an important role in this poem. Robert Frost uses symbolism to show the correlation between the woods and village with heaven. Mythological symbolism is also found in this poem. when the speaker talks about the lake. it is a reference to Hel in Norse MythologyRead MoreThree Elements Of Robert Frost Poetry1145 Words   |  5 Pagesdiscussion of depression, darkness, and death (as appears in â€Å"Out, Out—† and â€Å"Acquainted with the Night†), which issues from Frost’s own experiences after his 3-year-old son, mother, and grandfather died within two years of each other (Burnshaw). The third is a juxtapositioning of opposing ideas or choices (as appears in â€Å"The Road Not Taken† and â€Å"Fire and Ice†). All three elements coincide in what is arguably Frost’s most ce lebrated poem, â€Å"Stopping by Woods on a Snowy Evening†. At first glance, the poem seemsRead MoreEssay on Robert Frosts Life and Accomplishments1244 Words   |  5 Pagesof life. These poems help to show people just some of the difficult things that will be faced in life, despite everything done to prevent them from happening. In particular, his poems â€Å"Nothing Gold Can Stay,† â€Å"Fire and Ice,† and â€Å"Stopping by the Woods on a Snowy Evening,† incorporate this meaning into them while on the surface, they seem like just simple poems about nature. After a closer look into Frost’s life, it can be determined that he had a whirlwind of experiences, both positive and negativeRead MoreRobert Frost: A Poet To Remember Essay1004 Words   |  5 Pagesmeanings in his poetry. To the literal mind, ‘Stopping by Woods on a Snowy Evening might actually be about the character of the poem stopping near some woods while it was snowing. Almost expectedly, Frosts poem goes much deeper than that. The woods are lovely, dark and deep. But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep. This excerpt is from the last verse in Frosts poem, ‘Stopping by Woods on a Snowy Evening. One with a literal mind might possibly

Top Ten Characteristics of a Multicultural School Environment Free Essays

Top Ten Characteristics Of A Multicultural School Environment Not all students are the same so they cannot be taught the same way. Their cultures and experiences the way they learn and respond to schooling. Several cultural factors affect the way students behave in a classroom. We will write a custom essay sample on Top Ten Characteristics of a Multicultural School Environment or any similar topic only for you Order Now Each student is different because of physical and mental abilities, gender, ethnicity, race, language, religion, class, sexual orientation, and age (Gollnick and Chin, p. 6). Multicultural school has different characteristics. I think the most important is the composition of the faculty, administration, and other staff accurately reflects the pluralistic composition of the United States (Gollnick and Chin, p. 7) because this will influence a student’s behavior. The United States has one of the most extensive and diverse educational systems in the world. US population is composed of different races, each with different cultures. I think it would be helpful for a student to study in an environment wherein they value or give respect to different culture. The school environment and the faculty have great impact on student’s development. Because of this, students will be assured that they will not be discriminated. US has a federal legislation for elementary and secondary schools, No Child Left Behind, requires standardized testing of students to determine how effective a school is in helping students to learn (Gollnick and Chin, p. 12). A school is an institution where students learn the value of respecting others, if the faculty, staff and school administration lacks this, and then it can be hard for students with different culture to study and interact with others at school. Second is that the school curriculum incorporates the contributions of many cultural groups and integrates multiple perspectives throughout it (Gollnick and Chin, p. 7). Some people check on a school’s curriculum before they decide on what school they will go. It is important that the school gives value to the contributions of many cultural groups. I rank differences in academic achievement levels disappear between males and females, dominant and oppressed group members, and upper-middle-class and low-income students (Gollnick and Chin, p. ) as third because it is also important that students achievement will not be based on their gender, social group or race instead of their knowledge and abilities. With the persistence of racism, poverty, unemployment, and inequality in major social systems such as education, many persons have found it difficult to reconcile daily realities with the publicized egalitarianism that characterizes the public rhetoric (Gollnick and Chin, p. 36). In a multicultural school, students should not experience this, instead, they should experience equality no matter what race, culture, gender or social groups they are involved with. The faculty, administrators, and other staff see themselves as learners enhanced and changed by understanding, affirming, and reflecting cultural diversity (Gollnick and Chin, p. 7). The faculty, administrators, and other staff should be open for changes. They should learn on how to interact on different cultures. They should not be one-sided and be open for some changes because it is a part of life. Teachers and administrators are able to deal with questions of race, inter group relations, and controversial realities on an objective, frank, and professional basis (Gollnick and Chin, p. 7). States and school districts expect new teachers to have proficiencies related to multicultural education by the time they finish a teacher education program (Gollnick and Chin, p. 13). This means, since a teacher is one of the foundation in education, they should be the one to have the skill or proficiency to handle multicultural students. They should use professionalism in dealing with every student no matter what culture they possess. They should be proficient and unbiased in addressing