Ethical use of information technology Article Example | Topics and Well Written Essays - 250 words

Moral utilization of data innovation - Article Example Government Intelligence Organization and for breaking the trustworthiness and security of the U.S. Aviation based armed forces site (Chellel 1). In May 2013, they were imprisoned as these trustworthy associations endured with robust misfortunes of notoriety and cash because of these programmers. In prison, Ackroyd was really blameworthy and felt very humiliated for what he did and how seriously he utilized his talented abilities (Chellel 1). He chose to address every one of his missteps when he escapes prison, and utilize his characteristic gift of capacity to hack for the altruism of his country and individuals. Be that as it may, he was as yet far fetched if life would give him one more opportunity and he would persuade any chance to be a piece of the good society and study further, ever. Ackroyd’s detainment period was abbreviated to nine months. At the point when he was discharged out of prison in February, his well meaning goals helped him and he prevailing with regards to getting affirmation at Sheffield Hallam for a Masters capability in the field of Information Systems Security (Chellel 1). It was not late after, whenever he again got an opportunity of a lifetime to demonstrate his abilities, however now for a decent reason. His job became dynamic when organizations desperately requested moral hacking, because of flooding in of digital security. Organizations did not have the quick skill required to shield their business from suffocating in the surges of digital security. LulzSec’s hacking exercises against Pay Pal and Mastercard Inc. were seen at a promotion when they dismissed WikiLeaks to work for their installments from their foundation. These organizations got profoundly ready when Wikileaks dispatched all military classified data. LelzSec’s individuals directed their movement by recording FBI discussions, transferring all mystery information and bogus cases on YouTube. They turned into an incredible danger for the country. Ackroyd has a chivalrous job in this demonstration. Server snags and concealed examples were consistently a rush for Ackroyd (Chellel 1). With his tendency of accepting the covered up as a test and diving deep down, Ackroyd

Respond post Essay Example | Topics and Well Written Essays - 250 words - 1

React post - Essay Example at when the requirement for charge increment emerges, which is ordinary, it is hard to get support from general society as they would decipher it as an expansion in average cost for basic items. Second, the author features the recommendation that a national deals expense ought to be set up. In a word, the framework would include gathering deals charge at all retail foundations equivalent to 23% as opposed to burdening pay. My reaction is supportive of the proposition. This is on the grounds that the framework would spread the taxation rate equitably. This is on the grounds that everybody purchases things. In this way, it checks methods for cheating and dodging charge. 2. As indicated by the article, Income Tax Reform and Flat Tax, the government charge code is excessively definite and extensive. The scholars propose a level rate charge on salary. It will get sure residents have more cash-flow in their pockets just as dispose of administration, long and costly methodology during documenting. Another proposition is Simple Exact Tax, and that is unadulterated, reasonable and star development. My reaction is that change is essential as we are developing. The present framework expends time and cash. Any blunder in the structures is fined by the administration making the framework requesting (Jones, Thomas, and T.Lang, 2012). With the presentation of new duties like clinical extract charge, it gets all the more baffling. 3. The White House and Treasury Department have discharged Business Tax Reform that has proposals for disentangling charge law and animate monetary development. The report proposes selection of strategies that will make it simpler for individuals to begin and show new businesses to decreasing the findings (The White House and the Department of the Treasury, 2012). My reaction is that if the recommendations are to be received, they will spell accomplishment for a great many people. The advantages from this change would give an increasingly liberal eliminate plan and impressively streamline and rebuild the duty credit rules The White House and the Department of the Treasury. (2012, February). The Presidents Framework For Business Tax Reform. Recovered April 18, 2015,

A Brief History of Sick Days

A Brief History of Sick Days A Brief History of Sick Days A Brief History of Sick DaysWhen it comes to guaranteeing paid medical leave, the United States is behind many European nations and possibly the Ancient Egyptians as well.With Memorial Day almost upon us, millions of Americans are going to be enjoying a well-earned day off. But there is one kind of day off that many Americans don’t enjoy: paid sick leave. Why is that? We reached out to a few experts and consulted the historical record to find out why.The United States lags behind.Depending on where you work or what kind of job you have, you might or might not be able to take paid time off work when you’re sick and need to recuperate. And if it seems like there is little rhyme or reason to our country’s system for guaranteeing paid sicks days, well, you’re exactly not wrong about that.Last year, we wrote a post chronicling the evolution of the U.S. health insurance system, which mostly amounted to laying out a series of historical accidents leading to the current arrangement we enjoyâ€"or maybe don’t enjoyâ€"today. And when it comes to the history of sick days, particularly in the United States, the story is much the same.While some level of paid sick leave is a standard workplace benefit in at least 145 countries around the world, currently there are no federal laws requiring private employers to provide paid sick leave for their employees who work in the United States,” explained Timothy Wiedman, retired professor of Management Human Resources at  Doane University (@DoaneUniversity).“A few U.S. cities (notably San Francisco and Washington, D.C.) have passed such legislation to cover a great many local employees who work within their jurisdictions, but those situations are very rare at this point.”“On the other hand, the majority of government workers and private-sector unionized employees do receive some level of paid sick leave benefits, Wiedman continued. “Further, a great many large and medium-sized companies also voluntarily provide s ome sort of paid sick leave for their (non-union) salaried and clerical employees.”“So in America, exactly ‘who’ receives paid sick leaveâ€"and how much leave theyre entitled toâ€"amounts to a hodgepodge of disparate plans that lack any uniformity.”Sick leave traces its origins back to Ancient Egypt.If you expect us to say something like “sick leave actually dates back to the Ancient Greeks,” you’d only be half right. The Ancient Greeks sure did invent a lot of things, but sick leave wasn’t one of them. For that, you’d have to take a trip across the Mediterranean.“The first record of sick days goes back to ancient Egypt,” said Richard Pummell, Human Resources Lead at DevelopIntelligence. “Craftsmen who were working on the tombs journaled their work activities and when they were paid in grain.“Historians have noted that these craftsmen continued to receive their payments of grain even after evidence showed the workers had taken ill for a period of time and was unable to work, thereby documenting the first sick days!”It would take another couple thousand years before the United States of America would even existâ€"but even then, this country’s views on paid sick leave were a little behind the times. And that view didn’t just extend to paid sick leave, but to the concept of paid vacation in general.In the 20th century, paid sick leave slowly improves.After the Industrial Revolution hadâ€"wellâ€"revolutionized the American workforce, the idea that perhaps giving workers a little extra time off might be good for them and for their employers began to take hole. In 1910, President William Howard Taft proposed legislation that would have guaranteed U.S. two to three months off every year!As you might have guessed, that bill did  not make it through Congress.“Sick days in the United States have evolved very slowly, said Hummell.” They first entered the vernacular as unions became prevalent and were looking for ways to ensure that m embers pay was consistent. Losing paid time over illness was problematic, and limited amounts of compensation paid for time not worked due to illness became more common. As most unions were engaged in male-dominated fields, females were less likely to be in an occupation that offered paid sick time.”“As corporations offered expanded benefits starting in the 1950s and 60s, paid sick days became more common but only to those employed by large organizations. Due to the lack of any federal law regarding payment of sick days to employees, those working for themselves or for smaller companies were not typically afforded this benefit,” he continued.FMLA represented a big step forward.Even though paid medical leave was becoming a bit more standard for U.S. employees, there were still no overarching government policies in place. On that front, progress wouldn’t be made for decades: The biggest step forward for paid leave in the United States came during the Clinton Administration.“ In 1993, Congress passed the Family and Medical Leave Act (FMLA) which provides up to 12 weeks of unpaid leave per year for many (but certainly not all) U.S. workers (with no threat of job loss) to deal with personal or family health-related situations that are specified by the law,” said Wiedman.Still, unpaid medical leave isn’t the same thing as paid sick days. And decades after the passage of the FMLA, there’s a lot of progress still to be made.“Even now, employees in service industries such as restaurants and hotels are typically not provided with paid sick leave. This benefit is also usually only offered to full-time employees, so anyone who is part-time is also not likely to receive sick pay,” said Pummell.“Today, only nine states and a number of cities in the US require employers to offer paid sick leave. The United States definitely lags most of Europe in this regard, where extensive sick days that can extend into many weeks are offered and sick leave is managed by the employer, a physician, and the government.”So what does the future hold for sick days?A day off to rest up from a nasty cold is a great benefit, but being able to take paid time off to deal with a serious medical issue could mean the difference between a speedy recovery and filing for bankruptcy.These sorts of issues are how many people end up relying on predatory no credit check loans and short-term bad credit loansâ€"like payday loans, cash advances, and title loansâ€"to make ends meet, trapping them in a dangerous cycle of debt.So will things change anytime soon? Wiedman thinks so:“A great many business leaders (especially folks who represented the interests of small businesses) fought the passage of the FMLA It was thought to be the (so-called) thin edge of the wedge that would expand to cover more and more workersâ€"and would eventually require paid leave.“Thus far, that hasnt happened.  However, numerous politicians have made proposals that seem to fit that gener al agenda.  So personally, I doubt that the FMLA will remain in its current form indefinitely!”Are you prepared for a medical emergency?In order to protect yourself from an unexpected medical issue, you should have a well-stocked emergency fund in place. And that means creating a plan to save money on the regular. To learn more, check out  these other posts and articles from OppLoans:Save More Money With These 40 Expert TipsFinancial Basics: Expert Tips for Smarter SpendingBuilding your Financial Life: Budgeting for Beginners8 Good Habits to Get Your Financesâ€"and Your Lifeâ€"on TrackDo you have a   personal finance question youd like us to answer? Let us know! You can find us  on  Facebook  and  Twitter.  |  InstagramContributorsRichard Pummell has over 30 years of business experience in the software, human resources outsourcing and business process outsourcing industries. He has led management teams that enabled the rapid growth of start-up, small and medium-size companies, an d has worked with a number of Fortune 500 and multi-national companies on human resources, process improvement, and systems implementation projects. Most recently, Richard has launched workonnex in the United States, a company providing real-time data and consulting services on employee satisfaction, engagement, and well-being.After 13 years as a successful operations manager working at two different ‘Fortune 1000’ companies, Dr. Timothy G. Wiedman spent the next 28 years in academia teaching college courses in business, management, human resources, and retirement planning.  Dr. Wiedman recently took an early retirement from  Doane University (@DoaneUniversity), is a member of the Human Resources Group of West Michigan and continues to do annual volunteer work for the SHRM Foundation. He holds two graduate degrees in business and has completed multiple professional certifications.

The Culture Influence on the Collectivism of Chinese...

Available online at www.sciencedirect.com Available online at www.sciencedirect.com Energy Procedia Procedia 13 (2011) 4055 – 4062 Energy 00 (2011) 000–000 Energy Procedia www.elsevier.com/locate/procedia ESEP 2011: 9-10 December 2011, Singapore The Culture Influence on the Collectivism of Chinese Customers Behavior in the Fast-food Industry Yu Wang a, Changbo Shi a, Yalan Gu b, Yong Du c,* Tourism Management Cuisine School, Harbin University of Commerce, Harbin, P.R. China b School of Cross Cultural Communication, Newcastle University, United Kingdom c School of Computer Science Technology, Harbin Institute of Technology, Harbin, P.R. China a Abstract With the development of Chinese economy, the importance of†¦show more content†¦And with the sequential study of Chinese culture, another new dimension is discovered, that is long-term vs. short-term orientation (Hofstede Bond, 1998). In this article, the study target is to identify the collectivism/ individualism character of Chinese customers in Chinese fast food industry. According to Hofstede’s research, Chinese individual index is far less than western countries. Throughout history, collectivism has always as a mainstream culture to be praised and followed in China. On the contrary, western countries has highly influenced by individualism culture. And in fact, some one stated that the reason Chinese customers showed collectivism in their fastfood behavior is the result of the influence from traditional Chinese culture. And on the other hand, other factor also influence the collectivism characteristic in the behavior of Chinese customers in fast-food consumption, for example the perceived environmental uncertainty [6]. But in this article, we just want to find out whether the culture influence the collectivism of Chinese customers behavior in the fast-food industry. 2. Methodology 2.1. Questionnaires This research adopts the study methods which combine interview and questionnaire together, and mainly by questionnaire method. The interview is to get basic information of Chinese fast-food consumers and the consuming characters by communicating with managers of sample fast food restaurants, thus to build the research hypothesis. TheShow MoreRelatedThe Culture Influence on the Collectivism of Chinese Customers Behavior in the Fast-Food Industry3949 Words   |  16 PagesSingapore The Culture Influence on the Collectivism of Chinese Customers Behavior in the Fast-food Industry Yu Wang a, Changbo Shi a, Yalan Gu b, Yong Du c,* Tourism Management Cuisine School, Harbin University of Commerce, Harbin, P.R. China b School of Cross Cultural Communication, Newcastle University, United Kingdom c School of Computer Science Technology, Harbin Institute of Technology, Harbin, P.R. China a Abstract With the development of Chinese economy, the importance of Chinese market isRead MoreEssay on Globalization of McdonaldS on China5339 Words   |  22 PagesGlobalization of McDonald’s in China Executive Summary McDonald’s is one the largest fastest growing fast-food restaurant in the world. McDonald’s have become a household name across the world. The fast food giant has come a long way from being just a burger stand in San Bernardino, California in 1940. The original owners were two brothers, Richard and Maurice McDonald. The hot dog stand evolved into a restaurant offering 25 items on the menu. In 1947, Richard and Maurice (going forwardRead MoreThe Cultural Dimensions Of The International Adaptation Of Products2157 Words   |  9 Pagescomponents of culture which influence the international adaptation of products (Usunier, 1993). These three components have an effect on the individual’s consumption behaviours and the buying pattern. 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More than factual knowledge of Chinese culture the interpretative knowledge is very important and difficult, since it comes from a matrix of philosophic, religion and political explanations which are completely different of the western one. 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Although we have done many researches about the different cultures, marketing, which is as a discipline, has lagged behind other researches in recognizing the need for it. Before we have found the importance of marketing in different cultures, usually, the approach for marketing was too simple, and we often use the economic theory to explain facts and solve problems, however, international marketing andRead MoreDimensionalizing Cultures. the Hofstede Model in Context11051 Words   |  45 PagesConceptual Issues in Psychology and Culture 12-1-2011 Article 8 Dimensionalizing Cultures: The Hofstede Model in Context Geert Hofstede Universities of Maastricht and Tilburg, The Netherlands, hofstede@bart.nl Recommended Citation Hofstede, G. (2011). Dimensionalizing Cultures: The Hofstede Model in Context. Online Readings in Psychology and Culture, Unit 2. Retrieved from http://scholarworks.gvsu.edu/orpc/vol2/iss1/8 This Online Readings in Psychology and Culture Article is brought to you for freeRead MoreUsing the Cultural Dimensions Explored in Module 1, Discuss Some of the Ways in Which Australian and New Zealand Citizens Are Members of Cultures or Clusters That Are Different from the Clusters in Indonesia (About 8004416 Words   |  18 PagesUsing the cultural dimensions explored in Module 1, discuss some of the ways in which Australian and New Zealand citizens are members of cultures or clusters that are different from the clusters In Indonesia (about 800 words). Insert the bar chart that you created in the research activity as an Appendix , but use the descriptions of differences between the countries in the text. Hofstede (2005) describes the five dimensions of basic cultural values as follows: †¢ Expectations regarding equalityRead MoreUsing the Cultural Dimensions Explored in Module 1, Discuss Some of the Ways in Which Australian and New Zealand Citizens Are Members of Cultures or Clusters That Are Different from the Clusters in Indonesia (About 8004410 Words   |  18 PagesUsing the cultural dimensions explored in Module 1, discuss some of the ways in which Australian and New Zealand citizens are members of cultures or clusters that are different from the clusters In Indonesia (about 800 words). Insert the bar chart that you created in the research activity as an Appendix , but use the descriptions of differences between the countries in the text. Hofstede (2005) describes the five dimensions of basic cultural values as follows: †¢ Expectations regarding equality among

