How An Avalanche Forms :: avalanche snow form

darn there be many different ways for avalanches to set up, they are all related in the sense that the snows frictional hold on the sky has released and gravity is pulling the snow particles down pat(p). When the snow is deposited during the storm, the particles are bonding or locking together and creating beds of particles that are relatively similar. Every time the temperature changes during the storm, or the wind shifts directions, it has an effect on how the snow settles and may form a juvenile layer. Some of these layers are denser than others, and some will bond nicely with neighboring layers while others may not. The kick downstairs the bonding is between the layers, the more stable the snowpack is. When a faint-hearted layer is deposited, or created in the snowpack, the chances of that layer collapsing and causing an avalanche are much higher. The layer may fail out-of-pocket to the force of gravity, the weight down of new snow on top of it, or forces from a skier o r snowmachine on it. An avalanche occurs when the forces collectable to the previous instances become greater than the mechanical potence of the snowpack. There are two distinct types of avalanches loose avalanches and slab avalanches. While they are structurally different systems, two can be equally troublesome to those recreating in the mountains.Loose, or point-release, avalanches occur on slopes where the snow has simply lost its ability to remain on the slope. This is due to cohesionless snow sloughing off the surface, and picking up more snow as it falls down-slope. As the first particles of snow begin to release on the steeper aspects of the slope, they collide with lower particles, and create a fanned, triangular appearance on the slope. This type of avalanche generally occurs on slopes of 35 degrees or more and typically involves only the upper layers of the snow pack.Slab avalanches reach when a weak layer in the snowpack fails and the cohesive layer above, separate f rom the rest of the snowpack and flow down the mountain. The layer that separates remains intact as a unit, and resembles a slab of packed snow flowing down the mountain. As it travels downslope, collides with objects and rolls over the terrain, it generally breaks up and is crumple into smaller, broken pieces of slab by the bottom of its runout.When either the weak layer fails, or the bond between the slab and the bedsurface releases, the force is drastically increased on all remain bonds connecting the slab to the slope.How An Avalanche Forms avalanche snow formWhile there are many different ways for avalanches to set up, they are all related in the sense that the snows frictional hold on the slope has released and gravity is pulling the snow particles down. When the snow is deposited during the storm, the particles are bonding or locking together and creating layers of particles that are relatively similar. Every time the temperature changes during the storm, or the wind shi fts directions, it has an effect on how the snow settles and may form a new layer. Some of these layers are denser than others, and some will bond nicely with neighboring layers while others may not. The better the bonding is between the layers, the more stable the snowpack is. When a weak layer is deposited, or created in the snowpack, the chances of that layer collapsing and causing an avalanche are much higher. The layer may fail due to the force of gravity, the weight of new snow on top of it, or forces from a skier or snowmachine on it. An avalanche occurs when the forces due to the previous instances become greater than the mechanical strength of the snowpack. There are two distinct types of avalanches loose avalanches and slab avalanches. While they are structurally different systems, both can be equally troublesome to those recreating in the mountains.Loose, or point-release, avalanches occur on slopes where the snow has simply lost its ability to remain on the slope. This i s due to cohesionless snow sloughing off the surface, and picking up more snow as it falls down-slope. As the first particles of snow begin to release on the steeper aspects of the slope, they collide with lower particles, and create a fanned, triangular appearance on the slope. This type of avalanche generally occurs on slopes of 35 degrees or more and typically involves only the upper layers of the snow pack.Slab avalanches happen when a weak layer in the snowpack fails and the cohesive layer above, separate from the rest of the snowpack and flow down the mountain. The layer that separates remains intact as a unit, and resembles a slab of packed snow flowing down the mountain. As it travels downslope, collides with objects and rolls over the terrain, it generally breaks up and is crumpled into smaller, broken pieces of slab by the bottom of its runout.When either the weak layer fails, or the bond between the slab and the bedsurface releases, the force is drastically increased on all remaining bonds connecting the slab to the slope.

How Media Influences Women Essay -- essays research papers

We, the American public are hit from every imaginable direction every waking consequence of our lives by slick advertising agencies trying to coerce us into or tell us why we need to buy their products. Their products will make us happier or thinner, or prettier. The advertisers often use the picture of youth and vitality so that the public will associate that particular product or function with being young and handsome. They do this because of course in our society youth and viewer are to be coveted. Everyone would like to be forever young and beautiful or for as long as they can anyway. So, everyone is trying to look younger or wants to look younger. The things that we can associate with youth are obvious. We suppose the picture of youth and beauty everywhere. Look in any magazine, Watch TV, see billboards, everywhere you turn we see young, beautiful people. Youth is synonymous with beauty so little wonder why when you read this bumper sticker few women admit their age, few m en act it a lot of women wont divulge their age. To do so would be to admit they are perhaps older than they look or if we were to know their real age we might learn something (hopefully to ourselves) like jeez, she looks a lot older than thatThe media is really the one at work that shapes a lot of our attitudes and beliefs. They might not necessarily be honorable attitudes and beliefs but they are the ones that have been shoved in front of our faces from the day we were born. Believe me, they know how powerful and influential they (the media) can be.The most disturbing thing to me virtually advertising is the ideal feminine body they use. It is absolutely tight, contained, bolted down. Being thin is not enough. Women need to be in shape as well. Obtaining that body becomes a matter of self-control. It illustrates to me that they are saying thin women are in control. They have mastered the discipline of dieting and exercise. It is the fat women who are not in control. elaborate has become associated with laziness and lack of self-discipline.Of the statistics that I ran across while researching this topic said that eighty percent of girls between the ages of eight and twelve are on a diet. The number one wish of most women and girls is to loose weight. Media presents images that tell woman and girls that acceptance means being unnaturally thin. The average fashion model,... ...than among males.The ideals of female beauty have not always been inbodied in the figure of most of todays super models whose bodies resemble that of a young boy, not a woman. Figures like that of Marilyn Monroe, which today are considered fat, were the ideals of the time thirty years ago. It seems difficult to dispute that the attainment of the sylphlike ideal is very painful for many women. in light of the statistics given earlier (only five percent of women can achieve the ideal fashion model form), it is an impossible task for women to pursue. Women develop a extremely damagin g human relationship with food that does very little except limit their lives.Advertising has served as a disciplinary force in the lives of women. Advertisers create images that put cultural trends indicative of the time. The dominating image of the painfully thin woman in advertising remains the ideal for the American women. The grim truth is that attaining the slender body of today is not realistic for most women. Their bodies are not naturally shaped like those of twelve-year old boys. Eating disorders are on the rise, and the relationship women have with food is becoming an increasingly dangerous one.

Alcoholism In The 21st Century Essay -- essays research papers fc

Alcoholism in the 21st CenturyThe dictionary describes inebriety as continued excessive or compulsive use of intoxicantic drinks. However, this disease is much more complex. Alcohol abuse is a growing fuss in the United States today, causing more and more deaths each year. It affects nearly everyone in the U.S. today, either directly or indirectly. Over half of Americans have at least one close relative that has a drinking problem. About 20 million people in the United States abuse alcoholic drink. It is the third leading(p) cause of preventable deaths, and about 100,000 people die each year from alcohol related incidents (Peacock 11).Alcohol is not a new invention of in advance(p) societies. It has been around through many different ancient cultures, wine being the most prominent substance. Some cultures viewed alcohol consumption as good, while others perceive it good only in moderation. For example, the Greek god Bacchus was known for his excessive drinking while the Roman god Dionysus was known for teaching moderation in drinking (Peacock 20-21).Alcoholism was also learned to have existed in history. Interpreted writings on the tomb of an Egyptian king who lived over 5,000 years agone read, His earthly abode was rent and shattered by wine and beer. And the spirit escaped before it was called for. This shows that he died from alcohol related causes. However, most cultures began to limit alcohol use when they learned how to efficiently produce the beverage. Babylonian king Hammurabi and Chinese emperor Chung Kiang executed violators of their laws concerning alcohol (Peacock 20). Even in the Bible, refrain from alcohol is stressed. Nor drunkards will inherit the kingdom of God (Alcohol and the Bible). The United States was not immune to strict laws opposing alcohol. In 1919, the 18th Amendment was passed, limiting alcohol use. This period lasted for 14 years and became known as the Prohibition (Peacock 28).Ancient and modern literatures show that alcoh ol has been around longer than most people think. For example, in the ancient heroic poem of Giglamesh, written 4,000 years ago, one character was the goddess of wine and brewing, Siduri ( world literature 136, 139). The Chinese poet Tu Fu wrote about celebrating an old friends retirement with wine in his... ...rch on causes and treatment has increased substantially. There are many new and traditional treatment methods being tested to treat alcoholism. Looking toward the future, there is hope for a successful treatment of alcoholism, and prevention in generations to come.Works CitedAlcohol and the Bible New Expanded Version. 29 April 2001..Botsford, Christy. National Children of Alcoholics Week. 29 April 2001. Clinton Signs Bill to Lower drunk Driving Standards. Dallas Morning News. SIRS. 23October 2000.Peacock, Nancy. Drowning our Sorrows, Psychological Effects ofAlcohol Abuse. Philadelphia Chelsea House Publishers, 2001.Selected Poetry of Edgar Allen Poe (1809-1849). 29 April 2 001.Williams, Steven. Americas Drinking Problem. Teen People. March 2000 100-105.World Literature Third Edition. United States Holt, Rinehart, and Winston, 2001.