issues raised by students, however making sure that they answer it based on truth. Students are able to use their own cultural resources and voices to develop new skills and to critically explore subject matter (Gollnick and Chin, p. 7). I rank this as seventh because I believed that school is a place where a person develops his own knowledge and skills. The language in which students are taught is one of the most significant issues for schools. Many Americans have become concerned about how best to educate students who are new to the English language and to American culture. As children of all ages and from dozens of language backgrounds seek an education, most schools have adopted some variety of bilingual instruction. Students are taught in their native language until their knowledge of English improves, which is often accomplished through an English as a Second Language program. Cultural differences are treated as differences, rather than as deficiencies that must be addressed in compensatory programs (Gollnick and Chin, p. ). A multicultural school should be fair in giving compensatory benefits for students with different culture. Having different culture should not be a factor in receiving benefits that every student should receive. Instructional materials are free of biases, omissions, and stereotypes (Gollnick and Chin, p. 7). Instructional materials are important in teaching, because these are visualization of what the teacher is teaching. These should be free of biases or stereotyping. Students learn to recognize and confront inequities in school and society (Gollnick and Chin, p. 7). In an environment where there is no discrimination or prejudice, a student will learn how to recognize and confront inequities either in school or society. A multicultural school must teach student on how to address different discrimination. I put this on last because I think discrimination or inequity starts within us. A person must first learn to recognize and confront it inequalities by himself, in can be taught on school but experience is a best teacher. BIBLIOGRAPHY Gollnick, Donna M. Chinn, Philip C. 2006. â€Å"Multicultural Education in a Pluralistic Society. † Seventh Edition. Prentice-Hall/Merrill. How to cite Top Ten Characteristics of a Multicultural School Environment, Essay examples

Organization and Management for Crisis Management Strategy

Question: Discuss about theOrganization and Management for Crisis Management Strategy. Answer: Introduction The purpose of this essay is to analyse the change taking place in the modern business organization and to present before the ideas evolving in managing the organization. With the change the work process and advancement in the technology and innovation, modern organizations are changing the way of getting work done. Organization behavior is an extensive subject that looks into the management process to manage the overall process. Identification of major trends in the management and organizational changes is imperative to coordinate the functions in an effective way. The central part of an organizational theory is to develop the management thinking and to manage the changes accordingly (Booth, 2015). It helps in viewing the interrelationship between the different theories of management and organizational changes. A proper understanding of the organizational behavior is necessary for gaining attention. The management theories have developed by the time. The systematic development of th e management thinking is seen as a significant tool ensuring the associated structure. The development of organizational theories in the modern context has helped in managing the situation. Organization as a machinery has come across major changes by overshadowing the past way of carrying out the business function. Change is still considered as unusual factors whereas stability is a normal factor taking place in an organization (Bradley, 2016). The modern organization still focuses on exploration of existing advantage. Corporations nowadays are focusing on the shareholders for gaining competitive advantage. The rise of industrial revolution with a new mean of production and organization the owners depend on others for meeting targets. The goals of an organization are to optimize the output by generating specific set of instructions. The essay focus on understanding changes in the organisations and management since the beginning of the 20th century (Bridges and Bridges, 2017). It focuses on the organizational growth and development and different stages of growth in the structure at different time period. The report examines the organizational changes and development in Wilmar International Limited founded in 1991. The activities include oil palm cultivation; edible oils, refining oil and consumer pack edible oil processing (Corporate Profile, 2017). Changes in the organizational structure and business process are carrying ou t the business process in the most effective way due to the advancement of technology and innovation (Cameron and Green, 2015). Historical The change in the modern business organization and development is connected with the growth and development. The historical perspective was connected with world of small towns, small businesses, and agriculture to an industrialized network. The rise in the middle class in the previous time was responsible for early incarnation. A progressive push beside corrupt political bosses and the finance capitalists were hoarding oil and steel industry. Historically the progress in the field completely depends upon the changes in the way of conducting business. There was progress in the industrial prospect after 20th century due to an excess pressure. The evolution of management theory by F.W Taylor was a landmark in industrial growth. Ever since the evolution of various theories, the main focus is to understand the Organization development (OD) and its progress. The study of flourishing organizational change and performance management has developed as an important function. The emergence of th ese theories has led to an in-depth study in the 1930s. During this