Internship Assignment Internship For Deaf Education...

Assignment 1, due on September 6th, requires the DHH intern to submit a one-page summary including due dates of all the assignments required by the course, EDSP 5093: Internship for Deaf Education Teachers Part 1 (Fall 2016). The intern is also required to ask clarifying questions about Assignment 1 (or simply indicate â€Å"I have no questions,† otherwise) and to develop an assignment calendar, which will be completed and due with the internship summary at the end of the Fall Semester. Assignment 2, due on September 13th, requires the intern to review the AE Assignment (Assignment 12) and write a one-page summary of it, including the descriptions of all UKAT forms and dates on when to complete them based on the calendar of the intern. The intern is also required to ask questions about the assignment and to include to submit the calendar for completing the UKAT forms. 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In those early days, these sons of esteemed professors were focused on pursuing their Ph.Ds, not on getting rich. â€Å"In their families, nothing trumped the value of a great education. Neither of them had the slightest idea just how soon their heartfelt commitment to academia would be tested.†2 The Beginning In the mid-1990s, the Internet was just emerging. Millions of people were logging on and communicating through email

The pathogenesis of measles virus infection Free Essays

string(86) " infects cells of the immune system, monocytes are the mostly affected cells \(6,7\)\." Introduction Measles is one of the most important contagious diseases of mankind. It remains one of the leading causes of infant deaths in developing countries (1). In 1998 the world health organisation (WHO) estimated that despite all the efforts to eradicate measles it still accounted for more than 30 million infections and 1 million deaths every year (2). We will write a custom essay sample on The pathogenesis of measles virus infection or any similar topic only for you Order Now Most of infections, it is believed are from countries where vaccination has not been taken up properly and developing countries where vaccination programmes are not that robust. Measles is very infections with an infection rate of 90% (3) when susceptible individuals are exposed to the organism that causes measles. This organism is an RNA virus of the genus morbillivirus, hence measles sometimes being referred to as morbilli. This virus belongs to the virus family of the Paramyxoviridae (4). The measles virus is transmitted through bodily fluids mainly as aerosols (airborne exposure) or droplets (5). It enters the host through the respiratory tract and immediately starts to replicate in the epithelial cells of the respiratory tract (6), from here the virus start to invade some cells of the immune system in the lymph nodes particularly the monocytes (7) through which it then spreads to rest of the host body. Measles is a self limiting disease, which means it will normally resolve itself after a few weeks, but because measles also induces a transient profound immunosupression (8), most of its victims succumb to fatal opportunistic infections. Without these infections the host will normally clear the virus from its system as illustrated by the graph below. Fig. 1. Pathogenesis of measles in-host. The level of measles virus in the plasma is plotted versus day of infection (7) It should be noted that in very rare cases the measles virus cannot be cleared from the host and persist in the host system in what is termed persistent measles virus (PMV). This is the cause of most measles complications which includes a subacute sclerosing pan encephalitis (SSPE) (5)(9) which may occur in about 1:10 000 measles cases (9) and inclusion encephalitis (5) which may occur if the host does not have adequate cellular response to the infection. Infection and Spread Clinical symptoms of measles include fever, malaise, coryza (runny nose), conjunctivitis and tracheobronchitis (10). Other symptoms that appear at a later stage during infection are the Koplik’s spots, 10-12 days post exposure, and erythmatous maculopapular rash which appears at around day 14 (5). Symptoms like diarrhoea and pneumonia, which are from opportunistic infections, will not be discussed here as they are not a direct result of the measles virus. The direct results will be discussed later in this essay after discussing how the virus infects and spread around the host body. To fully understand the mechanism of measles virus infection, one has to understand the measles virus structure. The virus As a morbillivirus in the paramyxoviridae family, the measles virus is a negative, single strand enveloped RNA virus (11). It is about 150-300 nm in diameter and has a lipid bilayer surrounding the RNA forming the envelope. Protruding from this envelope are two glycoprotein ligands called haemagglutinin (H) and fusion (F), necessary for virus attachment to host cells. The RNA is enclosed in a nucleoprotein (N) and associated with two proteins called phosphoprotein (P) and large protein (L) (12). See diagram below for a schematic picture of measles virus. Fig. 2 Showing the components and structure of measles virus. (5) The lipid envelope on the outside of the virus is acquired from the host cell during budding (13), because this outer layer is made up of host material it becomes difficult for the body’s immune system to detect the virus as non-self in the initial stages of infection enabling the virus to gain a foothold. Directly beneath the lipid envelop is the matrix (M), a protein that is important in virus replication as it facilitates the assembly of virus particles to the cell surface membrane during budding (5). The nucleoprotein (N) forms a protective sheath around the virus RNA called the nucleocapsid. The associated proteins P and L have been suggested to act as virus polymerase by some studies (12), helping in RNA replication. Then there are the two glycoproteins H and F. As their names suggest, they are responsible for anchoring the virus to the host cell and penetration of the cell membrane. The haemagglutinin binds (agglutinates) the virus to the host cell receptor (CD46, to be discussed later) and the fusion protein fuses the virus envelope with the cell membrane (5). Infection The infective process occurs in two key stages of attachment and fusion. In order for the virus genome to gain entry into the host cell and start replicating it needs to â€Å"catch† and â€Å"inject† host cells with its genome. The â€Å"catching† of host cells occurs when the virus haemagglutinin protein (H) attaches to the host cell receptor CD46. CD46 in the human cell act as a co-factor for serine protease degradation of C3b and C4b (14), these are the complement proteins of the immune system hence immunosupression by the measles virus. Studies (15) suggest that there exist more undefined virus receptors that enable the virus to attach to its host cells. The formation of syncytiae, cell-to-cell contact, also allows virus to spread to other cells (5). The â€Å"injecting† of host cells with the virus genome occurs during fusion, and the processes are less understood. It is thought that the same fusion processes occur for all enveloped virus, and studies (16) on human immune-deficiency virus (HIV) has shed some light into this. Two glycoproteins are involved, gp41 and gp120. gp41 is anchored onto the virus envelope and gp120 attaches to the host cell CD4 receptor next to the CCR5 co-receptor. Structural changes then occur whereby the gp41 is driven into the membrane of the host cell thereby linking the two cells (virus and host). The whole structure of gp41, gp120, co-rector CCR5 and CD4 receptor then collapses leaving the two membranes in apposition for fusion (16). Spread As discussed earlier, the virus enters the host through the respiratory tract, where it replicated in the epithelial cells. Then it infects cells of the immune system, monocytes are the mostly affected cells (6,7). You read "The pathogenesis of measles virus infection" in category "Essay examples" B and T lymphocytes are also infected but at less proportions as compared to monocytes. This amplification of the virus occurs in the lymph nodes of the host (5). Monocytes, B and T lymphocytes are cell of the peripheral blood and therefore circulate around the body, carrying with them the virus and spreading the infection to other parts of the body including the skin, gastro-intestinal tract, liver and the central nervous system. Disseminated virus proliferation occurs in the epithelial and endothelial cells of the blood vessels and other infected organs. Another mode of spread (mentioned earlier) is the formation of syncytia, not only do infected cells aggregate together, they can also form syncytia with non infected cells therefore infecting them in the process. Symptoms The symptoms of measles infections as mentioned earlier are fever, malaise, coryza, conjunctivitis, cough and Koplik’s spots in the oral cavity, later on the erythmatous maculopapular rash appears. These symptoms are tied with the immune’s response as the virus infection progresses. From day 0 when the virus first enters the host to around day 8, the first response from the immune system is the innate one, which is characterised by inflammation, giving rise to fever and general body malaise. As the virus continues to replicate in the epithelial cell of the host especially the nasal cavity (causing coryza), the trachea and bronchus (causing coughs), the nasolacrimal duct (causing conjunctivitis) and the oral epithelia cells (causing Koplik’s spots), it irritates these mucosal surfaces and cause their inflammation. The appearance of Koplik’s spots is diagnostic of measles (7) and it signals the appearance of early symptoms and viral load start to peak in th e blood (refer to fig 1 for the measles timeline in-host infection). These spots are transient and last for only about 3 to 4 days; also it is about this time that the adaptive immune response starts to kick in. At day 14 the viral load is at its peak and the adaptive immune response is fully operational and is clearing the pathogen from the system, the formation of the immune complex on the skin as the virus gets cleared result in the measles rash signalling cytotoxic T cell clearance of virus-infected cells (5, 7). After peak levels of the virus, following successful adaptive immune response, the virus levels drop and the immunological memory begins (7). In rare circumstances the virus can persist in the host, causing complications (17). One of these complications is the subacute sclerosing panencephalitis (SSPE), discussed below. Subacute sclerosing panencephalitis This is one of the complications of persistent measles virus infection; it affects the central nervous system of children who are infected by measles virus at a very early age (18). These children normally lack the maternal antibodies in their circulation to help combat the infection at its early stages. Studies (19) found that 50-75% of children who develop SSPE had measles infection before the age of two and also the prevalence rates of SSPE are 1:10 000 cases (9). This complication can take a very long time to manifest itself, with an average time of 8 years before SSPE symptoms appear and the reported range is between 9 months and 30 years (9). The disease leads to neurological deficits and eventually the patient dies (20). The other two measles complication worth mentioning are progressive measles inclusion body encephalitis (MIBE) which can occur in patients who are immunocompromised, and the post infection encephalomyelitis which is an autoimmune disorder that attacks the myel in sheath covering neurons. Recovery from measles (assuming opportunistic infections have not prompted medical intervention) requires both the humoral and cell mediated immune response. Cytotoxic T lymphocytes clear infected host cells and measles antibodies reduce free viral load by serum neutralisation (5) these antibodies can also be directed directly against the virus. The humoral response as usual is mostly for preventing re-infection and is involved in building immunity, a process taken advantage of by vaccine developers. After cytotoxic clearance of infected cells; there follows an immunologic type 2dominance where cytokines IL4, IL5 and IL10 are secreted by type 2 CD4+ T cells (21). Vaccination Many virus infections are untreatable, they are either self limiting, maim, or kill the host, so the only intervention that is available is to prevent infection in the first place. As noted from fig 1, after day 21 when the pathogen has been cleared, immunological memory is activated. This activation of immunological memory can only happen after the host has encountered the measles virus. Subsequent infections are met with a robust humoral response and the virus does not progress to cause infection. This is the basis of immunisation, the host immune system has to be introduced to the virus first, and as there is a risk of the virus overwhelming the immune system most virus used in vaccines are â€Å"controlled†. Attenuated virus vaccine Once the measles virus was isolated and cultivated by Enders and Peebles (5) it was then able to be manipulated. They found that the virus once cultured in chick embryos was attenuated in virulence and immunogenic enough to stimulate the host immune system to produce antibodies against it and remembering it (22). Work to produce a licensed measles vaccine begun in 1958 (5) and by 1963 the first licensed measles vaccine, RUBEOVAX ®, was available. In 1968 a more attenuated vaccine ATTENUVAX ® was licensed. As more vaccines for viruses e.g. mumps and rubella were developed there was a need to combine the doses into one single shot. In 1971 (5) a trivalent vaccine with all the three vaccines, measles-mumps-rubella was licensed. In recent times a fourth vaccine has been added to the MMR vaccine, resulting in a tetravalent vaccine MMRV (23). The fourth vaccine is a chicken pox vaccine, varicella. Other virus vaccines Other less favourable virus vaccines exist. Experiments were done on high titre vaccines by Sabin et al (5). These were aimed at infants who are at risk because they have circulating maternal measles antibodies which prevent vaccine uptake by neutralising it. The other vaccine, an inactivated measles virus vaccine produced by killing the virus in formalin was produced and licensed in 1963. It fell out of favour because the immunity if offered lasted for only one year and it had to be taken in three doses (5). With vaccination and great knowledge gained from studying measles it can be said that total eradication of the virus is possible. It is the beliefs and cultures of people that are slowing this up because they are not taking up vaccination. (2134 words excluding Refs. And plagiarism statement) References: Mrkic B, Pavlovic J, Rulicke T, Volpe P, Buchholtz C.J, Hourcade D, Atkinson J.P, Aguzzi A, and Cattaneo R. Measles virus spread and pathogenisis in Genetically modified mice, Journal of Virology (1998), 72, 7420-7427 World Health Organisation. Standardization of the nomenclature for describing the genetic characteristics of wild-type measles viruses. Weekly Epidemiological Record (1998);73:265–272 Clements CJ, Cutts FT. The epidemiology of measles: thirty years of vaccination. In: Meulen V, Billeter MA, editors. Measles Virus. Berlin: Springer Verlag, (1994) Lamb RA, Kolakofsky D. Paramyxoviridae: the viruses and their replication. In: Fields BN, Knipe DM, Howley PM, editors. Fields virology. 3rd ed. Philadelphia: Lippincott-Raven, (1996). p. 1177–1204 [Chapter 40] Hilleman M.R, Current overview of the pathogenesis and prophylaxis of measles with focus on practical implications, Vaccine (2002), 20, 651-665 Salonen, R., Ilonen, J., Salmi, A, Measles virus infection of unstimulated blood mononuclear cells in vitro: antigen expression and virus production preferentially in monocytes. Clin. Exp. Immunol. (1988). 71, 224–228. Heffernan J.M, and Keeling M.J, An in-host model of acute infection: Measles as a case study, Theretical Population biol, (2008), 73, 134-147 Saimi AA, Suppression of T-cell immunity after measles infection: is the puzzle solvedTrend Microbiol (1997) 5: 85–86 Takasu, T., Mgone, J.M., Mgone, C.S., Miki, K., Komase, K., Namae, H., Saito, Y., Kokubun, Y., Nishimura, T., Kawanishi, R., Mizutani, T., Markus, T.J., Kono, J., Asuo, P.G., Alpers, M.P. A continuing high incidence of subacute sclerosing panencephalitis (SSPE) in the Eastern Highlands of Papua New Guinea. Epidemiol. Infect. (2003) 131, 887–898. Griffin DE. Immune responses during measles virus infection. Curr Top Microbiol Immunol (1995);191:117–34. Naniche D, Varior-Krishnan G, Cervoni F, Wild F.T, Rossi B, Rabourdin-Combe C and Gerlier D. Human membrane cofactor protein (CD46) acts as a cellular receptor for measles virus, Journal of Virology (1993) 67, 6025-6032 Horikami S.M and Moyer S.A, Structure, transcription, and replication of measles virus, Curr. Top. Microbiol. Immunol. (1995), 191, 35–50 Owen P, Jennifer E. Garrus and Wesley I. Sundquist. Mechanisms of enveloped RNA virus budding. Trends in Cell Biology, (2002),12, 569-579 Hughson F.M, Enveloped viruses: a common mode of membrane fusion?, Curr. Biol. (1997), 7. 565–569 Bartz R, Firschung R, Rima B, ter Meulen V, Schneider-Schaulies J. Differential receptor usage by measles virus strains. J Gen Virol (1998), 79:1015–1025. Chan DC, Kim PS. HIV entry and its inhibition. Cell (1998),93:681–684. Griffin DE, Bellini WJ. Measles virus. In: Fields BN, Knipe DM, Howley PM, editors. Fields virology. 3rd ed. Philadelphia: Lippincott-Raven, 1996. p. 1267–1312 [Chapter 3. Dimova P, Bojinova V. Subacute sclerosing panencephalitis with atypical onset: clinical, computed tomographic and magnetic resonance imaging correlations. J Child Neurol (2000);15:258—61. Dunn RA. Subacute sclerosing panencephalitis. Pediatr Infect Dis J (1991); 10: 68-72. Rima K.B, and Duplex W.P, Molecular mechanisms of measles virus persistent. Virus research (2005), 111; 132-147 Karp CL. Measles, immunosuppression, interleukin-12 and complement receptors. Immunol Rev (1999); 168: 91–101. Katz SL, Enders JF. Immunization of children with a live attenuated measles virus. Am J Dis Child (1959); 98: 605–7 Vesikari T, Sadzot-Delvaux C, Rentier B, Gershon A. Increasing coverage and efficiency of measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe: a role for the combined vaccine. Pediatr Infect Dis J (2007) 26 (7): 632–8 How to cite The pathogenesis of measles virus infection, Essay examples

