Trojan War Research Paper Example | Topics and Well Written Essays - 1500 words

Trojan War - Research Paper Example Primarily based on Homer’s epic poems Iliad and Odyssey, the Trojan War enjoys the status of one of the greatest incidents of ancient Greek mythology leading to chaos and bloodshed eventually. The epics also demonstrate The war also submits to narrate the ambitious nature and disposition of the ancient era people, who used to spend several decades in wars and hostilities on minor issues and trivial matters, which could easily be solved through negotiations. Started with the abduction of the Greek queen Helen, the war ended in the victory of the Greeks and destruction and ruination of Troy, where both the sides had to wash their hands of the splendid warriors and bravest men in the history of civilizations at large, tombs of whom are viewed to be the Trojan coast of cremations. Homer’s Iliad declares the rivalry among the three Greek goddesses including Hera, Athena, and Aphrodite over the Apple of Discord thrown by the goddess Eris for the fairest of the goddesses. Sinc e all the three claimed themselves to be the fairest one, Hera, Athena, and Aphrodite sought the judgment from King Zeus with regards to declaring the most beautiful one among the three. Since Zeus would not hurt any of the goddesses, he bestowed the power of announcing judgment to Paris, a local shepherd. Paris was actually the son of Trojan royal couple King Priam and Queen Hecuba, who had thrown the infant Paris in the wilderness because of the prophecy that the child, on growing young, would bring ruination to Troy.... Paris, according to the sources, was actually the son of Trojan royal couple King Priam and Queen Hecuba, who had thrown the infant Paris in the wilderness because of the prophecy that the child, on growing young, would bring ruination to Troy.10 Somehow, Paris’s extraordinary intelligence, comeliness and bravery had won Zeus’s favors, who had appointed him judge in order to decide the name of the most beautiful goddess of Greece. Since Aphrodite had revealed her complete body and stood naked before Paris, she was declared to be the most beautiful goddess. Aphrodite sought no bounds of joy, and in return provided Paris with all the information about Helen of Sparta, the most beautiful lady on the face of the earth. Immediately after obtaining information regarding Helen, Paris set out to discover the outstanding beauty, and fell in love with Helen. On receiving the powerful response from Helen, they planned to move to Troy for good. Helen’s elopement infuriated M enelaus, who called all the former suitors11 of Helen12 in Sparta, and sought their support in this matter. At first, the kings looked reluctant to participate in the war; somehow, on getting reminded of the pledge they were determined to wage war on the Trojans, who not only had abducted the spouse of Spartan King, but had also refused to return her to her consort. Out of sheer feelings of rage, the Greeks invaded Troy in order to take revenge of their humiliation from the Trojans eventually. Course of War: Since the Trojans had refused to return Helen to the Greeks through negotiation, they were certain regarding the fact that the war was evident and inevitable. Prince Hector had told his father i.e. King Priam about the prophecy of his triumph

Coca Cola Case Study Example | Topics and Well Written Essays - 5000 words

Coca Cola - Case Study Example The overall market of soft drinks in Australia has experienced a slow but steady growth rate. Key players in the market try as much as possible to amass the market power by acquiring other similar companies in the industry. However, concentration and other market activities in Australia are regulated by The Australian Competition and Consumer Commission. The competition in non-alcoholic market in Australia is stiff and it is difficult for Coca Cola Amatil to increase its market share beyond 75 percent. The greatest business rivalry of the company is Schweppes, which is followed by P& N. The other major challenge facing the industry include dietary issues, which has made most health conscious consumers switch to other products to avoid consumption of the carbonated soft drinks. According to SWOT analysis proper advertising, effective and efficient distribution lines as well as competent sales force are key to success in the soft drinks market. The company requires an extra AU$42 milli on to finance the marketing plan. The money will be obtained from the retained earnings. Table of Contents Table of Contents 2 2.2 Consumer trends 5 3.0 Marketing objectives 15 4.0 Marketing strategies 16 5.3 Monitoring, evaluation and control 19 7.0 References 21 8.0 Appendix 23 1.0 Introduction Coca-Cola Amatil is one of the dominant market players in the Australian soft drinks market. ... David Gonski.The products that are produced and distributed by Coca-Cola Amatil include Coca-Cola, Diet Coke, Coke Zero, Sprite, Sprite Zero, Fanta, Lift, Deep Spring mineral waters, Mother, Appletiser, Grapetiser, Kirks soft drinks, Mount Franklin bottled water, Pump bottled water, Vitamin Water, Powerade, Nestea, Neverfail water coolers, Goulburn Valley juices, Fruit Box, Grinder's Coffee and SPC Ardmona. The Australian beverage company faces stiff rivalry from Schweppes and other smaller players. Coca-Cola sales are driven by economic factors such as pricing, long-term trends, brand loyalty and awareness and seasonality 2.0 Situation Analysis The Australian Coca-Cola Amatil is a company that has distinguished itself as a market leader over the years in the beverage industry of Australia. 2.1 Industry trends Soft drink refers to a non- alcoholic drink whose main ingredient is water. Most soft drinks are sweetened and carbonated. In addition, some have vitamin or higher energy (ener gy drinks) additives. The retail environment of soft drinks is strengthening and major players are introducing new products. The new products are made for consumers who are health conscious and who need convenient beverages. Fraser (2010) revealed that carbonated drinks take over 56 market share of non-alcoholic drinks, bottled water takes 25 percent, the sports drinks takes about 19 percent and the remainder is taken by juice and energy drinks. The soft drink industry in Australia has experienced relatively steady and moderate growth rate in the last five years of about 1 percent per annual. However, the sale of carbonated soft drinks is declining because majority of health-conscious consumers are moving away from high-calorie and sugary beverages to fruit juices, water and non-carbonated

Environmental problems Essay Example for Free