The Cold War 1980’s-1990’s Essay -- World History

Upon hearing the mention of The Cold War most people begin to imagine and think of a time focused on political and military tensions betwixt two main powers, the United States of the Western world and The Soviet Union of the Communist world. The context of the Cold War has traditionally been seen this way, as a nontraditional war without any engagement of battle, as a nuclear arms race between to profoundly different political and economic ideologies. Though being accurate this view of the Cold War is not complete. The Cold War was not just a nonviolent war between the United States and the Soviet Union but one affecting the entire planet in different fashions and on multiple plains. It is for these reasons that while events during the 1980s-1990s on the face of it led to the conventional end of conflict, they ironically only facilitated the existence and continuance of the Cold War even until today. Probably one of the most recognized events of the 1980s is the collapse of commun ism but first it is important to look at events that leading up to this collapse to provide a better context of events set collapse. One very significant period of time was the mid 1980s when it seemed all eyes were on Africa in its entirety. The release of the song We are the humankind in 1985, the Break the Chains campaign of 1987, and the focus on the influential figure, Desmond Tutu, during 1986 are all examples of how the United States and other countries were focused on providing aid to africa. In her book, Enlightened facilitate U.S. Development as Foreign Policy in Ethiopia, Amanda McVety explains this aid and how United Sates foreign aid was a cold war project, It offered a Cold War weapon that was not a weapon and promised peace through peaceful me... ... 8.4 (2006) 29-56. Print.McVety, Amanda Kay. Enlightened Aid U.S. Development as Foreign Aid Policy in Ethiopia. refreshing York Oxford UP, 2012. Print.Suppression of Communism Act, No. 44 of 1950 Approved in Parliame nt South African History Online. South African History Online. Web. 03 May 2012. no-44-1950-approved-parliament.Totten, Samuel, and Rifiki Ubaldo. We Cannot Forget. Interviews with Survivors of the 1994 Genocide in Rwanda. Rutgers UP, 2011. Print.TED KENNEDYS AFRICAN LEGACY. Africa Is a Country. Web. 03 May 2012. .Ye, Weili, and Xiaodong Ma. Growing up in the Peoples Republic Conversations between Two Daughters of Chinas Revolution. New York Palgrave Macmillan, 2005. Print.

Religious Controversy During the Time of Karl Marx Essay -- Karl Marx

Religious Controversy During the Time of Karl MarxReligion in Europe before and during 1848, the year the Communist Manifesto was written, was spacious of trials and tribulations. This is not a new thing for religion, ever since the creation of religion there has been problems. Religion is the one uncertainty that has caused disputes even wars in the past and in the present. Religion is discussed briefly in the Communist Manifesto. However, There is enough content about religion to see Karl Marxs views on the matter but he does not go into depth on those views. Religion around the time of the Communist Manifesto was very unstable two events prior to this time that contributed to this unstableness are the Separation of Christianity into Eastern Orthodox and Roman Catholic, and the Protestant reformations that took place. One of the most significant turning points in the history of European religion was the detachment of Christianity into western and eastern religions. The Wes tern Church became the Roman Catholic Church while the Eastern Church became the Eastern Orthodox Church. There was no titular split, the bishops of each church recognize each other as being genuinely Christian just a little odd in their beliefs. The bang-up Schism shows the difference between the two religions, and they are not all theological. One difference is that Eastern Orthodox priests are allowed to be married. Only monks in the Eastern Orthodox Church must remain celibate. This differs from the Roman Catholic Church where all priest must be single and chaste. 1A major(ip) reason for the Schism was lack of communication. The two Churches grew so far apart in their mindsets and attitudes they could no longer understand each other. They... ...ring the time of the Communist Manifesto. Notes1. Roger E. Olsen, The chronicle of Christian Theology, (Downers Grove InterVarsity press) 290-91.2. John H. Smith, The Great Schism, (New York Weybright And Talley) 2 36-39.3. Olsen, 291.4. Alister E. McGrath, Reformation of thought, 2nd ed. (Oxford Blackwell, 1993) 2-12.5. McGrath, 2-3. 6. Discovery and Reformation, 1996,

Religious Controversy During the Time of Karl Marx Essay -- Karl Marx

Religious Controversy During the Time of Karl MarxReligion in Europe before and during 1848, the year the Communist Manifesto was written, was full of trials and tribulations. This is not a in the altogether thing for religion, ever since the creation of religion there has been problems. Religion is the one uncertainty that has caused disputes even wars in the past and in the present. Religion is discussed briefly in the Communist Manifesto. However, There is enough content about religion to see Karl Marxs views on the matter but he does not go into skill on those views. Religion around the time of the Communist Manifesto was very unstable two events prior to this time that contributed to this instability are the Separation of Christianity into eastern Orthodox and Roman Catholic, and the Protestant reformations that took place. One of the most significant turning points in the history of European religion was the separation of Christianity into western and eastern religions. The horse opera church building became the Roman Catholic Church while the Eastern Church became the Eastern Orthodox Church. There was no formal split, the bishops of each church grant each other as being genuinely Christian just a little odd in their beliefs. The Great Schism shows the difference between the two religions, and they are not all theological. One difference is that Eastern Orthodox priests are allowed to be married. Only monks in the Eastern Orthodox Church must remain celibate. This differs from the Roman Catholic Church where all priest must be single and chaste. 1A major reason for the Schism was escape of communication. The two Churches grew so far apart in their mindsets and attitudes they could no longer understand each other. They... ...ring the time of the Communist Manifesto. Notes1. Roger E. Olsen, The Story of Christian Theology, (Downers Grove InterVarsity press) 290-91.2. prank H. Smith, The Great Schism, (New York Weybright An d Talley) 236-39.3. Olsen, 291.4. Alister E. McGrath, Reformation of thought, 2nd ed. (Oxford Blackwell, 1993) 2-12.5. McGrath, 2-3. 6. Discovery and Reformation, 1996,

‘In Paris With You’ by James Fenton and ‘Hour’ by Carol An Duffy Essay

James Fenton born 25th of April 1949 is a modern English poet, journalist a literary critic and was also a former Oxford professor of poe effort. He wrote several books roughly poetry mostly about relationship and war like the entreaty of poetrys The Memory of War. He received multiple of awards for his poetry, the latest was in 2007 when he was rewarded a Queens G previous(a) Medal for Poetry. sing Ann Duffy born 23 December 1955 is also a modern Scottish poet and playwright. Her poetry style speaks about everyday life experiences through stages of her life about love, memory and languages. She wrote poetry collection, children books and plays. both poets show heavy feelings about love in their respectful numberss merely each poem contains different contents solely apply to the same theme love.In genus Paris With You makes the indorser count on that the poem is romanticist but it actually an anti-clich poem that focuses mostly on the poets bitterness towards love be endeavou r he speaks about his experience with his rejected love and his rebound relationship, the poem rejects conventional ideas about love. He might view been in love before and she left him, that is seen when he says Yes Im angry at the itinerary Im been bamboozled. and that is why hes wound and in need of go outting about his former lover but isnt quite there yet when he starts the poem in a negative way Dont tattle to me of love. Ive had an earful This suggests that the narrator finds the subject of love difficult to discuss because of his sh ar of love and heartbreak.Throughout the poem Dont is repeated and that indicates repetition in the start-off and last cardinal stanza, it also shows how controlling Fenton was with his former lover when hes evermore saying Dont as she left him. This gives the reader an impression of the poet is possessive and heartbroken because of the ending of his former relationship. The sentence Dont talk to me of love and that proves that the man is determined on keeping the subject of love out of a conversation and detest it being brought up by cause of his heartbreak from his past relationship as if trying to protect himself from further pain. I find the way the poet started the poem in a negative way unfeignedly intense because the poet jumps into the subject without pleasantries towards love and doesnt hide his distaste towards it and shows his deepbitterness against love.Fenton also talks about how hes victimized and has a feeling of self-pity by love throughout the poem when he pull backs the state he has been when his relationship ended with his ex lover, how he spent it agony and drowning his misery with alcohol to help him forget. In the first stanza, he says Im one of your talking wound. That has a strong visualisery of war because wounded suggests that someone is injured in battle and in this case, injured because of love. The poet also mentions that Im a hostage.Im maroonded and that show us his emphasise on him being abandoned and deserted as he describes it as hes trapped and stranded. He uses metaphors when he says that hes really trapped as a hostage and left alone in an inescapable place. He shows rebellion when he says maroonded instead marooned which is the right term. It gives the reader and idea of how painful love is to the poet and lowers the readers expectations of romance and love. Fenton uses a comical rhyme in wounded and maroonded to add a humor into the poem to lighten up the mood of the poem despite the bitterness. I think that the way the poet describes himself is in a devastating state after being deceived by love.The poems title In Paris With You suggests a romantic theme but its ironic that Paris is the city of love but Fenton is only in Paris because hes on the rebound but only because Paris reminds him of his former relationship. He uses repetition of Im in Paris with You throughout the poem reflects the talkers insistent concentration on the present. Fenton then goes off listing to show his disdain towards Paris landmark and how he doesnt want to visit Paris romantic landmarks If we skip the Champs Elysees beggarlying he would rather remain here in this sleazy, old hotel room meaning that the poet rejects the traditional and usual romantic gestures and places in Paris and that they are unimportant and that shows us that he doesnt care about the scene around him as long being together with his lover, but stay in Paris is only about being on the rebound to forget his former love, and that hed rather stay in a cheap hotel room instead of going out to romantic Paris features.It creates an pic in the readers mind of the whole tone of this poem where it goes from bitter, sad andmournful and tells us that the poet doesnt actually care about the woman or lover he had in company. Theres enjambment between stanzas three and four in in this sleazyOld hotel room. That is used because the poet wants the poem read in a faster pace instead of a slow one without pauses in between stanzas so it shows the poets thoughts. I think the way the poet emphasize his bitterness towards love resulted to him turning towards alcohol and lust, his behavior is relatable in many ways because after a heartbreak, people tend to try to forget their feelings and their aching heart.Hour talks about how time is an enemy of love and how it destroys love with how quick it goes, that time is an rampart for love and Duffy starts the poem with delight ins time beggar, which is personification and it suggests that love is myrmecophilous and is a slave for time, that it doesnt last forever and that is a negative sign. This has a huge have-to doe with on the reader because when being in love, there is never enough time to omit together with your lover and it goes quickly. The personification show us the image of love being a beggar and time being someone who would pass by and offer, that is when Duffy used but even a single arcminute, glimmery as a dr opped coin, makes love rich.And that means that time, which is the passer, offers love only an hour to be spent on and narrator values that and it also shows strong mental imagery of wealth to present that the love is far more precious than all the wealth in the world. This also suggests to the reader that the time spent between the speaker and her love is valuable for the both of them. Like I said above, love being put as a beggar has a negative tone and that only highlights the fact that time is a problem for love. The poem is a extended metaphor that time wastes love and that is seen when the narrator says For thousands of seconds we kiss and that could only mean that the narrator in the poem has been counting the time because she still couldnt get enough of her lover.Throughout the poem, the poet uses various of imagery of wealth that identifies that the narrator finds the hour spent with her love one precious to her, Duffy uses the sentence love spins gold, gold, gold from str aw, which links to the story of Rumplestilskin where it also talks about how straw turns to gold, it also introduces the telephone line to show that opposite functions mentioned in the poem like jewel and cuckoo spit and in the sentence, the poet says that love is spinning from straw which is negative and an ordinary thing to gold showing that love is cherished and valued.If the reader has experienced love in their life, they will find themselves relating to certain parts of the poem and find that thirst love does indeed leave you finding the small amount of time precious. Duffy uses colour like gold and wealth imagery when she mentions coin rich assess and etcetera to emphasize that love is more valuable than all the wealth and treasures of the world. I could agree that being in love with someone could leave you dependent on that person and set them as your reason of happiness and that is a beautiful thing, however, people shouldnt rely on love too oft because it will leave t hem in pain when the other person break their heart or falls out of love.Duffy uses romantic imagery in the first stanza, line 3 and 4 where she shows how unromantic scenery is more than enough for her that her and her lover would rather be out in nature. She says Spend it not on flowers or wine, but the whole of the summer sky and a grass ditch. And that the place to her isnt important as long as her lover and she are together, she prefers the outdoors because of the natural setting that surrounds them because of its simplicity. It also pompousnesss sign of sibilance and the effectiveness of the narrators feeling and her lover would rather enjoy the nature and the natural stemma instead of going on typical and traditional dates (courting) and that shows non-conventional ideas of love.The reader would find the idea of being out in nature a bit unnamed for dates but some may relate. Duffy suggests that the summer sky and a grass ditch which is far away from being a traditional pla ce to spend with your love one but the narrator finds it an exceeding choice to enjoy the summer sky and not be distracted with people in public, romantic places because the narrator only has an hour to spend it with her love. I find the setting of the poem odd to be a place spent by two people but it only defines who her lover and her are as a couple in this society and how different they are from the rest of normal couples and that is special.Both poems have similarity because they both show vivid feeling conveyed bythe poet. Whilst In Paris with You is bitter towards love, Hour is more about how time is an obstacle for love and spending an hour with your loved one is precious. The structure in both poems is also different. The similarities between both poems use metaphoric language to describe emotional feelings and also write in first person. I like the In Paris With You poem because it had a deeper meaning into the words and people would have to read between the lines to finall y get it with poetry. Hour is a beautiful poem but I didnt find myself pulled deeper into the words but Duffy does display both light and darkness and that is something interesting.