International Management Globalization - Cultural Integration

Question: Discuss about the International Management for Globalization, Cultural Integration. Answer: Introduction: In this modern world of globalization, cultural integration has become a part of our everyday life. Now, we cannot ignore the existence of a culture that is very different from that of ours in every sector of life. However, sometimes it becomes tough for us to overcome the cultural barriers and acclimatize ourselves with a complete new culture or atleast let them the part of our lives. In last summer, I had a visit to our office (branch) in China. It was my first time visit, and even being a close neighbor, I had not much knowledge of the culture and languages of the country, which led me to face a cultural dissonance. Discussion: As opined by Daenekindt and Roose (2014) Cultural dissonance can be identified as an uncomfortable or uneasy sense of conflict, disharmony, misunderstanding, or discord experienced by the individuals in the midst of change in theirculturalenvironment. A cultural dissonance can create a sense of aloofness and devastation of the moral values of an individual. The human being is a creature who loves to accommodate. However, as mentioned by Grimes (2012) the cultural clashes mainly disrupt our ability of accommodating with the situation, which becomes more critical with time. Such dissonance often occur due the language barriers, pre-set prejudices and lack of understating of the values that is the fundamental stem of that particular culture. One can face such dissonances in any sector of his/her social life. As we are working in a global world, such dissonances often disrupt our capacity of socialization in our office set up. As mentioned by Samnani et al. (2012) in the work places the language barrier and the lack of cultural knowledge decreases peoples motivation and competency. While I reached China, the first issue I faced the language barrier. In the office I had no idea what are others talking. It made me think that they are always talking about me and I stated to suffer an inferiority complex. Moreover, I find it hard to communicate with my colleagues regarding the professional issues; it gradually made my managerial skills down (Chan and Tong 2014). Moreover, as, I was almost unaware of the culture, my colleagues started to believe that I am showing disrespect to them. Chinese believe in collectivism, while my own philosophy of life is individualism (Kokkoris and Khnen 2013). It created a huge clash of interests. They do not like flowers as a gift, which is the most common in my culture. Moreover, they have a very good sense of humor, of which I often took an offence. They have a typical respect for the elderly persons and you cannot harshly reproach an aged person there. It gave me a huge trouble when I rebuked one of my sub-ordinates for his irrespon sible behaviours regarding a project. I was in sheer confusion and dilemma, as I have no idea of what exactly was going wrong. My failure of sending a meeting agenda, understanding the rank accuracy issues, lack of patience to close a deal even the use of my limbs were creating issues with my integration to the countries culture (Jiang 2013). It gradually made me demotivated and I was gradually losing my expertise of dealing with the people. I started to look at me as a minority and grown a sense of anger and abhor within me (Butcher 2016). It affected my emotional health and my career as well. My behaviour started to become disrespectful and I got a warning mail from the head office. Then, I stated to look for the issues, which were leading me in such an unbearable situation and affecting my professional life. To overcome, this situation I have tried a number of methods. As it was an official tour, I had to follow the schedules. I did not have any option of early leaving. It made me motivated to overcome this situation. Overcoming the language barrier: I tried to keep an interpreter with me who helped me by translating my opinions (Grimes 2012). He was a fellow employee and he was a native. In the course of time, we started to share a comfort zone with each other. Conversations with him helped me to understand the Indian values as well as the native language. Moreover, I tried to use the native terms while talking to hotel stuffs and other colleagues. It made them believe that I am trying to be a part of them and they started to communicate with me more frequently. Learning of the culture: With the passing time, I came to understand that, for acclimatizing with this new environment and reducing the cultural dissonance, I need to understand the culture and values of the country. Then I started to read books to guide myself for adjust in China. As mentioned by (Butcher 2016), by doing your own research about the country, you will be able to detect the potential threat and take the prior measures. It helped me to know about the greeting style, the importance of showing respect to the elders and the conservative ideologies of the country. It helped me a lot in gaining the confidence of my colleagues. Travelling: I do not know, whether one believe me or not, travelling to the corners of the city helped me a lot to make myself aware of the food, language, people and their mentality. In this country or other, travelling always helps us to be aware of the culture (Fang 2014). On the other hand, in doing so, I started to enjoy my time in China. Have a friend: As mentioned by Butcher (2016) to be adjusted in a situation, friendship is the best pathway. However, it was tough for me, but I managed to make friend with my interpreter. He made understand the wrongs of my behaviour and I started to imitate him in any social gathering. Thus, I gradually managed to overcome the cultural issues those were affecting my career. Conclusion: Hence, in conclusion, it can be said that, in the modern multi cultural world, cultural clash is normal. However, we need to take initiatives before it crosses the psychological boundary and start challenging our psychological limitations. On the other hand, in the official setup, eliminating the occurrences of cultural dissonance is a prerequisite for successful management as well as attaining the strategic goals. To overcome the cultural dissonance, we need to understand the cultural values and know the etiquettes of that particular culture. Some research and a leaning bent can easily make us accustomed with the boundaries and help us to acclimatize. References: Butcher, M., 2016.Managing cultural change: Reclaiming synchronicity in a mobile world. Routledge. Chan, K.B. and Tong, C.K., 2014. Singaporean Chinese doing business in China. InChinese Business(pp. 119-129). Springer Singapore. Daenekindt, S. and Roose, H., 2014. Social mobility and cultural dissonance.Poetics,42, pp.82-97. Fang, T., 2014. Understanding Chinese culture and communication: The Yin Yang approach.Global Leadership Practices, pp.171-187. Grimes, L.G., 2012.Teaching Evolution: A Heuristic Study of Personal and Cultural Dissonance. ProQuest LLC. 789 East Eisenhower Parkway, PO Box 1346, Ann Arbor, MI 48106. Jiang, Y., 2013. Business Negotiation Culture in China A Game Theoretic Approach.International Business Research,6(3), p.109. Kokkoris, M.D. and Khnen, U., 2013. Choice and dissonance in a European cultural context: The case of Western and Eastern Europeans.International Journal of Psychology,48(6), pp.1260-1266. Samnani, A.K., Boekhorst, J.A. and Harrison, J.A., 2012. Acculturation strategy and individual outcomes: Cultural diversity implications for human resource management.Human Resource Management Review,22(4), pp.323-335.

