Technology in Classrooms Essay Example for Free

Technology in Classrooms Essay Tablets. Smartphones. Smartboards. The biggest issue society will have to face in the near future is effectively incorporating technology into public schools. There is a mass of new equipment being thrown haphazardly into classrooms. But do teachers know how best to use it, or are they left drowning, trying to determine how to avoid the increased number of student distractions that inevitably accompany it? This is the newest challenge. How much is too much? Technology has the potential to revolutionize the classroom if used correctly, but it could also be severely detrimental to the education of our students. Initially, the most difficult part is discovering all of the possible uses for the new equipment. A tablet, for instance, is usually used for playing games, checking email, and using social media. For some subjects, it is easier to relate these uses productively to the curriculum than it is for others. A common example is English versus math. In an English class, a tablet can be used for projects, researching information, working collaboratively with other students via email, social media, or both. In a math class, this same tablet appears to be more of a hindrance than a help. Typing math symbols is more effort than it’s worth, games always seem more interesting than learning the lesson, and there aren’t usually research projects about algebra. Despite these obvious barriers however, tablets can actually become a useful tool in all classrooms. There are many apps that can aide in learning, and more are being created every day. â€Å"Factor Factory†, â€Å"Picturing Fractions†, and â€Å"Khan Academy† can all be helpful in a math classroom, especially on a review day. Khan Academy is especially useful for students, as it has coherent lessons for several different subjects, and many levels within each. There are apps for teachers as well, including some for monitoring students’ progress and aides for planning lessons. All in all, having tablets in the classroom for student use can be exceedingly beneficial. What about smartphones? Many students carry an iphone, an Android, or some similar device with them daily. How can they be used in the classroom? Several teachers choose not to deal with them at all because they can be such a distraction. Texting, checking social media websites, and playing games can interfere with learning, so these teachers practice â€Å"phone surrender†, requiring students to place their phone in a designated container at the beginning of class each day and only retrieve them at the very end. While this does seem to help students focus, there must be a way to use the phones productively instead. The same apps convenient for tablets are also available for smartphones, so students can make use of online flashcards for studying, or watch video tutorials. Some students can text faster than they can write, so taking notes on a smartphone could be potentially easier. If a student misses class and needs to copy that day’s notes, the camera feature can come in very handy. These phones can even record a lecture, eliminating the need for the old fashioned tape recorder still used by some college students. This recording can then be easily shared with the class for those who are auditory learners. Instead of fleeing from these handy little devices, perhaps it would be better to embrace them in classrooms. Finally, there are new tools for the teachers. Just as document cameras eliminated the necessity for the overhead projector, smartboards are becoming more and more common replacements for the document camera. Not so long ago, a whiteboard that doubled as a touch-screen computer was completely out of the question. They seemed like some technology to be acquired in the far distant future, akin to flying cars and teleportation machines. Now, they’re quickly working their way into classrooms, and it’s time to consider how to practically apply them. Not all teachers have a class set of tablets or laptops at their disposal, but a smartboard is a good alternative. These interactive whiteboards can be used in many ways. First, they eliminate the need to scan notes onto the computer; with a smartboard, notes can be immediately saved to a folder on the desktop. This means no more scanners required in classrooms, as well as less hassle for teachers. Next, they can be used for lectures. The ability to switch between webpages and program windows with just a tap is priceless. Teachers are now able to switch over to an interactive visual on a website, then back to the notes, and then over to a short video, all without ever leaving the front of the classroom, and students can do the same while giving presentations. Allowing students to work examples on the board has always enhanced learning, and now these tactile learners can interact with problems even easier. In a physics class, projectile motion can be easily demonstrated on the whiteboard by switching to an internet window with a simulator and adjusting variables such as height, weight, and velocity to see the effects on distance and time. No more confusing diagrams drawn by non-artistic physics majors! A geometry class could also discover 3D shapes more easily this way. The possibilities are endless. It just takes a little exploring to discover everything these interactive whiteboards can do for us, and that is a task the teachers are going to have to tackle soon. Technology is everywhere, and upcoming generations will be more immersed in it than ever. In the next decade or two, it is time to embrace it in schools. So many students could be benefitting from it if teachers would keep an open mind instead of becoming overwhelmed by the onslaught of new programs and equipment they find themselves trying to adapt to. Education is such an important topic because these students will one day grow up to lead the country. The teacher’s job is to provide them with the best education possible to prepare them for the challenges they will face as adults in their lives and careers.