The External Environment ( Strategic Management)

Review THE EXTERNAL ENVIRONMENT (STRATEGIC MANAGEMENT)A host of external factors influence a pixilateds pick of prudence and action, ultimately its organizational structure and internal factors. These factors, which constitute the external surround, can be divided into iii interrelated subcategories there argon as followsA. REMOTE ENVIROMENTThe remote surround comprises factors that originate beyond and usually irrespective of any single steadfasts operational situation economic, social, political, technological, and ecological factors.That environment presents firm with opportunities, treats, and constraint but rarely does a single firm exert any meaningful reciprocal influence.1. Economic FactorsEconomics factors concern the nature and complaint of the economy in which a firm operates. Because consumption patterns are affected by the relative affluence of various market segment, in strategic mean from each one firm must consider economic trend in the segment that affect it s constancy.2. Social FactorsThe social factors that affect a firm conduct the beliefs, values, attitudes, opinions, and lifestyles of persons in the firms external environment, as developed from cultural, ecological, demographic, religious, educational, and ethics conditioning. Like early(a) forces in the remote environment, social forces are dynamic, with constant transplant resulting from the efforts of individuals to satisfy their desires and needs by controlling and adapting to environment factors. One of the most profound social changes in recent years has been the opening of large poesy of women into labor market.Second, social change has been the accelerating interest of consumers and employees in quality-of-life issues. Third, social change has been the shift in the mount up distribution of commonwealth. A consequence of the changing age distribution of the population has been a sharp increase in demands made by a growing a number of senior citizens.3. Political Fac torsThe direction and st susceptibility of political factors in a major consideration for managers on formulating company strategy political factors define the legal regulatory parameters within which firm must be operate.Political constraint are placed on firm by dint of fair trade decisions, antitrust laws, tax programs, minimum wage legislation, population and pricing policies, administrative jawboning, and many more actions aimed at protecting employees, consumers, the general public, and the environment. Technological Fact To avoid obsolescence and promote the innovation, a firm must be aware of technological changes that might influence its industry. Technological forecasting can supporter protect and repair the probability of firm in the growing industries. It alerts strategic managers to both impeding challenges and bright opportunities.4. Ecological FactorsThe term ecology refers to the relationship between human beings and other living things and the air, soil, and wat er that support them. Threats to our life-supporting ecology caused in the main by human activities in an industrial society are commonly referred to as pollution, such as water and land pollution.B. INDUSTRY ENVIRONMENTTo establish a strategic agenda for dealing with these contending currents and to grow despite them, a company must understand how they work in its industry and how they affect the company in its particular situation.How Competitive Force Shape StrategyThe essence of strategy formulating is coping with the competition. In the fight for market share, competition is not manifested only in the other players. Rather, competition in an industry is rooted in its underlying economics, and competitive forces exists that go well beyond the established combatants in a particular industry.Contending ForcesEvery industry has an underlying structure, or a set of fundamental economics and technical characteristics, that gives rise to these competitive forces. A a few(prenominal) characteristics are critical to the strength of each competitive force.a. Threat of EntryNew entrants to an industry bring new capacity, the desire to gain market share, and often substantial resources. There are six major sources of barriers to entryEconomies of Scaledeter entry by forcing the aspirant either to come in on a large scale or to accept a cost disadvantage.Product Differentiationto stool high fences around their business, brewers couple brand identification with economies of scale in production, distribution, and marketing.Capital Requirementscapital is necessary not only for fixed facilities but also for customer credit, inventories, and absorbing start-up losses. Cost Disadvantage Independent of Sizeentrenched companies may have cost advantages not available to electromotive force rivals, no matter what their size and attainable economies of scale.Access to Distribution impart the more limited distribution channels are and more that existing competitors have tie d up, obviously the tougher that entry into the industry will be.Government Policycan limit or even foreclose entry to industries, which such as controls as license requirements and limits on access to raw material.b. Powerful SuppliersSuppliers can exert bargaining might on participants in industry by raising prices or reducing the quality of purchased goods and servings. A suppliers group is correctly if it is dominated by a few companies and is more concentrate than to the industry is sells, its product is unique or at least differentiated, or if it has built-up switching cost, it is not obliged to contend with other products for barter to the industry, it pounds a credible threat of integrating forward into the industrys business, the industry is not an important customer of the supplier group.. Powerful purchasersA buyers group is powerful if it is concentrated or purchases in large volumes, the products is purchases from the industry are standard or undifferentiat ed, the products it purchases from the industry form a component of its product, it earns profits, which create great inducement to lower its purchasing cost, the industrys product is unimportant to the quality of the buyers products or services, the industrys product does ot save the buyer money, the buyer pose a credible threat of integrating backward to make the industrys product.d. Substitute productsSubstitute products that deserve the most attention strategically are those that are subject to trends improving their price-performance trade-off with the industrys product or are subjected by industries earning high profits.e. Jockeying for PositionThe type of the intense rivalry is related to the carriage of a number of factors competitors are numerous or are roughly equal in size and power, industry growth is slow, the product or service lacks of differentiation or switching costs, fixed costs are high or the product is perishable creating strong temptation, capacity nor mally is augmented in large increment, exit barriers are high, and the rival are diverse in strategies, origins, and personalities. Industry Boundaries Definition of industry boundaries focuses attention on the firms competitors, and helps executives pose key factors for success. And also gives executives another basis on which to evaluate their firms goals. In defining industry boundaries is very difficult task.The difficult stems from three sources1. The evolution of industries over times creates new opportunities and threats,2. industry evolution creates industries within industries, and3.Industries are becoming global in scope.Having developed a preliminary fantasy of the industry executives flush out its current component.Industry StructureStructural attributes are the enduring characteristics that give an industry its distinctive character. To explaining the variation among industries can doing through examining the variable that industry comprises such are concentration, ec onomies of scale, product differentiation, and barriers to entry.Competitive AnalysisUsually have objectives such are to identify current and potential competitors, to identify potential moves by competitors, and to help the firm devise effective competitive strategies.C. OPERATING ENVIROMENTThe operating environment, also called the competitive or task environment, comprises factors in the competitive situation that affect a firm success in acquiring needed resources or in profitably marketing its goods and services. Competitive Position Assessing its competitive position improves a firm chance of designing strategies that optimize its environmental opportunities.Customer ProfilesDeveloping a profile of a firms present and perspective customers improves the ability of its managers to plan strategic operations, to bide changes in the size of markets, and to reallocate resources so as to support forecast shifts in demand patterns. The traditional approach to segmenting customers is based on customer profiles constructed from geographic, demographic, psychographic, and buyer behavior information. Suppliers Dependable relationship between a firm and its suppliers are essential to the firms long-term survival and growth.A firm regularly relies on its suppliers for financial support, services, materials, and equipment. In assessing a firms relationship with its suppliers, several factors, other than the strength of the relationships, should be considered. Creditors Because the quantity, quality, price, and accessibility of financial, human, and, material resources are rarely ideal, estimate of suppliers and creditors is critical to an accurate evaluation of a firms operating environment. Human Resources Nature of the Labor Market A firms ability to attract and hold capable employees is essential to its success.However, a firms personnel recruitment and selection alternatives often are influenced by the nature of its operating environment. A firms access to needed personnel is affected primarily by three factors the firms reputation as an employer, topical anesthetic employment rates, and the ready availability of people with the needed skills.D. EMPHASIS ON ENVIRONMENT FACTORSThe forces in the external environment are so dynamic and interactional that the impact of any single element cannot be wholly disassociated from the impact of other elements.Strategic managers are frequently frustrated in their attempts to anticipate the environments changing influences. Different external elements affect different strategies at different times and with varying influences. The only certainty is that impact of the remote and operating environment will be uncertain until a strategy is implemented. This leads many managers, particularly in less-powerful or smaller firm to minimize long-term planning, which requires a commitment of resources. Instead, they favor allowing managers to adapt to new pressures from environment.The companies that will be entr y to business must assessing and consider the external environment of the company that will have potential impact to the company. In assessing the potential impact of changes in the external environment offers a real advantage for the company. It enables decision makers to narrow the range of the available options and to refuse options that are clearly inconsistent with the forecast opportunities. Environment assessment seldom identifies the best strategy, but it generally leads to the elimination of all but the most promising options.The external environments that must be considered by the companies are remote environment, industry environment, and operating environment. These factors are lead how the company doing the business. How they take the opportunities from the external environment factor. And also how they make design of their business strategies is based on the conviction that a company able to anticipate future business condition will improve its performance and profita bility. So, the companies assessment of external environment is to anticipate the situation and condition of the company in current and future.