Cat unvarnished Review Essay Example

Cat unvarnished Review Paper Essay on Cat unvarnished Almost as for the classics wanting to amuse your mind decided yesterday to distract from the study of the linguistic heritage of the Old Believers Uimon, fierce satire of Ben Elton, and other Labuda and read something light, interesting and entertaining. Quite unexpectedly, this something was the work of Terry Pratchett -. The Unadulterated Cat No kidding, this is a very cute and funny book And, no kidding, it is clear that the author does not just love fluffy. purring, but, unfortunately, more closely familiar with them, and not one year shares with them the habitats and cozy sofas The Unadulterated Cat. this is a humorous comic book (in print only took 29 pages for a couple of hours reading in the evening), devoted to perhaps the most beautiful and the most repulsive creatures that coexist man: its nice after all dumate That if the future will not be as grim as predicted that is, if the future will generally be even after hundreds of years among the dome and pipe transitions space station orbiting the Earth, you will see the familiar picture stands near biomodule man with a strong chin. ., an expert on the part of mining on asteroids worth batters and a spoon on a plastic bowl We will write a custom essay sample on Cat unvarnished Review specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Cat unvarnished Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Cat unvarnished Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer All the feline habits are noticed by the author with the research accuracy and dressed in corporate pratchettovsky humor:. These cats actions no do not stop to eat from bowls with Kitty logo. If it says Arsenic and would not then disdain. These cats eat from anything And in the description of peculiar diseases koshachih can be found here such:. Trucks life-threatening. But not always. One of our friend the cat felt every car something of a mouse on wheels and never missed an opportunity to attack him. He had so many scars that fur bristling in all directions, like a thorn in the gooseberry. The seams had to apply to the old stitches. But the cat safely lived to adulthood. It still strikes fear in other cats with his one eye, and in a dream still rushed on the trucks. Perhaps I am hoping that some beeps . A longtime admirer of creativity Pratchett immediately recognize the good old mushroom from the Discworld, from the series about witches, whose prototype is quite exist in reality, as the author mentions repeatedly. well, and become the next episode for me, as a former owner tailed creature closest: Technology skarmlivanyai cat medications: Even the most healthy cat happens to fall ill so serious that can not do without pills . Oh, how we want to look in the eyes of the vet sophisticated, caring kotovladeltsami. We nod understandingly, listening to his explanation, and take his small packets (every five days one tablet of sulfur, and in ten days one brown, or vice versa.?). First, we naively believe that the handle is a piece of cake: all the same cat food smells like swamp mud, This cat will not even notice if we rastolchem ​​this garbage and admixed with the food And then we find out, that the taste of a real cat discern anything: most ingenious sensors, computer controlled against him is still that the poor fellow, sweltering with the common cold. One single molecule medicines cat will smell for a kilometer (as we may wisely with this meal, in which only a proportion of any mixed. It would seem, from the tablet is nothing left but the cat still guessed). begins the next stage. Now you start to deal with the mind. ( In the end, from the geometric point of view of a cat a cylindrical shape with a hole at one end ».) And you take in one hand and a tablet to another cat M yes Take the tablet in one hand, the other a wide dishcloth from which protrudes an angry cats head, the third arm decompress small jaw, between hectic pill, squeeze, and the fourth arm tickling the neck of the cat, until the sound it becomes clear that the tablet is swallowed. probably swallowed it would not be the case. The cat did not think her swallow. He for such an occasion has cheek pouches. This cat can take by mouth pill umyat his breakfast, and then spit out a little wet tablet with a sound that in the comics, is likely to be depicted as follows:. Ptyui » It is advisable not to go to the fourth stage where humans, animals and medications come in a feverish struggle, which is better to carve than to describe in words (see. the sculpture of Rodins The person giving a pill to a cat »). to start there to the fourth stage, decide for yourself. Usually by this time, the cat takes a body and cheerfulness of the spirit that the treatment can be considered successfully completed. And yet, try to crush the tablet, dissolve in water and a spoon to pour the composition of the cats mouth. One owner Real cat advised me grind this abomination into powder (no, not a cat, and a tablet, although the fourth stage come already, and such thoughts), mix with butter and spread on the cats paw. Kotovladelets assured that this is the surest way: neat by nature reluctant cat paw lick. I stuck to the counselor with questions, and he admitted that this is a purely theoretical assumption: to test his method in practice, it did not bother (kotovladelets was an engineer, thats it). We also believe, an animal that would rather starve to death or suffocate, than to take the medicine, in similar circumstances, would prefer to go with dirty hands . These descriptions are complete, otherwise youll have to copy an entire book. And by end, yet slightly poburchu: first, I do not understand why this book is now reissued in a series of Intelligent bestseller the series is good, but it was a little too omnivorous become something.. Secondly, it is still an entertaining read, and humorous. it is unlikely that Pratchett could debut b istatelno with this work, and the tone and the volume thereof is more suitable for a humorous newspaper Some jokes, still seem to be strained, they look like jokes a joke, and only A chapter devoted to a failed cat breeds -.. is a synthesis of purring and dog features show some tight and not necessary Well, its just my strange, petty carping As for the rest -.. funny to read in a couple of hours Owners of cats and dogs will be only sad sometimes nodding in time to the text. , saying the truth, the real truth vb Oleshi Terry.

Trans-national tourism corporation The WritePass Journal

Trans-national tourism corporation Introduction Trans-national tourism corporation Introduction  ReferencesRelated Introduction There are various of interpretations to what Trans-national Tourism Corporation means. However, this essay will suggest that Trans-national Tourism Cooperation (TNC) as Hampton (2011) suggested that it has been defined as large firms with subsidiaries in 2 or more countries. Hall suggested that TNCs are where the organisational behaviour ideas are an approach for marketing and promotion in the global market.   Mowforth and Munt states that 80% of mass tourism is dominated by TNCs and around 80% of tourists who travel by air to a less-developed country (LDC) will stay at hotels owned by TNCs. (Britton, 1991) TNCs benefits from vertical integration as it helps to reduce transaction cost because there is no ‘middle-man’ to deal with and the size of TNCs also mean that they will benefit from economies of scale.   TNCs are also known as   multinational companies. Tourism for the Trans-national co-operation is the centre point, and specifically more focused on Less Devel oping Countries. The first advantage of a TNC according to Mowforth and Munt Japanese Tourist arriving there from Tokyo. The tourist is transferred with a luxurious car Honda from the airport and stays at the Japanese owned Hotel as well as eats all the authentic Japanese food. However, travels back to Tokyo in the Hondo and explains that Japan is a good Third World destination. Furthermore, there could have been a BMW and an international hotel- but the point is argued that it is the main ownership that has made the benefit for the Tourism Industry. This now means that only the small proportion of the money is spent in the country itself so this connects to leakage as Mowforth and Munt adds that this does not just mean the purchase goods by the tourist in a destination also looks at goods and services by hotels and all other organisations. Leakage is not the main d of disadvantage for all financial aspects as Tourists itself but it is highly in use of Third World Countries. Mowforth and Munt say that the level of leakages is highly important the reason for this is this affects the economic power which is held by the TNCs for all local communities and government. What should be taken into account that due to not having a relevant collective data it is very difficult to calculate the leakage in a Tourist destination. Second advantage for a TNC in a poor country is having a TNC is powerful for the industrialisation especially for all the Asian countries where there needs to be rural development. Therefore, the government makes the farming prices quite low- and saves money; takes cheap food so the workers do not demand high wages. With the positive side to having a TNC this creates a good form of power for the poor people in LDCs as the TNCs clearly   know the wants and the basic needs of the poor people and making sure they are getting what they deserve. (Madeley, J. 2003) A general advantage for the TNCs is having more a Foreign Direct Investment (FDI) as this heavily benefits the Tourism factor. Nusa Dua in Bali is encouraging the TNCs to develop their restorts. FDIs are usually very good for funding for local or government projects that the country wants to run. This benefits Bali, by having a better economy, better jobs for the locals making Bali a better destination. This has helped Bali to succeed to be a better destination and improve its roads. This would mean more Tourists would now come into Bali and this will benefit them as a flourished economy. An disadvantage of a TNC reported by Pattullo in Mowforth and Munt (2005:51:-2)- this shows that there is a high level of leakage it is an overall of 50-70% but it states that for Jamaica it is 37% as this is known as more of a assorted economy therefore, the leakages here can be a lot lower then anywhere else. So this in general states that the money paid into the country never actually reaches the Third World Destination itself therefore, this is not a successful way for the country to expand economically. Another disadvantage is that all the First World Tourists who fly to a Third World Tourist destination- are mass tourists. The reason being for this is that they fly and possibly stay in a hotel which is TNS owned- these tourists may not form a mass or alternative tourism and may not be seeking for, adventure, wildlife and authenticity. This is not a huge factor but, mass tourism is becoming more of a straight focus however, they are being affected by the new, sustainable and alternative forms of tourists. An disadvantage of having a monopoly firm and the TNC being in control of this is being in contention with the mass tourism being contend of the Third World Tourism which often is different, and causes a lot of problems of dependency, and exchange leakages with under-developed economies by foreign owned enclaves.   (Brohman, J 1996) So the important aspect of this is that the TNC must address the issue of sustainability. Carothers in Mowforth and Munt   (1993:15) quoted that the final touches of the Earth Summit (agenda 21) the main focus was to remove the TNCs from the text of the Agenda 21. Agenda 21- is when there is aware of the environment being eco-friendly as well being sustainable. In the Third World Country it had to be clear that they knew what the term â€Å"multinational operate†. All the governments also needed to know what a Trans-national cooperation did for them was to gain more stability and have an increase in the legal rights. (Hamed, D 2005) The impact on all the human resources is an encouragement in employment and as the TNC has an increasing wage levels. The local firms- which are Tourism related (TNCs) make more connection with the suppliers and the distributors which makes a good business when they make the effort to have a better connection with the local suppliers and the distributors. However, there is no proof of how the TNC if they are crowding over the local firm. (Hamed, D 2005) Advantage of a TNC is that they are usually very small in most of the developing economies, because much of the involvement takes the non-equality forms. Some of the government assists the main development of the infrastructure itself. The new technology that can be introduced in a developing country and different management skills can make the Less Developing Country a lot better. (Hamed, D 2005) Another disadvantage stated by Mowforth and Munt is that the British tour operators are not aware of visiting Burma the reason being for the unawareness is purely the ethical reasons. As hotels were being built by the TNCs- Asia countries of: Japan, Malaysia, Singapore, South Korea and Thailand, with also French and Swiss Interests were very involved. Tourism in Burma is a good example of with a lot of interest to the government itself. But in many Less Developed countries the government and the TNCs and the case of Burma itself (SPDC) enlisted the assistance of this body. However, the clarity of the human rights and the nature and the culture Tourism and the leaflets of the tourism companies will praise all its virtues. Mowforth and Munt acknowledge that it is very important that the understanding and the issue of power is transparent strong if the destination wants a development. The TNCs commonly under the impression that the community has a strong and that the locals are in work by the power for the rest of the national government. This is a case some but not all. But the policies of the national government itself are in some situations influenced by the external organisations. The policies for the development of tourism are largely suitable for profits and for First World investors rather then the communities and the government itself. Another strong case study to support this essay is that the FDI- has been considered towards a strong factor of the economic development. The TNCs in the imports industry especially for Argentina and Brazil, there has been a strong relation of the TNCs being involved in the manufacturing industry just before the recent FDI boom took place. (Chudnovsky, D and Lopez, A 2004) The TNCs in Argentina and Brazil showed a significant amount of performance with a high level of technology and the productivity which was related to the TNCs. But, for the domestic market they wanted to take advantage of their own domestic markets itself. However, the TNCs did its best and used its own strategies for all different areas for all its economic development for the host country itself.There had been a huge number of arrivals of the FDI itself for all the presences of the TNCs as the economies increased in the 1990s. In this particular case Argentina and Brazil gained a very strong level with all the TNCs which were present. All the investments made by the TNCs aimed to increase all the assets, and with a better market. ( Chudnovsky, D and Lopez, A 2004) As competition becomes more of a wider spread- the TNC then has simple integration strategies. All the TNC searches are done very effectively with a range of assets in all the different locations. More than 50% of the TNCs sales In Brazil as compared with the number of sales itself as these were hardly even 25% the figure seems significantly low. Since the Brazilian Industry- it is not a major surprise to find that the TNCs in the country are more of an export orientated then of Argentina itself. The TNCs within the groups are Tourist operated with a much of a generally larger coefficients in Argentina and Brazil. ( Chudnovsky, D and Lopez, A 2004) ( Chudnovsky, D and Lopez, A 2004) suggests that the Brazilian Tourist Industry itself has much of a widespread the reason being for this is due to the number of linkages between the elements of being spread around than Argentina. In general this suggests that the TNCs have looked at the domestic market itself rather than the any of the human resources itself. This means that the TNCs have their goods that are more strategic in relationship to the firm’s performance at all national and regional level. In Argentina the TNCs clearly affect the imports and the exports. This is due to the relationship of all the sales and a result of a down side in the negative foreign trade balances. In Brazil similarly the TNCs for all the domestic firms are at a higher rate and grow incredibly faster. In Argentina and Brazil there has been an FDI (Foreign Directive Investment) which has helped the TNCs become more recognised as a main leader in Argentina and Brazil. The key linkages between the Foreign Directive Investment and The Foreign Trade show that the TNCs have had a bigger contribution than all the national firms itself. However, there is a higher chance for the imports with the local enterprises. From, the whole research of Brazil and Argentina the TNCs have had a lot less linkages with the local community itself then the domestic firms. From the research Brazil and Argentina has TNCs but with a reduce amount of linkages with the local community itself than the domestic firms. ( Chudnovsky, D and Lopez, A 2004) In conclusion to this essay despite the fact the concerns over TNCs on the Less Developed Country having TNCs are very beneficial for a host country. Additionally, the government has to make sure that they are fully in power with this and this situation should not be changed around as the government should be powerful enough to help a host country. Every point that was discussed in this essay has some understanding to the aspect of the impacts and the implications of the TNCs in some LDCs. From the understanding of the TNCs it is felt that International Tourists tend to understand better to what TNCs do and how they will profit the Less Developed countries- due to the complications in an Less Developed Country not having enough educated people therefore, the International Tourists will look at the wider focus of the capitalist mode as the product if recognised can not be in separation. (Jenkins, R 1987)   References Brohman, J (1996) New Directions in Tourism for Third World Development (Online), 23 (1), 48-70 Available from: stepuptravel.org/downloads/library/new_directions_for_tourism_in_third_world.pdf (Accessed 23 March 2011) Chudnovsky, D and Lopez, A (2004) Trans-national Corporations Strategies and Foreign Trade Patterns in Mercosur Countries in the 1990s (Online), Cambridge Journal of Economics 28 (5), 1-18, Available from: law.wisc.edu/gls/documents/foreign_investment_recommended2.pdf (Accessed 21 February 2011) Hamed, D (2005) What is Agenda 21? (Online). Avaliable from: lbhf.gov.uk/external/la21/index.htm (Accessed 20 March 2011) Hampton, M. (2011) Lecture Slide 6 on Trans-national Tourism Jenkins, R, Fist Edition (1987) Trans-national Corporations and Uneven Development. London Madeley, J. 2003 Transnational Corporations and Developing Countries Big Business Poor Peoples (Online) The Courier ACP-EU no 196 January-February 2003 Available from: (http://ec.europa.eu/development/body/publications/courier/courier196/en/en_036_ni.pdf) [Accessed 30 March 2011] Mowforth, M., and Munt, I Third Edition (2008) Tourism and Sustainability Development, Globalisation and New Tourism in the Third World War. Routledge, London Scheyvens, R. (2002) Tourism for Development. Prentice Hall, London. Harrison, D., (2001) Tourism and the Less Developed World. CABI, Wallingford.