Relationship Between Drug Use and Crime

Relationship Between Drug Use and Crime Reviewing empirical research examining the relationship between drug use and crime. Undeniably, there is a strong association between illicit drug use and criminal activity, which appears to be consistent across much of the empirical literature with regard to the relationship between drug use and crime. (Moore, T. et.al, 2007, p.369) However, the relationship between drug use and crime is complex and dynamic, often associated with entrenched social and health problems such as unemployment, socio economic inequality, and poor mental health. Furthermore, the complexity of the relationship further develops with the links being neither simple or linear, nor universal across offending. (Raskin White Gorman, 2002) Goode argues that drugs and crime are intimately related in the public mind and suggest currently, that drugs and crime are connected in a very specific way and whether their connection bears directly on a specific issue of whether or not property crime would decline under decriminalisation of certain illicit substances. (1997). The issue that comes to the fore is that there is sometimes a tendency in the literature, and policy and public debate, to over simplify and over-draw the links between these two phenomena. This is supported in the work of Makkai (2002) whereby the argument that much of the Australian discussion on illicit drugs and crime is ill defined, simplistic, and lacking in evidence where an assumption that there is a causal relationship between drug use and crime is made without sufficient supporting evidence. (p. 113) Furthermore, Raskin White and Gorman also supports the view of Makkai stating, policy makers assume that an important connection between drugs and crime exist, however the precise nature of the connection remains elusive. There is clear evidence in literature suggesting and supporting that drug use and crime tend to be associated or co-existing in the same populations. Within Australian literature this evidence is contained within the studies of Kevin, 1999; Loxley, 2001; Makkai, 1999 and Makkai, 2001. Interestingly, when reviewing literature examining the drugs and crime nexus, the body of research pertaining to offending/drug use careers and initiation into drug use provide useful insight into the relationship. Pudney (2002); Best et al (2001a) argue that the onset of criminal behaviour generally precedes the onset of initial and/or regular drug use. This assertion is demonstrated empirically whereby 17 per cent of prisoners reported illicit drug use prior to offending, 29 per cent report that crime and drug use occurred at the same age, but offending before the commencement of illicit drug use was reported at 54 per cent. These results that generally the lifetime drug-using/ criminal career begins with the onset of offending, then illicit drug use, with continuing cycle of regular offending and regular drug use (Makkai Payne, 2003a, p10). Moreover, this bolsters the relationship between drug use and crime. The aim of this paper is to review the literature regarding the relationship between drug use and crime, particularly the theoretical models and the empirical evidence surrounding the three main theories in order to find gaps in the research and to identify future trends and research parameters regarding the relationship between drugs and crime. The three main theories to be examined is the assertion that substance use leads to crime, crime leads to substance use and that crime and drug use have common causes. As stated during the introduction the relationship between drugs and crime is dynamic and complex. There are a variety of ways into and out of the drug offending nexus which vary between individuals and according to a range of factors. For example, Scott et al 2001 state the links between drugs and crime can vary according to factors such as age (p.161), or sex as argued by Mazerolle (2008); Johnson (2004); Haas Peters (2000), or the order of introduction as to whether drug use or offending came first (Farabee et al, 2001). Furthermore, according to Scott et al 2001, that serious illicit drug use contributes to continuity in serious crime, and vice versa, concluding that crime affects drug use and drug use affects crime (p.270) This argument is supported by both Best et al, 2001a, p161 and Welte et al, 2001, p436 who suggest a two way relationship between drug use and offending. Theories concerning the relationship between drug use and crime Substance use leads to crime Goldstein, considered the first to originally develop the theory between the relationship of drugs and crime, suggested three separate explanations of how the link occurs. Goldstein asserts that psychopharmacological, economic motivation and a systemic theory explain the drugs and crime nexus. (1985) The first explanation and described as the psychopharmacological theory defines, that the short or long term use of certain drugs produces physical effects which lead to offending behaviour. This theory has been applied to both property and violent crime, but it is mainly associated with violent offending and attributes acute or chronic intoxication or the effects of drug withdrawal as contributing factors towards criminal behaviour. This psychopharmacological theory gains support in research conducted by Lo Stephens (2002) proposing that offenders were (or claimed to be) intoxicated with illicit drugs at the time of the offence (p 125). Further research within Australia also suggest within Drug Use Monitoring Australia (DUMA) data that 34 percent of police detainees claimed to be under the influence of an illicit drug when they committed the offence, furthermore 14 percent claimed to be under the influence of alcohol. Further support is provided to Goldsteins initial theory in Indermaurs (1995, p 156) Western Australian study of robbery that found 52.8 per cent of offenders reported being under the influence of illicit drugs at the time of offending and 5.7 per cent were experiencing the effects of withdrawal. The objective of the Drug Use Careers of Offenders (DUCO) project is to further understand the drug use and criminal histories of incarcerated offenders and to contribute to the empirical evidence on the link between drug use and crime. In the example of the DUCO study, questions regarding whether the offender was intoxicated and whether the offender committed the offence because they were intoxicated were asked. The study found that 24 per cent of prisoners reported they were intoxicated with illicit drugs, 17 per cent with both illicit substances and alcohol, and 21 per cent just with alcohol. However, these proportions more than halved when examining whether the crimes could be asserted to be causally attributed to intoxication, with 10 per cent for illicit drugs, 8 per cent for both and 9 per cent for alcohol only (Adams et al, 2008; Makkai Payne, 2003a, p16). Although research asserts that there is some significance of the psychopharmacological theory in explaining the link between drugs and crime, ambivalence surrounds the conclusion. For example, the Australasian Centre for Policing Research (ACPR, 2001, p15 16) conclude that it is probable that intoxication by either drugs and/or alcohol plays a role in the dynamics of the drugs and crime nexus, but that it should not be overestimated. Additionally, Raskin White Gorman (2000 p.185); MacCoun et.al (2001, p. 5) argue