time-period the psychologists realized that organizational structures and processes influence worker behavior and motivation (Cummings and Worley, 2014). These rapid changes in the organizational growth and development have changed the entire learning, knowledge management and alteration of organizational norms and values. There has been an aggressive stimulation in the process of organizational growth has become important. An organization is a socially constructed phenomenon. The Organizations are a tool created to achieve means. In a complex structure it is a paradoxical phenomenon. This is challenging for both the organization and an individual to understand the overall concept of organizational development. Metaphor is a primitive force throughout which humans generate connotation by via one element of experience to appreciate one another (Daft, 2014). Use of dissimilar metaphors guides an individual to broaden explanations and theories from perspectives. This provide with a convinced view of the organization by discovering the implications of different metaphors. This allow in gaining a better understanding towards the organization. Machines have become a central part of our lives. They influence every aspect of individual day-to-day activities. Like, in a machine every part is important and its role is clearly been defined. Similarly, in an organization it is important to works together in order to meet the result. The employees of the organization have been working carefully on their assigned tasks to gain effectiveness. A majority of the organizations today can be seen as an effective way to operate in a mechanical way. The Image of an organization takes time to establish itself. Any failure in the implementation of policies in an organization is harmful in gaining competencies. The systematic development of the management thinking is seen as a significant tool ensuring the associated structure. The development of organizational theories in the modern context has helped in managing the situation (Demirkan, Spohrer and Welser, 2016). Sociological The sociological viewpoint of an organization indicates the conflict element which may lead to a change required in the organization. The changes taking place in the organization with respect to the entire organizational issue through the lens of unfair labour laws, employment practices and the various allied issues. With no intention to create an injustice to the rest of the people and customers across the world, Wilmar International plays a major sociological role in stipulations of substitute as a viewpoint to allow the people to fetch more employment. The change management process in the organization act as an important tool to impart justice and honesty to the customers. This has led to the provision to employment to many. In terms of the employment policies in the current context, The Company is paying attention to the elders are concerned, the elderly people working at the organization. This is acting as an important tool to benefit the terms of the organizational growth. The Wilmar International as an organization is meeting the individual requirements especially after its changed management policies (Gibbons, 2015). The organization has worked effectively in planning its cultural requirements. They are focusing on implementing better opportunities for catering people from different cultu ral background. Apart from this, the organization is also looking into improving the working condition by synchronizing the efforts of employees and paying them according to working hours, employment practices, etc. The organization in the current context has implemented effective change management policies helping better growth opportunities. Health and safety issues are also given importance by designing a better growth and opportunities prospect. Environment and ecology are important aspects important for functioning in a well coordinated environment (Gollenia, 2016). The change in organizational growth and progress has helped in managing the activities in mutual cooperation. . Change is still considered as unusual factors whereas stability is a normal factor taking place in an organization. The modern organization still focuses on exploration of existing advantage. Corporations nowadays are focusing on the shareholders for gaining competitive advantage. For gaining effectiveness , the purpose of gaining organizational growth and development is to meet the target with a focused approach (Sustainability, 2017). Rational technical The rational and technical approach is related with the wide growing approach dedicated to management of technical issues. This is a better way through which an organization can gain better results and can focus on incorporating growth structure. Wilmar is focused on incorporating a formal approach towards growth and development of innovative technology. It understands the fact that the organization does need an effective technology and innovation for gaining growth. It is important for managing organizational growth and development (Palmer, Dunford and Akin, 2009). The rational and technical approach towards organizational growth is necessary to manage the changes. The company by the time has incorporated changes as per the changing scenario. It understands the importance of updating better technology and support system in order to gain competencies. In a short time the company has gained fame in term of technology base. They have incorporated an effective technology and mechanism t o meet the regular needs of the customers. The process in all help in meeting the organizational goal established to meet the imperative target (Rothwell et al 2009). Wilmar is a world famous brand looking onto the growing needs of the customers through consistent innovation and technology development. This has helped in gaining competency and managing the activities in order to meet the result. This is necessary from the point of view of rational thinking and a better planning process. This process will allow in managing organizational goal. The purpose of an organization is to catch up with