Fear of Islam Research Paper Example | Topics and Well Written Essays - 2500 words

Fear of Islam - Research Paper Example Islam is perhaps the most misunderstood major religion in the world today.   As a Muslim, this student has experienced this truth on numerous occasions.   Because of media propaganda and rumors circulating around the world, Muslims are seen as terrorists and a people who promote and condone violence.   Many believe, in fact, that these are central tenants contained in their holy book, the Quran.   Because of this, Muslims worldwide have spent many years trying to help the world understand their true faith and identity. It is true that there are some ‘bad apples’ that advance their terrorist causes in the name of Islam.   This student is certainly not condoning their actions.   In fact, few Muslims condone the actions of terrorism.   It must be pointed out, however, that Islam is not the only religion that has committed acts of violence on people of other faiths.   Yet, these events seem to be washed over and the Islamic faith receives much of the bad pres s in global media today.   It is out of this press coverage that people have begun to have an outright fear of Islam.    Moustafa Bayoumi recently remarked that â€Å"every group has it loonies. And yet the idea that American Muslim communities are foul nests of hatred, where dark-skinned men plot Arabic violence persists† (11).   It begs the question as to why people are so afraid of Islam.   It seems that many in the West perceive every Muslim to be a potential terrorist. The fear is so strong in some localities that the mentioning of Islam is not permitted in certain locations. The state of Texas, for example, recently decided that reading about Islam in the classroom was not permitted because it did not constitute education, but rather was indoctrination (Bayoumi 12). This kind of attitude on the part of adults will only serve to further widen the divide of children in terms of their perception of Muslim. Finally, research and common opinions about the root of the fear of Islam appears to stem from an ‘us against them’ mentality. If you do not support the wars in Iraq and Afghanistan, for example, then you are a supporter or Islamic terrorists. The perception should not be that wars are fought over religion, but that is exactly what is taking place in modern society. If you support and allow a mosque to be built in your community, you are with them, not us. This kind of attitude, on both sides, has created a fear that exists in the heart of Muslim and non-Muslims alike. Farhad Dalal recently commented that â€Å"Ironically both the neo-conservatives and fundamentalist Islamists are in agreement that what is occurring in the world today is indeed a clash of civilizations, and that it is a continuation of a Holy War†

Walmart Article Example | Topics and Well Written Essays - 750 words

Walmart - Article Example Wal-Mart purchases directly from the manufacturer. This coupled with the effective use of technology and warehousing strategies, Wal-Mart is able to provide its customers with quality products at competitive prices. Such decisions made by companies, which help them gain a competitive edge against their rivals in the market are termed strategic decisions. These decisions involve some degree of innovation and thus, help companies gain advantages which are sustainable (Hayden et al, 4). One of the key components of Wal-Mart’s business model is its human resource. The company has a frugal culture yet the working environment is pleasant. The employees are called associates as opposed to employees. An associates’ well being is of high priority for the management. There is no concept of work-union, as the company takes care of associates’ needs and demands. The promotion criterion for managers is dependent upon the profits made by their particular outlet; thus, it leads to maximum work efficiency. In order to inculcate spirit of competitiveness, the stores are not only encouraged to compete with other retail franchises, but also amongst themselves. The organization is well equipped with the latest technological innovations, which are like real time market research, satellite system and store performance tracking. In addition to this Wal-Mart is very particular about its logistic partnerships with various vendors from around the world. Low cost logistics are the reason why Wal-Mart has its present competitive edge. Thus, the company pays special attention to its procurement process (Canak, 5). Over the years Wal-Mart has thrived by using a number of various different factors to its advantage. This includes a business model which till date is a mystery to those outside the organization. The company is also very good at hiding its deficiencies and covering its faults. Thus, it provides an example of organisational model to the competitors seems which virtually seems flawless and is overall very efficient and effective. Such effective strategies by the company, has made it one of largest retailers of America. Wal-Mart follows three fundamental and generic strategies - Focus Strategy, Differentiation Strategy and Cost Leadership. Wal-Mart started its operations by opening large stores in small shops (Canak, 5). At that time, all the other companies focused their efforts and resources on large metropolitan cities. However, Wal-Mart saw a gap and thus, capitalized on it by opening stores in small towns, not only did the company had a monopoly, but also had to pay low rental costs and goods were available at cheap local prices. Wal-Mart aims to not only provide products at low prices, but also provide unique and differentiated products to its consumers. The store’s USP is high quality products at lowest possible prices. This is one strategy that Wal-Mart has followed since the very beginning and plans to follow for its future strategic plans as well. It order to reduce its product cost, the company streamline its procurement process by getting products manufactured from different parts of the world. This reduces the production costs and thus, the eventual end price of a product (Hayden et al 12). High inflation has plagued the world over the past few years. Even though countries have found their way out of the recession, high economic inflation is still a problem. Wal-Mart plans to provide goods at affordable

Romantic Era And The Byronic Hero English Literature Essay

Romantic Era And The Byronic Hero English Literature Essay The Romantic Era and the Byronic Hero. During the eighteenth and early nineteenth centuries, literature and art as well as political philosophy were deeply influenced by new ideas about individualism and citizen rights. The American and French Revolutions illustrate the power and volatility of these new ideas. Although the term Romantic wasnt applied to this period until many decades later, the writers of this period expressed a sense of collective intellectual energy that they called the spirit of the age.†It was a time for questioning the status quo, challenging conventions of social hierarchy, and elevating the value of the common man and woman. Romantic writers reflected on the beauty of the natural world as a means of discovering, illuminating, and articulating their own insights about human nature. Their writing frequently included scathing critiques of social injustices, mainly associated with growing urbanization; meanwhile, they idealized rural landscapes and lifestyle s. Many of these authors were profoundly influenced by Miltons poetic works, especially  Paradise Lost. For example, William Blakes  Songs of Innocence and Experience  juxtaposes poetic visions of the world first through the eyes of a child, or innocent, and then through experienced eyes that recognize sin and inhumanity as part of the human fallen condition. As mentioned in the readings, Blake argued that Miltons Satan was the true hero of  Paradise Lost, and many of his contemporaries agreed with him. Miltons Satan inspired a new figure in English literature: the Byronic Hero. In this lesson, we will read several defenses of this rebellious and misunderstood, tragic character. In particular, we will investigate how this figure informs Mary Shelleys famous gothic novel,  Frankenstein. During the Romantic period, the art form of the novel became increasingly popular, in conjunction with a growing reading public. Some of the most famous and influential novels of this era include Jane Austins satiric novels of sensibility and manners, Walter Scotts historical novels, and Mary Shelleys critique of science and society in  Frankenstein. Most of us are familiar with the monstrous figure of Frankenstein from popular culture: film and television images. Mary Shelleys original creature was conceived in the aftermath of the French Revolution and the subsequent bloodshed that shocked and disillusioned many of the initial supporters of this revolution. Note that the name Frankenstein refers specifically to the scientist, Victor Frankenstein, who created a living Creature. The relationship between Victor and the Creature offers a complex commentary on the duties and responsibilities of both a creator and the created, which invites comparisons with Miltons depiction of the rel ationships between God, Adam and Eve, and Satan. Shelley interweaves the Biblical narrative of the Fall in Genesis with the Greek myth of Prometheus, another creation myth about duty, betrayal and punishment. Furthermore,  Frankenstein  explores themes of pride and ambition by combining these grand epic narratives with Shelleys own personal experiences of procreation, parenting, and death. Lesson Four Reading Assignment Readings: In  Masters of British Literature  (Longman, Vol. B), skim â€Å"The Romantics and their Contemporaries†, (pp. 3-28). Also read: William Wordsworth, â€Å"The World is too much with us†; â€Å"London 1802† (231-2); â€Å"Manfred’ and Its Time: The Byronic Hero† (386-7); and Coleridge, â€Å"Satanic Pride and Rebellious Self-Idolatry† (392-3) In the Longman Cultural Edition of Mary Shelley’s  Frankenstein, please read Susan Wolfson’s introduction (pp. xvii-xxii) before you read the novel. Then read Mary Shelley’s  Frankenstein  (the 1818 edition). And, then read the excerpts in â€Å"God, Adam, and Satan† (301-322). Reading Questions: As you read the novel, consider the following questions: What is the effect on the reader of learning about Victor’s story through the third-person, Walton, and his letters to his sister? On page 34, Victor images the gratitude that his creation will feel towards him. How does he respond, on page 37, when he actually animates the body of his creation? How does Victors initial vision of being a creator differ from the reality throughout the rest of his tale? How would you describe Victors character? How is he perceived by other characters in the novel? At various points in the narrative do you find your allegiance shift from Victor to the Creature, or vice versa? Why might the author want the reader to feel sympathy for each of these characters? Traditionally, a novel will have a protagonist, or hero, and an antagonist, or villain. Who is the protagonist and who is the antagonist in this work? Consider how this narrative evokes the story of the Garden of Eden, the Forbidden Fruit of the Tree of Knowledge, the desire to be godlike, and the Fall from Grace. What is the effect of these allusions? How does this novel view science and the quest for knowledge? Does Walton learn anything from Victor’s tale? Is it significant that he acquiesces to his men’s desires to return to England? Lesson Four Writing Assignment Essay Assignment: Select one of the following essay prompts. After considering how you would answer each of the questions in the prompt, craft a thesis based on your answers and write a 5-page essay, supporting your selected topic. In Chapter VII of volume II, the Creature finds a bag of books, including Milton’s  Paradise Lost. How is the Creature affected by reading this epic poem as â€Å"true history† (98)? Shelley invites us to compare Victors creation with Miltons retelling of Genesis. How does this comparison influence our interpretation of  Frankenstein?  Is the Creature more similar to Adam or to Satan? Does Shelley’s novel encourage us to view Satan as a heroic rebel or the arch-fiend? Explain your answers with evidence from both  Paradise Lost  and  Frankenstein  and additional readings about the Romantic poets. Milton embellishes much of the Genesis story, but regarding the punishment of Eve, he restates the King James Bible text (Genesis 2:16) with almost no alteration or addition; Miltons God decrees to Eve: Thy sorrow I will greatly multiply By thy conception; children thou shalt bring In sorrow forth, and to thy husbands will Thine shall submit, he over thee shall rule. (Book X, lines 193-6) Mary Shelleys mother, Mary Wollstonecraft, was a famous feminist who died from complications of childbirth soon after Mary was born. Mary Shelley suffered miscarriages and the early deaths of several of her own children. Many critics hypothesize that Shelleys experiences of birth and death greatly influenced her creation of  Frankenstein. They argue that Victors obsession with creating a human represents a desire to possess and/or circumvent human reproduction. In your essay, connect Victors desire to supplant human procreation to Eves temptation to possess knowledge and become godlike. How are their transgressions similar and different? How are their punishments similar and different? You might consider the theory of the Fortunate Fall† in your discussion. Discuss how the Romantic Poets interpreted Miltons  Paradise Lost. Explain the political and social events that influenced their ideas about God and Satan.   Refer to at least two examples from the poets writings in the Reading Assignment, as well as the scholarly commentary.  Then, consider Mary Shelleys incorporation of  Paradise Lost  into  Frankenstein.   Does her adoption of Milton reflect or challenge the ideas of what Susan Wolfson terms Romantic Satanism (p 301 in the Longman Cultural Edition of  Frankenstein)?   In other words, how does Shelleys novel respond to the Romantic Poets interpretation of Miltons epic poem? Paradise Lost (Paradise Lost) revealed human sin and corruption. The poem describes the rebellious angels of Satan. Adam and Eve were possessed by Satan, ate the fruit from the tree of the knowledge of good and evil that God prohibited eating. Finally, Satan and his cohorts were turned into snakes. Adam and Eve were expelled from the garden of Eden. The poem reflects the poets freedom to pursue the lofty spirit. Satan had gathered many rebel angels under him. The poem describes how Satan and his angels fall into hell by the thunder and the heat of fire, after a while, he wakes from dizziness. Satan awakens all the same angles in Heaven, and they got up. Satan comforts them in the speech, inspiring them, finally he told them, according to an ancient prophecy or report in heaven, there is a new world and a new creature to be created. So they decided to hold a plenary session of the prophecy, and discussed countermeasures. At the beginning of the meeting, the first question is debated: it is necessary to take a risk of war to restore the kingdom of heaven. The final three take a proposal, which is Satan mentioned, to explore whether the prophecy or hagiography is correct. According to legend, the God is creating a new world and a new species, a creature with not much difference between them. The difficult question is who will be sent to do the difficult exploration. Their leader Satan alone bears the task, winning peoples admiration and applause. After the meeting, other members pursue pleasure randomly. In the journey of Satan through the hell gate, the door is closed, the person in charge of the gate talked with Satan. Finally, the man opened the door. Satan saw a big pit between the hell and the heaven, which is chaotic world. Under the guidance of the ordeal, he only went to see what hes looking for in new world. When Satan went into the new world, God seated on a throne saw. The God refers to the prophecy that Satan will seduce human, and his plot will succeed. Human beings are free, and there is resistance to temptation, sweeping all slander to justice, the ability of wisdom. He also claims; people commit crime because of many reasons. Satan is wandering edge of a wasteland for a while in the new universe. Seen from what is called empty border place, people and things soaring; then, he would fly to the sun. He first pretends to deform for junior angels, sincerely, to see a new world and live in one of these people. Under Youlies guidance, he flies to paradise. Satan finally reached the new world, and it landed in a survey of the garden of Eden place, where it has been close to his destination, he alone takes bold adventure, to be against God, man. The moment he got into all kinds of confusion, his heart occupies many strong emotions: jealousy, fear, despair and so on. But in the end he decided to implement the evil plans, along the radial paradise. He crossed the border, into a cormorant, squatting on the tree of life the highest office park, looking around. It is his first sight of Adam and Eve. His wonder at their beautiful appearance and the happy scene make him determined to make them fall. After eavesdropping on their conversation, knowing they were forbidden to eat the fruits from the park tree of knowledge, which can let them under penalty of death. He decided to start, entice them to transgress. He leaves here, trying to further understand the situation. As night falls, Adam and Eve want Gabriel to send an angel, sending two power ful angels to Adams house, to protect the sleep of Adam and Eve, lest suffering from evil. They found him on the ear of Eve, in her dream to seduce her. The devil was arrested on the spot, brought before Gabriel. When questioned, his attitude is very strong; but for the warning, flies out of paradise. After snooping the Satan has sinister motives, like a lost soul in the night and returns to paradise, into the inside body of sleeping serpent. In the morning Adam and Eve are out to work, and each person does the job by their own. Adam did not approve of it, worrying about the danger, which had been previously warned the enemy will seduce her at her when she was alone. Eve would not be as strong and decisive enough, so she wants to separate labor, to test her ability. Adam finally gave in. Seen her alone, snake skillfully came to her, close to her; at first look, then opening, said a lot of flattery, flattering her how outstanding she is. Eve, listening to what the snake spoke, became very curious, asking how he can speak like human beings, but also can also understand so well. The snake answered, that is because of eating fruit from a certain tree in the garden, which can also make people more rational. Eve asked him to have a look of that tree. She looks, what is unexpected is tha t this tree is the right tree of the knowledge that the God forbids her to eat. The snake is of strong courage, using many reasons to persuade her to try. She finally tries, feeling very delicious. She thought to let Adam have a taste of this thing. But she hesitated, finally decided to give him this fruit, and advised him to eat. Adam was frightened at first because this is forbidden. But finally he decided to eat the fruit. The forbidden fruit in the two persons takes effect, they feel ashamed; and they find something to cover their nakedness. Then two people quarrel with one another. God said: they are unable to prevent Satan going into the park. Sin and death, sitting in the gate of hell, are excited to find Satan succeeds in the new world of conspiracy, so they are determined to follow their father Satan. They followed their path according to Satan, building a road or bridge on the chaotic world. As they prepare to leave back to hell, they meet Satan, returning after a conceited triumphant. Satan successfully indulges in verbiage before all the people for human conspiracy. Audience only applauds. And they, like in the paradise, are suddenly transformed into a snake. In their eyes, the scene of the forbidden tree appeared, they stretched to pick the fruit, but full of dust.Sin and death still continue their work. Adam came to know of his degraded condition, deeply sad, and Eve comfort is also rejected by him. Eve adheres to persuade him. In order to avoid the curse fallen to his descendants, she advised Adam to use violence; he strongly opposed, but reminded her of her sons to revenge snake, thereby holding good hope, encouraging her to pray with him to appease the anger of god. Then Satan, in the snakes image, committed a terrible, hateful deception behavior in the garden. Milton has been very clever in describing this story. He uses the story to deliver a spirit of freedom. And he makes full use of this story to show his ideas.