Environmental problems Essay There are numerous environmental problems facing our planet at the moment. Economic globalisation is causing destruction of rainforests in South America while boring a hole through the ozone layer, global warming occurs because of the increased emissions by transport and industries, melting of polar ice-caps is threatening low-lying coastal areas, damage of marine resources through overfishing is taking place, acid rain and pollution of soil and groundwater resources results from using chemicals and artificial fertilisers to boost crop output, incidence of hurricanes and other natural disasters is increasing. There is little consensus within both academic and lay circles as to whether the nature is able to cope with the environmental problems itself. In my opinion, ecosystems have a great potential of restoring the state of natural balance; however, the devastating influence of the humankind has significantly undermined this ability. At the dawn of the 21st century, environmental problems are looming large, and many processes are already irreversible. For instance, species that became extinct due to man’s activity could have been essential elements of certain food chains and habitants. The frequency of large-scale natural calamities, especially in the places that have been for a long time considered relatively safe, is a telling manifestation of the inability of nature to sustain its balanced state. Yet the film argues that today is exactly the day when the humanity can redeem its attitude to nature and prevent a global catastrophe. Therefore, the need for a different approach to the relations between the mankind and environment is necessary. It is imperative to carry on conservation and purification activities coupled with a persistent effort by both businesses and individuals to reduce (and, under the dream scenario, to stop) their environmentally damaging activities. Both individuals and corporations can make a considerable contribution to stopping (or at least slowing down) the degradation of the environment. In fact, many individuals seldom realize how their consumption patters are contributing to the aggravation of the situation. The culture of consumerism that constitutes the underlying philosophy of the West fuels unnecessary overproduction: reconsidering one’s consumption pattern can be the first step on the long way of saving the Earth. As Hertsgaard (2000) argues, the adoption of Western consumerist lifestyle by developing nations poses great dangers and has to be stopped before it firmly catches on. Such an approach implies not only reduction in consumption of non-essential goods and services but also buying from companies that are known to use environmentally-benign technologies in the process of production. The question as to who will suffer first, the Earth or the humans, is incorrect in its essence. Such thinking about the environment is the root cause of the imminent crisis. It is a fatal mistake to think that man is the king of nature. Indeed, our disconnection from the nature resulted in the great degree of alienation and ignorance. While human species is an inherent part of the Earth’s global ecosystems, men prefer to view themselves as ‘outsiders,’ superior to other species. Such approach brought about the overexploitation of the Earth’s resources, considerable environmental damage, and global warming. As Hertsgaard (2000) argues, in many countries, like in Sudan, environmental problems are inherently and explicitly linked to survival through the supply of food and drinking water. In China, pollution at factories equally harms humans and nature. The future of our planet in 50 years is solely dependent on the measures the humankind implements now to prevent the imminent crisis. Hertsgaard (2000) associates hopes with new environmentally friendly industries such as solar power. Given the changing attitudes towards environmental problems, growing awareness, and public policy commitment to betterment of our natural habitat, the outlook for the Earth is not as grim as some doomsayers think.

Nursing Processes for Emesis Management

Nursing Processes for Emesis Management Nausea and vomiting are common complications of multiple conditions, procedures, therapies, and events such as motion sickness, pregnancy, anesthesia (general, regional, or local) or radio/chemotherapy. Symptoms can be debilitating for many patients, and in the case of post-operative nausea and vomiting (PONV) physical damage may result, such as rupture of sutures, stitches, and esophageal tissue, and metabolic problems, such as electrolyte imbalances and dehydration (Golembiewski et al, 2005; Gan 2006). In severe cases of PONV, although rare, aspiration of gastric contents may occur, resulting in pulmonary sequelae, such as pneumonia or pneumothorax (Scuderi and Conlay 2003; Bremner and Kumar 1993). Thus effective treatment of PONV, possibly through multimodal antiemetic prophylaxis, is an important are of research (Skledar et al. 2007). This essay will consider two commonly used, well-recognized antiemetic treatments namely cyclizine and prochlorperazine. Both represent very old drug therapies, with cyclizine having been launched as an antiemetic in 1953, and prochlorperazine as an antipsychotic in 1957 (Broccatelli, 2010), its use as an effective antiemetic emerging soon thereafter (Finn et al, 2005). These drugs are commonly used on most wards in my practice setting and therefore it is vital for nursing staff to understand their respective pharmacodynamic (PD) and pharmacokinetic (PK) profiles. Prior to prescribing it is also important that the nurse have relevant knowledge regarding how these drugs work, how their PD and PK properties are altered by disease processes such as kidney/liver failure and whether there are any relevant contraindications or precautions. Additionally, the potential for drug-drug interactions and the dose appropriate for the patients age and weight should be ascertained if beneficial pati ent orientated outcomes are to be achieved. These issues will be comprehensively discussed within this essay. Pharmacology of emesis There are a plethora of drugs on the market to treat emesis, however, deciding upon an appropriate and effective treatment for patients requires the cause of the underlying nausea and vomiting to be ascertained. This is because the symptoms can manifest as a result of a number of underlying pharmacological processes, as will now be described. Vomiting is a complex reflex action controlled by the vomiting centre (VC) in the medulla region of the brain, an important part of which is the chemotrigger zone (CTZ); stimulation of this in turn leads to VC stimulation which ultimately leads to vomiting (Goodman Gilman, 1996). Neurotransmitter mediated stimulation of the VC can arise from both peripheral and central impulses (Shanbhag, 2008). Thus gastrointestinal irritation, motion sickness and vestibular neuritis all manifest in nausea and vomiting as a result of neurotransmitter release. The three main neurotransmitters involved in the control of vomiting are acetylcholine (ACh; via muscarinic-receptors), dopamine (via dopaminergic receptors), histamine (via H-1 receptors), and serotonin (via 5-HT3 receptors) (Shanbhag, 2008). Inhibition or antagonism of these receptors achieves emetic control. The VC has neurons which are rich in muscarinic cholinergic and histamine containing synapses and is directly stimulated by the vestibular input (e.g. through motion sickness), whilst dopamine and serotonin release are involved in the visceral stimuli pathway (e.g. through chemotherapy treatment) and also in the CTZ stimulation pathway as shown in Figure 1. Thus drug classifications of anti-emetics arise on the basis of which of the three pathways that they target (Flake et al., 2004). Selective serotonin receptor antagonists and antidopaminergics target the visceral stimuli and the CTZ, whilst the antihistamines and anticholinergics target the vestibular input pathway (Hornby , 2001; Flake et al., 2004). Etiology of Nausea and Vomiting Cyclizines anti-emetic effects are not fully understood but it is thought that it works by blocking the transmission of information from the labyrinthine apparatus in the inner ear (i.e. the vestibular pathway) to the VC (Goodman and Gillman, 1996). Cyclizine may also target the CTZ and it thought to exhibit some ACh muscarinic receptor blockade which probably contribute to the antiemetic potential thus operating at several pathophysiological levels. However, a side effect of ACh blockade is sedation in some individuals along with the potential for certain deliriant and hallucinogenic effects, probably responsible for cyclizines abuse potential (Bailey and Davies, 2008). Cyclizine produces its antiemetic effect within two hours and it lasts approximately four hours (emc, n.d.). The exact mechanism of prochlorperazines antiemetic action is also unclear, but the drug is thought to inhibit apomorphine induced vomiting by blocking dopamine D2 receptors centrally in the CTZ and possibly peripherally through dopaminergic receptors in the intestine (Perwitasari, 2011).   