that the psychopharmacological theory explains little in terms of the relationship between drugs and crime. The second theory to explain the drugs and crime nexus is termed the economic compulsive and suggests that crime is commissioned in order to finance a drug habit. Makkai, 2002b argues that this theory primarily relates to property crimes, however may also relate to violent crime such as robbery where violence may be used during the commission of a property crime (p111 113). Support for this theory is derived by the research within Australia of Maher et al whereby high proportions of drug users report commit crime and in particular property offences to aid in paying for a drug habit (2002). These findings also concurs with Best et al, 2001a whose finding suggested that the most typical property crime was that of shoplifting (48 per cent of respondents), followed by burglary (28 per cent) then unarmed street robbery such as bag snatches and muggings (13 per cent). Furthermore, empirical studies examining the drugs and crime nexus such as Collins, 1999 and Nelson et al, 2002 asserts th e tendency that burglary is the offence associated most with financing drug use, however not as high as the income derived from offenders involved in drug selling. (Weatherburn et al, 2003, p193). Pritchard Payne cite that the main reasons for burglary are to support a drug habit (44 per cent of respondents), to obtain money or goods (42 per cent) and money was needed as a result of unemployment (41 per cent) 2005, p 46. In conclusion and although strong evidence has been provided in support of the theory, economic motivation cannot provide a complete explanation of the link between drugs and crime, however does contribute and explain why crime accelerates as addiction increases (ACPR, 2001, p.16). Furthermore, Bennett Holloway (2005); Raskin White Gorman (2001) identifies gaps in the research where there is a need to distinguish between different categories of drug users when examining the relationship between drugs and crime. Systemic theory as examined by Goldstein suggest the engagement within drug market activities results in offending, that is, drug related crime results from negative interactions in the illegal drug market, where it is argued that distribution and use of illicit drugs are inherently connected to the commission of crime, with particular reference to crimes of violence (Raskin White Gorman, 2000, p191) Reiss Roth argues that systemic crime is associated with drug distribution through organisational crime, transaction related crime and third party related crime. Although there is some anecdotal evidence suggesting a strong connection between drugs and crime, however as Bean (2002) asserts, research on organised crime outside the United States is limited and states that it does not directly discuss the relationship between organised crime and drugs and, furthermore the literature available could be classed as journalistic in nature rather than empirical research. On the other hand, Findlay states without drug trafficking, dealing and use being illegal, profit would not be assured (1999, p.26), which in turn suggest that drug related crime is an artefact of law and policy (McBride et al, 2001, p5). Crime leads to substance use The second proposed theory is that offenders are more likely to become illegal drug users. Thus, individuals who are deviant are more likely to be involved or choose social situations where drug use condoned or encouraged. Raskin White Gorman state that this theory may arise when deviant individuals use drugs to self medicate or to provide and excuse to commit deviant or criminal acts (2000, p174.) or that income from criminal acts providing additional income enables the offender to purchase drugs, contrasting the previous theory of drugs compelling the offender to commit a crime. In short, both overarching theories receive support and even reinforce each other in the sense that crime may lead to drug use and drug use may lead to more crime. Crime and drug use have common causes The third theory suggests that crime and drug use are not directly causally related to each other, however are related due to sharing other common causes in terms of individual level, interpersonal level, environmental and situational factors. Pudney states that social, economic and family circumstances appear to be influences on young peoples risk of becoming involved in both crime and drug use (2002, p28) A range of risk factors (which may increase the likelihood of an offence occurring) and protective factors (which reduce the impact of an unavoidable negative event) are described within this theory where Weatherburn et al simply state that were risk factors outweigh protective factors, the greater the likelihood of becoming in drugs and/or crime (2000 p 49 -53) and there is considerable overlap and relationship between illicit drug use and criminality (ACPR, 2001, p28). After describing the drugs and crime association within this literature review it is possible to conclude and identify recommendations for further research. No one individual theory can adequately explain the drugs and crime nexus in every instance, furthermore the relationship between drugs and crime is very complex, whereby the conclusions researched on this topic vary and depend on which area the researcher examines and interprets the data. Furthermore, consideration to all theories is prudent in order to develop a true assessment of this relationship. Illicit drug use and crime are mutually reinforcing where both can precede the other, and be interrelated with a broad range of other variables, however there is no required criteria or necessary causal links between the relationship. That is, most drug users do not engage in criminality and there is an absence of evidence suggesting that drug use in and of itself causes criminality, and that criminality in and of itself forces people into drug use. With this said, drugs are important within the context of violence and property crime (MacCoun et al, 2001, p2), where the drug using offending population commit a disproportionate amount of crime. Although it can be said that the drugs and crime nexus is intimate, further research is necessary to assist in further defining and understanding the links, where the methods of disaggregation or examining specific areas may prove beneficial and give greater clarity such as, the relationship between crime and particular kinds of drugs, connecting empirical findings to drugs and crime theories, and researching the casual connection between drugs and crime. Finally, an area of interest to the writer to identify gaps in the research pertaining to the drugs and crime nexus is drug use in prison. This paper reviewed a number of studies in reference to the relationship between drugs and crime in an effort to illustrate the complexity of the connection. After examining the link the paper discussed three theoretical models which endeavour to explain the relationship; the psychopharmacological link; the economic-compulsive link; and the systemic link. Drug users dependency on expensive drugs where affordability is lacking demonstrates the closest link between drugs and crime; however even with this example the relationship is not automatic due to crime not being an inevitable consequence of drug use. Finally, involvement in crime is also dependent on economic, social and cultural contexts, not simply drug use.