Nursing: Epidemiology and Health

U N I T Concepts of Health and Disease arly peoples were considered long-lived if they reached 30 years of age—that is, if they survived infancy. For many centuries, infant mortality was so great that large families became the tradition; many children in a family ensured that at least some would survive. Life expectancy has increased over the centuries, and today an individual in a developed country can expect to live about 71 to 79 years. Although life expectancy has increased radically since ancient times, human longevity has remained fundamentally unchanged.The quest to solve the mystery of human longevity, which appears to be genetically programmed, began with Gregor Mendel (1822–1884), an Augustinian monk. Mendel laid the foundation of modern genetics with the pea experiments he performed in a monastery garden. Today, geneticists search for the determinant, or determinants, of the human life span. Up to this time, scientists have failed to identify an aging gene th at would account for a limited life span. However, they have found that cells have a ? nite reproductive capacity. As they age, genes are increasingly unable to perform their functions.The cells become poorer and poorer at making the substances they need for their own special tasks or even for their own maintenance. Free radicals, mutation in a cell’s DNA, and the process of programmed cell death are some of the factors that work together to affect a cell’s functioning. I E CHAPTER Concepts of Health and Disease Georgianne H. Heymann Carol M. Porth 1 ogy. There has been an increased knowledge of immune mechanisms; the discovery of antibiotics to cure infections; and the development of vaccines to prevent disease, chemotherapy to attack cancers, and drugs to control the manifestations of mental illness.The introduction of the birth control pill and improved prenatal care have led to decreased birth rates and declines in infant and child mortality. The bene? ts of scienc e and technology also have increased the survival of infants born prematurely and of children with previously untreatable illnesses, such as immunode? ciency states and leukemia. There also has been an increase in the survival of very seriously ill and critically injured persons of all age groups.Consequently, there has been an increase in longevity, a shift in the age distribution of the population, and an increase in age-related diseases. Coronary heart disease, stroke, and cancer have now replaced pneumonia, tuberculosis, and diarrhea and enteritis—the leading causes of death in the 1900s. This chapter, which is intended to serve as an introduction to the book, is organized into four sections: health and society, historical perspectives on health and disease, perspectives on health and disease in individuals, and perspectives on health and disease in populations.The chapter is intended to provide the reader with the ability to view within a larger framework the historical aspects of health and disease and the relationship of health and disease to individuals and populations, and to introduce the reader to terms, such as etiology and pathogenesis, that are used throughout this text. HEALTH AND SOCIETY HEALTH AND DISEASE: A HISTORICAL PERSPECTIVE The In? ence of Early Scholars The Nineteenth Century The Twentieth Century The Twenty-First Century PERSPECTIVES ON HEALTH AND DISEASE IN INDIVIDUALS Health Health and Disease as States of Adaptation Disease Etiology Pathogenesis Morphology Clinical Manifestations Diagnosis Clinical Course PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS Epidemiology and Patterns of Disease Prevalence and Incidence Morbidity and Mortality Determination of Risk Factors The Framingham Study The Nurses’ Health Study Natural History Levels of Prevention Evidence-Based Practice and Practice Guidelines e concepts of what constituted health and disease at the beginning of the last century were far different from those of thi s century. In most of the industrialized nations of the world, people now are living longer and enjoying a healthier lifestyle. Much of this has been made possible by recent advances in science and technol- T Health and Society Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place. 3 4 UNIT I Concepts of Health and Disease After completing this section of the chapter, you should be able to meet the following objectives: ? Describe the concepts used to establish belief systems within a community and the effects on its health care practices ? Identify a disease believed to be generated by speci? c emotions and the characteristics ascribed to it ? Explain how mythologizing disease can be detrimental to individuals in a society There is a long history that documents the concern of humans for their own health and well-being and that of their community.It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick. In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. In time, this task became the job of the ealers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Prehistoric h ealers probably also discovered that many plants can be used as drugs. The community as a whole also was involved in securing the health of its members.It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. Despite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the community, which had incorporated compassion for its members into its belief system. Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communication, they relied on herbal medicines and group activity to maintain health. Throughout history, peoples and cultures have developed their he alth practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld.Some traditions, such as those re? ected in Chinese and Indian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural. Over time, modern Western thinking has shed its adherence to all such elements. Originating with the Greek tradition—which dismissed supernatural powers, although not environmental in? uences—and further shaped by the In? uences of zodiac signs on the human body. (Courtesy of the National Library of Medicine) ourishing anatomic and physiologic programs of the Renaissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minu tely into the ? esh, its systems, tissues, cells, and DNA. 3 Through Western political and economic domination, these health beliefs now have powerful in? uence worldwide. Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shape the concept of health in a society.Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks. The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions.Although the Aztecs ? rst thought the mounted, gunpowered Spaniards were gods, experience soon showed CHAPTER 1 Concepts of Health and Disease 5 otherwise. Armed clashes revealed the limitations of horse? esh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any ? rearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards.Because the population lacked inherited or acquired immunity, the results were catastrophic. It is presumed that a quarter to a third of the population died from the initial onslaught. Even more devastating were the psychological implications of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Christianity and submitted meekly to Spanish control. Although we live in an age of science , science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunode? ciency syndrome (AIDS). The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character— sensitive, creative, a being apart.Melancholy, or sadness, made one â€Å"interesting† or romantic. The general perception of TB as â€Å"romantic† was not just a literary device. It was a way of thinking that insinuated itself into the sensibilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis. The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regard ed sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self. Current accounts of the psychological aspects of cancer often cite old authorities, starting with the Greek physician Galen, who observed that â€Å"melancholy women† are more likely to get breast cancer than â€Å"sanguine women. † Grief and anxiety were cited as causes of cancer, as well as personal losses. Public ? gures such as Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scienti? evidence to support the view that speci? c emotions, or emotions in general, can produce speci? c diseases—or that cancer is the result of a â€Å"cancer personality,† described as emotionally withdrawn, lacking self-con? dence, and depressive. These di sease mythologies contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation.Conversely, they also can be the impetus for compassion to those who are ill, for commitment to improving one’s own health, and for support of efforts to improve the health status of others. In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, including magic charms, spells, and incantations; surgical treatment; and plan t medicines.Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for disabled community members, tend to safeguard human communities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease. Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise.In previous centuries, diseases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members. Health and Disease: A Historical Perspective After completing this sectio n of the chapter, you should be able to meet the following objectives: Describe the contributions of the early Greek, Italian, and English scholars to the understanding of anatomy, physiology, and pathology ? State two important advances of the nineteenth century that helped to pave the way for prevention of disease ? State three signi? cant advances of the twentieth century that have revolutionized diagnosis and treatment of disease ? Propose developments that will both hamper and contribute to the promotion of health and the elimination of disease in the twenty-? rst century It has been said that those who do not know history are condemned to repeat it.There are many contributors to the understanding of how the body is constructed and how it works, and what disease is and how it can be treated, which in turn leads to an understanding of what health is and how can it be maintained. Much of what we take for granted in terms of treating the diseases that af? ict humankind has had its origin in the past. Although they are seemingly small contributions in terms of today’s scienti? c advances, it is the knowledge 6 UNIT I Concepts of Health and Disease produced by the great thinkers of the past that has made possible the many things we now take for granted.THE INFLUENCE OF EARLY SCHOLARS Knowledge of anatomy, physiology, and pathology as we now know it began to emerge with the ancient Greeks. They were the ? rst to recognize the distinction between internal and external causes of illness. To Hippocrates and his followers, we owe the foundations of the clinical principles and the ethics that grew into modern medical science. Hippocrates (460–377 BC) was a blend of scientist and artist. He believed that disease occurred when the four humors—blood from the heart, yellow bile from the liver, black bile from the spleen, and phlegm from the brain—became out of balance.These humors were said to govern character as well as health, producing phl egmatic, sanguine, choleric, and melancholic personalities. This belief paralleled the even older Chinese tradition, which was founded on the complementary principles of yin (female principle) and yang (male), whose correct proportions were essential for health. Hippocrates is identi? ed with an approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet. It was Aristotle (384–322 BC) who, through his dissection of small animals and description of their internal Hippocrates: A blend of scientist and scholar. Courtesy of the National Library of Medicine) anatomy, laid the foundations for the later scrutiny of the human body. For Aristotle, the heart was the most important organ. He believed it to be the center of the blood system as well as the center of the emotions. However, Aristotle’s main contributions were made to science in general. The person who took the next major step was Galen (AD 129–199), a physician to t he emperors and gladiators of ancient Rome. Galen expanded on the Hippocratic doctrines and introduced experimentation into the study of healing. His work came to be regarded as the encyclopedia of anatomy and physiology.He demoted the heart—in his view, the liver was primary for venous blood, whereas the seat of all thought was the brain. He described the arteries and veins and even revealed the working of the nervous system by severing a pig’s spinal cord at different points and demonstrating that corresponding parts of the body became paralyzed. According to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried â€Å"natural spirit† from the liver; the arteries, â€Å"vital spirit† from the lungs; the nerves, â€Å"animal spirit† from the brain. The heart merely warmed the blood.After Galen’s death, however, anatomic research ceased, and his work was considered infallible for almo st 1400 years. As the great medical schools of universities reformed the teaching of anatomy in the early 1500s and integrated it into medical studies, it became apparent to anatomists that Galen’s data—taken from dogs, pigs, and apes—often were riddled with error. It was only with the work of Andreas Vesalius (1514–1564) that Galen’s ideas truly were challenged. Vesalius, professor of anatomy and surgery at Padua, Italy, dedicated a lifetime to the study of the human body.Vesalius carried out some unprecedentedly scrupulous dissections and used the latest in artistic techniques and printing for the more than 200 woodcuts in his De Humani Corporis Fabrica (â€Å"On the Fabric [Structure] of the Human Body†). He showed not only what bodily parts looked like but also how they worked. The book, published in 1543, set a new standard for the understanding of human anatomy. With this work, Vesalius became a leading ? gure in the revolt against Gal en’s teachings. One of the most historically significant discoveries was made by William Harvey (1578–1657), an English physician and physiologist.He established that the blood circulates in a closed system impelled mechanically by a â€Å"pumplike† heart. He also measured the amount of blood in the circulatory system in any given unit of time—one of the ? rst applications of quantitative methods in biology. Harvey’s work, published in On the Motion of the Heart and Blood in Animals (1628), provided a foundation of physiologic principles that led to an understanding of blood pressure and set the stage for innovative techniques such as cardiac catheterization. With the re? ement of the microscope by the Dutch lens maker Anton van Leeuwenhoek (1632–1723), the stage was set for the era of cellular biology. Another early user of the microscope, English scientist Robert Hooke (1635–1703), published his Micrographia in 1665 in which CHAPTER 1 Concepts of Health and Disease 7 William Harvey’s most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a dissected deer heart. (Courtesy of the National Library of Medicine) he formally described the plant cells in cork and presented his theories of light and combustion and his studies of insect anatomy.His book presented the great potential of the microscope for biologic investigation. In it, he inaugurated the modern biologic usage of the word cell. A century later, German-born botanist Mathias Schleiden (1804–1881) and physiologist Theodor Schwann (1810–1882) observed that animal tissues also were composed of cells. Although Harvey contributed greatly to the understanding of anatomy and physiology, he was not interested in the chemistry of life. It was not until French chemist Antoine Lavoisier (1743–1794), who was schooled as a lawyer but devoted to scienti? pursuits, overturned 100year-old theories of che mistry and established the basis of modern chemistry that new paths to examine body processes, such as metabolism, opened up. His restructured chemistry also gave scientists, including Louis Pasteur, the tools to develop organic chemistry. In 1796, Edward Jenner (1749–1823) conducted the ? rst vaccination by injecting the ? uid from a dairymaid’s cowpox lesion into a young boy’s arm. The vaccination by this English country doctor successfully protected the child from smallpox. Jenner’s discovery led to the development of vaccines to prevent many other diseases as well.Jenner’s classic experiment was the ? rst of? cially recorded vaccination. Painting by Georges-Gaston Melingue (1894). The ? rst vaccination. Here Dr. Jenner introduces cowpox taken from dairymaid Sarah Nelmes (right) and introduces it into two incisions on the arm of James Phipps, a healthy 8-year-old boy. The boy developed cowpox, but not smallpox, when Jenner introduced the organis m into his arm 48 days later. (Courtesy of the National Library of Medicine) THE NINETEENTH CENTURY The nineteenth century was a time of spectacular leaps forward in the understanding of infectious diseases.For many centuries, rival epidemiologic theories associated disease and epidemics like cholera with poisonous fumes given off from dung heaps and decaying matter (poisons in the air, exuded from rotting animal and vegetable material, the soil, and standing water) or with contagion (person-to-person contact). In 1865, English surgeon Joseph Lister (1827–1912) concluded that microbes caused wound infections. He began to use carbolic acid on wounds to kill microbes and reduce infection after surgery. However, Lister was not alone in identifying hazards in the immediate environment as detrimental to health.English nurse Florence Nightingale (1820–1910) was a leading proponent of sanitation and hygiene as weapons against disease. It was at the English base at Scutari dur ing the Crimean War (1854–1856) that Nightingale waged her battle. Arriving at the army hospital with a party of 38 nurses, Nightingale found nearly 2000 wounded and sick inhabiting foul, rat-infested wards. The war raged on, deluging the hospital with wounded as Nightingale not only organized the nursing care of the wounded but also provided meals, supplied bedding, and saw to the laundry.Within 6 months, she had brought about a transformation and slashed the death rate from approximately 40% to 2%. 