the changing growth structure and to develop competencies in alignment with the international strategies. This will help in improving the overall growth structure and will allow in managing the task for a longer time-period. The organizational change management and development is effective in meeting the targets in order to gain perseverance. With evolution of new organizational structure and c ulture, there has been better growing opportunities for the business to work in alignment with the organization (Storey, 2007). These objectives are important for meeting the long term sustainable goals and drawing the attention of the international organization. These rapid changes in the organizational growth and development have changed the entire learning, knowledge management and alteration of organizational norms and values. There has been an aggressive stimulation in the process of organizational growth has become important. The rapid industrialization has increased the overall capacity of the company in meeting the target. This is evident from them point of view of organizational growth and advancement in terms of delivering result (Turner Parish, Cadwallader and Busch, 2008). Role of each individual attached to the organization has changed creating a wide range of opportunities to perform well. It is due to the wide scope of the organizational performance and widening oppor tunities that is creating better results for the entire segment related to the organization. Excessive competition in the market is contributing towards aggressive policies implementation. A huge amount of competition in the market is affecting the mode of conducting business. Globalization has changed the complete way of doing business. Even a small company has managed to expand its business across border. The easy and liberal policies by the government have helped in creating better opportunities overseas (Weiner, 2009). Political Political background is important to be understood while implementing the organizational theories. While developing a better connection in between the organizational goal and objective it is important to focus on primitive activities. These activities contribute in gaining competencies. The political background in Singapore is favourable for organizational growth and development. In such condition it is favourable for the companies in meeting the organizational target (Pinder, 2014). This is effective way for an organization to manage the business activities. The political intervention plays a significant role in meeting the organizational targets. This is affecting the organizational in attaining growth and progress. Strict political norms are dangerous for an organization. They act as a barrier for an organizational development. Wilmar has absorbed the political structure in a short time-period. They understand the importance of growth and development and the purpose of stimulating a good culture. These activities are important for gaining competencies on a long run and in managing the business functions. Theories of organizations play a vital as well as integral part in terms of building up a foundation for the change of the organization involved (Miner, 2015). Psychological The psychological changes in the organization management are imperative from the point of view of customer understanding. The purpose of an organization is to gain competencies as per the needs of the customers. It is evident from the point of view of the customers to gain the expectation and to meet the set target. This is effective in gaining competencies and to deliver better result. The expectation of an individual is to manage the growth and to deliver the better result through a focused growth approach. The psychological satisfaction is important for the organization in meeting the targets based on long-term sustainability. Thus Wilmar is quiet evidently focusing on attaining better result through a wide approach. The changes in the organizational structure are evident for gaming market competencies (Greenberg, 2013). The organizational structure and growth is important for meeting the long term sustainable culture. This is important in managing the organizational target and competencies for managing result. The political intervention is important in meeting the target and to manage the changes according the necessities (Burr, 2015). Cultural (organisational and national) The culture inside the organization is important to manage the organization. It is evident to focus on the cultural background and to focus on attaining better result through implementation of policies. The cultural background of the organization is important to meet the pre-defined goals. This provides employee with a better culture and an opportunity for the employees. It is necessary for the organization to manage the activities to meet the possibilities. The purpose of Wilmar is to manage the activities and to provide an effective environment. This will help in managing the activities in gaining better results (DuBrin, 2013). Organization behavior is an extensive subject that looks into the management process to manage the overall process. Identification of major trends in the management and organizational changes is imperative to coordinate the functions in an effective way. The culture advocacy and ability to manage the changes is important in maintaining long-term sustainabili ty. The culture inside the organization provide with better advancement in opportunities. In managing the culture it is important to manage the challenges imposed by the external environment (Greenberg and Colquitt, 2013). These changes are playing a tough role in gaining competencies. A better organizational culture helps in fostering organizational growth and strength. They help in managing an effective culture and foster development on a long run. The national culture is supportive in term of gaining growth and competencies for supporting organization supports. This provides with a better opportunity to the business organization. The culture plays an important role in stimulating growth and sustainability. This