Health Care Communication Technology

Health care communication technology is rapidly advancing. New modes of communication in the health care arena are making it easier for the forbearing and the physician to communicate in a more effective manner. With the technological advancements that have taken place everyplace the past decade, communication has evolved from handwritten charts to every last(predicate) told paperless electronic communication. Whereas before, correspondence could have taken days or weeks, information can now be transmitted in a matter of seconds.The writ of execution of Electronic Medical Records (EMR) has allowed forbearings to be involved in their health care, the system enables physicians to record patient histories, enter orders, display test results, write prescriptions, and print patient instructions and educational materials (Makoul, G. , Curry, R. , & Tang, P. 2001). The electronic medical checkup record is much more efficient to the patient the patient no longer has to wait until the report is filed in chart to obtain results.It allows the patients information to be securely accessed by the physician and shared with a specialist for consultation. With access to vital information such as diagnosis, allergies, medications, treatments, and other medical information the patient is able to participate and be accountable for their health care needs. In 1996, The Health Insurance Portability and Accountability toy (HIPAA) were created to ensure privacy and confidentiality of patients medical information.The Administrative Simplification provisions of HIPAA were designed to improve the quality of health care and simplify the attention of health information. Beca example the effectiveness for identity theft is increasing with web-based programs, the importance of maintaining confidentiality is critical. One aspect relating to the values and importance of maintaining patient confidentiality when using EMR is trust.Despite concerns regarding breaches of confidentiality and computer systems,patient thumb that if they can trust their physician, then they would trust the provider with their medical information, as well as its storage and use in a computer interlock (Whetten-Goldstein, Nguyen, and Sugarman, 2001). Although there are many different modes of communication between the patient and the physician, such as email, texting, web based forums or electronic medical records all have the same thing in common, that is interaction between the patient and the physician. EMR is unique in that it offers features that lead to increased patient safety.Many of the other forms of communication do not have a continuous safety feature that EMR has. The overall safety of patients through reduced medical mistakes, built in reminders and alerts, the detection of potential drug interactions, it makes errors more difficult for physicians to commit (Spratt, A. D. and Dickson, K. E. 2008). Media and social networking has changed communication in health care. Infor mation is accessed and shared in a matter of seconds from all over the world. The internet providesmarketers and consumers with opportunities for much greater interaction and individualization (Kotler, Shalowitz, & Stevens, 2008, p. 463). Social networking holds considerable potential value for how patients research their health care issues. If a patient is expression for others with the same medical condition, they can find support and share their findings with anyone around the world. Many organizations are creating Facebook pages to market services they provide, introduce new staff, give word of honor updates, or advertise new products.This type of social networking caters to the younger generation that prefers searching the web over reading an ad in a theme or magazine. As technology becomes accessible to most people, printed advertisement will be seen as a nuisance rather than a form of communication. locomote technologies in health care are increasing, allowing information to be accessed in a matter of seconds. The media and social networking that allows organizations to communicate with consumer has become individualized to their needs.Organizations must use these tools to encourage communication by inviting suggestions, questions or even complaints via the website from consumers. communication in health care has benefited from this technology it has improved the interaction between the patient and the physician. Communication modes used in health care are reducing the risk of errors and increasing workflow. Electronic medical records offers features that lead to increased patient safety, including fewer medical mistakes, the detection of potential drug interactions, and improved maintenance of chronic conditions.

Janet Laurence Biography

Janet Laurence is a contemporary Australian artist, who is well known for her fervid connection with the environment. Laurences fascination in the nexus between cognizance and art, has profoundly displayed humans relationship towards character. Janet Laurence explores the limits of art by converging fundamental practices much(prenominal) as science, memory, imagination and insanity. She displays this by her confronting organic use of materials and subject matter. Laurence carefully considers her use of metaphors in her art use.Each piece of artwork contains a dark moment or message towards her audience. Laurence displays powerful political messages through her passionate concerns with the environment. Janet Laurences subject matter and process has changed coarsely over the years, Janet changes her artworks themes correspond to her personal concerns and changes in the environment. Her aims as an artist are to up rise empathy and compassion from her audience. Janet Laurence uses the Australian landscape as a metaphor, as a example regarding the fragility of our environment.Her work is symbolic of the fragility of nature, Janet Lawrence demonstrates this in a metaphorical way through her concern with the landscape and natural world. By getting glimpses of nature through the use of acrylic or glass could be compared to a looking glass which could be understood as seeing into a inscrut fitting place. Janet Lawrence is also interested in the connection between space and the environment, this concept is a metaphorical example used within her practice as a comparison to scientific practices.Janet uses an assortment of practices including installation, photography, painting and sculpting. She is commonly known for her public commissions and architectural collaborations. Laurences artworks are created in response to specific sites or environments that choose powerful meanings behind them. Laurence creates artworks in response to a specific life form or environm ent. She achieves this by using a diverse selection of materials such as plants, mineral materials and animals. Another example of her own individual use of unconventional materials comprise of glass, lead, ash and fur.Janet incorporates dead specimens such as owls and eggs to apologize the living and a way of presenting an almost museum approach. Each artwork is a reminder that all living life forms are interconnected and have a relationship with each other. Laurence has displayed this through her choice of diverse materials, colours and technique. Janet Laurences concern about Australias environmental health is extremely evident in her artwork. One of my favorite artworks is Plants eye view. This artwork recently won the $40,000 Glover Prize for landscapes.This award is very significant in Australian art score as Janet Laurence is the first female artists to be awarded the prize. The artwork is a multi-dimensional mirror and acrylic display. A judge from the Glover prize counci l quotes The work is very beautiful from the bakshis of view of colour. The artwork consists of numerous shades of green and black which emphasizes both nature as well as a more sinister tone. The vast majority of colour shades provide the artwork with a spooky and mysterious monotone. One of my favorite aspects of Plants eye view is the very vivid and arresting effect it has on the audience.The artwork almost makes you believe that you are hallucinating, some audiences commented that it makes you feel like you are experiencing drugs. This piece of art could be symbolic of oddment or dying, which is another example of Laurences use of metaphor in her work. The artwork is a portrayal of the Tarkine forest in North West Tasmania. Janet Laurence has displayed the oversize endangered forest on a micro scale to suggest that it is a small and insignificant problem compared to the millions of endangered forestry in the world.She quotes The Tarkine Forest is very close to my heart. Jan et said that she would practically bushwalk through the Tarkine forest, as it contained a fragile but aggressive attitude which somehow made her feel at home. Laurences main aim was to accurately display her passion for the environment, and to let her audience experience the same incredible feeling of home as she did. She would often refer to the Tarkine Forest as a secret place that anybody could call home. The second artwork that I have chosen to annotate is Heart appall.This particular piece of artwork is a large dead tree that is artfully suspended upside down. Laurence has cleverly attached elongated transparent silican electron tube to each branch, projecting a sinful shadow across the walls. Each tube is consumed with a mysterious fluid, acting like sap dripping from the decaying plant. This work is an excellent example of the way that the scientific use of the acrylic tubes could be compared to that in a laboratory for research purposes, and is symbolic of bringing life guts to a dying or an ill object.The comparison to a scientific experiment that is connected to a laboratory is symbolic of Laurences interest in both science and its relationship to art which could be seen as another example of a metaphor in her work. Heart shock is a late artistic piece of work which contains a sad message. Laurence is attempting to show her audience the devastation of endangered plants through her artwork. Janet Laurences art work is an immersive experience for its viewers. She is able to draw people into the inspiring meaning behind each piece.Laurences work has been described as echoing architecture while retaining a smack of the instability and transience found in nature. Laurence has commonly worked with peoples reactions towards her artwork, she loves to view what people think, and create her next piece of work on her audiences interaction with nature. An art reporter for Featured gallery quotes Through its reflective surfaces, the work engages the viewer directly as though we enter right into the landscape and become one with the nature. I personally love this quote because it proves that Janet Laurence has successfully delivered her message to her audience. In conclusion, Janet Laurence is an incredible artist who has an inspirational message to share with the world. She has a profound connection with nature, which creates a beautiful memorial to endangered environments. Laurences intelligent metaphorical connection between science and art has inspired people to take care of their environment. By Nancy Whiston