Inotropes, Vasopressors and Vasodilators

Inotropes, Vasopressors and Vasodilators Suruchi Hasija, Jatin Narula ,Vandana Maravi. ADRENERGIC RECEPTORS AND SIGNALING PATHWAYS The main control over cardiac contractility is provided by the ÃŽ ²Ã¢â‚¬â€œadrenergic signaling pathways and that over the vascular tone by both ÃŽ ±- and ÃŽ ²Ã¢â‚¬â€œadrenergic pathways. The ÃŽ ± and ÃŽ ² receptors are stimulated by catecholamines circulating in the bloodstream and those released locally from the adrenergic nerve endings. The two main subtypes of ÃŽ ²Ã¢â‚¬â€œadrenergic receptors (ÃŽ ²Ã¢â‚¬â€œARs) in the cardiovascular system are the ÃŽ ²1 and ÃŽ ²2 subtypes. Myocardial ÃŽ ²1 and ÃŽ ²2-AR stimulation leads to increased contractility, whereas vascular ÃŽ ²2-AR stimulation induces vascular smooth muscle relaxation. Drug binding to myocardial ÃŽ ²Ã¢â‚¬â€œARs activates stimulatory G protein. This leads to activation of the enzyme adenylate cyclase that catalyzes the conversion of ATP to cAMP. A cascade of intracellular reactions finally leads to the physiological effect of increased myocardial contraction or vasodilation. The ÃŽ ±Ã¢â‚¬â€œadrenergic receptors (ÃŽ ±Ã¢â‚¬â€œARs) are further classified as ÃŽ ±1 and ÃŽ ±2 subtypes. ÃŽ ±1-AR on vascular smooth muscles are the main mediators of vasoconstriction. ÃŽ ±2-AR on the neurons function in a negative feedback loop to control ÃŽ ±-adrenergic vasoconstriction. Stimulation of ÃŽ ±1-AR coupled to G protein activates phospholipase C which in turn raises intracellular Ca+2. Stimulation of ÃŽ ±2-AR coupled to inhibitory G protein inhibits adenylate cyclase, thereby lowering intracellular Ca+2. INOTROPES Inotropy or contractility is the intrinsic property of the cardiac myofibril. It defines the amount of work that the heart can perform at a given load. Contractility is primarily determined by the availability of intracellular calcium. Depolarization of the cardiac myofibril leads to the entry of a small amount of Ca+2 into the cell which triggers the release of additional Ca+2 from intracellular storage sites (sarcoplasmic reticulum). The binding of Ca+2 to troponin, displacement of tropomyosin from the binding site on actin and formation of actin-myosin crossbridges eventually leads to contraction of the myofibril. All inotropic agents act by increasing intracellular calcium. Catecholamines, phosphodiesterase inhibitors and calcium sensitizers are the broad classes of available inotropic agents. Catecholamines Catecholamines comprise the major type of available inotropic agents. Their chemical structure includes a catechol ring, catechol hydroxyl groups and variable side chains. Endogenous(present naturally in the body) catecholamines include epinephrine, norepinephrine and dopamine, and synthetic catecholamines include isoprenaline, dobutamine, dopexamine and fenoldopam. Besides acting directly on adrenergic receptors, some catecholamines may act indirectly by releasing or inhibiting reuptake of norepinephrine at the nerve terminal or by metabolism to form norepinephrine. Table 1: Site and mechanism of action of sympathomimetics Table 2: Haemodynamic effects of catecholamines and phosphodiesterase inhibitors CO=cardiac output, dp/dt=force of myocardial contraction(change in pressure/time), HR=heart rate, SVR=systemic vascular resistance, PVR=pulmonary vascular resistance, PCWP=pulmonary capillary wedge pressure, MVO2=myocardial oxygen consumption Modified from Lehmann A, Boldt J: New pharmacologic approaches for the perioperative treatment of ischemic cardiogenic shock. J Cardiothorac Vasc Anesth 19:97-108, 2005. Epinephrine Epinephrine, a naturally occurring catecholamine, is secreted from the adrenal medulla. The effects on ÃŽ ²Ã¢â‚¬â€œARs predominate at lower doses and on ÃŽ ±Ã¢â‚¬â€œARs at higher doses (> 0.1  µg/kg/min). It increases heart rate (HR), stroke volume (SV) and coronary blood flow (CBF). The rise in blood pressure (BP) results from increase in HR and cardiac output (CO). Systemic vascular resistance (SVR) decreases at low doses (ÃŽ ²2-AR effect) but increases at high doses (ÃŽ ± effect). It is metabolized in the liver by the enzymes catechol-O-methyl transferase (COMT) and monoamine oxidase (MAO), and the metabolites are excreted in urine. It has arrhythmogenic potential. In cardiac surgical patients it is used as an infusion at 0.01-0.4  µg/kg/min to wean patients with poor ventricular function off cardiopulmonary bypass (CPB). (Tables 1 and 2) Norepinephrine Norepinephrine is the postganglionic neurotransmitter in the sympathetic nervous system. It acts on ÃŽ ±1–AR, ÃŽ ±2–AR and ÃŽ ²1–AR, and has negligible action on ÃŽ ²2–AR. The ÃŽ ²1-AR action predominates at lower doses, thereby increasing inotropy, SV and CBF. It increases BP and SVR; but decreases HR. The CO remains unchanged. It has arrhythmogenic potential. The clinical dose range is 0.01 to 0.1  µg/kg/min. Like epinephrine, it is easily oxidized. It is metabolized by COMT and MAO and taken up by the sympathetic neurons. It decreases renal, hepatic, mesenteric and splanchnic blood flow. Dopamine Dopamine is a neurotransmitter in the central and peripheral nervous system. It is the immediate metabolic precursor of norepinephrine and epinephrine. It acts on ÃŽ ±Ã¢â‚¬â€œARs, ÃŽ ²Ã¢â‚¬â€œARs and dopaminergic receptors (DA1-DA5). At 0.5-3  µg/kg/min it increases renal and mesenteric blood flow (dopaminergic effects), between 3-8  µg/kg/min it increases HR and contractility (ÃŽ ²-AR effects) and, above 8  µg/kg/min it causes vasoconstriction (ÃŽ ±-AR effects). Intravenous dopamine does not cross the blood brain barrier. It is metabolized in the liver by COMT and