provide with a better opportunities in gaining competencies. It is important to manage the business activities in a strategic way. This is to gain long-term sustainability and to manage the competencies in long-term sustainability. Change is still considered as unusual factors whereas stability is a normal factor taking place in an organization. The modern organization still focuses on exploration of existing advantage. Corporations nowadays are focusing on the shareholders for gaining competitive advantage. These changes are important for meeting out the target and to develop better opportunities in order to manage sustainable growth and management (Bolman and Deal, 2017). Symbolic This structure allows management, employee and the customers to see the changes as the organization. This is an important part in gaining competencies and adopting a competent culture in order to make advancement. In todays competitive scenario, this has become evident to measure the changes taking place in the surrounding and to adopt the changes accordingly. Each characteristic attached to an organization plays an important role in meeting the organizational goals. This helps in meeting the target and to organize the features according to the organizational capabilities. The symbolic behavior of an individual is important to manage the diverse activities. These activities are important for managing the organizational activities as per the condition. These activities allow the organization in meeting the target and to follow the objectives accordingly. This is important for meeting the effectiveness and to manage the activities in order to manage the goal. This is the primary functi on of an organization in the context of cultural changes in the organizational background. These changes allow in managing the organization in order to attain better growth opportunities and to develop effective prospect on a long term. These sustainable changes taking place in the environment are important for an organization in order to implement a change. Conclusion To conclude, the purpose of defining the term, progress is to understand the importance of organizational change and management. This is important from the point of view of defining and exercising progress in any organization in order to implement a change. Change Management is consequently, the necessity in todays competitive scenario. The organizational management helps in implementing the changes which may be included in the form of vision and goal of the company. The organization is complying with the duties that are entailed in the process. In addition, the objectives of the change management and leadership are to engage in regular efforts. This signifies a deep promise of the organizations which behavior change management. Wilmar enables the display of top management and support from each and every individual from the organizational structure. Consequently, development is guaranteed throughout the procedure of change management in the organizations. In the era of change managem ent and development the purpose is to ensure growth and consistency. During this the organizational structures and processes influence worker behavior and motivation. These rapid changes in the organizational growth and development have changed the entire learning, knowledge management and alteration of organizational standard and principles. References Bolman, L.G. and Deal, T.E., 2017.Reframing organizations: Artistry, choice, and leadership. John Wiley Sons. Booth, S. A. 2015. Crisis management strategy: Competition and change in modern enterprises. Routledge. Bradley, G. 2016. Benefit Realisation Management: A practical guide to achieving benefits through change. CRC Press. Bridges, W., and Bridges, S. 2017. Managing transitions: Making the most of change. Da Capo Press. Burr, V., 2015.Social constructionism. Routledge. Cameron, E., and Green, M. 2015. Making sense of change management: A complete guide to the models, tools and techniques of organizational change. Kogan Page Publishers. Corporate Profile, 2017. Online Available at: https://www.wilmar-international.com/who-we-are/corporate-profile/ Accessed on: 22 September 2017 Cummings, T. G., and Worley, C. G. 2014. Organization development and change. Cengage learning. Daft, R.L., 2014. The leadership experience. Cengage Learning. Demirkan, H., Spohrer, J.C. and Welser, J.J., 2016. Digital Innovation and Strategic Transformation. IT Professional, 18(6), pp.14-18. DuBrin, A.J., 2013.Fundamentals of organizational behavior: An applied perspective. Elsevier. Gibbons, P. 2015. The Science of Successful Organizational Change: How Leaders Set Strategy, Change Behavior, and Create an Agile Culture. FT Press. Gollenia, L. A. 2016. Business transformation management methodology. Routledge. Greenberg, J. and Colquitt, J.A. eds., 2013.Handbook of organizational justice. Psychology Press. Greenberg, J. ed., 2013.Organizational behavior: The state of the science. Routledge. Miner, J.B., 2015.Organizational behavior 1: Essential theories of motivation and leadership. Routledge. Palmer, I., Dunford, R. and Akin, G., 2009.Managing organizational change: A multiple perspectives approach. New York: McGraw-Hill Irwin. Palmer, I., Dunford, R. and Akin, G., 2009.Managing organizational change: A multiple perspectives approach. New York: McGraw-Hill Irwin. Pinder, C.C., 2014.Work motivation in organizational behavior. Psychology Press. Rothwell, W.J., Stavros, J.M., Sullivan, R.L. and Sullivan, A. eds., 2009.Practicing organization development: A guide for leading change(Vol. 34).John Wiley Sons. Storey, J., 2007.Human resource management: A critical text. Cengage Learning EMEA. Sustainability, 2017. Online Available at: https://www.wilmar-international.com/sustainability/ Accessed on: 22 September 2017 Turner Parish, J., Cadwallader, S. and Busch, P., 2008. Want to, need to, and ought to: employee commitment to organizational change.Journal of Organizational Change Management,21(1), pp.32-52. Weiner, B.J., 2009. A theory of organizational readiness for change.Implementation science,4(1), p.67.