Hurricane Katrina- a Natural Disaster

Did you know that a hurricane is basically a small tornado? When warm striving and cool air collide over a large water source such as a sea or ocean, a hurricane is made. Hurricane Katrina just happened to be the irregular largest hurricane in United States history. Being formed in the Caribbean Sea, it was at first a category 1 hurricane. It gained strength in the disjuncture of Mexico, placing its rank at category 5. After hitting Louisiana at its risqueest peak, it decreased to category 3.Winds at 120 miles per hour and waves as tall as three stories high put together the nearly horrifying event ever known to the Statesns. During evacuation, umpteen people fled to a safe area in search of shelter. Texas was one(a) place that most people went to since they welcomed them more(prenominal) than any other state. However, after the victims got there, crime soared and Texans had no way to control or deal with so very much crime. Because of this, it is very unlikely that Texans w ill welcome victims with such hospitality next time. There was, however, a dome built to house the Katrina victims the Astrodome.Even though the Katrina victims had so many places to go, some were forced to stay behind because of hospitalization, they were abandoned by their caretakers, a lack of transportation, e. t. c. Out of all areas that were hit by Katrina, New Orleans suffered the most damage. 80% of the city was flooded. About 204,000 homes were either damaged permanently or temporarily and more than 800,000 citizens uprooted from New Orleans. The population shrunk to 75% of its original population. The number of homeless person people doubled to 12,000 people within two years.Experts have estimated that it will take 8 to 11 years for New Orleans to fully rectify from Katrina. Most people think of hurricane deaths as direct, but in reality, deaths caused by hurricanes are mainly indirect. Some examples of indirect deaths caused by Katrina are suicide, unsoundness, murder, starving, and dehydration. Mental illness and tragic suffering can lead many people to suicide. Lack of medical care can lead to infection or weakness, causing more deaths. Because of lack police force, crime rate and murder was at its peak.Since there was no way to access food overseas or through drop, starvation and dehydration was very common. During and after Hurricane Katrina, the economy crashed. There was an estimated $200 billion worth of economic damage. Not only did the prices for gasoline, oil, and other chemicals increase, but there were shortages in many areas all over America. The failed economy in America also upset the economy externally. India, Iran, Russia, and Cuba were just some other countries affected by the international terror. Oil was the part of the economy that was affected the most.There were about 580 reports of oil, petroleum, and other hazardous chemical spills. Only one of these spills alone would release about 1 trillion gallons of oil. Because of this, they had to reduce oil use greatly to have any remaining at all. Another reason is that 60% of oil imports traveling through the Gulf couldnt get through. In consequence, the Department of Energy was forced to release 30 million barrels of emergency oil. Through all of these disappointments, there is some delectation caused by Hurricane Katrina. It caused the construction of of innovation funds.In time, the areas hit by Katrina were renovated and the most beautiful that theyve ever been. There was also an international hurricane awareness introduced by Katrina. Other countries and America now know to be more prepared for future hurricanes similar to Katrina. It also created the ability to redevelop land using more modern technologies. The land hit today has the most advanced technology in the country. Even though Katrina has had some good outcomes, it was overall horrid. It has affected America and the rest of the world in sad, cruel ways.Thousands of people died, others we re relocated, supplies were minimized, and it took people years to recover from their experience. not just a disaster of nature, but a breakdown of government. The words of Barack Obama, legitimate President of the United Stated. Seven years have passed by, and since 2005, America had made great progress. Besides the very few places and people that are still recovering, it is just about as if these horrid times have never existed. But even though damage has almost gone away completely, we will always think the damage and hardships that were due to Hurricane Katrina a natural monster.

Analysis of Girl Interrupted

Movie Analysis Girl, Interrupted. Brittany Clontz Nursing 114 Girl interrupted is a gripping tale of a girls maladaptation to the challenges of life. The movie focuses on a young girl named Suzanna Kaysen growing up in the 1960s and struggling with the world around her. Suzanna is admitted to Clarmoore innovation after she consumes a whole bottle of aspirin and alcohol to deal with her pain. When admitted to Clarmoore she claims she was not trying to commit suicide, but that she just had a headache. She is everyplacewhelmed and apprehensive as she enters the substructure and observes the people around her .Suzanna is quickly introduced to many patient ofs, including her roommate, a pathological liar named Georgina. Polly, a woman who burned herself as a child in attempts to remove the rash she was receiving from her dog so she would not have to part with him. Down the hall from Suzanna is Daisy, a girl suffering from various mental illnesses stemming from her over intimate relati onship with her father. The most whirlwind introduction is the arrival of Lisa, a sociopath returning from her most recent escape from the hospital.Suzanna is immediately intimidated by Lisa and her sociopathic ways. It is Suzanna first mediated apt with her very self-indulgent parents that her diagnosing is revealed. Suzanna is taking aback by the doctors haggle, borderline soulfulnessality disorder. Suzanna exhibits her defiance and affirms the doctors diagnosis by becoming a side kick to Lisas insane ways. Suzanna becomes an accomplice to Drugging a nurse to steal music supplies to cheer up Polly, breaking into the doctors office to view her medical records, and world noncompliant with her medications.Following Lisas return from her most recent treatment for a maniac episode Suzanna reveals her true dependence on Lisa by following Lisa in her escape from the institution. Lisa has planned for them to stop by the new house Daisys soda bought her when she got released, then hea d to Florida to work at the new Disney world. When they arrive at Daisys, Lisa further reveals her manipulative disorder by pushing daisy about her dad, how she is not incured(p) and pulling up Daisys sleeve revealing the cut marks along her forearms.The next morning Suzanna goes upstairs to find Lisas twisted words had pushed daisy over the edge and she hung herself. Suzanna is devadeclared at the sight and the fact that list doesnt seem supposed. She finally realizes she has been under Lisas spell and she will never recover this way. So while Lisa runs, Suzanna lets the doctor take her back to the intuition and focuses on her recovery. Suzannas return marks a change in the movie and she makes massive strides towards recovering.. The day before her release, the sensation women who could tear it all down returns.At the sound of commotion Suzanna looks out the window to see Lisa being b uptightt in by an officer. That nighttime Lisa steals Suzanna diary and reads aloud all her private thoughts, including remarks about the other patients Suzanna had befriended. When Suzanna hears her reading her private thoughts it seems Lisa may get her wish and tear all Suzanna progress apart. precisely in a twist so revealing of her recovery, Suzanna stands up to Lisa and tells her she is the one who needs attend to and she is dead inside.It is this action of wanting to be out in the real world and standing up to this women who she has let control her that shows the strides she has made. Suzannas final departure is not a bitter one, it seems she has made a contravention in every patient there and is ready to begin her new life, with her new diagnosis, borderline aroundbodyality disorder, recovered. In my opinion this movie uses the chief(prenominal) character, Suzanna, to garnish the various ways a mental illness may present.Suzannas chart states Psychoneurotic Depressive reaction, highly intelligent, but in denial of her condition and person pattern disturbance ,resistant, sixed type, r/o undifferential schizophrenia. Diagnosis minimal temper Disorder. This diagnosis seems quite confusing if you dont know the characteristics of a person with borderline personality disorder. Because in all honesty at first it just seems Suzanna is a young girl, growing up in a rough era and just struggling to cope. But this struggle to cope and maladaptation to the stressors in her life are the triggers to her illness and her attempt at suicide .According to Townsend Borderline Personality disorder is described as A pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes toward other people. These various(prenominal)s are impulsive, are directly and indirectly self-destructive, and lack a clear sense of identity. (Townsend, 2011, Pg. 569) This is a broad definition but even at first glance I can pluck out some of the behaviors Suzanna exhibited in this movie. Suzanna exhibited intense relationships with men, and she developed a very intense and beyond chaotic with the other patient on the ward, Lisa.She exhibited constant acts of lust and instead of coming up with these acts on her own, they were often thought out by Lisa and Suzanna just followed. This consistent following of Lisa and lack of personal decision fashioning clearly revealed Suzannas devoid sense of a clear identity. According to the DSM IV a person suffering from Borderline Personality Disorder exhibits quin or more of the following nine criterions. 1) Frantic efforts to avoid real or imagined abandonment. 2) A pattern of unstable and intense interpersonal relationships characterized by jump between extremes of likinglization and devaluation. ) Identity disturbance markedly and persistently unstable self-image or sense of self. 4) Impulsivity in at least two areas that are potentially self-damaging (e. g. , spending, sex, substance abuse, reckless driving, binge eating). 5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior***. 6) Affective mood instability. 7) Chronic feelings of emptiness. 8) Inappropriate, intense anger or difficulty dogmatic anger (e. g. , frequent displays of temper, constant anger, recurrent physical fights). 9) Transient, stress-related paranoid ideation or severe dissociative symptoms. (NAMI)Suzanna exhibits many of these symptoms throughout the film. A few very lucid symptoms are her uncertainty about her identity that leads to her dependence on others and her impulsivity and self-damaging behaviors. On access she seems to have a clear understanding of whats right and treat but is in denial of why she is there, yet by the middle of the movie she is throwing her beliefs and values to the wind and participating in Lisas schemes. She becomes very codependent on Lisa and when Lisa is transferred to another ward after the drug a nurse and steal music equipment, Suzanna spirals into a different person.Suzanna becomes defiant, refuses to get o ut of bed and becomes easily angered. Her main thought is where is Lisa and when is she coming back. This demonstrates her lack of her own identity, without Lisa she is back to being confused about her life. Suzanna not only shows impulsivity with her actions with lisa, she shows impulsive sexual tendencies as well. Before her admission she was having sex with a married man who was a friend of her family. She too has a relationship with a man named toby who she met at a caller after high school.When toby surprises her at the institution her first actions toward him are sexual advances. He takes her outside and says he is passing game to Canada to avoid the draft and that she is going with him. She tells him she is not living and admits to trying to kill herself. That evening she starts kissing a male orderly she knows is very fond of her. Her sexual tendencies are clearly self-destructive and they show how every relationship is completely lacking emotion. Suzannas diagnosis of Bo rderline Personality disorder has no certain cause but several(prenominal) risk divisors have been identified.Genetic, family and social factors all play a role in the development of Borderline Personality Disorder. Suzannas mother clearly has some mental issues of her own although a diagnosis is not ultimately stated in the movie. Borderline personality disorder is also more common in women than men. Suzannas parent also show olive-sized regard for her condition and seemed to be more concerned about keeping up appearances. All these factors and the slight to no communication with her family can account for factors that may have contributed to the development of her mental illnesses.Borderline Personality disorder is diagnosed through a psychological evaluation and judgement of risk factors. In the movie Suzannas doctor is fairly quick to give her the diagnosis of Borderline Personality disorder after very few visits with her. Although throughout the movie Suzannas actions give evidence to her diagnosis. Common treatment for Borderline Personality Disorder consists of medication therapy to stabilize mood, decrease impulsivity and help the patient develop a more logical way of thinking.Psychotherapy is used in combination with these medications and patients usually participate in therapy sessions several times a week. Suzannas treatment plan was not quite evident until the end of the movie when she finally opened herself up to the possibility of recovery. Although the medication names were not stated she received medication therapy along with therapy sessions with the Dr. Wick two to three times a week. Suzanna also used expressive therapy during her treatment. She wrote down her thoughts in a journal in order to clear her head and participated in expressive art.One aspect that contributed to her recovery that is not presented is how the other patients affected her. Lisas actions were the most influential on her in the beginning but in the end she develops the ability to stand up to Lisa. Daisys suicide also played a big factor in her recovery, she realized you cant want to die, but once Death is staring you in the face your perception of the world changes a little bit. Girl Interrupted is an eye opener to several regarding several different mental illnesses. By the end of this movie the stigma of mental illness and an institution is gone and replaced by an accepting attitude.The main character Suzanna paints a picture of the various ways mental illness may present itself, but also that management and recovery of mental illness is attainable. References Encyclopedia, A. (2010, November 15th). PubMed Health. Retrieved September 1st, 2012, from Borderline Personaility Disorder http//www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001931/ NAMI. (n. d. ). mental Illnesses Borderline Personality Disorder. Retrieved September 2nd, 2012, from National Alliance On Mental Health http//www. nami. org/Template. cfm? Section=By_Illness&Template=/Tagge dPage/TaggedPageDisplay. fm&TPLID=54&ContentID=44780 Townsend, M. C. (2011). Essentiasl of Psychiatric Mental Health Nursing fifth edition. Philadelphia F. A Davis Company. Borderline Personality Disorder handling through Psychotherapy What is Psychotherapy? Psychotherapy is the first line of preferred treatment for patients with borderline personality disorder. Psychotherapy is a one on one or group interaction with a therapist to address symptoms that occur with Borderline Personality Disorder. The most important factor in psychotherapy is growth a trusting bond with you therapist.When a trusting relationship is established between patient and therapist, research shows Psychotherapy can relieve some symptoms of Borderline Personality Disorder. Types of Psychotherapy Cognitive Behavioral Therapy This type of therapy can help identify and relieve beliefs and behaviors that cause inaccurate perception of themselves. This type of therapy can help reduce mood swings, control anxiety a nd can be helpful in reducing suicidal behaviors. Dialectical Behavior Therapy This type of therapy focuses on being attentive and aware of the current situation.The therapist teaches skills to help control overwhelming emotions and reduce self-destructive behaviors. This therapy is also helpful in helping clients improve relationships. Schema-focused Therapy This therapy stems from the idea that borderline Personality Disorder stems from a persons dysfunctional self-image. Therapy combines several different types of psychotherapy to help change a persons self-image. This therapy is helpful in helping people interact with others react appropriately to their environment and proper contend methods to problems and stress. Plan of Care for Susanna KaysenNursing Diagnosis Ineffective header Risk Factors Lack of impulse control, Anxiety, Denial of mental illness NOC Outcomes (Nursing Outcomes Classification) Client will verbally express feelings and actively participate in learning copi ng strategies. Therapeutic Interventions * Encourage Client to participate in constructive outlets to address feelings. ( writing ,painting ,etc) * Provide the client with positive feedback. * Teach effective coping strategies. * dissertate clients diagnosis and address questions regarding diagnosis. Nursing Diagnosis Personal Identity DisturbanceRelated Factors Symptoms related to diagnosis of Borderline Personality Disorder. NOC Outcomes (Nursing Outcomes Classification) Patient will discuss various aspects of individuation that make up their personality. Patient will be able to distinguish behaviors, thoughts and feelings that differentiate their personality from others. Therapeutic Interventions * Work with client to recognize their own individual thoughts, values, and beliefs. * Encourage client to discuss feelings and claim ownership over these feelings. * Use photographs to increase clients awareness of their individuality.