MAO. Isoprenaline Isoprenaline has pure ÃŽ ²Ã¢â‚¬â€œAR agonist activity. It causes an increase in HR and contractility (ÃŽ ²1-AR effect) and decreases SVR (ÃŽ ²2-AR effect). CO increases due to combined ÃŽ ²1 and ÃŽ ²2-AR effect. It dilates pulmonary, skeletal, renal and mesenteric vascular beds. It is indicated in the treatment of pulmonary hypertension, bradycardia (especially after orthotopic heart transplantation), heart block and conduction abnormalities. It is used in the dose 0.01 to 0.1  µg/kg/min. it is metabolized in the liver by COMT. It is arrhythmogenic. Dobutamine Dobutamine is primarily a ÃŽ ²1-AR agonist and has positive inotropic effects. It causes modest increase in HR (ÃŽ ²2-AR effect) and decrease in SVR (ÃŽ ²2-AR effect). The clinical dose range varies from 2-15  µg/kg/min. It is particularly indicated in patients with myocardial pump failure. Its chemical structure lacks the hydroxyl group of catecholamines. It is metabolized in the liver, although not by COMT and MAO. It increases SV, CO and CBF. The arrhythmogenic potential is less than other catecholamines. Dopexamine Dopexamine is a synthetic analog of dopamine. It has potent ÃŽ ²2-AR and dopamine agonist properties and little ÃŽ ²1-AR and ÃŽ ±-AR activity. It causes vasodilation, increase in HR and inotropy. CO and renal blood flow are increased. It is used in the dose 1-10  µg/kg/min. It undergoes methylation and sulfation in the liver and is taken up into the tissues via extraneuronal catecholamine uptake mechanisms. Unlike other catecholamines, it lacks arrhythmogenic potential. Fenoldopam Fenoldopam mesylate is a dopamine DA1 receptor agonist that causes systemic and renal arteriolar vasodilation. It increases renal blood flow at doses of 0.05-0.1  µg/kg/min and reduces BP at 0.1-0.3  µg/kg/min. Phosphodiesterase inhibitors Phosphodiesterase inhibitors act by preventing the breakdown of cAMP, thereby prolonging its physiological response. They do not act via ÃŽ ²-AR stimulation. Their addition to a catecholamine has a synergistic effect in increasing inotropy. They also produce vasodilation and are termed ‘inodilators’. They improve myocardial diastolic relaxation (positive lusitropic effect) and augment coronary perfusion. The clinically used phosphodiesterase inhibitors include amrinone, milrinone and enoximone. Amrinone Amrinone is a bipyridine derivative. It provides positive inotropy and decreases SVR. The decrease in SVR is apparent immediately after administration, whereas positive inotropy is appreciable after 10-15 minutes. They are particularly useful in heart failure by increasing forward flow. It is administered as a bolus loading dose (0.5-1.5 mg/kg) followed by infusion (5-20  µg/kg/min). The potential side effects are thrombocytopenia (2-3%), gastrointestinal upset, myalgia, fever, hepatic dysfunction, ventricular arrhythmias and allergy. Milrinone Milrinone is a derivative of amrinone and is 20 times more potent. It does not cause fever or thrombocytopenia. It is administered as a bolus loading dose (50  µg/kg over 10 minutes) followed by infusion (0.375-0.75  µg/kg/min). Enoximone Enoximone is an imidazole derivative that has more pronounced vasodilatory effect than inotropic effect. It is administered as a bolus loading dose (0.5-1 mg/kg) followed by infusion (5-10  µg/kg/min). Levosimendan Levosimendan is a new inotropic agent belonging to the class of calcium-sensitizing agents, i.e., it sensitizes the myocardium to the actions of calcium. It has vasodilating and anti-ischemic properties mediated by opening of K+-ATP channels. The haemodynamic effects include increase in SV and CO and reduction in filling pressures, mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) and SVR. It also promotes lusitropy. It is useful in patients with compromised left ventricular function, difficulty in weaning from CPB and right ventricular failure. It is used in a loading dose of 12  µg/kg over 10 minutes followed by an infusion of 0.1  µg/kg/min. Calcium chloride Calcium ions play an important role in excitation-contraction coupling in the cardiac myofibrils. It has positive inotropic effect that is effective after CPB and in the short-term treatment of myocardial pump failure. The rise in BP occurs secondary to increased inotropy and vasoconstriction. However, it can attenuate the ÃŽ ²-AR effects of epinephrine in the postoperative cardiac surgical patients. It is administered in the dose of 2-4 mg/kg every 10 minutes. Calcium Gluconate the clinically available compound of calcium ,contains less than half of ionized calcium and has to be metabolized in the liver before action. VASODILATORS Vasodilators cause relaxation of arterial smooth muscle thereby reducing SVR and MAP. In addition, they also have venodilating property. They aid discontinuation of CPB by decreasing preload, right and left ventricular afterload, improving lusitropy and CBF. They are useful in the perioperative treatment of systemic and pulmonary hypertension, myocardial ischemia and ventricular dysfunction complicated by excessive pressure or volume overload. Sodium nitroprusside Sodium nitroprusside (SNP) acts by acting as a substrate for the formation of nitric oxide (NO) in the vascular endothelium. Binding of NO to its receptor induces a conformational change in the enzyme guanylate cyclase and production of cGMP from GTP. cGMP is the second messenger that eventually leads to vascular smooth muscle relaxation via numerous intermediate steps. SNP predominantly causes arterial and arteriolar vasodilation, but at high doses venodilation also occurs. Reflex tachycardia is apparent with its administration. SV