3 8 UNIT I Concepts of Health and Disease Florence Nightingale caring for wounded at Scutari, Turkey, during the Crimean War. (Courtesy of the National Library of Medicine) From the 1860s, the rise of bacteriology, associated especially with chemist and microbiologist Louis Pasteur in France and bacteriologist Robert Koch in Germany, established the role of microorganismal pathogens. Almost for the ? rst time in medicine, bacteriology led directly to dramatic new cures.The techni que of pasteurization is named after Louis Pasteur (1822–1895). He introduced the method in 1865 to prevent the souring of wine. Pasteur’s studies of fermentation convinced him that it depended on the presence of microscopic forms of life, with each fermenting medium serving as a unique food for a speci? c microorganism. He developed techniques for culturing microbes in liquid broths. Through his work, he was able to dispel the disease theory that predominated in the mid-nineteenth century, attributing fevers to â€Å"miasmas,† or fumes, and laid the foundation for the germ theory of disease.The anthrax bacillus, discovered by Robert Koch (1843–1910), was the ? rst microorganism identi? ed as a cause of illness. Koch’s trailblazing work also included identifying the organism responsible for tuberculosis and the discovery of a tuberculosis skin-testing material. In 1895, German physicist Wilhelm Rontgen (1845– 1923) discovered X rays. For the ? rst time without a catastrophic event, the most hidden parts of a human body were revealed. Even though he understood that it was a signi? cant discovery, Rontgen did not initially recognize the amazing diagnostic potential of the process he had discovered.THE TWENTIETH CENTURY The twentieth century was a period of revolutionary industry in the science and politics of health. Concerns about the care of infants and children and the spread of infectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick. The placement of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charg e. 5 Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Congress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well. 5 Scienti? c discoveries and innovations abounded in the twentieth century.In the early 1900s, German bacteriologist Paul Ehrlich (1854–1915) theorized that certain substances could act as â€Å"magic bullets,† attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic compound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy. CHAPTER 1 Concepts of Health and Disease 9 The operating room. With the advent of anesthesia, knowledge of how microbes cause disease, and availability of incandescent ligh ting in the operating room, surgery became an option for treating disease.Rubber gloves had not yet been invented and the surgical team worked with bare hands to perform surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ) The ? rst antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881–1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one microorganism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic.By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; su lfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes. At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T. M. , Kennedy S.M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams & Wilkins) 10 UNIT I Concepts of Health and Disease With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Banting (1891–1941) and physiologist Charles Best (1899–1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts.Although still incurable, it became possible to live with diabetes. One disease that remained not only incurable but u ntreatable through much of the twentieth century was tuberculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to controlling the spread of tuberculosis. It was then that an alliance between organized medicine and the public resulted in the formation of voluntary local organizations to battle the disease. These organizations focused on education to counteract the fear of tuberculosis; at the same time, they warned against the disease.In 1904, the local organizations joined together to form a national organization, the National Association for the Study and Prevention of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973. 6 The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanatorium or tuberculosis hospital.There, good nourishment, fresh air, and bed rest were prescribed in the belief that if the body’s natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemotherapy, that streptomycin was used to treat tuberculosis. Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914–1995).At its peak, the virus was claiming 50,000 victims annually in the United States. 3 Test trials of Salk’s vaccine with inactivated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use. Surgical techniques also flourished during this time . A single technical innovation was responsible for opening up the last surgical frontier—the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate. American surgeon John Gibbon (1903–1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953—probably none more so than the ? rst successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922–2001). For centuries, the inheritance of traits had been explained in religious or philosophical terms. Although English naturalist Charles Darwin’s (1809–1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo-A tuberculosis skin testing clinic. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 49]. Philadelphia: Lippincott Williams & Wilki ns) CHAPTER 1 Concepts of Health and Disease 11 The â€Å"iron lung,† which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with â€Å"bulbar polio. † (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 91]. Philadelphia: Lippincott Williams & Wilkins) anist Gregor Mendel’s (1822–1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and researchers contributed to the storehouse of genetic knowledge. With the work by American geneticist James Watson (1928–) and British biophysicists Francis Crick (1916–) and Maurice Wilkins (1916–) in the early 1950s, which established the double-helical structure of DNA, the way to investigating and understanding our genetic heritage was opened.It is dif? cult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty. Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the result of dogged work by many people and yield results only after a number of years, and then they frequently go unheralded.For example, vaccination programs, control of infectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identi? cation of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century. THE TWENTY-FIRST CENTURY The twenty-? rst century reveals new horizons, but also new problems. In greater numbers than ever, goods an d people travel the world. There is unprecedented physical mobility—travel and migration from villages to cities and country to country—and interconnectedness.However, the bene? ts of physical mobility and interconnectedness are accompanied by risks. Diseases such as AIDS remind us that nothing is regional, local, or limited in its reach: contagious illness has a worldwide arena. The challenges of maintaining health and well-being in this global community are increasingly apparent. The inadvertent introduction of pathogens poses an unrelenting threat to public health, as does the deliberate use of microorganisms as weapons (see Chapter 18 for a discussion of bioterrorism and emerging global infectious diseases).In February 2003, the viral respiratory illness named severe acute respiratory syndrome (SARS) by the World Health Organization was ? rst recognized in China. 8 In the next few months, the illness swept through parts of Asia and spread to more than two dozen cou ntries in North America, South America, and Europe. The disease was characterized by rapid onset and variable severity, ranging from mild illness to death. The prevention of SARS was a particular challenge because preventive interventions (e. g. , vaccines and antibiotics) were unavailable.Containment became a global collaboration, with public health authorities utilizing isolation and quarantine to focus delivery of health care to people who were ill and to protect healthy people from getting sick. During the February to July outbreak, more than 8000 people worldwide became infected, and more than 900 died. Commerce also is an integral part of the growing world community, bringing goods and services once unobtainable into the global marketplace. Expanded international trade also provides the vehicle for the unwitting introduction or transmission of disease. One such instance occurred in the spring of 2003 in the United States. A multistate outbreak of human monkeypox, ? rst identi? ed in the Democratic Republic of the Congo in 1970, was traced by investigators to pet prairie dogs. The prairie dogs became infected when they were housed or transported along with infected Gambian giant rats, dormice, and rope squirrels that were part of a shipment of small mammals from Ghana. Spread of nonindigenous zoonotic pathogens to indigenous susceptible animal populations can be rapid and deadly. With such outbreaks lurks an additional danger—the potential for interspecies exchange, including between humans and animals such as pets.The widespread distribution of infected and potentially infected animals allowed epizootic spread of monkeypox through several states before effective interventions could be put into place. One of the challenges to the world health community will be to study the role of international travel and commerce in the emergence of infectious diseases through the dissemination of pathogens and their vectors throughout the world and then to develo p long-term strategies of surveillance and intervention with the ultimate goal of curtailing their occurrence.In 1976, the World Health Organization (WHO) actually succeeded in eliminating smallpox from the face of the earth. 10 This triumph gave substance to the idea that other infections, like measles, also might disappear if suf? cient efforts were directed at worldwide campaigns to isolate and cure them. However, new infectious diseases, such as Lyme disease and Legionnaire’s disease, and new forms of old diseases, such as resistant strains of tuberculosis and malaria, have emerged and are readily spread 12 UNIT I Concepts of Health and Disease ing on Hippocratic doctrines and introducing experimentation into the study of healing.His work, gleaned through his role as physician to the emperors and gladiators of Rome and animal dissections, came to be regarded as the encyclopedia of anatomy and physiology and was considered infallible for almost 1400 years. Signi? cant chal lenges to long-held beliefs began with the work of Andreas Vesalius (1514–1564), professor of anatomy and surgery at Padua, Italy. His published work, On the Fabric [Structure] of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy.Other significant early contributions were made by scholars such as William Harvey (1578–1657), the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals, provided a physiologic framework for the circulation of blood; Anton van Leeuwenhoek (1632–1723), the Dutch lens maker who refined the microscope and set the stage for the era of cellular biology; and Edward Jenner (1749–1823), the English country physician who conducted the first successful vaccination. The nineteenth century was a time of major discoveries that paved the way for understanding infectious diseases.Signi? cant contributions were made by suc h scientists as Joseph Lister, the English surgeon who concluded that microbes caused wound infections; German bacteriologist Robert Koch, who discovered the anthrax bacillus, thus identifying for the ? rst time a microorganism and the illness it caused; and French chemist and microbiologist Louis Pasteur, who developed the technique of pasteurization. Perhaps the most notable technical innovation of the century was the discovery of X rays by German physicist Wilhelm Rontgen. The scienti? undertakings and discoveries of the twentieth century were revolutionary. In 1910, Paul Ehrlich introduced chemotherapy, and in 1928, Sir Alexander Fleming discovered the ? rst antibiotic as he studied the relationship between bacteria and the mold Penicillium. Diseases that had once been fatal or crippling were managed or prevented by new advances, such as the discovery of insulin by Sir Frederick Banting and Charles Best in 1922 and the development of the polio vaccine by Jonas Salk in 1953. Tech nical innovations set the stage for new surgical techniques.The creation of the heartlung machine by American surgeon John Gibbon paved the way for coronary bypass surgery and the ? rst successful heart transplantation in 1967, which was performed by Christiaan Barnard, a South African surgeon. Other important advances included kidney dialysis, oral contraceptives, the CAT scanner, and coronary angioplasty. Public health programs also were responsible for greatly affecting the health of populations, such as those dedicated to increasing vaccination, improving sanitation of water and waste disposal, and identifying health risks.Knowledge about the in? uence of heredity on health and disease originated with Charles Darwin’s (1809–1882) evolutionary theories about inherited traits and with Gregor Mendel’s (1822–1884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity. In the ear ly 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their ? ndings on the double-helical structure of DNA. worldwide.The powerful interventions used to ? ght these infections have had the unexpected effect of accelerating their biologic evolution and making them impervious to one after another form of chemical attack. Pathogens also can be introduced into the food chain and travel worldwide. The discovery that beef from cattle infected with bovine spongiform encephalopathy (BSE) may be the source of Creutzfeldt-Jakob disease led many countries to ban beef products from the United Kingdom when BSE was found to be prevalent in English herds.The introduction of such pathogens can be the result of ignorance, carelessness, or greed. Tobacco is a product that serves as a pathogen. In a quest for ever-increasing pro? ts, the tobacco industry created a demand for its product by arti? cially raising the nicotine content of cigarettes so as to increase their addictive potential. This was done with the knowledge of the health risks of tobacco products, thanks to experiments conducted by the tobacco companies’ own medical scientists, but kept secret.If there is a blueprint for future advances, it is in the genes. The twenty-? rst century is destined to be dominated by advances in genetics. With the mapping of the human genome comes hope of cure for some of the most dreaded crippling and fatal diseases. The mapping of the human genome also has posed new ethical dilemmas, for with it comes the potential to predict the future health of persons based on their genes. It soon may be possible to differentiate between persons who will develop certain debilitating diseases and those who will not.Although advances in science and technology will continue to provide new treatments for many diseases, it has become apparent that there are more impressive rewards to be had by preventing diseases from becomin g established in the ? rst place. Ultimately, maintaining health is more resource conservative and cost effective than relying on the treatment of disease. Many decades ago, we learned that even though the â€Å"magic bullets† such as antibiotics had the ability to cure what was once considered incurable, much of our freedom from communicable disease is due to clean