Character and Sex Education

As Americans we tend to have a conditioned view toward sexual activityuality as a normal, level-headed part of life. However, it seems that one whitethorn underestimate the power that sex has on culture, which is evident in the many beas. Most recently discussions on a sexual nature received extreme national prominence with the public events surrounding the Kenneth Starr investigation and report, which focuses on the sexual aspects of the relationship between President Bill Clinton and a former intern, Monica Lewinsky. The result was a war of beliefs, example philosophy and differences of cultures mixed with political anipulations.With the increase of sexual presence in our smart set, it is often wondered how this increase has affected morals and values of those who live it. Sex is everywherenot retributive limited to the bedroom, but to the television, movies, billboards, office buildings and almost every fragment of modern culture. Around the sport of the twentieth centur y, open discussion and study of sex was well on its way. Sexual/cultural pioneer, Sigmund Freud believed that sexuality was tightly woven in all(prenominal) persons, open from birth.His breakthrough thinking affected social practices and was nstrumental in breaking the moral fog that had enshrouded sexuality for most of the nine jejuneth century did not begin to airlift until after the First World War (Janus 1993). By analyzing modern culture, a person can accurately determine the effects of the sexual revolution and how it has guide to the alterations or evolution of personal, moral and Where do we get our morals and values? Character education was what took place in coach and society in the past.This cut of acceptable social conventions seemed to contain our culture for many long time. In modern years society has shifted to the decision-making approach (Kilpatrick 1993). This approach takes many forms, sometimes as a course in itself, sometimes as a strategy in sex education classes, sometimes as a unit in civics or social sciencesit has set the tone for modern moral education in public and even private schools. The shift from character education to the decision-making model was begun with the beaver of intentions.The new approach was meant to help students to think more independently and critically about values (Kilpatrick 1993). Followers of this approach claimed that a young person would be more committed to self-discovered values than to ones that were simply handed d receive y adults. That was the hope, but the actual effect of the shift has been quite different. For students, it has meant confusion about moral values learning to question values they have scarcely acquired, unlearning values taught at home, and concluding that questions of right and wrong are always changing with the bias of society.We live in a sexual world, but Americans have been slow to fully acknowledge its enormous impact. Among those interviewed in the Janus Report who w ere 18 to 26 years old, 21% of the men and 15% of the women had had sexual intercourse by succession 4 a small percentage of them had had their first intercourse before age 10. It ought to be the oldest things that are taught to the youngest people. (Noonan 1999) This statement accurately portrays moral education today. The Day America Told the Truth, a 1990 survey of American beliefs and values contains this scene from a calcium high school.The setting, Friday afternoon and the students are going away a class in social living. The teachers parting words are, have a great weekend. Be safe. rumple up. Just say no. And if you cant say No, then use a condom (Kilpatrick 993) Although the teacher in this example gives a nod in the focalization of abstinence, his approach is basically of the responsible sex variety. Sex is an image that Americans have grown accustomed too. Sex is everything. If youre good looking, then youre having sex. If youre sexy, then youre having sex.If youre h aving sex, youre popular, and people are more likely to buy stuff from your company if you show people having sex. Sex sells. Sex sells cigarettes. Sex sells cars. Sex sells clothes, alcohol and One way that a breakdown of sexual restraint hurts society is the educational sphere. There is abundant evidence that the more sexually active students do poorly in school and tend to drop out more frequently (Noonan 1999). For all of the teenage girls, who drop out of school, half of them do so because of pregnancy.But that figure precisely suggests one small aspect of the problem. The constant distraction caused by worries about sex and about relationships takes a tool on schoolwork. Dieting has become an untoward cultural phenomenon, especially for women and girls, whose self-image is often closely linked with their body image. Eating disorders are more common in girls ecause they believe its their role in society to be sexy. Numerous studies have been conducted to determine the history of sexual abuse in eating disorders patients, and the findings have been controversial.The figures range from 7% to 74%, with most studies presentation that between 20-69% of anorexics and bulimics have been abused (Janus 1993). It is important to note, however that not everyone who has been sexually abused develops anorexia and not all anorexics have been sexually abused. For many survivors, anorexia can too serve as a way to make their bodies less desirable to potential perpetrators. In one sense, mature adolescents deny their sexuality by travel to a prepubescent state, developing amenorreah or loss of menstruation, which is one of the criteria for diagnosing anorexia.Unfortunately, teachers have been reluctant to discuss sex in absolute moral terms, leaving students with the impression that its purely as subjective matter. It turns out that when adults confront teens over sexual misbehaviors, a frequent response is simply, I didnt know it was wrong. Everyone is a result of his or her culture. We tend to conform to cultural expectations, even if not perfectly. Our present culture sends out confused and misleading messages about sex-messages that, in the long run, may cause more harm than good.A former secretary of education observed,I have never had a parent tell me that he or she would be offended boy a teacher telling a class that it is better to postpone sex. Or that marriage is the best setting for sex, and in which to have and raise children. On the contrary, my impression is that the overwhelming majority of parents would gratefully welcome help in transmitting such values. (Kilpatrick 1993) The long history of sexually transmitted diseases has made aution in sex one of the events of life. In the late 1980s, the AIDS epidemic made caution in sex a fact of life or death.It was no longer a moral issue. When AIDS surfaced as a national problem, the sexually active momentarily panicked. The enormous tensions generated by these devastating STDs mad e practice of casual sex pause. The new social and sexual changes in lifestyles have been adopted by many opposite participants. Divorced or separated men and women, newly single, are dating again and searching for sex partners and new love. Parents in their 40s and 50s and 0s are enjoying a new sexual style at the same time their teenage or young adult children are also experimenting with sex, and seeking loving relationships.There are few guidelines now, except for cautions about sexually transmitted diseases. The old rules governing sex no longer apply, and many individuals and couples now create their own moral and lifestyle decisions, or make them within the morality of their own small, peer In the Janus report, 45% of women and 19% of men claimed to have been sexually harassed on their jobs. In the interviews, the men attributed the harassment they xperienced to both heterosexual and homosexual individuals the women ascribed their harassment almost entirely to men.In an age of liberation, it is interesting that an issue so colossal gained national attention so accidentally. Why all the sudden there an underlying awareness of widespread sexual harassment on the part of women? The volume and speed of reaction to the charges readily advocate this assumption. Sexual Harassment has become a household topic across America. Today, men and women are more easy than ever to explore their sexual beings in or out of marriage. Their ransformed sex roles, feminism movement and the sexual revolution cause increase communication removed the home.Today, medicine, psychology and sociology advise that people should keep on having sex as long as they wish. Sexuality becomes adapted to the context of the sexual experience, at all ages. While early adolescence are experimenting with full sexual activities of diverse varieties and young couples are seeking sex for reproduction, older couples are enjoying the comfort and excitement of sex in a new appreciated form. A new , vital, and active sexuality has been identified mong mature, and post mature Americans.While society frets about preteens frolicking and college students antics on confine break in Florida, the graying segment of Americans may be leading the way in superior sexual experience (Janus 1993). Other issues relating to sexuality have also made headlines over the past two decades. Divorce rates leaped in the 1970s, absent or self-involved parents and child-rearing practices were blamed for creating misbehaving, out-of-control kids the family was believed to be in big trouble. in truth young adults are living together without the benefit f marriage.Meanwhile, kids are experimenting with their own sexuality at earlier and earlier ages. Barely out of their own childhood, teenagers are producing babies at ever-growing rates. By the 1980s, nearly a million mothers under 18 were giving birth every year. (Janus 1993) Of these young women, 70% were unmarried, up from 30% only a decade earlier. Some estimates indicate that as many as 10,000 extremely young women age 12 or younger, become with child(predicate) every year. (Janus 1993) The younger these children are when they have their first child, the more likely they are to ave at least one more child before their teen years end.These children who have children are particularly at risk of dropping out of school and becoming social throwaways who face a bleak prospective and are wanted only on the streets. Later, unable to get and hold jobs, they will drop out of the labor market as well, creating cycles of deep, depressing, poverty as their children and grandchildren in turn become teenage, single, unemployable parents. This idea represents the attitude of our culture to criticize teen parents and to make an example of those kids. look what can happen to you. and so onHowever, this is not always the case, many teen mothers are extremely successful in personal and professional careers. Many times the father will support the baby who shares his genes, even if they do not act as a family unit. By analyzing many factors where sex is apparent on modern culture, it is obvious how this increased presence has significantly affected values and morals on related topics. There has been a dramatic shift in attitude in just a small period of time and it will be interesting to see how these changes will continue to evolve and adapt to new introductions of culture and its influence.

Aetiology, pathogenesis, diagnosis and treatment Cystic fibrosis: role of P. aeruginosa infection in cystic fibrosis patients

IntroductionCystic Fibrosis (CF) is a genetic disorder of salt and wet regulation in the carrel. The disease is social movementd by mutations in the cystic fibrosis trans membrane conductance regulator (CFTR) gene (Cohen and Prince, 2012). The molecular basis of CF depends on its transmembrane conductance regulator (CFTR) protein, which functions as a channel and regulates the movement of ions and water across the epithelial barrier. The barrier opens in resolution to change magnitude levels of intra jail cellular cyclic adenosine monophosphate (cAMP). The gene in approach pattern condition is responsible for salt (chloride) and water balance in the body. However, if mutated, is not able to excrete out enough salt of the cell thus resulting, the build of salt within the cell forming sticky mucus. If accumulated in the lungs, this sticky mucus whitethorn clinically affect the epithelial innate function of the lungs and may result in futile respiratory tract inflammation that fails to persona up pulmonary pathogens (Cohen and Prince, 2012). The working mechanism of CFTR protein under normal condition is shown in figure 1.Studies have shown that increase in sodium (Na) re-absorption on the epithelial cells may indicate an compositors case in cystic fibrosis lung disease (Cohen and Prince, 2012).These mutations on the (CFTR) protein have impacts on its production and transfer to the epical membrane of the epithelial cells, thereby influencing the conductance of chloride and bicarbonate ions across the channels resulting in the CFTR ionic imbalance of on the epithelial cells of different organs. This leads to the formation of excessive mucus in the cells, which bears an exemplification condition for bacteria growth and multiplication. Interestingly, heretofore un car park lung bacteria much(prenominal) as pseudomonas have been found to inhabit in the lungs exploiting the ideal condition (Clunes and Boucher, 2007).Abnormality in the CFTR pathway resu lts in the increase of glycolipids on the go on of CF airway epithelial cells. These glycolipids serve as receptors to increase the binding activities of bacteria, thereby facilitating the early infection process, which is a assay-mark of the disease. Moreover, defect in CFTR gene is in any case associated with decreased nitric oxide concentration in the cell. Nitric oxide possesses antibacterial drug properties thus, decrease in its concentration may predispose an individual to severe infections with faulty CFTR gene (Clunes and Boucher, 2007). In addition, the role of inflammation in CF pathogenesis seems equally important. Inflammatory response produced against the infectious pathogens in CF patients may have detrimental effects to the force cells. Inflammatory infiltrates including macrophages, neutrophils, cytokines and interleukins may induce tissue misuse responses, further deteriorating the lung function (Cymberknoh, et.al. 2013).Inhabitation of bacteria in cystic fibr osis lung As mentioned earlier, even uncommon bacterium including genus genus Pseudomonas aeruginosa terminate reside in the cystic fibrosis lung (Hauser, et.al. 2011). Pseudomonas aeruginosa is a gram negative, rod shaped, aerobiotic bacterium that prefers moist environment for growth. Commonly they are found in places much(prenominal) as sewerage and in certain areas of the human body. Furthermore, they reside in lakes, moist vegetables, moist soil and streams. Studies have also suggested that that almost human infections repayable to P. aeruginosa result due to contact with these natural reservoirs (Friman, et.al. 2013).Pseudomonas aeruginosa has been recognized as an important pathogen in CF. Soon after residence in the lungs, it aims extremely difficult to eradicate them by antibiotics. The relentless presence of these bacteria in the lungs ultimately results failure of the immune system to provide a defense against them this leads to respiratory failure resulting in death of the patient (Folkesson, et.al. 2012).Firstly, P.aeruginosa acquires the airway of the patient with cystic fibrosis, which occurs during the very early phase of the disease. Infection may ensue once this bacterium enters the CF troops and colonizes the oropharynx, then to the lower respiratory tract by process of micro aspiration. Infection becomes intermittent at the initial stage as a result of acquisition of different strains. During the early stage of infection, the sequester looks like environmental strains, non-mucoid and susceptible to antibiotics. Eventually P. aeruginosa establishes itself and continuing infection ensues (Folkesson, et.al. 2012).In chronic stage of CF, P. aeruginosa produces a mucoid alginate by growing in bio-film of the end- bronchiolar space. It lacks lipopolysaccharide and becomes non-motile, resulting in the development of antibiotic foe during. patronage the known mechanism and availability of antibiotics, P.aeruginosa is able to chronica lly infect the airway of patients with CF and is able to cause an unrelenting decline in pulmonary function and deterioration but how these happen has been foc utilize on intense research (Folkesson, et.al. 2012).Molecular pathogenesis of P.aeruginosa infection in CFThe molecular basis of infection due to P. aeruginosa in CF is still not fully understood. However, it may be peculiar to a particular(prenominal) strain at the cadence of adaptation after acquisition. Studies have indicated that the persistence of the bacterium in the lungs business leader be due to its extravagantly level of propensity and the ability to adapt with environmental changes and stress (Hauser, et.al. 2011).aeruginosa possesses traits that modify them to colonize and persist in acute and chronic infection. These traits include High electric resistance to antibiotics (Zhang, et.al. 2011) Effective cell-cell discourse singalling for growth and multiplication (Friman, et.al. 2013). Ability to form biof ilms, plethora and virulence products and metabolic versatility (Wagner and Iglewski, 2008).The biofilms are synthe size of itd by the bacterium encased within a hydrated polymeric matrix and are clinically important this is because, P. aeruginosa in this mode of growth utilizes it to cope with phagocytes by the neutrophils and macrophages, as well as to the killing by antibiotics. This tolerates them for persistent survival in chronically infected CF despite the continuous natural immune response and antibiotics effect (Zhang, et.al. 2011).The disease pathogenesis and severity is further triggered by inflammatory responses in the later stage of the disease. primarily the pro-inflammatory enhancers become physiologically active in the absence of function CFTR gene. Although the exact inflammatory pathophysiology of CF still remains debatable, persistent infection, poor pathogen clearance, acidic environment and are considered some of the key triggers for initiating chronic infla mmatory response in the lungs of the patient with CF (Pier, 2008). The mechanism is explained in figure 2.Synthesis of ceramide from sphingomyelin by acid sphingomyelinase (ASM) and degradation by acid ceramidase (AC) is optimal at an acidic pH, much(prenominal) as that of normal intracellular vesicles (pH 4.5). Lack of functional CFTR increases vesicle pH to 5.9, partially inhibiting ASM and senior last schoolly inhibiting AC, resulting in ceramide accumulation in the vesicle and age-dependent pulmonary inflammation. Other properties of the cystic fibrosisaffected lung, including lack of the CFTR receptor needed for clearing Pseudomonas aeruginosa, enhanced mucin secretion, a dehydrated airway surface liquid, viscous mucus and DNA deposits released from ceramide-engorged apoptotic cells, also precede to P. aeruginosa airway colonization. Eventually, this microbe establishes a chronic infection wherein bacterial cells reside in low-oxygen mucus plugs and become highly resistant t o clearance or killing by host defenses (Pier, 2008)P.aeruginosa potentially synthesize factors such as proteolytic enzymes, which disablement the host cells by altering the host iron-containing protein forming hydroxyl radicals that contribute to host tissue injury and inflammation thereby decreasing the level of anti-inflammatory cytokines including IL-10, and at the selfsame(prenominal) time, trigger off neutrophils in the airway lumen. Continuous recruitment of these neutrophils induces tissue damaging inflammatory response mainly alter pulmonary tissue. Furthermore, neutrophils trigger the production of pro-inflammatory cytokine such as IL-8, which further contributes in the tissue damage process. In addition to pro-inflammatory cytokines, neutrophils also release the oxygen free radicals that induce apoptosis (programmed cell death) of the epithelial tissue in the lungs. Thus, to conclude, the role of neutrophils in airway inflammation in patients with CF seems crucial. o r else of providing innate immunity to the infected lung, it rather triggers detrimental inflammatory response and promote the growth of P. aeruginosa though the production of different growth enhancing cytokines, leading to the destruction of the lung tissue (Sagel, et.al. 2009).The effectiveness of the immune response in CF is exploited, allowing the establishment of a relentless cycle, whereby persistent bacteria cause increased inflammation that itself leads to increased bacterial densities, which in turn results