and CO are increased only if the preload is maintained with intravenous fluids. SNP has a potential to cause ‘coronary steal’ phenomenon in patients with coronary artery disease as the epicardial coronary arteries also dilate diverting blood away from the stenosed endocardial coronary arteries. It decreases pulmonary vascular resistance (PVR) and MPAP. It abolishes hypoxic pulmonary vasoconstriction and may contribute to hypoxia. The infusion rate is 0.5  µg/kg/min, and titrated to effect. It is reconstituted in a dextrose-containing solution. SNP is sensitive to light, therefore the infusion syringe and tubing are wrapped with opaque material to prevent light induced structural breakdown of the drug. Cyanide toxicity may occur with the use of SNP above 1.5 mg/kg acute dose or 8  µg/kg/min chronic infusion. SNP is used during hypothermic CPB to promote uniform cooling by preventing cold induced vasoconstriction, to reduce the perfusion pressure, to reduce afterload by decreasing SVR and to increase pulmonary blood flow by decreasing PVR. Nitroglycerin Nitroglycerin (NTG) acts by the same mechanism as other nitrates. NTG is primarily a venodilator and reduces ventricular preload and myocardial oxygen consumption. NTG is of particular importance in patients with congestive heart failure as it unloads the left ventricle. It has modest effects on SVR and BP. It reduces PVR. The starting dose of intravenous nitroglycerin is 0.5  µg/kg/min which may be titrated to effect. Attention must be paid to the fluid status as CO may drastically reduce. At higher doses systemic vascular dilation occurs. NTG is helpful in coronary artery disease because it causes epicardial coronary artery dilation. It is metabolized in the liver. Methemoglobinemia occurs at high infusion rates. Intravenous nitroglycerin has a half-life of 1-3 minutes. Tolerance develops when administered for more than 8 hours. Nitric oxide Nitric oxide (NO) is the endothelium derived relaxing factor. Its mechanism of action has been described above. It has a very short half-life of 5 seconds. Inhaled NO promotes pulmonary vascular dilation. It can be used upto 80 parts per million (ppm) in patients with severe right ventricular failure and pulmonary arterial hypertension. As inhaled NO is rapidly taken up by the heme group of guanylate cyclase, it only acts locally in the pulmonary vascular bed causing pulmonary vasodilation. It has no systemic effects. Phenoxybenzamine Phenoxybenzamine is a non-competitive ÃŽ ±1 and ÃŽ ±2-AR blocker. It decreases PVR and SVR, thereby increasing CO. It is used to promote vasodilation during deep hypothermic circulatory arrest for uniform cooling and for the treatment of pulmonary hypertension. Phenoxybenzamine is a very potent and long acting vasodilator. It was traditionally used for afterload reduction, pulmonary vasodilatation, and in adrenal tumors such as pheochromocytoma. Phentolamine, a shorter acting agent is now more commonly used. VASOPRESSORS Vasopressors act on arteries and arterioles to increase SVR (ÃŽ ±-AR effect). They have some ÃŽ ² –AR effect also. Catecholamines such as norepinephrine, and epinephrine and dopamine at high concentrations are potent vasoconstrictors. In addition, sympathomimetics such as phenylephrine, methoxamine, ephedrine, metaraminol and mephentermine are also vasoconstrictors. They are metabolized by COMT and MAO. Phenylephrine Phenylephrine is a pure ÃŽ ±1-AR agonist and its primary action is to increase SVR. Reflex bradycardia may be seen. Vasoconstriction of renal, splanchnic and other vascular beds occurs. Coronary perfusion pressure is increased due to increase in diastolic pressure. The intravenous bolus dose is 50-100  µg and infusion rate is 0.5-1.0  µg/kg/min. Its effect is apparent in 1 minute and lasts upto 20 minutes. It is commonly used to increase SVR and therefore the perfusion pressure on CPB. Mephentermine Mephentermine has direct action on ÃŽ ±-AR and ÃŽ ²-AR, and indirect action by releasing norepinephrine at the nerve terminal. It increases CO and SVR. Its acts immediately on intravenous injection and it’s action lasts 30 minutes. It is used in 15-45 mg bolus doses and as 0.1% infusion titrated to effect. Vasopressin Vasopressin,a hormone of the anterior pituitary is a potent vasoconstrictor. It mediates vasoconstriction by inhibiting K+ ATP channels on vascular smooth muscles and blunting the rise in cGMP (due to NO and ANP) and cAMP (due to ÃŽ ²2-AR stimulation). It is one of the modalities of treating vasodilatory shock after CPB. It is used in the infusion dose of 0.01-0.1 U/min for this purpose. At higher doses it has the potential to cause renal and splanchnic vasoconstriction. It is also administered as a bolus dose of 40 U i.v. during cardiopulmonary resuscitation. Suggested reading Hoffman TM. Newerinotropesin pediatric heart failure. J Cardiovasc Pharmacol. 2011 Aug;58(2):121-5 Rognoni A, Lupi A, Lazzero M, Bongo AS, Rognoni G. Levosimendan: from basic science to clinical trials. Recent Pat Cardiovasc Drug Discov. 2011 Jan;6(1):9-15. Tavares M, Rezlan E, Vostroknoutova I, Khouadja H, Mebazaa A. New pharmacologic therapies for acute heart failure. Crit Care Med. 2008 Jan;36(1 Suppl):S112-20. Petersen JW, Felker GM. Inotropesin the management of acute heart failure. Crit Care Med. 2008 Jan;36(1 Suppl):S106-11 Ward RM, Lugo RA Cardiovascular drugs for the newborn.Clin Perinatol. 2005 Dec;32(4):979-97 Hug CC Jr. Making a choice ofinotropesandvasodilatorsin clinical situations.J Card Surg. 1990 Sep;5(3 Suppl):272-7 Stanford GG. Use of inotropicagentsin critical illness. Surg Clin North Am. 1991 Aug; 71(4):683-98.

The Reality of Cloning Essay -- Critical Thinking Essays

  Ã‚  Ã‚   Jerry L. Hall, then a researcher at the George Washington University Medical Center, presented the results of his in-vitro fertilization experiment at the 1993 meeting of the American Fertility Society in Montreal. Dr. Hall gave an interesting speech and the comments on his speech consisted of "nice job" and other positive remarks. On his return to George Washington University, Dr. Hall expected the same feedback, and he was shocked when the October 26, 1993 cover of the New York Times announced, "Scientist clones human embryos, and creates an ethical challenge." Ethicists pictured images of baby farming and of clones cannibalized for "spare parts." Protesters chanted on the streets to immediately ban human-embryo cloning. The cover of Newsweek had images of babies in beakers, and the debate concerning test tube babies resurfaced. L'Osservatore Romano from Vatican city stated these "procedures could lead humanity down a tunnel of madness." And many other groups and individuals expressed their horror of cloning humans. Professor Hans Bernhard Wuermeling, a medical ethicist at the University o... ...y the price for Michael Jordan if this was a possibility? Be at rest, no Hitler race will take over the world in the near future. But Jerry Hall may help many couples have families because the goal of his experiment was to help people.    Works Cited Elmer-Dewitt, Philip. Where Do We Draw the Line? Time. November 8, 1997: 64-70. Herbert, Wray. The World After Cloning. U.S. News and World Report. March 10, 1997: 59-64. Scientist clones human embryos, and creates an ethical challenge. New York Times. October 26, 1993: A1.      

Book Review of Plagues and Peoples by William H. McNeill Essay

William H. McNeill makes a monumental contribution to the knowledge of humanity in his book Plagues and Peoples. He looks at the history of the world from an ecological point of view. From this viewpoint the history of human civilization is greatly impacted by changing patterns of epidemic infection. Plagues and Peoples suggests that "the time scale of world history...should [be] viewed [through] the "domestication" of epidemic disease that occurred between 1300 and 1700" (page 232). "Domestication" is perceived "as a fundamental breakthrough, directly resulting from the two great transportation revolutions of that age - one by land, initiated by the Mongols, and one by sea, initiated by Europeans" (page 232). This book illustrates how man's environment and its resident diseases have controlled human migration, as well as societal successes and failures. McNeill discusses the political, demographical, and psychological effects of disease on the human race. He informs his audie nce that epidemics are still a viable threat to society, and warns of potential future consequences. Since Plagues and Peoples covers several subjects of knowledge, he helps the reader understand key concepts by fully explaining parasitism and its dependence on humans and animals. People in the field of history, which make up a majority of this books audience, would need more insight into epidemiology to grasp its key concepts. It would not be likely for a historian to be knowledgeable in a branch of medical science that deals with the incidence, distribution, and control of disease in populations. There is a lot of information presented in the text. This is why McNeill has to be careful with the organization of concepts in his book. M... ...ur current political, demographical, and psychological state will surely be altered. McNeill's argument is important because it forces everyone to rethink humanity's role in history. His thesis enables one to take a step back from trivial details and truly examine the larger picture. History classes have always viewed life and events from a political and military point of view. They should consider teaching this approach to history as well. Plagues and Peoples is a very insightful book, that explains in fine detail the causes and events that built up the disease pool. Once reading Plagues and Peoples, history will never seem quite the same. Works Cited Plagues and Peoples. By William H. McNeill. (New York: Anchor Books: A division of Random House, Inc., 1976 and Preface 1998. Pp. 7 + 365. Acknowledgements, preface, map, appendix, notes, index.)

Managing Financial Resources Essay

1.Managing Financial Resources: Provides students with an understanding of the nature of resources available to an organization; how resources can be managed to add value; understand the value chain and how sustainable competitive advantage can be maintained; how linkages between value systems are created for competitive advantage; and how the core skills and competencies of an organization are identified and managed. 2.Corporate Finance and Evaluation: Introduces students to the modern theory of finance. It examines decision rules for financial decisions in firms and the capital market context in which these decisions are made. The subjects covered are the value and capital budgeting, portfolio theory, models of security valuation, efficient markets, long-term financing, company dividend decisions, capital structure, and interactions of investment and financing decisions. 3.Financial Accounting and Analysis: Aims to take students from first principles financial accounting rules and concepts to a broad understanding of some of the key practices and techniques in financial accounting and analysis. The module covers the principles underlying financial statements, the preparation of basic financial statements, key elements of financial accounting theory, accounting standards and the interpretation of published financial statements. 4.Strategic Management Simulation: This module aims to introduce to students key aspects of strategic management through a business simulation exercise. Students work in a team environment to develop their knowledge and skills in strategic decision making, with tasks centered on finance and human resource management. The simulation is a computer based. The teams compete against each other in a simulated business environment and the strategic decisions they make have real time affect on how their organization performs. Decisions are therefore coordinated within the team based on the interpretation of various forms of information, which in turn translate into poor or successful business performance. 5.The Liverpool MBA Management Game: Only top 12 students among the entire cohort of University of Liverpool’s MBA were chosen to work on this project. Worked on a MBA Consultancy Project for T.J. Morris Ltd., to prepare a Strategic and Financial Business Plan for their entry into th e foreign retail market, the recommendations for which were well received by Mr. Joe Morris – Operations Director of the company. 6.Managing the Environment: The module draws, especially, from the closely related disciplines of strategy and marketing and deals with the macro and micro environments, buying behavior in consumer and industrial markets. It covers the nature and scope of the issues typically associated with understanding the business environment, environmental and organizational analysis, preparation of a marketing plan, the components of strategic management and the role of marketing within the strategy process. 7.Managing People: The module aims to develop students’ understanding of the realities of organizations and strategies for managing people in organizations with regard to striking a balance between the needs of the organization and employee needs. 8.Managing Change: The course examines issues and dilemmas facing those managing change via an examination of the main types, strategies and processes of change in organizations, as well as the main problems that are encountered in successfully implementing organizational change; the methods and strategies that can be employed to analyze complex organizational systems and decide what needs to change and how; the components of change, and the ‘levers’ of organizational change; the conditions in which innovative and evolutionary change is likely to occur and the management thinking and the skills necessary to cope with ambiguity on an ongoing basis. 9. 3 month dissertation – Impact of Foreign Direct Investment on the Indian Economy.

How effective is the first chapter of Lord Of The Flies? Essay

The first chapter of the L.O.T.F was very effective. It’s written after the Second World War but it talks about the first world, when the children from the city are flown to a hiding place, so they don’t get killed in the war. But the plane crashes in an island and the adults are all dead. This part makes the story effective because there’s suspense in it and excitement. There are no adults and no one knows where they are. They are stranded in an unknown island which makes this part of the story effective. The story starts with the â€Å"fair boy† getting out the crashed plane and stepping into the â€Å"scar†. The scar is made when the plane crashed into the island. This attracts attention to reader so this makes the story effective. Then as we go into the story we get introduced to â€Å"piggy† and we find out that the â€Å"fair boys† name is â€Å"Ralph†. They find something called a conch and â€Å"piggy† explains to â€Å"Ralph† what it does and this, what’s used to call the other children who were in the aeroplane. As we get introduced to each character the story starts to unfold and becomes more effective. The story is very effective when â€Å"Ralph† betrays piggy’s trust. Ralph – Ralph is a dependable and reliable person. He’s basically kind and he is sensitive. He demonstrates physical courage. He believes the good within people and represents the value of civilisations as well as democracy. He’s a posh person. â€Å"Piggy† is the intelligent person out of the group. â€Å"Jack† is a stubborn character and wants to be a leader because he wants to hunt and kill pigs. He says the best way to kill a pig is â€Å"you cut a pigs throat to let the blood out† so this shows his dark side. Ten there’s the twins â€Å"Sam† and â€Å"Eric†, they act the same, do the same and you can’t tell them apart. Then there’s â€Å"Maurice† who’s always smiling and is always a happy character. Then threes other boys where we don’t know much about except their names â€Å"Roger†, â€Å"Bill†, â€Å"Robert†, â€Å"Harold† and â€Å"Simon†, â€Å"Henry† and a boy with the birthmark. The symbolisms that are used in this novel are â€Å"piggy† he’s using this word to get the meaning across of the fact that he’s fat and ugly, which interests readers and makes the chapter effective. Then there’s piggy wearing glasses which shows symbol of intelligence. The conch with Ralph shows the symbolism of the world of democracy and how they are using the conch to show symbolism of democracy. There’s the beast which is the evil inside everyone. Jacks actions are symbolism of savagery. So all the symbolism attracts the readers attention and makes the chapter one effective. There are lots of themes in the novel betrayal, evil, order savagery power and leadership. In the novel there is a descent into savagery and is seen in the choir who became the hunters which makes the story effective because they change dramatically from little weak choir boys into hunters which makes the chapter effective. Jack releases his savage instincts by creating his mask. Then they become savages following his lead which makes the story effective. The conch becomes the symbol for the world of order and civilization. Where the boys come from they live in a democracy which is one of the themes here and they try to establish this on the island, however a democracy won’t work with few people trying. The uses of language in lord of the flies have a meaning behind each sentence. It’s structured well and you have to analyse each words to find out what the significance is behind the sentences. â€Å"them fruit† showing the bad english of piggy. â€Å"We can use this to call the others† and this is saying this is the first attempt at order. There is lots of imagery in the novel. It describes the person’s character and looks. Jack is an obstinate character and we can imagine him being blood lust as he wants to kill a pig. Then there’s piggy who we can imagine being intelligent fat and detested person. To my judgment chapter one is very effective because as a reade4r I loved how the sentence started and how it gradually built up interestingly and it was so effective it made you want to read more and more. As the chapters go I am sure the novel will be interesting.