However, it also has some potential to block anticholinergic and alpha-adrenergic receptors, and therefore can also result in sedation along with muscle relaxation, and orthostatic hypotension (Kelly, 2000). Following intramuscular administration prochlorperazine has an onset of action within ten to twenty minutes and a duration of action of three to four hours (globalrph, n.d.). Indications and dosage form Cyclizine is indicated for the control of postoperative and drug-induced vomiting and in motion sickness (BNF, 2012; emc, n.d.). It is given by mouth at a dose of 50mg tablets up to three times a day or parenterally as a 50mg in 1ml solution intramuscular (im) or intravenous (iv) injection again at a frequency of up to 3 times a day (Reynolds, 1993). The recommended dose in children aged 6-12 years is lower: 25 mg up to 3 times daily. For motion sickness, it is recommended that tablets be taken 1-2 hours before departure. Cyclizine can also be given for vertigo and, morning sickness in pregnancy, and to combat  opioid nausea. It is also prescribed for radiation sickness (medsafe, n.d.) and PONV (Cholwill et al., 1999), indeed it is given iv before the induction of general anaesthesia at half the recommended dose, to increase the lower oesophageal sphincter tone thus reducing the hazard of regurgitation and aspiration of gastric contents (medsafe, n.d.). Although prochlorperazine is classified as an antipsychotic, its principal use nowadays is in the treatment of severe nausea and vomiting of various causes including, PONV, vertigo and motion sickness (BNF, 2012). It has several dosage forms: tablet (5mg: one or two tablets 3-4 times daily), syrup (5mg in 5ml: 5-10 ml 3-4 times daily), suppositories (25mg twice daily), dissolvable tablet (buccal tablet 3mg: one or two tablets twice a day in adults and children aged 12 years and over), im injection (12.5mg in 1ml; 5-10mg repeated every 3-4 hours with a maximum daily dose of 40mg) and iv injection (2.5 -10 mg by slow IV injection or infusion  with a maximum daily dose of 40mg). The oral (and buccal) route is the only method of administration recommended for children, and it is not recommended in children younger than  12 years (BNF, 2012). The different dosage form of prochlorperazine provides the nurse with flexibility for example the elderly and children may prefer the syrup or b uccal tablet, or in dysphagia suppositories or intra-muscular injections could be more appropriate. Cyclizine and prochlorperazine are both considered first line treatments for nausea secondary to vertigo and motion sickness (Quigley, 2001) and are first line treatments in many hospitals in PONV (NHS, Salisbury; NHS Plymouth). A review by Matchar, et al. (2003) has suggested that oral prochloperazine may also be used as an adjunct in the treatment of nausea associated with migraine (Matchar et al, n.d.). No randomized controlled trial has been found which formally compares efficacy of cyclizine and prochlorperazine, however, two studies comparing cyclizine with perphenazine in ameliorating drug-induced emesis, have shown the former to have comparable antiemetic efficacy to this related phenothiazine drug (Dundee et al., 1975; Chestnutt and Dundee, 1986). These studies are featured in a Cochrane report (Stevenson, 2006) which investigates drugs for preventing PONV and highlights eight drugs which reduce PONV by a similar amount in this patient group, cyclizine being one. The report concluded, therefore, that the most important question to answer when treating emesis is What are the types and risks of side effects experienced by patients exposed to these antiemetics? Thus safe and effective prescribing requires the nurse to identify patient variables or comorbidities relevant to the drugs side effects, for example heart failure patients should not be prescribed cyclizine and individuals susceptible to visual disturbances should avoid prochlorperazine as per the drugs contraindications. It is noteworthy that both drugs may be prescribed in the later stages of pregnancy if considered appropriate by a doctor (Schaefer, 2007; CKS, n.d.).  [1]   The choice of antiemetic would depend upon the precise cause of the nausea in conjunction with the specific receptor affected. However, since several different neurotransmitters stimulate the CTZ, combining drugs with different mechanisms of action can often be more effective than increasing the dose of one individual drug (King and Brucker 2011). Indeed, combinations of antiemetics are often used in palliative care (NHS Scotland, n.d.). Notably, vomiting of unclear or mixed origin may respond to a phenothiazine such as prochlorperazine because, in addition to acting on dopamine and serotonin receptors in the CTZ, it also acts at the VC and vestibular area. Cyclizine and prochlorperazine are both commonly used anti-emetics in palliative care where nausea and vomiting are present in up to 70% of patients with advanced cancer (NHS Scotland, n.d.). Treating this patient population requires particular vigilance, since there may be a number of underlying reasons for and comorbidities contributing to the nausea and vomiting, and antiemetics may be inappropriate. Consideration for causes of the symptoms might include intestinal obstruction or constipation, anxiety, raised intracranial pressure (ICP), oesophageal candida, severe pain or hypercalcaemia all of which might warrant interventions other then antiemetics. Conversely, should the nausea and vomiting be identified as drug induced, then anti-emetics such as cyclyzine or prochlorperazine might be appropriate. Raised intracranial pressure stimulates vomiting centre via pressure receptors and can be problematic in patients with known or suspected brain metastases. Notable, cyclizine can be g iven to such patients, especially where corticosteroids are contraindicated (NHS Scotland, n.d.). Pharmacokinetics Cyclizine, like most antihistamines, is well absorbed from the GI tract. After oral doing the effects develop within 30 minutes, are maximal within 1-2 hours and lasts for 4-6 hours. A single oral dose of 50 mg cyclizine in healthy adult volunteers resulted in a peak plasma concentration of approximately 70 ng/mL, occurring at about two hours after drug administration. The plasma elimination half-life is approximately 20 hours.  [2]  Cyclizine is extensively metabolised in the liver via N-demethylation to the inactive metabolite norcyclizine (Figure 4), which is widely distributed throughout the tissues and has plasma half-life of approximately 20 hours. This metabolite has minor antihistaminic activity compared to parent drug. A single 50 mg dose of cyclizine when given to an adult male volunteer, results in less than 1% of the total dose administered being excreted as parent drug in the urine over a 24 h period. Thus urinary excretion of metabolite rather than parent drug is th e major route of elimination for  cyclizine. The metabolism is thought to be mediated through CYP 2D6 and therefore exhibit inter-subject variability dependent upon the CYP 2D6 genotype as demonstrated by Vella-Brincat et al. (2012) in their study of the PK of cyclizine (Appendix 1) and its major metabolite (Appendix 2) in palliative care patients receiving sub-cutaneous cyclizine. Results indicated that the metabolic ratio of parent drug to metabolite differed significantly according to CYP2D6 genetics.  [3]   Prochlorperazine is reasonably well absorbed from the GI tract and highly protein bound. It undergoes extensive metabolism both in the gastric mucosa and on first pass through the liver via the cytochrome P450 enzyme system (CYP 2D6 and CYP 3A4)  [4]  to inactive metabolites, which are subsequently excreted in the urine. Parent drug has a plasma half-life of between 4 and 8 hours, the precise half-life differing according to the mode of administration. An im injection produces its antiemetic effect in 5-10 minutes and it lasts for 3-4 hours. Onset of effects are related to the mode of administration hence the pharmacokinetic profile, thus an oral dose would have a slightly slower onset of action but would last longer compared with an im injection.  [5]  According to Finn et al (2005), although the drug has been accepted as a useful anti-emetic for over half a century, its therapeutic success has been limited by its low and variable absorption and high first-pass metabolism. H owever, the development of a new buccal formulation has improved the PK, since studies demonstrate that buccal administration of prochlorperazine produces plasma concentrations more than twice as high as an oral tablet, with less than half the variability (Finn et al., 2005)  [6]  (Figure 5). When placed in the buccal cavity between the upper lip and the gum the formulation forms a gel from which the prochlorperazine is released and absorbed. The plasma levels achieved at steady-state on a dosage regimen of one 3mg buccal tablet twice daily are similar to those observed with the standard oral dosage of one 5 mg tablet taken three times daily. The elimination half-life of prochlorperazine in this formulation is 9 hours. The safety and efficacy of this relatively new formulation has also been demonstrated by Bond  [7]  (1998) in a randomised, double-blind, double-dummy trial in patients with vestibular disorders. Side effects By virtue of their pharmacology, cyclizine and prochlorperazine are both central depressants and can cause impairment of performance (Benson, 2001). Consequently, the pharmaceutical data sheets for both drugs have warnings regarding their potential to interfere with the ability to drive or operate machinery safely due to their ability to cause drowsiness (BNF, 2012). Despite the fact that cyclizine is one of the older antihistamines it is considered less potent in this regard compared to others in its class (Broccatelli, 2010), however, there is considerable variability in response to this side effect which can range from slight drowsiness to deep sleep. For this reason in practice, when one drug is not effective or poorly tolerated then it is justifiable to give another drug or combination of drugs (Benson, 2001). This unwanted side-effect is also a feature of prochlorperazine especially in the elderly, and often diminishes with continued treatment of both drugs (emc, n.d.). Cyclizines other more common side-effects include headache and psychomotor impairment plus antimuscarinic effects, such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances (BNF, 2012). Less common side effects are palpitations and arrhythmias, also dizziness, hypotension, muscular weakness and poor coordination (Goodman and Gilman, 1975). Prochlorperazine commonly causes CNS related side effect such as acute dystonia or dyskinesia, however these tend to be transitory (usually occur within the first 4  days of treatment) and are more common in children and young adults. Dopamine antagonists like prochlorperazine can also cause extrapyramidal effects, QT prolongation and even severe hypotension, especially in the elderly (emc, n.d.). Muscle spasms and restlessness are other reported side effects. Interactions Cyclizine exhibits pharmacological interactions with other drugs due to antagonism of its action (donepezil, galantamine, rivastigmine) or enhanced anticholinergic actions (tacrine, trimethobenzamine, triprolidine, trospium). Pharmacokinetic interactions may arise since cyclizine is an inhibitor of the hepatic CYP 2C9 isozyme system, which is involved in an NADPH-dependent electron transport pathway. This isozyme oxidizes a variety of structurally unrelated compounds, including steroids, fatty acids, and xenobiotics and contributes to the wide pharmacokinetics variability of the metabolism of drugs such as S-warfarin, diclofenac, phenytoin, tolbutamide and losartan. Pethidine and propanidid are also listed as having a potential to interact with cyclizine. Cyclizine also acts as an inhibitor of estrogen sulfotransferase, the enzyme responsible for estradiol metabolism. Prochloperazine has a plethora of interactions, both pharmacological and pharmacokinetic. The pharmacokinetic interactions are largely due to competitive metabolic interactions at the hepatic CYP 3A4 and CYP 2D6 enzymes. The CYP 3A4 isozymes are responsible for a variety of oxidation reactions e.g. caffeine 8-oxidation, omeprazole sulphoxidation, midazolam 1-hydroxylation and midazolam 4- hydroxylation, plus metabolism of structurally unrelated compounds, including steroids, fatty acids, and many other xenobiotics. Whilst the CYP 2D6 isozymes are responsible for the metabolism of many drugs and environmental chemicals, via oxidative transformation along with metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic antidepressants.  [9]  Consequently, the data sheet for prochlorperazine lists many drugs with interaction potential including adrenaline, amphetamine, carbamazepine, clonidine, desferrioxamine, guanethidine, levodopa, lithium, phenobarbital and propranolol. Managing Drug Therapy When managing the care of a patient, nursing staff must initially thoroughly assess the patient, then identify significant interactions between core drug knowledge (PD, PK, ADRs, interactions, contraindications) and the patients core variables (health status, age and gender, life-style and diet, environments, culture). Thereafter the nurse can plan and implement suitable interventions, which will maximise therapeutic effects whilst minimising adverse effects (Aschenbrenner and Venable, 2008). In order to achieve such objectives the nurse should ensure administration of the appropriate medication is given through a suitable route on a regular basis or as required, with ongoing patient evaluation and monitoring. Cyclizine and prochlorperazine are both considered first line treatments for nausea secondary to vertigo and motion sickness (Quigley, 2001) and are first line treatments in many hospitals in PONV (NHS, Salisbury; NHS Plymouth). A review by Matchar, et al. (2003) has suggested that oral prochloperazine may also be used as an adjunct in the treatment of nausea associated with migraine (Matchar et al, n.d.). No randomized controlled trial has been found which formally compares efficacy of cyclizine and prochlorperazine, however, two studies comparing cyclizine with perphenazine in ameliorating drug-induced emesis, have shown the former to have comparable antiemetic efficacy to this related phenothiazine drug (Dundee et al., 1975; Chestnutt and Dundee, 1986). These studies are featured in a Cochrane report (Stevenson, 2006) which investigates drugs for preventing PONV and highlights eight drugs which reduce PONV by a similar amount in this patient group, cyclizine being one. The report concluded, therefore, that the most important question to answer when treating emesis is What are the types and risks of side effects experienced by patients exposed to these antiemetics? Thus safe and effective prescribing requires the nurse to identify patient variables or comorbidities relevant to the drugs side effects, for example heart failure patients should not be prescribed cyclizine and individuals susceptible to visual disturbances should avoid prochlorperazine as per the drugs contraindications. It is noteworthy that both drugs may be prescribed in the later stages of pregnancy if considered appropriate by a doctor (Schaefer, 2007; CKS, n.d.).  [10]   The choice of antiemetic would depend upon the precise cause of the nausea in conjunction with the specific receptor affected. However, since several different neurotransmitters stimulate the CTZ, combining drugs with different mechanisms of action can often be more effective than increasing the dose of one individual drug (King and Brucker 2011). Indeed, combinations of antiemetics are often used in palliative care (NHS Scotland, n.d.). Notably, vomiting of unclear or mixed origin may respond to a phenothiazine such as prochlorperazine because, in addition to acting on dopamine and serotonin receptors in the CTZ, it also acts at the VC and vestibular area. Cyclizine and prochlorperazine are both commonly used anti-emetics in palliative care where nausea and vomiting are present in up to 70% of patients with advanced cancer (NHS Scotland, n.d.). Treating this patient population requires particular vigilance, since there may be a number of underlying reasons for and comorbidities contributing to the nausea and vomiting, and antiemetics may be inappropriate. Consideration for causes of the symptoms might include intestinal obstruction or constipation, anxiety, raised intracranial pressure (ICP), oesophageal candida, severe pain or hypercalcaemia all of which might warrant interventions other then antiemetics. Conversely, should the nausea and vomiting be identified as drug induced, then anti-emetics such as cyclyzine or prochlorperazine might be appropriate. Raised intracranial pressure stimulates vomiting centre via pressure receptors and can be problematic in patients with known or suspected brain metastases. Notable, cyclizine can be g iven to such patients, especially where corticosteroids are contraindicated (NHS Scotland, n.d.). Administration Precautions Due to its centrally acting effects, patients taking cyclizine should avoid alcohol and other depressants e.g. hypnotics or tranquillisers. Food may reduce irritation to cyclizine and since there is no interaction with food, this drug can be taken without regard to meals. The datasheet indicates it should be used with caution in hepatic disease, whilst in renal impairment there is a need for dose reduction (BNF, 2012). Cyclizine should also be used with caution in patients with severe heart failure. Other anticholinergic effects include visual disturbances, and sedation, which can make them dangerous for the elderly population or younger patients. Further, cardiovascular side effects e.g. hypotension, tachycardia, and palpitations have been reported, plus minor GI effect e.g. dry mouth and constipation. Cyclizine has a well-known abuse potential (Ruben et al. 2006). In opiate dependents receiving long-term methadone cyclizine is often taken in large doses intravenously to provide a m ore intense high. Thereafter the addict experiences depressive mood changes and a craving for cyclizine. Many individuals receiving long-term prescriptions of oral methadone have been identified as being habitual abusers of cyclizine.  [11]  Consequently, there is considerable reticence by pharmacists in prescribing the drug, and alternative treatments are generally sought. Obviously in the hospital setting there is little opportunity for such abuse, and the efficacy and cost-effectiveness of the drug would therefore take precedence over its abuse potential (Barber, 1995; Philips and Thompson, 1997). Although prochlorperazine being an antipsychotic phenothiazine drug can be employed in psychiatry, in lower doses it is usually prescribed for its anti-emetic properties. Patients taking the drug should take with a full glass of water, avoid excessive quantities of coffee or tea (containing caffeine) and also avoid alcohol. Prochlorperazine should be used with caution in patients with renal and hepatic impairment and cardiovascular disease; also in Parkinsons disease, epilepsy and in patients with a history of glaucoma. While the drug does not deliver the euphoria that is associated with many commonly abused drugs, it still has some abuse potential since it can alter mood and perception, but not to the extent of cyclizine. Moreover, dependence and tolerance can develop, which can drive the individual to continue to seek more of the drug  [12]  and result in overdose, characterised by symptoms of central nervous system depression to the point of somnolence or coma. Agitation and r estlessness may also occur in overdose. Other possible manifestations include convulsions, EKG changes and cardiac arrhythmias, fever and autonomic reactions such as hypotension, dry mouth and ileus. Managing Drug Therapy Nausea and Vertigo: In emetic patients, antiemetics should only be prescribed when the underlying cause is known, indeed antiemetic administration may be harmful when the cause can be treated, e.g. in diabetic ketoacidosis or digoxin/antiepileptic overdose. In addition to motion sickness cyclizine can be given to patients with nausea caused by mechanical bowel obstruction and raised intracranial pressure.  [13]  Once a decision has been made that antiemetic drug treatment is appropriate, the drug and the dosage form should be chosen according to the aetiology of vomiting along with core drug knowledge and patient variables. Thus prochloperazine is useful for episodes of more severe nausea and vomiting e.g. associated with diffuse neoplastic disease, radiation sickness, and the emesis caused by drugs such as opioids, general anaesthetics, and cytotoxics. Indeed, prophylactic use may be required if severe nausea is anticipated such as following chemotherapy treatment. (Aschenbrenne r and Venable, 2008). Prochorperazine may be a suitable choice because of its dosage forms, thus rectal suppositories can be useful in patients with persistent vomiting or with severe nausea and the buccal tablet dosage form is also useful in such instances. However, during use of phenothiazines it is important to monitor severe dystonic reactions, especially in children. It is recommended as a second-line treatment for vomiting in pregnancy after promethazine.  [14]   Whereas the efficacy of cyclizine in treating nausea and vomiting has already been unequivocally proven, it is only available in tablet and injectable form. Nevertheless, cyclizine may be the choice of drug over prochlorperazine in children since in this patient population the latter can only be administered orally (BNF, 2012), and therefore requires patient compliance for success. There is no evidence that either of the two drugs is superior to the other in terms of efficacy; also despite cyclizines longer plasma half-life compared with prochlorperazine, the duration of action is similar at around 4 hours. The adverse event profiles do however differ slightly, because of the differing underlying pharmacology of these two drugs. This is an important consideration in the choice of drug, alongside special precautions which, as described earlier, must be considered in conjunction with patients co-morbidities. It is also noteworthy that educating patients and their families regarding the drug of choice is important; for example warning patients against consuming alcohol with both prochlorperazine and cyclizine and warning patients against driving or operating machinery if susceptible to drowsiness with either drug. In summary, both cyclizine and prochloperazine have similar safety, tolerability and toxicity profiles despite their differing modes of action on a cellular level. Tolerability in terms of drowsiness is a potential problem for both drugs, but is generally dependent upon the individual patients susceptibility, warranting a trial and error type approach when determining which is the optimal drug of choice. Also, due to the drugs both being substrates of CYP 2D6 their phamacokinetic profiles may exhibit inter-subject variability by virtue of the different phenotypes of this enzyme which exist in the population. This differing pharmacokinetic profile would logically translate into a varied response in terms of therapeutic effects. Likewise, their potential to interact with other drugs is inextricably linked with their metabolism, namely metabolic competition at the cytochrome P450 enzyme receptor sites. Thus both drugs have the potential to interact with a wide range of other medications . Moreover, since both drugs are extensively metabolised in the liver, with excretion of metabolites in the urine, there is a need for caution in renal and hepatic disease. Cyclizine and prochlorperazine appear to be similarly efficacious with regard to their treatment of emesis caused by motion sickness. The literature is inconclusive regarding which drug would be more superior for PONV, or vertigo, and even though it has been suggested that prochlorperazine should be chosen over cyclizine when the nausea is severe, there does not seem to be any compelling evidence for this and many hospitals tend to choose cyclizine over prochlorperazine in their antiemetic protocols/guidelines. The most compelling evidence for choosing prochlorperazine over cyclizine in the primary care setting would be the high abuse potential with cyclizine. However, in the secondary care setting this is of minimal concern. Therefore a more compelling reason for choosing prochlorperazine over cyclizine in this setting might largely hinge on the greater flexibility in formulations available for prochlorperazine. Whereas both drugs can be given orally as a tablet, when patients are vomiting this may be inappropriate. The buccal tablet or rectal suppository, which is available for prochlorperazine, and is less invasive than an injection formulation may be more acceptable to many patients in such cases. To conclude, the present essay has demonstrated that the nursing process for effectively dealing with emesis is challenging and complex. Here we have witnessed the plethora of facts which the nurse must take into account prior to prescribing the antiemetic drugs cyclizine and prochlorperazine, and that even after attempting to optimise drug selection on the basis of such facts, success cannot be guaranteed. Ongoing monitoring of patient response/progress with the possibility of altering or augmenting the chosen drug therapy is necessary to improve outcomes, ensure patients receive optimal care, and that they enjoy maximal therapeutic success with minimal side effects. References Matchar DB, Young WB, Rosenberg JH, Michael P. Pietrzak, Stephen D. Silberstein, Richard B. Lipton and Nabih M. Ramadan. Evidence-based guidelines for migraine headache in the primary care setting: Pharmacological management of acute attacks. Available at: www.aan.com/public/practiceguidelines/03.pdf/. Accessed 28/10/12. CKS: Clinical Knowledge Summaries http://www.cks.nhs.uk/nausea_vomiting_in_pregnancy/management/prescribing_information/prochlorperazine/advice_about_prochlorperazine Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 607). Benson A J, Medication for Motion S

Free Essay: Restructuring Relationships Shakespeares King Lear :: King Lear essays

Restructuring Relationships in King Lear The play of "King Lear" is about a search for personal identity. In the historical period in which this play is set, the social structure was set in order of things closest to Heaven. Therefore, on Earth, the king was at the top, followed by his noblemen and going all the way down to the basest of objects such as rocks and dirt. This structure was set up by the people, and by going by the premise that anything that is man made is imperfect, this system cannot exist for long without conflict. Through tattered clothes small vices do appear; Robes and furred gowns hide all. Plate sin with gold, And the strong lance of justice hurtles breaks; (IV, vi). The chaos that occurs in "King Lear" is due the reshaping of bonds within the society. Thus naturally, bonds must be broken, kept and most importantly, formed. This rearrangement of bonds is necessary to Lear understanding his personal identity. Bonds that are broken include those relations between King Lear and his two eldest daughters (Regan and Goneril), between Glouster and Edmund and also between Edmund and Edgar. Lear and Cordelia; Lear and Kent; Glouster and Edgar include those bonds that are existent at both the beginning and conclusion of the play. By the ending of the play, Lear is able to come to terms with himself and with nature. For the rearrangement of the bonds, it is necessary that those based on money, power, land, and deception be to abandoned. In the case of Lear and Goneril and Regan, his two daughters have deceived their father for their personal gain. Furthermore, they had not intended to keep the bond with their father once they had what they wanted. Goneril states "We must do something, and i' th' heat." (I, i, 355), meaning that they wish to take more power upon themselves while they can. By his two of his daughters betraying him, Lear was able to gain insight that he is not as respected as he perceives himself to be. The relationship broken between Edmund his half- bother, Edgar and father, Glouster is similarly deteriorated in the interest of material items. By the end of the play, Edgar has recognized who is brother really is and when he has confronted him says "the more th' hast wronged me...

Pupil School :: Papers

Pupil School The whole building seemed to moan in pain as the merciless wind battered it's crumbling walls. The Hayes boarding school had just called lights out. Mr Branston, the head teacher, doddered down the corridor at a snails pace rattling his cane across every radiator he walked past in an attempt to intimidate the students. He was making sure the dormitories were locked down and secure, but he was too drunk to check any locks properly. So he stumbled blindly back to his office to finish off the whiskey. As the rattling faded and finally ceased small lights could be seen through the dusty cobwebbed windows of the dormitories and the murmuring of whispered speech could be heard through the thin walls. Word had gone round school through word of mouth and notes passed in class that Norris had organised a meeting in the gym that very night. So as the school fell silent the children crept to the gym where Norris, or Gregory Norris as he was known to the teachers, stood waiting on the stage. He was hugely respected by the students and despised by the teachers. He held the record for the most detentions in a row after getting one hundred and thirty five for setting Mr Branstons wig alight during a chemistry class in year eight. He had dark messy hair and light brown eyes, which seemed to stare right through you as he spoke. He stood tall on the stage watching over the students as they entered the hall. First to arrive were the year seven and eight pupils looking warily around to make sure that the meeting wasn't an ambush by the older students, then quickly scuttling into a corner near the stage. Next came the year ten and eleven pupils who were used to sneaking round at night and had stopped off at the kitchens for a midnight snack. Finally came the year nines who shuffled grumpily in and sat on the tables at the back complaining about how they need to sleep. Pupil School :: Papers Pupil School The whole building seemed to moan in pain as the merciless wind battered it's crumbling walls. The Hayes boarding school had just called lights out. Mr Branston, the head teacher, doddered down the corridor at a snails pace rattling his cane across every radiator he walked past in an attempt to intimidate the students. He was making sure the dormitories were locked down and secure, but he was too drunk to check any locks properly. So he stumbled blindly back to his office to finish off the whiskey. As the rattling faded and finally ceased small lights could be seen through the dusty cobwebbed windows of the dormitories and the murmuring of whispered speech could be heard through the thin walls. Word had gone round school through word of mouth and notes passed in class that Norris had organised a meeting in the gym that very night. So as the school fell silent the children crept to the gym where Norris, or Gregory Norris as he was known to the teachers, stood waiting on the stage. He was hugely respected by the students and despised by the teachers. He held the record for the most detentions in a row after getting one hundred and thirty five for setting Mr Branstons wig alight during a chemistry class in year eight. He had dark messy hair and light brown eyes, which seemed to stare right through you as he spoke. He stood tall on the stage watching over the students as they entered the hall. First to arrive were the year seven and eight pupils looking warily around to make sure that the meeting wasn't an ambush by the older students, then quickly scuttling into a corner near the stage. Next came the year ten and eleven pupils who were used to sneaking round at night and had stopped off at the kitchens for a midnight snack. Finally came the year nines who shuffled grumpily in and sat on the tables at the back complaining about how they need to sleep.

Qualitative Research or Quantitative Research Essay

Both qualitative and quantitative research methods have their specific qualities which make them useful to a researcher, however in the course of this short essay I will explain why, for several reasons, qualitative research is better. As both methods operate within different assumptions, it is important to stem criticism for each method’s respective theoretical base in order to adequately judge them. In the course of this essay I will highlight each method’s theoretical assumptions and then I will assess each method by pointing out their positive and negative factors. The underlying assumption behind qualitative research is that the entire subject needs to be examined in order to understand the phenomenon. Quantitative research however, places importance in collecting and analyzing data from parts of a trend and in so doing, can miss important aspects which could lead to a complete understanding of the whole phenomenon. ‘There’s no such thing as qualitative data. Everything is either 1 or 0†²(Fred Kerlinger: 1999)Unlike quantitative research, there is no overarching framework for how qualitative research should be conducted; rather each type of qualitative research is guided by the particular philosophical stances that are taken in relation by the research to each phenomenon (Miles & Huberman: 1994, p. 40) This enables qualitative research to be more involved with the subject at hand whereas quantitative research has the same rules which it applies to every subject matter, thus making it easier to overlook important evidence. As the researcher using qualitative methods becomes entirely immersed in the data collection phase of the project, he himself actually becoming the data collection tool as opposed to the questionnaires and equipment used by quantitative researchers, it allows him to gain a better understanding of the subject matter as a whole and observe the subject in its own environment:Human behaviour is significantly influenced by the setting in which it occurs; thus one must study that behaviour in situations. The physical setting  ¬e.g., schedules, space, pay, and rewards  ¬and the internalized notions of norms, traditions, roles, and values are crucial contextual variables. Research must be conducted in the setting where all  the contextual variables are operating. (Marshall & Rossman: 1980)Quantitative research disregards these valuable contextual variables as most of the work is done in a laboratory with the researcher using the principles of impartiality and an objective portrayal of the subject. In conclusion, qualitative research is better than quantitative research because it places emphasis upon the subject itself by studying it in an in-depth manner and becoming involved with it on a personal level. Quantitative research keeps a level of impartiality with the subject matter thus making it neglect important contextual factors crucial to the research itself. 1.Using British Election Study data for example, why is it problematic to do quantitative research on ethnic minorities?It is problematic to do quantitative research on ethnic minorities because the standard deviation is so small, thus the observations are spread out over a very small sample which would not accurately represent the entire ethnic group. There is such a small valid percent that subjects would need to be targeted as they are unlikely to be caught during random sampling. 2.Providing either hypothetical and/or published examples, how accurate is it to label content analysis as a quantitative method?It is quite accurate to label content analysis as a quantitative method for several reasons. The comparisons of their theoretical patterns are numerous and therefore it has more in common with quantitative than qualitative methods. In the course of this short essay I will explain why it is accurate to label content analysis as a quantitative method by using an example of research employing content analysis and pointing out the similarities between the two. Content analysis has been described as:’Any technique for making inferences by objectively and systematically identifying specified characteristics of messages’ (Holsti: 1969 p. 14)Compare this with a definition of quantitative research:’The aim is to classify features, count them, and construct statistical models in an attempt to explain what is observed. It is objective – seeks precise measurement & analysis of target concepts.’ (Miles  & Huberman: 1994, p. 40)Both of these definitions contain the term objective, which shows that both of the methods share the core aspect of non-interference with subjects:’Content analysis is often referred to as an unobtrusive method'(Bryman: 2008, p. 289)This key concept lies at the heart of both content analysis and quantitative research methods, it is an obvious similarity. In Shephard’s study of the dynamics between the party, candidates and constituencies he used content analysis on party leaflets to spot recurring trends. His method (content analysis) bears a striking resemblance to quantitative research, for example both methods begin with hypotheses and theories, Shephard choosing to ask whether emphasis in leaflets matches the profile of the constituents. He then made two hypotheses stating that -the higher the unemployment rate the higher the emphasis on jobs and job creation and the higher the home ownership, the higher the emphasis on interest rates and mortgages. Quantitative research methods also start off with hypotheses and theories; therefore it is clear to see that content analysis could be labelled quantitative due to this fact. Furthermore, both methods of research have a high level of transparency because they are both highly structured and systematic in their approach. Shephard stated that to conduct his analysis ‘objectively and systematically’ (two quantitative features) that he had to identify his sample, sample period, text/images and what words and images to count. This shows that both content analysis and quantitative research share ‘epistemologically grounded beliefs about what constitutes acceptable knowledge’ (Bryman: 2008, p. 155)In conclusion, it is accurate to label content analysis as a quantitative method due to the fact that it shares many features in common with quantitative research. These include, maintaining objectivity during the study, transparency and a systematic approach to research. These features indicate that content analysis is grounded in the same theoretical processes and philosophy as quantitative research. 3.Providing examples of focus group research from the literature, discuss the advantages and disadvantages of focus groups. Focus groups are a highly useful method of data collection but they have many advantages and disadvantages. I will discuss the advantages and disadvantages of focus groups in this essay and also consider real-life examples of focus group research to illustrate this. Focus groups can provide an insight into the way in which people organize and interpret knowledge as well as how people construe information. This is especially useful in the study of audience reception- how audiences receive different kinds of television and radio programmes, etc. Such a study was conducted by Morley in 1980 into how Nationwide, a popular television programme at the time, was received by specific groups of people. He noticed that different groups had different interpretations of the programmes which they had watched, which indicated that the meaning of the programme was based in the way it was watched and interpreted not in the programme itself. (Bryman: 2008, 475) This provides more information that a simple interview because the interviewee has the choice to respond to fellow participants and argue with them, leading the researcher to gain a greater insight into why they hold such beliefs and how strongly they feel about them. Another advantage of focus groups is that they can provide a more open environment to respond to questions by the way in which they are selected prior to the event. For example, Kitzinger notes in her research on HIV that any attempts at discussions about risks for gay men were blocked out by strong homophobic clamouring amongst homophobic men. (Kitzinger: 1994b in Bloor, et al: 2001, p. 20) Therefore focus groups consisting of specific groups such as male prostitutes, retirement club members, etc, provided a more relaxed environment in which views could be openly discussed without fear of being criticised for one’s beliefs. In addition to this, organising groups consisting of only HIV positive people meant that disclosure of a potentially stigmatising status could be overcome. (Bloor: 2001 p. 23)However focus groups also have their disadvantages, the most prominent one being the role of the researcher within the discussion- the way in which the focus group is designed, the pa rticipants selected to take part, where the meeting takes place, how the questions are worded and delivered and who the instigator is may affect the responses which are obtained. This raises  the question over the validity of the results as the researcher has less control over a focus group than he would over a one on one interview with respondents possibly talking amongst themselves on irrelevant issues, or the simple fact that they may get bored or have personality issues with other members of the group. (Walvis: 2003 p. 405)Another disadvantage of focus groups is the tendency of researchers to (either consciously or subconsciously) pick groups so that they align with pre-determined beliefs about a subject. One famous example of this was when Coca-Cola launched ‘New Coke’ in 1985 despite the fact that the focus groups had made it explicit that they would not like to see the traditional coke removed from the shelves. (Pendergast: 1993 and Greising: 1998) The taste-tests however had proved positive, but they had not been asked the vital question about how they would feel if traditional coke was removed from the shelves, this positive response was more in line with how the CEO of Coca-Cola felt about the product and it was launched based on the back of poorly conducted focus groups. The subsequent product was a massive failure and lost Coca-Cola a large share of the market; it was obvious that Coca-Cola had spent too much time and money on the plan to dismiss it on the results from focus group research at the last minute. One final disadvantage of focus groups is their limited spread of views; Morgan (1998) suggests that the average size of a group should be around six to ten people. This clearly cannot be representative of the population as a whole- Stephen Fisher and Robert Andersen (2005) state that in order to have a representative sample for one million people you would need, with a margin of error of 5%, 384 participants. Bibliography †¢Bloor, M. et al. (2001) Focus Groups in Social Research (London: Sage). †¢Bryman, A. (2008) Social Research Methods (2nd Ed.) (Oxford: Oxford University Press). †¢Greising, D. (1998) I’d Like the World to Buy a Coke: The Life and Leadership of Robert Goizueta (New York: Wiley)†¢Holsti, O.R (1969) Content Analysis for the Social Sciences and Humanities (Reading, Mass.: Addison-Wesley)†¢Kerlinger, F. Foundations of Behavioural Research (Nova York: Holt, Rinehart and Winston 1965)†¢Marshall, C., & Rossman, G. (1980). Designing qualitative research. Newbury Park, CA: Sage. †¢Miles & Huberman (1994, p. 40). Qualitative Data Analysis†¢Pendergast, M. (1993) For God, Country and Coca-Cola: The Unauthorised history of the World’s Most Popular Soft Drink (London: Weidenfeld & Nicholson)†¢Shephard, M. (2007) ‘Multiple Audiences, Multiple Messages? An Exploration of the Dynamics between the Party, the Candidates and the Various Constituencies’, Journal of Elections, Public Opinion and Parties†¢Walvis, T.H (2003), â€Å"Avoiding advertising research disaster: Advertising and the uncertainty principle†, Journal of Brand Management, Vol. 10, No. 6