stronger inflammatory response (Sagel, et.al. 2009). The net result is go onive tissue damage and pathological consequences and sequelae of CF that include mucopurulent plugging of bronchioles, chronic bronchitis (inflammation of the bronchioles) and bronchial gland hyperplasia (increase in the cell size of bronchial gland cells). The airway later becomes dilated and results bronchiectatic due to loss of support cartilage (Pickett, 2013).Treatment options for cystic fibrosisThe decision to treat patients who are infected with P.aeruginosa fanny be very challenging. Prolonged treatment with antibiotics can have toxic side effects, as well as increases the chance of microbial resistance in the patients. Also, prolonged treatment may cause long term harm. Data suggest that 80% of the patients with CF die indirectly or directly from pulmonary disease (Hurley, et.al. 2012).Clinically, there has been very little progress in the development of new antibiotics with novel mode of action. Recently, researchers exploited the adjuvant therapeutic agents that may be used alongside the conventional antibiotics. Source control measures, de-escalation of antibacterial should be followed up in patients with clinical response, especially with known antibacterial susceptibilities (Hurley, et.al. 2012). Considering the virulence of this pathogen, the progress of various strategies such as natural spring pumps and lectins, the use of iron chelators, immunization, immunotherapy, and inhibition of quorum sensing are currently being tested clinically for the better oversight of the disease. It has also been suggested that the impacts of intervening virulence of P. aeruginosa should also be assessed (Hurley, et.al. 2012).Some novel therapies are also found upon the fact that CF is caused by the mutation of the gene encoding CFTR protein targeting the defects produced in CFTR with invacaftor in one such approach. This novel treatment seems promising in patients with specific genotype of CF. Although the long term-outcome remains unknown, the development of CFTR targeted drug is an important milestone in CF (Petit, et.al. 2012).More recently, gene therapy has been extensively studied for the contend cure of the disease. However, the technique is not easy and has several limitations and hurdles. For instance, the research on this approach is very time consuming and often very expensive. However, focus of research has been on identifying the op timal vector for gene therapy (Picket, et.al. 2013).Thus, the prudence of CF has been a major challenge ever since the discovery of the disease. However, advancement in medical technologies and treatments has amend the prognosis of the disease. More sophisticated treatment including gene therapy (replacing faulty CFTR gene with a normal gene) has been the focus of intense research.P. aeruginosa resistance in CFPseudomonas aeruginosa is one of the common infections in western society, because of its high level of resistance to antibiotics. The synergistic relationship between the outermost membrane permeability and the efflux pumps is the most important factor influencing intrinsic antibiotic resistance in Gram-negative bacteria like P. aeruginosa (Liu, et. al. 1996). The high level of P. aeruginosa resistance is due to the acquired genes coding for amino glycoside-modifying enzymes or periplasmic beta-lactamases or mutations in fluoroquinolone targets (Liu, et.al. 1996). Low oute r membrane permeability, which is caused by either less production of the OprD porin, or by expressing multidrug resistance efflux pumps contributes to high level of intrinsic antibiotics resistance (Liu, et.al. 1996).Numerous efflux pumps such as MexAB-OprM and MerXY-oprMb MexAB-OprM, MeXY-OprM, MexCD-OprJ, MexEF-OprN, MexJK, MexGHI-OpmD, MexVM, MexPQ-OpmE, MecMN and TriABC are encoded in the genome of Pseudomonas aeruginosa. These are of clinical importance because of their chemical ability to remove chemical-unrelated antibiotics. Among all, resistance-nodulation division (RND) exonerates(predicate) family contains the main efflux pumps of P. aeruginosa. This efflux pump has been discussed in greater details below. The energy source is derived from its proton motive force.Resistance Nodulation instalment Efflux Pump StructureThere are five families of multidrug resistance efflux pumps which include the ATP-binding cassette (ABC) super family, the major facilitator super family (MFS), the multidrug and toxic-compound extrusion (MATE) family, the small multidrug resistance (SMR) family and the resistance nodulation division (RND) family (Paddock, 2006). Efflux of antibiotics from the periplasm is a sarcastic mechanism of antibiotic resistance utilized by Gram-negative cells. P. aeruginosa is capable of actively effluxing antibiotics from the periplasmic space using efflux pumps primarily from the RND family. The RND interlocking is tripartite in nature, composed of an outer membrane channel protein (OMP), knowledgeable membrane RND transporter, and a membrane fusion protein (MFP) (Kumar and Schweizer, 2005). The RND transporter provides the energy for the molecular transport and is often referred to as the RND pump protein (Misra and Bavro, 2009). The OMP interacts with the RND protein in the periplasm producing a channel capable of transporting antibiotics into the extracellular space. The MFP is believed to stabilize the interactions between the RND t ransporter and the OMP (Misra and Bavro, 2009). whole three of these components are essential for efflux function.The RND transporters are comprised of a homotrimer folded into a ?-helical transmembrane domain, with a large, soluble periplasmic domain. The top of the bacteria have semi-permeable membranes which may limit the passage of some types of antibiotics into the cell (Avrain, et.al. 2013). Multidrug resistance efflux pumps allow the bacterium to pump antimicrobials out of the cell. Porins maintain osmotic pressure by allowing the entrance/exit of hydrophilic small molecules but do not permit the passage of larger molecules. Enzymes can modify the antibiotic so that it is no longer recognized by the target, or modify them so that they are no longer functional. This is particularly prevalent with antibiotics that alter the ribosome or interfere with ribosome binding to inhibit protein synthesis. Inhibition of informational RNA synthesis occurs by binding to DNA dependent RNA polymerase inhibiting initiation (Avrain, et.al. 2013). The mechanism of antibiotic resistance is shown in figure 3.Fig3 Different mechanisms of antimicrobial resistance in Gram-negative bacteria (adapted from Fluit, et.al. 2001). In the figure, A represents mRNA and B represents tRNA.When exposed to antibiotics, MexAB-OprM and MexXY-OprM remain inducible but the rest of the systems when expressed in resistant strains may immensely contribute to biocide or antibiotics resistance. Antimicrobial components are released by the RND systems and these include first line anti-pseudomonal drugs such as beta-lactams and beta-lactamase inhibitors (Poole, 2011). Furthermore, alteration or loss of the outer membrane porin protein OprD is yet another common mechanism of resistant to carbapenems(Wang, et. al. 2010). Since P. aeruginosa infections are usually treated by the use of fluoroquinolone (Ciprofloxacin), its high level resistance is as a result of mutations in the DNA gyrase and topoisom erase IV enzymes, which target these antibiotics.Outbreak of P. aeruginosaAn outbreak can be defined as deuce or more sterile site isolate of the same species, with the same antibiogram, from different babies within the space of two weeks. A Pseudomonas aeruginosa infection outbreak on neonatal intensive care units reflects a degree of breakdown in infection prevention measures. measly hand hygiene, low nurse patient ratio, inadequate spacing between cots, overcrowding, environmental colonization (especially of water systems), inadequate cleaning of common use equipment, injudicious use of antibiotics, particularly broad spectrum and prolonged courses and delaying the initiation of material breast milk, all contribute to the emergence of outbreaks. It has been reported that infection from P. aeruginosa usually occurs 48hrs after birth, which affects two to three per thousand babies in the UK (Walker, et.al. 2013). The occurrence of the infection is even higher in those born untime ly or with surgical conditions (Durojaiye, et.al. 2011).Microbiological analysis In previous studies, (Walker, et.al. 2013) carried out the following microbiological investigations.Dismantling of tapsTaps and flow strengtheners from relevant hospital were dismantled, categorized into components, swabs and water samples were also taken. Samples for microbiological assessment were placed in 10 ml of maximum recovery diluents together with 10 sterile glass beads (3 mm diameter, VWR International, Lutterworth, UK). The surface of each component was scraped with a sterile plastic loop (Sterilin, Newport, UK) and the suspension was then vortex-mixed (10 s) to remove biofilm and to stop dead the micro-organisms. Each sample was then spirally plated (Don Whitley, Shipley, UK) on to plate count agar (Oxoid, Basingstoke, UK) and Pseudomonas selective agar (PCN, Oxoid, UK), for determination of aerobic colony count (ACC) and P. aeruginosa count respectively. This was then incubated at 30C on (Plate Count Agar) or at 37C (PCN) for 48 h.It was found out that complex flow straightener had significantly higher P.aeruginosa counts (P