water, ef? ient sanitation, and good nutrition. We have become increasingly aware of the importance of preventive measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life. In summary, Greek scholars were responsible for establishing the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge base for understanding health and disease.It was Hippocrates ( 460–377 BC) and his followers who laid the foundations of the clinical principles and ethics that grew into modern science. Although his belief that disease occurred when the four humors—blood, yellow and black bile, and phlegm—became out of balance was disproved, his approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet remains valid. Galen (AD 129–199) took the next major step, expand- CHAPTER 1 The twenty-? rst century is predicted to be a time of great advances in the ? ld of genetics, already evidenced by the substantial mapping of the human genome that has taken place. Scientists look to genetic research to provide advances that not only will predict who may develop disease but also will provide new treatments for those diseases. However promising future advances may appear, it is readily apparent that prevention is an equally important tool in maintaining health. Concepts of Health and Disease 13 P erspectives on Health and Disease in IndividualsAfter completing this section of the chapter, you should be able to meet the following objectives: ? State the World Health Organization de? nition of health ? Describe the function of adaptation as it relates to health and disease ? State a de? nition of pathophysiology ? Characterize the disease process in terms of etiology, pathogenesis, morphology, clinical manifestations, and prognosis ? Explain the meanings of reliability, validity, sensitivity, speci? city, and predictive value as they relate to observations and tests used in the diagnosis of diseaseWhat constitutes health and disease often is dif? cult to determine because of the way different people view the topic. What is de? ned as health is determined by many factors, including heredity, age and sex, cultural and ethnic differences, as well as individual, group, and governmental expectations. HEALTH The World Health Organization (WHO) in 1948 de? ned health as a â€Å"stat e of complete physical, mental, and social well-being and not merely the absence of disease and in? rmity. †10 Although ideal for many people, this was an unrealistic goal.At the World Health Assembly in 1977, representatives of the member governments of WHO agreed that their goal was to have all citizens of the world reach a level of health by the year 2000 that allows them to live a socially and economically productive life. 10 The U. S. Department of Health and Human Services in Healthy People 2010 described the determinants of health as an interaction between an individual’s biology and behavior, physical and social environments, government policies and interventions, and access to quality health care. 1 with which the need to adapt occurs (see Chapter 9). Generally speaking, adaptation affects the whole person. When adapting to stresses that are threats to health, the body uses those behaviors that are the most ef? cient and effective. It does not use long-term mec hanisms when short-term adaptation is suf? cient. The increase in heart rate that accompanies a febrile illness is a temporary response designed to deliver additional oxygen to tissues during the short period that the elevated temperature increases metabolic needs.On the other hand, hypertrophy of the left ventricle is a long-term adaptive response that occurs in persons with chronic hypertension. Adaptation is further affected by the availability of adaptive responses and the ability of the body to select the most appropriate response. The ability to adapt is dependent on the availability of adaptive responses—the greater number of available responses, the more effective the capacity to adapt. Adaptive capacity is decreased with extremes of age and with disease conditions that limit the availability of adaptive responses.The immaturity of the infant impairs the ability to adapt, as does the decline in functional reserve that occurs in the elderly. For example, infants have d if? culty concentrating urine because of the immaturity of their renal tubular structures and therefore are less able than an older child or adult to cope with decreased water intake or exaggerated water losses. Similarly, persons with preexisting heart disease are less able to adapt to health problems that require recruitment of cardiovascular responses. Adaptation also is less effective when changes in health status occur suddenly rather than gradually.For instance, it is possible to lose a liter of blood through chronic gastrointestinal bleeding without developing signs of shock. On the other hand, a sudden hemorrhage that causes the loss of an equal amount of blood is apt to produce hypotension and circulatory shock. Even in advanced disease states, the body retains much of its adaptive capacity and is able to maintain the internal environment within relatively normal limits. DISEASE The term pathophysiology, which is the focus of this book, may be de? ned as the physiology of a ltered health. The term combines the words pathology and physiology.Pathology (from the Greek pathos, meaning â€Å"disease†) deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease but also with the effects that these changes have on total body function. Pathophysiology also focuses on the mechanisms of the underlying disease and provides the background for preventive as well as therapeutic health care measures and practices.A disease has been de? ned as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs; the etiology, pathology, and prognosis may be known or unknown. 12 The aspects HEALTH AND DISEASE AS STATES OF ADAPTA TION The ability of the body to adapt both physically and psychologically to the many stresses that occur in both health and disease is affected by a number of factors, including age, health status, psychosocial resources, and the rapidity 14 UNIT I Concepts of Health and Disease f the disease process include the etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis, and clinical course. ity, the progression from fatty streak to the occlusive vessel lesion seen in persons with coronary heart disease represents the pathogenesis of the disorder. The true etiology of atherosclerosis remains largely uncertain. Etiology The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e. g. , bacteria, viruses), physical forces (e. g. , trauma, burns, radiation), chemical agents (e. g. , poisons, alcohol), and nutritional excesses or de? its. At the molecular level, it is important to distinguish between sick molecu les and molecules that cause disease. 13 This is true of diseases such as cystic ? brosis, sickle cell anemia, and familial hypercholesterolemia, in which genetic abnormality of a single amino acid, transporter molecule, or receptor protein produces widespread effects on health. Most disease-causing agents are nonspeci? c, and many different agents can cause disease of a single organ. For example, lung disease can result from trauma, infection, exposure to physical and chemical agents, or neoplasia.With severe lung involvement, each of these agents has the potential to cause respiratory failure. On the other hand, a single agent or traumatic event can lead to disease of a number of organs or systems. For example, severe circulatory shock can cause multiorgan failure. Although a disease agent can affect more than a single organ, and a number of disease agents can affect the same organ, most disease states do not have a single cause. Instead, most diseases are multifactorial in origin . This is particularly true of diseases such as cancer, heart disease, and diabetes.The multiple factors that predispose to a particular disease often are referred to as risk factors. One way to view the factors that cause disease is to group them into categories according to whether they were present at birth or acquired later in life. Congenital conditions are defects that are present at birth, although they may not be evident until later in life. Congenital malformation may be caused by genetic in? uences, environmental factors (e. g. , viral infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a combination of genetic and environmental factors.Not all genetic disorders are evident at birth. Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease, take years to develop. Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate n utrition, lack of oxygen, inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of a genetic predisposition and an environmental event or events that serve as a trigger to initiate disease development. MorphologyMorphology refers to the fundamental structure or form of cells or tissues. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of body tissues. The most common method used in the study of tissues is the preparation of histologic sections that can be studied with the aid of a microscope. Because tissues and organs usually are too thick to be examined under a microscope, they must be sectioned to obtain thin, translucent sections.Histologic sections play an important role in the diagnosis of many types of cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue. De scriptions of lesion size and characteristics often can be obtained through the use of radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by biopsy and the tissue samples subjected to histologic study. Clinical Manifestations Disease can be manifest in a number of ways. Sometimes, the condition produces manifestations, such as fever, that make it evident that the person is sick.Other diseases are silent at the onset and are detected during examination for other purposes or after the disease is far advanced. Signs and symptoms are terms used to describe the structural and functional changes that accompany a disease. A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, dif? culty in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease.Signs and symptoms may be related to the primary disorder, or they may represent the body’s attempt to compensate for the altered function caused by the pathologic condition. Many pathologic states are not observed directly—one cannot see a sick heart or a failing kidney. Instead, what can be observed is the body’s attempt to compensate for changes in function brought about by the disease, such as the tachycardia that accompanies blood loss or the increased respiratory rate that occurs with pneumonia. It is important to recognize that a single sign or symptom may be associated with a number of different disease states.For example, an elevated temperature can indicate the presence of an infection, heat stroke, brain tumor, or any number of other disorders. A differential diagnosis that describes the origin of a disorder usually requires information regarding a number of signs and symptoms. For example, the presence of fever , a reddened sore throat, and positive throat culture describe a â€Å"strep throat† infection. A syndrome is a compilation of signs and symptoms (e. g. , chronic fatigue syndrome) that are characteristic of a speci? c disease state. Complications are possible adverse ex-Pathogenesis Pathogenesis is the sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology describes what sets the disease process in motion, and pathogenesis, how the disease process evolves. Although the two terms often are used interchangeably, their meanings are quite different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart disease. In real- CHAPTER 1 Concepts of Health and Disease 15 ensions of a disease or outcomes from treatment. Sequelae are lesions or impairments that follow or are caused by a disease. Diagnosis A diagnosis is the designation as to the na ture or cause of a health problem (e. g. , bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful history and physical examination. The history is used to obtain a person’s account of his or her symptoms, their progression, and the factors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function.The development of a diagnosis involves weighing competing possibilities and selecting the most likely one from among the conditions that might be responsible for the person’s clinical presentation. The clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality often is in? uential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies, CT scans, and other tests often are used to con? rm a diagnosis. Normality. An important factor when interpreting diagnostic test results is the determination of whether they are normal or abnormal.Is a blood count above normal, within the normal range, or below normal? Normality usually determines whether further tests are needed or if interventions are necessary. What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people. The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean  ± 2 SD]) of test results for the reference population. 14 Thus, the normal levels for serum sodium (135 to 145 mEq/L) represent the mean serum level for the reference population  ± 2 SD.The normal values for some laboratory tests are adjusted for sex or age. For example, the normal hemoglobin range for women is 12. 0 to 16. 0 g/dL and for men, 14. 0 to 17. 4 g/dL. 15 Serum creatinine level often is adjusted for age in the elderly (see Chapter 36), and normal values for serum phosphate differ between adults and children. Reliability, Validity, Sensitivit y, Speci? city, and Predictive Value. The quality of data on which a diagnosis is based may be judged for its reliability, validity, sensitivity, speci? city, and predictive value. 6,17 Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the persons making the measurements. For example, blood pressure measurements may vary from one observer to another because of the technique that is used (e. g. , different observers may de? ate the cuff at a different rate, thus obtaining different values), the way the numbers on the manometer are read, or differences in hearing acuity.Validity refers to the extent to which a measurement tool measures what it is intended to measure. This often is assessed by comparing a measurement method with the best possible method of measu re that is available. For example, the validity of blood pressure measurements ob- tained by a sphygmomanometer might be compared with those obtained by intraarterial measurements. Measures of sensitivity and speci? city are concerned with determining how well the test or observation identi? es people with the disease and people without the disease.Sensitivity refers to the proportion of people with a disease who are positive for that disease on a given test or observation (called a true-positive result). Speci? city refers to the proportion of people without the disease who are negative on a given test or observation (called a true-negative result). A test that is 95% speci? c correctly identi? es 95 of 100 normal people. The other 5% are false-positive results. A false-positive test result, particularly for conditions such as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being tested (see Chapter 22).In the case of HIV testing, a positive res ult on the initial antibody test is followed up with a more sensitive test. On the other hand, false-negative test results in conditions such as cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. A positive predictive value refers to the proportion of true-positive results that occurs in a given population.In a group of women found to have â€Å"suspect breast nodules† in a cancer-screening program, the proportion later determined to have breast cancer would constitute the positive predictive value. A negative predictive value refers to the true-negative observations in a population. In a screening test for breast cancer, the negative predictive value represents the proportion of women without suspect nodules who do not have breast cancer. Although predictive values rely in part on sensitivity and speci? city, they depend more heavily on the prevalence of the condition in the population. Despite unchanging sensitivity and speci? ity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls. Clinical Course The clinical course describes the evolution of a disease. A disease can have an acute, subacute, or chronic course. An acute disorder is one that is relatively severe, but selflimiting. Chronic disease implies a continuous, long-term process. A chronic disease can run a continuous course, or it can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a lessening of severity and a decrease in symptoms).Subacute disease is intermediate or between acute and chronic: it is not as severe as an acute disease and not as prolonged as a chronic disease. The spectrum of disease severity for infectious diseases such as hepatitis B can range from preclinical to persistent chronic inf ection. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible to