Chest Pain

CHEST PAIN Chest Pain Overview If you are having severe pain, crushing, squeezing, or pressure in your chest that lasts more than a few minutes, or if the pain moves into your neck, left shoulder, arm, or jaw, go immediately to a hospital emergency department. Chest pain is one of the most frightening symptoms a person can have. It is sometimes difficult even for a doctor or other medical professional to tell what is causing chest pain and whether it is life-threatening. * Any part of the chest can be the cause of the pain including the heart, lungs, esophagus, muscle, bone, and skin. Because of the complex nerve distribution in the body, chest pain may actually originate from another part of the body. * The stomach or other organs in the belly (abdomen), for example, can cause chest pain. Potentially life-threatening causes of chest pain are as follows: Causes of Chest Pain 1. Heart attack (acute myocardial infarction): A heart attack occurs when blood flow to the arteries that supp ly the heart (coronary arteries) becomes blocked. With decreased blood flow, the muscle of the heart does not receive enough oxygen. This can cause damage, deterioration, and death of the heart muscle. . Angina: Angina is chest pain related to an imbalance between the oxygen demand of the heart and the amount of oxygen delivered via the blood. It is caused by blockage or narrowing of the blood vessels that supply blood to the heart. Angina is different from a heart attack in that the arteries are not completely blocked, and it causes little or no permanent damage to the heart. â€Å"Stable† angina occurs repetitively and predictably while exercising and goes away with rest. â€Å"Unstable† angina results in unusual and unpredictable pain not relieved totally by rest, or pain that actually occurs at rest. . Aortic dissection: The aorta is the main artery that supplies blood to the vital organs of the body, such as the brain, heart, kidneys, lungs, and intestines. Dissec tion means a tear in the inner lining of the aorta. This can cause massive internal bleeding and interrupt blood flow to the vital organs. 4. Pulmonary embolism: A pulmonary embolus is a blood clot in one of the major blood vessels that supplies the lungs. It is a potentially life-threatening cause of chest pain but is not associated with the heart. 5. Spontaneous pneumothorax: Often called a collapsed lung, this condition occurs when air enters the saclike space between the chest wall and the lung tissue. Normally, negative pressure in the chest cavity allows the lungs to expand. When a spontaneous pneumothorax occurs, air enters the chest cavity. When the pressure balance is lost, the lung is unable to re-expand. This cuts off the normal oxygen supply in the body. 6. Perforated viscus: A perforated viscus is a hole or tear in the wall of any area of the gastrointestinal tract. This allows air to enter the abdominal cavity, which irritates the diaphragm, and can cause chest pain. . Cocaine-induced chest pain: Cocaine causes the blood vessels in the body to constrict. This can decrease blood flow to the heart, causing chest pain. Cocaine also accelerates the progression of atherosclerosis, a risk factor for a heart attack. Causes of chest pain that are not immediately life-threatening include the following: 8. Acute pericarditis: T his is an inflammation of the pericardium, which is the sac that covers the heart. 9. Mitral valve prolapse: Mitral valve prolapse is an abnormality of one of the heart valves in which the â€Å"leaves† of the valve bulge into the upper heart chamber during contraction. When this occurs, a small amount of blood flows backward in the heart. This is believed by some to be a cause of chest pain in certain people, although this has not been proven with certainty. 10. Pneumonia: Pneumonia is an infection of the lung tissue. Chest pain occurs because of inflammation to the lining of the lungs. 11. Disorders of the esophagus: Chest pain from esophageal disorders can be an alarming symptom because it often mimics chest pain from a heart attack. (a)Acid reflux disease (gastroesophageal reflux disease, GERD, heartburn) occurs when acidic digestive juices flow backward from the stomach into the esophagus. The resulting heartburn is sometimes experienced as chest pain. (b)Esophagitis is an inflammation of the esophagus. (c)Esophageal spasm is defined as excessive, intensified, or uncoordinated contractions of the smooth muscle of the esophagus. 12. Costochondritis: This is an inflammation of the cartilage between the ribs. Pain is typically located in the mid-chest, with intermittently dull and sharp pain that may be increased with deep breaths, movement, and deep touch. 13. Herpes zoster: Also known as shingles, this is a reactivation of the viral infection that causes chickenpox. With shingles, a rash occurs, usually only on one small part of the body. The pain, often very severe, is usually confined to the area of the rash. The pain may precede the rash by 4-7 days. Risk factors include any condition in which the immune system is compromised, such as advanced age, HIV, or cancer. Herpes zoster is highly contagious to people who have not had chickenpox or have not been vaccinated against chickenpox for the five days before and the five days after the appearance of the rash. HEART ATTACK A heart attack is caused by coronary heart disease, or coronary artery disease. Heart disease may be caused by cholesterol build-up in the coronary arteries (atherosclerosis), blood clots, or spasm of the vessels that supply blood to the heart. Risk factors for a heart attack are:- (a) High blood pressure (b) Diabetes (c) Smoking (d) High cholesterol (e) Family history of heart attacks at ages younger than 60 years, one or more previous heart attacks, male gender (f) Obesity (g) Postmenopausal women are at higher risk than premenopausal women. This is thought to be due to loss of the protective effects of the hormone estrogen at menopause. It was previously treated by hormone supplements (hormone replacement therapy, or HRT). However, research findings have changed our thinking on HRT; long-term HRT is no longer recommended for most women. (h) Use of cocaine and similar stimulants. Angina Causes 1. Angina may be caused by spasm, narrowing, or partial blockage of an artery that supplies blood to the heart. 2. The most common cause is coronary heart disease, in which a blood clot or buildup of fatty material inside the blood vessel (atherosclerosis) reduces blood flow but does not completely block the blood vessel. 3. Angina can be triggered by exercise or physical exertion, by emotional stress, or by certain heart rhythm disorders (arrhythmias) that cause the heart to beat very fast. Aortic Dissection Causes Aortic dissection may be caused by conditions that damage the innermost lining of the aorta. (a)These include uncontrolled high blood pressure, connective-tissue diseases, cocaine use, advanced age, pregnancy, congenital heart disease, and cardiac catheterization (a medical procedure). (b) Men are at higher risk than women. (c) A similar condition is aortic aneurysm. This is an enlargement of the aorta that can rupture, causing pain and bleeding. Aneurysms can occur in the aorta in the chest or the abdomen. Pulmonary Embolism Causes Pulmonary embolism risk factors include: (a)Sedentary lifestyle, (b)Obesity, (c)Prolonged immobility, (d) Fracture of a long bone of the legs, (e) Pregnancy, (f)Cancer, (g) History or family history of blood clots, (j)Irregular heartbeat (arrhythmias), (k) Heart attack, (l)Congestive heart failure. Spontaneous Pneumothorax Causes 1. Spontaneous pneumothorax (collapsed lung) occurs when the pressure balance between the sac that contains the lung and the outside atmosphere is disrupted. 2. Injury to the chest that pierces through to the lung sac is the most common cause of this condition. This can be caused by trauma, as in a car wreck, bad fall, gunshot wound or stabbing, or in surgery. 3. Some very thin and tall people may suffer a spontaneous pneumothorax due to stretched lung tissues and abnormal air sacs in the upper portions of their lungs. It is possible for these abnormal air sacs to rupture with even a sneeze or excessive coughing. 4. Other risk factors for pneumothorax include AIDS-related pneumonia, emphysema, severe asthma, cystic fibrosis, cancer, and marijuana and crack cocaine use Perforated Viscus Causes Perforated viscus may be caused by direct or indirect injury. Irritation to the diaphragm in this case comes from below the chest. The diaphragm is the muscle that allows us to breathe. It is located up under the ribs and separates the chest and abdominal cavity. Any irritation to the diaphragm, even from below it, can cause pain to be felt in the chest. Risk factors not related to trauma are: (a)Untreated ulcers, * (b)Prolonged or forceful vomiting, * (c)Swallowing a foreign body, * (d)Cancer, * (e)Appendicitis, * (f)Long-term steroid use, (g)Infection of the gallbladder, * (h)Gallstones, and * (j)AIDS. * * * Pericarditis Causes Pericarditis can be caused by viral infection, bacterial infection, cancer, connective-tissue diseases, certain medications, radiation treatment, and chronic renal failure. (a) One life-threatening complication of pericarditis is cardiac tamponade. Cardiac tamponade is an accumulation of fluid around the heart. This prevents the hear t from effectively pumping blood to the body. Symptoms of cardiac tamponade include sudden onset of shortness of breath, fainting, and chest pain. Pneumonia Causes Pneumonia may be caused by viral, bacterial, or fungal infections of the lungs. Esophagus Related Causes Chest pain originating from the esophagus may have several causes. Acid reflux (GERD) may be caused by any factors that decrease the pressure on the lower part of the esophagus, decreased movement of the esophagus, or prolonged emptying of the stomach. This condition may be brought on by: (a)Consumption of high-fat foods, (b)Nicotine use, (c)Alcohol use, (d)Caffeine, pregnancy, (d) Certain medications (for example, nitrates, calcium channel blockers, anticholinergics, estrogen, progesterone), (f)diabetes, g)scleroderma. (h) Esophagitis may be caused by yeast, fungi, viruses, bacteria, or irritation from medications. (j) Esophageal spasm is caused by excessive, intensified, or uncoordinated contractions of the smooth muscle of the esophagus. Spasm may be triggered by emotional upset or swallowing very hot or cold liquids. Heart Attack Symptoms Typical heart attack pain occurs in th e mid to left side of the chest and may also extend to the left shoulder, the left arm, the jaw, the stomach, or the back. Other associated symptoms are shortness of breath, increased sweating, nausea, and vomiting. Women may experience symptoms of heart attack similar to men (chest pain), but they also may be more atypical. Atypical symptoms include: (a) Neck pain (b) Jaw pain (c) Shoulder pain (d) Upper back (e) Abdominal discomfort, (f) Shortness of breath, (g) Nausea or vomiting, (h) Abdominal pain, (j)Heartburn, (k) Sweatiness, (l) Light-headedness, (m) Dizziness, or (n) Unexplained fatigue. * Angina Symptoms Angina is similar to heart attack pain but occurs with physical exertion or exercise and is relieved by rest or nitroglycerin. Angina becomes life threatening when pain occurs at rest, has increased in frequency or intensity, or is not relieved with at least three nitroglycerin tablets taken five minutes apart. This is considered to be unstable angina, which may be a warning sign of an impending heart attack. Aortic Dissection Symptoms The chest pain associated with aortic dissection occurs suddenly and is described as â€Å"ripping† or â€Å"tearing. † The pain may radiate to the back or between the shoulder blades. Because the aorta supplies blood to the entire body, symptoms may also include: (a)Angina-type pain, (b)Shortness of breath, (c)Fainting, d)Abdominal pain, or (e)Symptoms of stroke. Pulmonary Embolism Symptoms Symptoms of a pulmonary embolus include: The sudden onset of shortness of breath, rapid breathing, and sharp pain in the mid chest, which increases with deep breaths. Symptoms of pneumothorax include: The sudden onset of shortness of breath,sharp chest pain, rapid heart rate, dizziness, lightheadedness, or faintness. Perforated Viscus Symptoms Perforated viscus comes on suddenly with severe abdominal, chest, and/or back pain. Abdominal pain may increase with movement or when breathing in and may be accompanied by a rigid, boardlike abdominal wall. Pericarditis Symptoms The pain of pericarditis is typically described as a sharp or stabbing pain in the mid-chest, worsened by deep breaths. pain may mimic the pain of a heart attack, because it may radiate to the left side of the back or shoulder. One distinguishing factor is that the pain is worsened by lying flat and improved by leaning forward. When lying flat, the inflamed pericardium is in direct contact with the heart and causes pain. When leaning forward, there is a space between the pericardium and the heart. people report a recent cold, fever, shortness of breath, or pain when swallowing just before developing pericarditis. Mitral Valve Prolapse Symptoms Mitral valve prolapse usually has no symptoms, but some people experience palpitations (sensation of rapid or strong heartbeat) and chest pain. Chest pain associated with mitral valve prolapse differs from that of typical angina in that it is sharp, does not radiate, and is not related to physical exertion. Other symptoms include fatigue, light-headedness, and shortness of breath. Complications include infection of the heart valves, mitral valve regurgitation (an abnormal blood flow within the chambers of the heart), and abnormal heart rhythms, which rarely cause sudden death. Pneumonia Symptoms The chest pain of pneumonia occurs during prolonged or forceful coughing. The pain is usually one-sided an is worsened by coughing. Other associated symptoms include fever, coughing up mucus (sputum), and shortness of breath. Esophagus Related Symptoms With chest pain originating from the esophagus, symptoms depend on the source. * (a)Symptoms of gastroesophageal reflux disease (GERD) include: (b)Heartburn, (c)Painful swallowing, (d)Excessive salivation, (e)Dull chest discomfort, (f)Chest pressure, or (g)Severe squeezing pain across the mid chest. h)You may feel uncomfortable or may experience: (j)Profuse sweating, (k)Pallor, (l)Nausea, and (m)Vomiting. Symptoms of esophagitis include difficulty swallowing, painful swallowing, or symptoms of GERD. The chest pain comes on suddenly and is not relieved by antacids. The pain of esophageal spasm is usually intermittent and dull. It is located in the mid-chest and may radiate to the back, neck, or shoulders. DIAGNOSIS He art Attack In the hospital emergency department, the healthcare providers use three basic procedures to decide if a patient is having a heart attack. (a) The first is the symptoms reported by the patient. * (b) The second is an electrocardiogram (ECG or EKG), an electrical tracing of the heart's activity. On the ECG, it may be possible to tell which vessels in the heart are blocked or narrowed. * (c) The third is measurement of enzymes produced by the heart muscle cells when they do not receive enough oxygen. These enzymes are detectable with blood tests and are called cardiac enzymes. Angina Angina is diagnosed by the same methods doctors use to diagnose heart attacks. In angina, the test results reveal no permanent damage to the heart. The diagnosis is made only after the possibility of a heart attack has been ruled out, usually by negative results on three sets of cardiac enzyme tests. the ECG may show abnormalities, these changes are often reversible. * Another way to diagnose angina is the stress test: these tests monitor your ECG during exercise or other stress to identify blockages in blood vessels to the heart. * Cardiac catheterization is used to identify blockages. This is a special type of x-ray (angiography or arteriography) that uses a harmless dye to highlight blockages or other abnormalities in blood vessels. Aortic Dissection The diagnosis of aortic dissection is based on the symptoms the patient describes, chest x-ray, and other special imaging tests. On a chest x-ray, the aorta will have an abnormal contour or appear widened. * Transesophageal echocardiography is a specialized ultrasound of the heart in which a probe is inserted into the esophagus. The technique is performed under sedation or general anaesthesia. The dissection may be identified very accurately by a CT scan of the chest or angiography. * * Pulmonary Embolism * * The diagnosis of pulmonary embolism is made from a variety of sources. Description of the patient's symptoms and results of ECG and chest x-ray all may contribute to the diagnosis, but are not definitive. patient will be asked if they have had any symptoms of a blood clot in the leg. The healthcare provider may draw blood drawn from the patient's artery to check the levels of oxygen and other gases. Abnormalities in blood gases indicate a problem in the lungs that is preventing the patient from getting enough oxygen. A ventilation-perfusion scan (V/Q scan) compares blood flow to oxygen intake in different segments of the lung. An irregularity in just one segment can indicate an embolism. CT scan of the lungs is another way to determine if a patient has a pulmonary embolus. It may be done instead of the V/Q scan. Spontaneous Pneumothorax Spontaneous pneumothorax is diagnosed by physical exam and chest x-ray. A CT scan may be helpful in locating a small pneumothorax. Perforated viscus usually can be identified by a chest x-ray with the patient standing upright or an abdominal x-ray lying on the left side. -rays in these positions allow air to rise to the diaphragm, where it can be detected. The symptoms and the results of the physical exam and other lab tests also assist in diagnosis. * Pericarditis * * Acute pericarditis is usually diagnosed by the patient's symptoms, serial ECGs, and echocardiography. Certain lab tests may be helpful in determining the cause. * * Pneumonia Pneumonia is diagnosed by the patient's symptoms and medical history, physical examination, and chest x-ray. Esophagus Disorders of the esophagus causing chest pain are diagnosed by a process of el imination. The diagnosis is made on the basis of the patient's symptoms and medical history, after ruling out cardiac causes and observing whether the patient experiences pain relief from antacids. Chest Pain Treatment Self-Care at Home Heart Attack If you suspect that you or someone you are with may be having a heart attack, call for emergency services or go to the nearest hospital emergency department. * While waiting for the ambulance, have the patient chew two baby aspirin or at least half of a regular aspirin – at least 160 mg. There is no evidence that taking more than this helps more, and the patient could have unwanted side effects if they take too much. * It is important to chew the aspirin before swallowing it because chewing decreases the time the medicine takes to have an effect. Chewing an aspirin in the early stages of a heart attack may reduce the risk of death and it may also reduce the severity of the attack. Angina If the patient has had angina and has nitroglycerin tablets available, have the patient place one under the tongue. This may aid in increasing blood flow to blocked or narrowed arteries. If the chest pain continues in the next five minutes, take another tablet under the tongue. If, after three nitroglycerin tablets, the patient does not have relief of the chest pain, go to the nearest emergency department. Esophagus the pain is from acid reflux (GERD), it may be relieved with antacids. Even if the patient's pain goes away after taking an antacid, do not assume they are not having a heart attack. The patient should still be evaluated in a hospital emergency department. Medical Treatment Heart Attack Treatment 1. Treatment for a heart attack is aimed at increasing blood flow by opening arteries blocked or narrowed by a blood clot. * 2. Medicines used to achieve this include aspirin, heparin, and clot-busting (thrombolytic) drugs. * 3. Other medications can be used to slow the heart rate, which decreases the workload of the heart and reduces pain. * 4. Angioplasty is a way of unblocking an artery. Angiography is done first to locate narrowing or blockages. A very thin plastic tube called a catheter is inserted into the artery. A tiny balloon on the end of the catheter is inflated. This expands the artery, providing a wider passage for blood. The balloon is then deflated and removed. Sometimes a small metal scaffold called a stent is placed in the artery to keep it expanded. * 5. Surgery may be required if medical treatment is unsuccessful. This could include angioplasty or cardiac bypass. * * Angina Treatment * * Treatment of angina is directed at relieving chest pain that occurs as the result of reduced blood flow to the heart. The medication nitroglycerin is the most widely used treatment. Nitroglycerin dilates (widens) the coronary arteries. It is often taken under the tongue (sublingually). People with known angina may be treated with nitroglycerin for three doses, five minutes apart. the pain remains, nitroglycerin is given by IV, and the patient is admitted to the hospital and monitored to rule out a heart attack. Long-term treatment after the first episode of angina focuses on reducing risk factors for atherosclerosis and heart disease. Aortic Dissection Treatment 1. Suspected aortic dissection often is treated with medications that reduce blood pressure. 2. Medications that slow the heart rate and dilate the arteries are the most widely used. * 3. Close monitoring is required to avoid lowering the blood pressure too much, which can be dangerous. * 4. Surgical repair is required for any dissection that involves the ascending (upward) portion of the aorta. * * Pulmonary Embolism Treatment * * 1. Anyone with a presumed or documented pulmonary embolism requires admission to the hospital. * * 2. Treatment usually includes supplemental oxygen and medication to prevent further clotting of blood, typically heparin. * * 3. If the embolism is very large, clot-busting medications are given in some situations to dissolve the clot. * * 4. Some people undergo surgery to place an umbrella-like filter in a blood vessel to prevent blood clots from the lower extremities from moving to the lungs. * * Pneumothorax Treatment 1. A pneumothorax without symptoms involves six hours of hospital observation and repeat chest x-rays. * 2. If the size of the pneumothorax remains unchanged, the patient is usually discharged with a follow-up appointment in 24 hours. * 3. If the patient develop symptoms or the pneumothorax enlarges, they will be admitted to the hospital. The patient will undergo catheter aspiration or have a chest tube inserted to restore negative pressure in the lung sac. Perforated Viscus Treatment Any disruption or perforation of the intestinal tract (viscus) is a potentially life-threatening emergency. Immediate surgery may be required. Pericarditis Treatment Viral pericarditis usually improves with 7-21 days of therapy with nonsteroidal anti-inflammatory agents such as aspirin andibuprofen (for example, Motrin). Pneumonia Treatment Pneumonia is treated with antibiotics, and pain medication is given for chest wall tenderness. Costochondritis Treatment Costochondritis is usually treated with nonsteroidal anti-inflammatory medication such as ibuprofen. Esophageal Conditions Treatment The three major esophageal disorders that cause chest pain; 1) acid reflux (GERD), 2) esophagitis, and 3) esophageal spasm, are treated with antacid therapy; antibiotic, antiviral, or antifungal medication; medication to relax the muscles of the esophagus; or some combination of these. Follow-up No matter what the cause of chest pain, regular follow-up visits with your healthcare provider are important. This will help you remain as healthy as possible and prevent worsening of your condition. Prevention Heart Attack Prevention Prevention of heart attack and angina involves living what the American Heart Association calls a â€Å"heart healthy† lifestyle. Reducing your risk factors has a significant effect on reducing your risk. * (a) Don't smoke. * (b) Maintain a healthy weight. * (c) Eat nutritious, low-fat foods in moderate quantities. * (d) If you drink alcohol, use alcohol moderately. * (e) Engage in physical activity or exercise for at least 30 minutes every day. (f) Control high blood pressure and high cholesterol. * (g) If you have diabetes, control your blood sugar every day. Aortic Dissection Prevention Aortic dissection may be prevented by controlling high blood pressure and getting proper screening if the patient has a familial disposition to this disorder. Pulmonary Embolism Prevention (a) Prevention of pulmonary embolism includes living a heart healthy lifestyle. (b) No one should smoke, but women older than 35 years who use birth control pills are at especially high risk from smoking. c) When traveling on extended trips that require sitting for long periods of time (plane, car, train, etc. ) or other times of leg immobilization, get up and allow time for stretching and movement of the legs. Isometric contractions of the calves are helpful if getting out of the seat is not possible. * (d) If the patient has leg swelling, particularly if one is disproportionate to the other, see the doctor or healthcare provider. (e) You should always receive preventive anticoagulant medication after surgery, especially after orthopedic surgery. Spontaneous Pneumothorax Prevention Smoking cessation decreases the risk of spontaneous pneumothorax. Perforated Viscus Prevention Treating peptic ulcers appropriately and avoiding swallowing foreign bodies reduces the risk of perforated viscus. Pericarditis Prevention Because many cases of acute pericarditis are caused by viruses, effective handwashing may reduce transmission of infectious viral agents. Pneumonia Prevention Effective handwashing and good hygiene will help reduce the transmission of infectious viruses and bacteria that can cause pneumonia. Esophagus Disease Prevention (a) Acid reflux (GERD) can be prevented to a certain extent in most people. * (b) Avoid foods and other substances that bring on or worsen symptoms, especially fatty foods * (c) Stop smoking * (d) Use alcohol in moderation, if at all * (e) Avoid eating large meals * (f) Avoid eating for three hours before bedtime * (g) Avoid lying down right after eating * (h) Elevate the head of your bed Outlook Early medical intervention improves survival in potentially life-threatening illnesses involving chest pain. Heart attack and unstable angina: Heart disease, which includes heart attacks and angina, is the leading cause of death for American adults . Whether you survive a heart attack depends on the time it takes to get medical treatment, the region and extent of injury within the heart, and the presence of any other risk factors. Aortic dissection: This condition is life-threatening. Quick action in getting medical treatment is essential with aortic dissection. When left untreated, about 33% of patients die within the first 24 hours, and 50% die within 48 hours. The two week mortality rate approaches 75% in patients with undiagnosed ascending aortic dissection. Pulmonary embolism: Even with early treatment, 1 in 10 people with pulmonary embolism die within the first hour. It is treatable if it is not rapidly severe and caught early. Patients are often maintained on blood thinners as treatment. Pneumothorax: Most people with this condition recover fully as long as it is not associated with other life-threatening injuries (like in an auto accident). It occurs mostly tall, thin, young people without lung disease. Patients who have had one spontaneous pneumothorax have about a 50% chance of recurrence. Other illnesses causing pneumothorax and complications from the chest tube placement may prolong or worsen the condition. Perforated viscus: With early detection and intervention, the prognosis for perforated viscus is good in relatively healthy people. If you are in poor health prior to the perforation you will have a worse outcome. Acute pericarditis: Although the course may vary with each person, the outcome is good if the disorder is treated promptly. Most people recover in two weeks to three months. Pneumonia: In young, healthy adults, the prognosis for pneumonia is good with appropriate treatment. Prognosis is generally poorer in the elderly and in people with weakened immune systems such as those with HIV/AIDS. Chest pain originating from the esophagus: Reflux disease (GERD) affects about one-fourth of the adult population and has a very low death rate. Esophagitis may lead to ulcerations, scarring, or narrowing of the esophagus. With the exception of possible perforation, which has a high death rate, the overall prognosis is good. Esophageal spasm has a good outcome.

Deadly Feasts

Erica Dunyon Directed Readings Deadly Feasts by Richard Rhodes I have to admit, on the opening scene I was really skeptical about reading this book. I really have always hated the idea of cannibalism, so when I was reading and imagining this, in my mind one word came to my attention, â€Å"Disgusting! † Progression into the book, however, received my attention, and I continued forward. I enjoyed reading this book. It was very informative, easy to understand, and easy to read. I learned about various prion diseases and their effect on each species they infect.Deadly Feasts is about spongiform encephalopathies including Creutzfeldt-Jakob disease, Scrapies, Rida, Kuru, and mad cow disease. This book explains the relationships each spongiform disease has in common with each other, as well as their signs and symptoms. Mad cow disease and scrapies are quite similar to each other, and was endemic in Britain when this book was published. Another rare disease occurring in humans known as Creutzfeldt-Jakob disease has then been related to mad cow disease. Creutzfeldt-Jakob disease is one in which eats human brains. Kuru is thought to be another spongiform disease.Kuru was thought to be a result of sorcery. Initially when this disease was discovered, the belief was leaning toward this disease taking on a genetically transmissible role. After much research, it is known that it is a transmissible disease spread by the consumption of infected flesh. The extremely unusual thing about kuru, along with other spongiform encephalopathies, is that it lacks the presence of inflammation. Transmissible spongiform encephalopathies (TSEs) are also known as prion diseases. The infectious microbe in TSEs is a specific protein called prion protein.These prion proteins and proteins of the brain are extremely similar. This may be the reason these proteins are not detected by the immune system which is why they do not cause inflammation. These diseases are unique because they are impo ssible to kill. They have been exposed to virtually everything including, extreme temperatures and radiation, and still have the ability to infect and cause disease. Gajdusek believed that transmission of these spongiform encephalopathies was in the form of protein in diseased dead animals, including sheep and cattle that were fed to other cattle.Rhodes refers to a concept known as industrial cannibalism. This means that the supplements were made from dead cows. Despite the fact that cattle were coming down with a disease that decreases the cow population, supplements were still made with the remaining’s of diseased cattle and fed to other cattle. Transmission of this disease can occur months or even up to decades because the disease can incubate for the allotted time. Britain was responsible for the initiation of research in this epidemic group of diseases. Britain did not inform the public in regards to this disease.They also bought diseased animals for half of the market v alue. The British government banned individuals from feeding animal waste to other animals, in 1989 to limit the spread of these diseases. In addition to limitting the transmission of these diseases, as a safety measure, the FDA prevented industries from feeding cattle protein from dead sheep, cattle, and other susceptible diseased animals. Europe still has increasing cases of the disease, which it infects many various herds and species of animals, supporting that the epidemic disease is able to spread across the species barrier The British government, by making the wrong public health choices, has conducted a frightening natural experiment, allowing a lethal disease agent to spread through the human food supply, exposing the entire British population. † (Rhodes 97) America is trying to prevent the spread of spongiform disease transmission from Britain to the U. S. by manufacturing our own beef and meat products. Unfortunately, it would not be known if the disease has affected our population until it is a point when it might be too late. TSE’s are essentially unidentifiable until they progress to the point of brain damage. † (Rhodes 97) Spongiform diseases are still a known problem in the world, and the protection we give ourselves, or lack of protection is an issue brought up by Rhodes. Rhodes refers that spongiform diseases might be Britain's †new Black Death. † He states that the transmissible spongiform encephalopathies are public health problems and not only clinical. Transmission is controlled by actions of both social and institutional aspects.The term the â€Å"new Black Death† refers to the ease of the transmission of the disease. If the plan for eradication is not carefully planned and executed, transmissible spongiform encephalopathies can be a serious epidemically known disease that can cause many deaths. In conclusion, I recommend Deadly Feasts to all individuals, not necessarily limited to only those interest ed in microbiology. This book gives insight on a former, and always possible, group of diseases that can become epidemic at any time. I believe knowledge is power, so knowing about these diseases only contributes to public safety.

Awareness to the Health Problem of Violence Against Women

The American Nurses Association (ANA) supports education of nurses, health care providers and women in skills necessary for prevention of violence against women; assessment of women in health care institutions and community settings; and research on violence against women. ANA believes there is a need to increase awareness to the heath problem of violence against women, as well as reduce injuries and psychological misery associated with this crime. ANA believes health care professionals must be educated as to their role in the assessment, intervention, and prevention of physical violence against women. Further, ANA supports the YEAR 2000 Health Objectives, which cite the surveillance, prevention and intervention for violent behavior as a priority issue for the nation. Physical violence against women is behavior intended to inflict harm and includes, slapping, kicking, choking, punching, pushing, use of objects such as weapons, forced sexual activity and injury or death from a weapon. Physical violence is by definition, assault and it is a crime. Ninety-five percent of serious assaults by a spouse or intimate partner are men battering women. Abuse is the leading cause of injury to women and homicide a major cause of traumatic death to women. Physical violence against is pervasive and cuts across all ethnic, racial, religious, and socio-economic groups. Based on national survey results, 1. 8 million women are beaten by their husbands each year. Stated another way, one of every eight husbands assaults his wife at least once during a given year. Abuse during courtship and cohabiting relationships affects between 16 and 23 percent of all dating relationships. The FBI estimates that her male partner will physically assault one in two women during her lifetime. Frequently physical abuse begins during pregnancy with 25-30 percent of pregnant women reporting abuse prior to or during pregnancy. Pregnant women reporting abuse are more likely to deliver a low birth weight infant. Injuries to women sustained from abuse include contusions, concussions, lacerations, fractures and gun shot wounds. Emergency room records document that 22 to 35 percent of women presenting any complaint are there because of symptoms related to physical abuse. Some 1,000 women are killed each year by their male partner, almost always following years of physical abuse. The economic costs of interpersonal violence are high especially if a weapon is involved. The lifetime cost of firearm deaths and injuries are estimated at $23 billion in 1990 with more than 80 percent of the medical care costs borne by public funds. During the same year, injuries caused by interpersonal violence requiring hospitalization cost an estimated $80 billion. Because most physical violence between intimate partners goes underreported, the economic costs are grossly underrepresented. The American College of Obstetricians and Gynecologists, Surgeon General and Centers for Disease Control have forwarded recommendations that all women be routinely screened for physical abuse and offered counseling, education, advocacy and appropriate referrals. Year 2000 Health Objectives cite the surveillance, prevention for violent behavior as a priority issue for the Nation.  · Routine education of all nurses and health care providers in the skills necessary to prevent violence against women Routine assessment and documentation for physical abuse of all women in any health care institution or community setting  · Targeted assessment of women at increased risk of abuse including pregnant women and women presenting in emergency rooms.  · Education of all women as to the cycle of violence, the potential for homicide, and community resources for primary, secondary and tertiary prevention and care.  · Education of school age children and adolescents in public schools about relationships without violence and community resources for help. Research on violence against women, including the development and evaluation of nursing models for preventive assessment, intervention, and treatment for abused women, their children and perpetrators of violence. Partner abuse victims tend to obscure their victimization. They are acutely aware that disclosure of their dilemma will be met with defiance or minimization by their partner, friends, and relatives and by increased abuse by their partners. When a woman becomes independent financially and emotionally the abuse increases the violence by their partner. Some end results are women killing the abusive partner, most of the time it is in self- defense after a history of beatings. Studies have been performed in reference to domestic violence and the abuse of drugs and alcohol. Some abusers are abstainers, however, more are substance abusers than not. The present view is that abusers use alcohol and drugs as an excuse for their violence and drink when are about to become violent. Apparently there seem to be a connection between alcohol and drugs and the severity of violence committed against women. In contrast, victims of domestic violence tend to blame the abuse on the substances used rather than on the abuser personally. The victim acknowledges that they do not enjoy the abuse, but believe their partners philosophy that they deserve the abuse. Victims of domestic violence stay with their abusive partner due to economic status, fear of physical danger to themselves and their children, fear of losing children, lack of job skills, lack of alternative housing, lack of support from family members and friends, lack of information regarding alternatives, fear of court procedures, and fear of partner retaliation. The majority of women have poor self image, are lonely, embarrassed and tend to protect the abuser, they are insecure about themselves and believe their partner is sick and needs their help.  · Backache, abdominal pain, indigestion, headaches, hyperventilation, anxiety, insomnia, fatigue, anorexia, heart palpitations, injuries without explanations and embarrassment about them, hidden injuries to head and neck, internal injuries, genital injuries, scars, burn, joint pain or dislocation, numbness, hearing problems, or bald spots. Injuries from a belt, iron, raised ring, teeth, fingertips, cigarette, gun, or knife, jumpiness or flinching in the presence of the abuser, substance abuse/suicidal thoughts or attempts, denial of any problems in their relationship, lack of relationships of friends or family, isolation or confinement to home. Believing in family unity at all costs and in traditional stereotypes, an overzealous partner who does not want to leave spouse alone in an emergency care unit. Battered woman syndrome is being suggested as a sub classification of PTSD due to repetitive abuse being a serious threat to the victim†s health and life. Battered women report nightmares, flashbacks, recurrent fears of more violence, emotional detachment, numbness, startle response, sleep problems, impaired concentration, and hyper vigilance. Victims show reactions to chronic trauma, but no symptoms of psychopathology are present. How can we help? We can offer information and assistance to these individuals who are victimized by their partners. Recognizing the symptoms (listed above) is the first step in offering assistance. Make an assessment (length/frequency of abuse, types of abuse; physical, psychological, sexual, financial) and recommend the victim to available services offered in the surrounding area. Do not be judgmental, be objective, and non threatening, ask directly if abuse is occurring, identify the abusers behavior, acknowledge the seriousness of the abuse, help the victim to asses internal strengths, encourage use of personal resources, give the victims a list of shelters, police departments, legal assistance, and financial aid, allow the victim to choose his or her own options, teach victim to develop a safety/escape plan, tell the abuser to stop the abuse and get himself help, do not blame the victim, do not get angry with the victim, refuse no help to the victim even though they are not ready to leave the abuser, do not retaliate with the victim against the abuser, do not encourage the victim to leave the abuser before she is ready. It is however, important to assure the victims they are not alone and they do not deserve the abuse they have become accustomed to. We must impart to them that they have dignity and worth and acknowledge their mental and physical exhaustion, fears, ambivalence about the abusers and leaving, and their wish to help the abuser as well as themselves. The victim may want to try counseling with a community agency or a local pastor, do not discourage this, it is always the victims decision on how to go about, stopping the violence in their own life.

Black swan Essay Example | Topics and Well Written Essays - 2000 words

Black swan - Essay Example The movie was released by Fox searchlight pictures. (IMDb, n.d.). The black swan is a thriller that has actually portrayed the hidden reality of the ballet world. The director of the movie is widely known because of the creative depiction of his imagination. The movie is actually inspired by a popular play; the swan lake by Pyotr IIyich Tchaikovsky. The play is actually about a princess who is changed into a white swan by the curse of a witch; the princess falls in love with the prince but then commits suicide because the prince confesses his love for the black swan. The opening stage of the movie is seen with the ballerina on stage dressed in a white tutu, focused by a bright light whereas everything else seemed to be completely surrounded by darkness. The ballerina is approached by another dancer who moves her in a circular motion. The scene which was filled with serenity is at once transformed in to a scene of horror which gives a sense of control of the dancer over the ballerina. The feathered dancer twists and turns the ballerina in the opposite direction of the camera and then releases her at once leaving her in a state of ecstasy and contentment and then dances away into the far away, abating spotlight. Ever since the beginning of the movie the director clearly indicates the clash of personality between the lead actress and her inability to distinguish the reality from dream. Nina has always wanted to play the lead character in the play and this is what fuels her ambition and passion and this is what drives a person to achieve his dreams. The director has also tried to show to that there always comes a time when one’s personality must be overtaken by the other. The movie has also portrayed ambition through the protagonist of the movie whereby she transforms to another form. The movie has tried to replicate the themes of the swan lake because of

Designer Babies Research Paper Example | Topics and Well Written Essays - 2750 words

Designer Babies - Research Paper Example Parents should be allowed to modify their unborn child’s genes only for health reasons, and not cosmetic reasons. There are a number of parents who are not able to give birth to children. This is because it is proven scientifically that the baby will have a genetic disease and the baby will die when they are still young or in some instances the baby might even die before they are born. Parents always wish for the best when it comes to their baby and thus, they should be allowed to modify their unborn babies but only for health reasons. Recent research has shown that by use of various genetic techniques, parents can be assisted in preventing certain genetic diseases. Thus, these genetic techniques save the baby from undue suffering and death as well as assist in reducing emotional strain that is associated in bringing up an ill baby and also reduces medical costs significantly. This will evidently lead to happier parents and their babies. Further research done recently has prov en that there a number of parents who are giving birth to spare part children in few cases whereby if one baby suffers from a serious blood disease, the parents use IVF (In Vitro Fertilization) in selecting embryos in order to give birth to another baby who acts as a tailor-made, future bone marrow or blood donor. Such cases have shown that the baby will be born healthy and will assist the older baby stay well by being a donor (Bliss, 04). Where do we stop with enhancing and engineering unborn children? In instances like the spare part babies, it is unethical since doctors and parents are creating babies who act as an organ-donating factory and this should be discouraged at all cost. It is paramount to note that the fundamental issue of giving birth should be left to Mother Nature and when the spare part baby eventually grows up, they will be depressed once they discover that they born with the sole purpose of being an organ or blood donor. The principle behind giving birth is to ch erish and love the baby for what they are and not for what they can do for others (Naff, 08). Enhancing and engineering unborn children should strictly be done for health purposes only and not for cosmetic or spare part reasons. There is also a possibility of widening the already devastating imbalance between the poor and the rich since genetic techniques are extremely expensive and therefore only the rich can afford. This effectively means that only the rich will be able to eradicate genetic diseases in their families whereas the poor continue wallowing in the sea of genetic diseases (Murray and Dave Holmes, 11). The possibility of breeding a super-human race is indeed a reality since these designer babies will look down on those babies without genetic enhancements. Examples in reality are those people who are born with various disabilities and they are never comfortable when in the company of a normal person. They feel inferior and they also face intolerance. Thus, this discrimina tion against various people who are born with disabilities will evidently increase (Murray and Dave Holmes, 14). There is also the likelihood of parents being carried away in correcting perfectly healthy babies. This is possible since parents will always look for any opportunity to eliminate embryos since they have a gene for a particular disease and a dangerous trend will start

Comparison of the media systems between USA and China Essay

Comparison of the media systems between USA and China - Essay Example Media is an overall term used to identify the different types of mediums that enriches us with vital information and knowledge. It is a flow of information running throughout the society in a form of print, visual and audio mediums known as newspaper (newsletters, magazines and tabloids), television, radio and the Internet. These mediums play significant roles in communicating to the general public as an audience as well as changing their perception. Agencies in the advertising industry have seized the opportunity giving out repetitive messages of a place or brand that promises to improve people’s lives and make them better, suggesting cost saving plans, educating people about bank loans and investment opportunities, and suggesting cost effective medicines. In our everyday lives we witness how we rely on the different types of media to assist and change us in our day-to-day activities making information more accessible and convenient just at a click of a mouse or an arm stretc h away. The newspaper, also known as print media differs slightly to magazines, newsletters and tabloids. However, these mediums mainly showcase news, entertainment or advertisement related information to audiences. Newspapers have been around since the time of Julius Caesar in the form of government bulletins kick starting journalism and later giving way to radio as a medium of communication. Radio was a huge turning point in how information was relayed to the general public. It was the first form of communication medium that could transmit voice over a long distance. People depended and still depend on source of news and information from the radio.

Critically analyse and evaluate current research and literature Essay

Critically analyse and evaluate current research and literature relating to the significance of the presence and absence of ano-genital injuries in posr puberta - Essay Example Male have testosterone while female have estrogen and progesterone. The reproductive stage continues until old age both in male and in female and eventually these are the secondary sex characteristics and events of puberty. It is essential to remember that however, that it is the puberty that represents the beginning period of the reproductive system activity. (Marieb, 2002) The ano-genital area of the human body, sometimes referred to as â€Å"genito-anal† includes the anus and the genitals of both sexes. The genito-anal plays a vital role in pre-pubertal and post pubertal stages. Earlier, the certain part of the body is not taken into consideration unlike nowadays where certain diseases can de diagnosed through the examination of the anus and the genitals. The observations can also serve as indicators of the sexual abuse especially in women. Many of the characteristics of the ano-genital areas are further studied to show its significance in many other reproductive processes and development. The ano-genital areas of both male and female can be differentiated if these were abused or not. In pre-pubertal ano-genital area is most likely have the characteristic of none presence of warts, hematomas, and lacerations mostly in children. These are just some of the sign if the certain individual have been sexually abused. In post-pubertal stages, the ano-genital appears to be the opposite of that of the pre-pubertal. In female victims, bleeding and discharge in both genital and anal region are more visible. (Hobbs and Wynne, 1999) The ano-gential index (AGI) or the value of the distance between the anus and the genitals divided the body weight, is primarily the comparative tool between individuals (Barett, 2006). The ano-genital index is commonly used in boys who had been exposed in chemicals. Scientists believed that exposure to chemicals such as

Analyzing Understanding the War on Terror 3rd Edition Essay

Analyzing Understanding the War on Terror 3rd Edition - Essay Example It was probably then when the notion of America on war with terrorism took birth. Later on, George W. Bush, US President and other officials of USA having high ranks used this term of War on Terror extensively to show that America is against terrorism and the organisations that use weapons and keep armaments for the purpose of spreading terror. This campaign was started because these terrorist organisations were not only causing threat to USA but they are threatening to other countries as well. Such militant organisations are dangerous for humanity on the whole. The phrase of the war on terror is particularly used against militant Islamic organisations like al-Qaeda. On the other hand, the present President of USA Barack Obama does not use the terminology of war on terror officially as he makes use of the term Overseas Contingency Operation for the same idea as that of war on terror. But the term of the war on terror is still in use and is used by political persons in media and some parts of government also makes use of it e.g. Global War on Terrorism Service Medal. Some people believe that the term of the war on terror was introduced by the US President George W. Bush after the 9/11 terrorists attacks on the twin towers of USA. The term the war of terror is developed to show America’s clash with the people who have Islamic extremist thoughts. This term of the war on terror was selected by George W. Bush when the higher officials of USA wanted to introduce the term "global struggle against violent extremism† (Coaty and Babst, pp. 222–228). USA had already a strained relationship with Iraq and also with Afghanistan which was led by Taliban. This stress in relationship occurred as a result of Gulf War of 1991 but the situation worsened and the terrorists’ attacks on the Twin Towers on 9 September 2011 made the US President Bush to take some steps against terrorism. The attack on the Twin Towers is observed as the attack on humanity and not on USA alone. Terrorism is a problem which has threatened not only America but also its allies and other independent countries. Furthermore, after the 9/11 attacks on the Twin Towers the anthrax-laced letters which were sent to USA took the lives of five American people and it is thought to be the worst biological attack in the history of USA created by Islamist militant extremists, according to the Federal Bureau of Investigation (FBI). As these events occurred together so United States of America had to take an action. The union of happenings forced USA to make amendments in its foreign policy as well as domestic policy. As a consequence, American officials drafted USA Patriot Act and also developed Department of Homeland Security. These steps helped in the renovation of the security measures such as operation involving investigation and intelligence. Along with the alterations made in the domestic and foreign policy the President Bush ordered the Taliban government of Afghani stan to give Osama Bin Laden to the US government. It was suspected that Osama bin Laden was the hand behind these terrorists’ attacks and it is he who developed the whole plan of terrorism and executed it. Along with Osama bin Laden, US government wanted to capture other members of al-Qaeda which could be a threat for any further act of terrorism. But the government of Taliban did not accept the orders of President Bush which made US President to start operations of war against

The literature of exile and imaginary homelands in salman rushdie, Essay

The literature of exile and imaginary homelands in salman rushdie, bharati mukherjee, and v. s. naipaul - Essay Example The exile is not (he cannot be, he cannot exist) -- at least in the common Western conception of being -- but is rather the sum of competing and contradictory forces that play out over the surface of the exiles being, without ever constituting a rigid and single edifice. If the exile can be said to have a "being" at all, then, it can only be understood to be one that is based on the formation of certain circumstances, of history, of discourse, of culture--what Walter Benjamin might have called a "constellation."1 However, these very structures--history, discourse, culture--can no longer be considered looming edifices of constitutive control and hegemonic power, after the experience of the exile as portrayed in these novels they lose some of their force. For the strange logic of the exile invades these structrues too, works within them too, and they (the structures), like the exile, cannot be considered single, unitary, or stable. The exile steals from them their authority by the power of his or her interruption. The exile too follow this logic and the structure which both pervades the exiled individual, and which gives him or her the power for resistance. In the preceding analyses of the writings of Salman Rushdie, Bharati Mukherjee, and V. S. Naipaul, I have attempted to chart the trajectory of the logic of the exile as it passes through their writing. I have tried to put into the words (however problematically) the flow of constitution and dissolution that occurs on the boundary of both language and self, and which is what forms the particular literary power of these writers, and determines their placement as writers of the post-colonial situation. Now, in this conclusion, I would like to situate these various writers back into a dialogue with both the theory and practice of post-colonial scholarship, and attempt to see precisely how the various movements within and between the six texts that I have concentrated upon play themselves out against the wider background of the post-colonial situation. Perhaps more importantly, I wish to cement the argument I speculatively began in the preceding chapters that these three writers, though extremely different in matters of style, material, and/or execution, all present a seriously radical answer to the malaise that the post-colonial situation presents. They are certainly not, as some critics have presented them, writers who have benefited from the comforts of exile, and have been accepted into the mainstream of their chosen land (for Naipaul, England; for Mukherjee, the United States; for Rushdie, England and the United States ) unproblematically. None of them are conservative, nor are they apolitical. However, they do come to the notion of a post-colonial politics with a new mode of functioning and from a new place of departure. Their politics is not of the old kind, but of a markedly new and total aspect: the target of their revolutionary destruction cannot be put in such simple terms as party, nation or racial groups. Let us consider the various kinds of exile that make up the cast of characters within Midnight's Children, The Satanic Verses, Jasmine, The Holder of the World, The Mimic Men, and The Enigma of Arrival. In all cases these novels concentrate on the personal nature of the central character's exile. In

Developing Cross-Cultural Capabilities Essay Example | Topics and Well Written Essays - 3250 words

Developing Cross-Cultural Capabilities - Essay Example The company has its top management in the UK while it wants the rest of employees in the other countries to be locals. In the researcher's case, the manager would get adapted to the new culture easily. There are varieties of potential opportunities in the global markets. It requires managers of organizations to ensure there is the development of cross cultural capabilities. The managers should ensure their employees have the necessary knowledge that will see them blend well with foreign cultures. They have to conduct extensive research about foreign cultures. The lessons will ensure the employees have created sustainable working relations with the business community. They have to understand in depth the different communication styles and cultural patterns. The report recommends the top management of any organization has to engage in diversifying management. It will assist in creating an environment that promotes cross-cultural capabilities. It will assist in developing an interactive working environment. The report recommends for training and awareness of employees. It will play an important role in building cross-cultural capabilities. The report recommends for an organization that attracts, retain, and motivates its employees. It will be a means of the business improving its competitive margin. The business will be in a position to compete with highly competitive businesses in the global markets. Additionally, the organizations have to diversify its workforce in order to attract the top talents.

In Dr Jekyll and Mr Hyde and in The Fifth Child Essay Example for Free

In Dr Jekyll and Mr Hyde and in The Fifth Child Essay In Dr Jekyll and Mr Hyde and in The Fifth Child an outsider is progressively released into an existing society destroying peace and goodness as it comes In Dr Jekyll and Mr Hyde by Robert Louis Stevenson the outsider is Mr Hyde. Dr Jekyll is a very clever person who does not like having to be a good, respectable member of society and trying to live up to his reputation all the time. After living his life like this for a while and becoming ever more frustrated by living like this he uses his knowledge of drugs and medicine and Mr Hyde is born as the evil side of Jekylls personality. In The Fifth Child by Doris Lessing the outsider is a boy called Ben the fifth of five children from a couple called David and Harriet. David and Harriet wanted a happy family life with many children and a big house. This dream world was going fine until the outsider Ben is introduced. This essay is going to look at the similarities and differences between the two books and the two outsiders. The reader from the first time they are met views both Ben and Hyde as outsiders. Harriet just after she has given birth to Ben describes him as a troll or goblin This is certainly not the usual reaction a mother gives her new born child or creature as Harriet describes him. Ben was not like other new born babies he was muscular, yellowish, long his forehead sloped from his eyebrow to his crown. His hair grew in an unusual pattern from the double crown where started a wedge or triangle that came low on his forehead, the hair laying forward in a thick yellowish stubble. He did not look like a baby at all. The first time we meet Mr Hyde he is attacking a small child in the street trampled calmly over the childs body which is not normal practice for the normal man in the street. Stevenson makes this more horrific by saying it sounds nothing to hear but I think it does sound quite nasty to hear but it was hellish to see implying that it is much worse than it sounds. Mr Hydes appearance made the doctor who would usually have nothing to hold against Hyde turn sick and white with the desire to kill him. Later in the book Mr Utterson tries to describe Hyde there is something wrong with his appearance, something displeasing, something downright detestable. I never saw a man I so disliked and yet I scarce know why. He must be deformed somewhere, he gives a strong feeling of deformity, although I couldnt specify the point. All this suggests that Mr Hyde is not normal. Stevenson then goes to describe Hyde through his house and his front door. Mr Hydes house lies just past a market that is described as having an air of invitation, like rows of smiling sales women. Mr Hydes house is nothing like this being situated in a court and is one of a sinister block of buildings this description immediately makes you imagine a dark house with dark anti-social inhabitants. Stevenson then goes on to say the house showed no windows, nothing but a door on a lower story and the door which was equipped with neither bell nor knocker, was blistered and distained all of this is not actually just describing the house but Hyde as well. It says Hyde is a dark anti-social man that does not like visitors and does not generally fit in. In The Fifth Child there is also an object like Mr Hydes door used to describe, but this time peoples feelings and what is going on. This is the big table; it is used to show the state of the family and relationships. The table near the beginning of the book before Ben is born is full of people at Christmas who are all happy and Christmassy but when Ben is born less and less people come around until at the end of the book the table is totally empty apart from Harriet. Harriet is imagining what it used to be like before Ben was born with many people all enjoying themselves and how much better it would have been without him. Mr Hyde and Ben are both violent people. Mr Hyde had trampled over a small child in the street and killed an MP with a walking stick; both of these people were people that someone of Hydes age should have been stronger than, an old man and a small child. Ben had sprained his older brothers arm and attacked an older girl in the playground, both of these people should have been able to overpower someone of Bens age but Ben seems to be abnormally strong. When Ben was a small baby his mother did not breast-feed him like she did with her others because it hurt too much the child looked at her and bit, hard. This may suggest that Ben is more evil than Hyde in being able to attack people that should be stronger than him. Stevenson describes the event of Hyde trampling a small child in a different way to the way Lessing describes how Ben attacks a girl in the playground. Stevenson tells the story through Mr Enfield who is talking to Mr Utterson but Lessing uses Harriets thoughts to tell the story of Ben. Stevenson doesnt just describe what Hyde did to the girl he goes on and makes the incident more realistic and tries to compare Hyde with other things such as a juggernaut to provoke more feeling in the reader it sounds nothing to hear but it was hellish to see. Lessing on the other hand describes Bens actions almost as a series of bullet points, stating what he did and nothing else he had pulled her down, bitten her and bent her arm back until it broke. For this reason, that Stevenson used more description in parts of his book I can find parts of Dr Jekyll and Mr Hyde more believable and mare memorable. These parts of the two books also show how far apart they were written. In Dr Jekyll and Mr Hyde Stevenson uses the word juggernaut, which then meant a large unstoppable force but in todays world has become to be associated with large lorries. Also in Dr Jekyll and Mr Hyde there are few women and the ones we do hear about are servants or maids but in the Fifth Child there are many women and one of the most important people in the book, Harriet, is a woman. We also do not hear many people called by their first names in Dr Jekyll and Mr Hyde but in the Fifth Child last names are seldom used. The title of this essay I agree with most of except for the part that says, progressively released. This part of the statement is true for Dr Jekyll and Mr Hyde, as Mr Hyde is only really understood at the end of the book he is not easy to describe. In the Fifth Child Ben is thrown into the middle of everything suddenly and can even be different before he was bourn David felt a jolt under his hand. The second part of this statement destroying peace and goodness as it comes I totally agree with. In Dr Jekyll and Mr Hyde, Hyde causes Jekyll so much pain that eventually he commits suicide. In the Fifth Child Ben scares Harriet and David off having any more children and breaks the family apart by making some of Harriets other children go to boarding school and by making them go and live with relatives.

Ethical Decisions Scenario Analysis Essay Example for Free

Ethical Decisions Scenario Analysis Essay Reflection Question: Discuss whether you generally make ethical decisions using a traditional or a modern ethical model. Provide an example using an experience you have had in your daily life. I would have to say that what is right is right and what is wrong is wrong. Being true to oneself is ethically speaking. I used to get detention in HS and being an honor student really hurt me. Peer pressure was another feeling that couldn’t be surpassed. Stress and anxiety are add-ons to one’s life experience. I have both. Depression is yet another I have not really dealt with. These feelings are not mutual and do not come easily. Ethics are the study of moral standards and how they affect conduct, by definition. Traditional ethics are from the past and are from the way that people thought about morals and the way that life should be lived back then. Modern ethics came from traditional ethics, but were revised a bit to fit in with new times and with new ways of thinking. Ethics are a part of everyone’s lives. Both are similar, but I believe that the development with the two came from within a person. Someone did not just make up how a person feels inside. A person knows right from wrong from being taught. With that  being said, a person would know that stealing is wrong and that there would be something inside of them saying something like if you take that money from that person that is wrong and you will feel bad if you have good morals. Both forms of ethics have changed through the years and are now at what is called the modern ethics that we have adjusted to fit into today’s society. I would think that the biggest connection between the two forms of ethics is that it is based on morals and how a person feels deep down inside. I feel that it is based on what your heart tells you.

Intercontinental Hotels Group Analysis

Intercontinental Hotels Group Analysis Intercontinental Hotel Groups is an international hotel company that has a goal that it always aims at achieving is that to create Great hotels that the Guests love. Intercontinental hotels group which is also known in short form as IHG has more guest rooms available under their banner than any other hotel group. IHG has grown from a very small company to a massive company handling various branded hotel properties under its wings. IHG has more than 650.000 rooms in over 4,400 hotels across 100 countries the total stays that are done by guest in the IHG properties is over 130 million every year. 1(IHG website) With a clear view of what are its priorities, IHGs main purpose is creating Great Hotels Guests Love with everything done focused on the guest the staff. It operates hotels in three different ways as a franchisor, a manager and on an owned and leased basis. It also operates seven leading hotel brands InterContinental, Crowne Plaza, Hotel Indigo, Holiday Inn, Holiday Inn Express, Staybridge Suites and Candlewood Suites. It also manages the worlds largest hotel loyalty programme in the industry known as the, Priority Club Rewards, which has 48 million members worldwide. IHG is molded around these three regions: The Americas; Europe, Middle East and Africa; and Asia Pacific. 2(IHG Annual Report) 1 Strategic Corporate Development History of IHG: The formation of IHG has gone through various stages as any other company would have gone through which was taken successfully by William Bass who had a brewery in 1777 slowly but gradually entered in the hotel industry by acquisition of a breweries like the Mitchells Butlers in the 1960s which grew considerably large which when the government realized issued orders in legislations that breweries cannot hold on a large number of pubs which then made Bass reduce the pubs it owned dramatically which triggered a huge amount of cash flow which gave Bass an ability to develop an international hotel business which started with the acquisitions of a few hotel groups like Holiday Inn in 1988 also launched the Holiday Inn Express to be complementary to the Holiday Inn brand, side by side Bass grew his pub business side by side acquired The Harvester Chain of Restaurants in 1994 also launched its new brand of hotels known as Crown Plaza Hotels resorts climbing up to the upscale hotel mar ket. In 1996 bass tried to acquire  ½ of Carlsberg Tetley which again was hampered by the UK government which helps Bass to come back on line concentrate on the hotels pubs divisions leaving breweries aside. A year later in 1997 the hotel business focus becomes truly brand focused because Bass had already sold a few north American midscale hotels but held back to the brand name of the hotels through franchising agreements. Also that year Bass created launched a new brand of hotels known as the Staybridge Suites which was targeted at the upscale hotel market. Staybridge suites became the fastest brand in this upscale segment to reach 50 units in America. In 1998 Bass acquired the intercontinental hotel company, adding adding to its fold another upscale brand to its hotel portfolio. It was another considerable acquisition to cost saving synergies to the fold of hotel portfolio run by Bass. In 1999 Bass again acquired 550 handpicked high potential sites in UK also a strong 3500 strong pub estate from allied domecq. In 2000 Bass went on to acquire the Southern Pacific Corporation (SPHC) in Australia, which guaranteed Basss position as the leading hotel company in Asia Pacific. Later in the year Bass sold of his Bass breweries for 2.3 billion pounds. This was the final step by Bass to completely focusing on being the international hospitality retailer from being a domestic brewer a process which took a long period of 10 years to complete. Over the period of time Bass sold off name of bass and changed the name to Six Continents PLC. a name which it bettered into to reflect the global spread of the groups business. In the month of February 2001 Six Continents sold 988 of its smaller unbranded pubs for 625million pounds, which further funded the buying of the European Posthouse chain of hotels for 810million pounds. The acquisition of this company which had strategically placed hotels could be converted to Holiday Inn concentrating the Holiday Inn brand in UK Europe. Later that year it went on to acquire Intercontinental Hong Kong for 241 Million pounds strengthening its position in the Chinese Asia Pacific markets. On 1st October 2002 Six Continents Plc announced its separation of the groups hotel soft drinks businesses (to be called Inter Continental Group Plc) from the retail business (to be called Mitchells Butlers Plc) of which 700 million Pounds of the proceedings returned capital to shareholders. The whole procedure of separation was completed on the 15th of April 2003. Intercontinental Hotels Group Plc (IHG) from then on is a distinct, discrete company, listed in the UK US stock markets. In July 2003 IHG sold Staybridge Suites to Hospitality Properties Trust (HPT) entered into a 20year management agreement. Later in the year they added a midscale extended stay brand Candlewood Suites to its portfolio. In the year 2004 IHG announced the introduction of a new brand, hotel Indigo which focused on providing affordable boutique accommodation. In the same month, the group adopted new standards for selling and re-selling hotel rooms for guest stay through online travel companies. Following the success of the Up Scale market brand of Staybridge Suites North America IHG launched its extension of Staybridge suites to UK in April2005. Also in 2005 IHG went ahead disposed of its soft drinks 100% holdings in Britvic Plc. With this disposal IHG became a company with a pure hotel focus. In 2006 IHG went ahead signed a joint venture with All Nippon Airways (ANA), resulting the following projects IHG ANA hotels group Japan will be the largest international hotel operator in Japan, the worlds second largest hotel market. The deal saw the introduction of three new brands created for Japan. ANA-IHG, ANA-Crowne Plaza ANA Holiday Inn. In the year 2007 IHG announces that a worldwide relaunch of the Holiday Inn brand family, comprising Holiday Inn, Express by Holiday Inn Holiday Inn Express. The re launch was done with the intention of giving it a refreshed contemporary brand image. All the hotels were supposed to have completed the re launch in 2010 with the 1st re launch taking place in 2008. In the year 2008 after the re launches of Holiday Inn taking place Staybridge Suites extended its brand more in UK the first Hotel Indigo opened in London. In 2009 the1500th hotel was relaunched over the 40% of Holiday Inn Holiday Inn Express. Strategy used from the start to the current time period: Bass the main brain behind the whole formation of the Intercontinental Hotel Group has played a major role in the slow but steady growth of this company from a small company to a worldwide known company. Bass has grown this huge group through the basis of trial error round which he has experimented in various concepts of owning then selling then franchising finally managing properties. Bass has being following the linear model of growth through various acquisitions. InterContinental Hotels Group PLC was formed by the separation of Six Continents PLC (previously Bass PLC) on 15 April 2003. The restaurant and pubs part of Six Continents became Mitchells Butlers plc. However, IHGs brands trace their history back much further than 2003. Our Holiday Inn brand, one of the worlds most recognized was created in the 1950s by Kemmons Wilson in the US. InterContinental, another of our brands was created by Pan Am in the 1940s, when hotels were built in many of Pan Ams destinations. 3(ihg.com) Over the past few years, Intercontinental hotels group has maintained itself strategically to be more efficient and effective and make full use of their global status. A predominantly franchised and managed, fee-based business was the main focus of IHG. The strategy that IHG followed made their income stream predictable with a strong cash generation which allowed it to continue in growth because all their new hotels were funded by third-party investment. IHG went ahead and relaunched Holiday Inn in 2007 and although the unexpected economic circumstances that came by IHG during that time period, it went on and got on with the $1 billion programme because of the belief of the heads of IHG that it was exactly the right time to go ahead with the relaunches. The relaunch went on to building back peoples perceptions of Holiday Inn. The guest wanting to try Holiday Inn with IHG with its value theyre giving the Brand once down another try and liking and accepting what they found. Guest satisfaction was going up and owners could see the Revenue per rooms out perform. These economic circumstances might seem like a great reason to shy away from making such big changes, but time will show that it is both a very opportune and very effective initiative for this, our biggest brand, as quoted by the CEO of IHG Mr. Andrew Cosslett. 3 http://www.ihgplc.com/index.asp?pageid=40 Current strategy used by Intercontinental Hotels Group: Bass the main brain behind the whole formation of the Intercontinental Hotel Group has played a major role in the slow but steady growth of this company from a small company to a worldwide known company which currently has an operating strength of 4400 hotels with 130 million guests visiting a year and under its umbrella has and widely known and reputed hotel brands covering all the major segments of the market, also have a reservations system which consists of 10 call centers in 29 languages it has also strived to be the top leader in the market has been able to position itself through its strategy of growing doing retailing in hotel sector have been able to position itself among the 6 largest hotel market, much more than any other company. Intercontinental hotel group has also been able to make the no.1 website for its guests investors in 13 different languages. They also have a global sales team of 8000 to conduct the sales of the hotels situated all over the 100 countries that they have their presence. Intercontinental hotels also has a loyalty programme which offers priority club rewards which are largest in the industry for over 48milllion of the guests which has been planned so strategically that . It has been stated on IHGs website that We have moved from investing heavily in hotel properties to return to our roots as a hotel franchise and management company with only a few owned assets. This change of focus has led to an industry-leading asset sale programme. Since 2003 we have sold  £2.9 billion worth of property. Many of these hotels have remained under our brands with management or franchise contracts, thereby creating a future income stream for IHG 4 (ihg.com). Over the past few months, IHGs continued growth in new rooms has helped to put off some of the revenue lost from Revenue per room declines. Driving in coming revenue into the hotels had been a priority and its system is the key to delivering this. Their system comprises of world class reservations centres, websites, global sales teams and Priority Club Rewards loyalty scheme and delivered 68 per cent of rooms revenue to the hotels in 2009. Reducing the overall cost base of IHG was crucial to managing through the downturn. IHG was already reducing costs to run the properties more effectively but with the economic downturn they steeped up the pace of change that was being gradually run. While they were reducing costs by taking better advantage of their way of operation as well their spread being worldwide, this also forced them to make reductions in the number of staff which unfortunately impacted jobs of IHG staff all over in the majority of properties. All these actions were taken in 2009 to reduce costs, while it was a very difficult period of the economic downturn; it allowed IHG to save a lot of cash and continue its investments in those things that attract guests to come to its hotels and revenues to the owners. The great working relationship that IHG shares with the owners of their properties, both directly and through the IAHI, which is IHGs Owners Association, has also been major contributor to the quick recovery also to the massive expansion taking place. By working alongside with the hotel owners, IHGs able to focus on the guest experience and on delivering Great Hotels Guests Love. 5 (ihg.com). 4http://www.ihgplc.com/files/reports/ar2009/files/pdf/2009_Annual_Report.pdf 5http://www.ihgplc.com/index.asp?pageid=40 The 48 million members of IHGs Priority Club Rewards programme remained loyal though the economic downturn and had been most supportive during the difficult times. Not only did these guests stay with IHG more often, they spent more when they did. A guests loyalty can never be taken for granted it is something that can take years to achieve and seconds to lose. So IHG had made sure they have continued to add benefits to the loyalty programme right through the downturn, and made membership of it even more worthwhile. In 2009 it enrolled six million new members into the programme thats a significant number of people whose first choice will now be to stay in one of IHGs hotels. IHGs future growth will be achieved predominantly through franchising and managing rather than owning hotels which in turn will drive down costs increase profits by the fact that all the investment in the hotels would be done by third parties. Approximately 641,000 rooms operating under the Group brands are franchised or managed and 5,800 rooms are owned and leased. The franchised and managed fee-based model is attractive because it enables the Group to achieve its goals with limited capital investment at an accelerated pace. A further advantage is the reduced volatility of the fee-based income stream, compared with ownership of assets. A key characteristic of the franchised and managed business is that it generates more cash than is required for investment in the business, with a high return on capital employed. Currently 87% of continuing earnings before regional and central overheads, exceptional items, interest and tax is derived from franchised and managed operations. The Current Strategies followed by IHG Hotels Group: à ¢Ã¢â€š ¬Ã‚ ¢ 90% of deals signed in scale markets and key gateway cities; à ¢Ã¢â€š ¬Ã‚ ¢ 10 signings of Hotel Indigo and Staybridge Suites outside of North America; à ¢Ã¢â€š ¬Ã‚ ¢ 439 hotels opened globally. à ¢Ã¢â€š ¬Ã‚ ¢ Increased proportion of revenue delivery through IHG global reservations channels and PCR members direct by four percentage points to an average 68% of global hotel rooms revenue in 2009 à ¢Ã¢â€š ¬Ã‚ ¢ Major procurement savings made; à ¢Ã¢â€š ¬Ã‚ ¢ Increased use of offshore transaction processing; à ¢Ã¢â€š ¬Ã‚ ¢ Technology infrastructure developed to support owner management and loyalty marketing. à ¢Ã¢â€š ¬Ã‚ ¢Continued to cascade Great Hotels Guests Love in hotels and corporate offices; à ¢Ã¢â€š ¬Ã‚ ¢Meeting ongoing resourcing requirements to match hotel growth in scale markets; à ¢Ã¢â€š ¬Ã‚ ¢ Managing employee engagement; à ¢Ã¢â€š ¬Ã‚ ¢ Continued focus on attracting and retaining talent. 1,697 relaunched Holiday Inn and Holiday Inn Express hotels open around the world; à ¢Ã¢â€š ¬Ã‚ ¢ Industry-leading Priority Club Rewards (PCR) loyalty programme with 48 million members, contributing $5.6bn of global system rooms revenue à ¢Ã¢â€š ¬Ã‚ ¢Green Engage sustainability management system developed (patent pending); rolled out to over 900 hotels by 31 December 2009; à ¢Ã¢â€š ¬Ã‚ ¢Extensive consumer research undertaken to quantify green opportunity with consumers; and (IHG annual report) 3 Future strategies to be used by Intercontinental Hotels Group: IHGs prime focus should be on growing faster by making its brands the first choice for both guests and hotel owners. We will do this by building the hotel industrys strongest operating system, focused on the biggest markets and segments where scale really counts. 5 (ihg.com). During these tough economic times, IHG had taken decisive action both to strengthen the efficiency of its businesses and to keep their course with its growth strategy. IHG should continue to invest in its staff, its systems and its brands, while moving even closer in working relationships with its hotel owners and partners. With momentum and a united, winning spirit inside the business, IHG is well placed to make the most of the upturn when it comes. As quoted by the CEO of IHG Mr. Andrew Cosslett. IHGs Ambition IHG should focus on its core purpose of creating Great Hotels Guests Love as the moto has always been, which is a growing crave to deliver among other key performance indicators (KPIs), closely enduring top quartile shareholders returns when measured against a broad global hotel peer group. For the three-year period of 2007 to 2009, IHG was fourth among its peers on Total Shareholder Return (TSR) and should always remain focused and try to come to the 1st position. Measuring IHG against a collection of specific KPIs aimed at delivering its core purpose, cascaded to the hotel level. Successful performance against various combinations of these metrics would result in higher profitability.. IHGs Future Strategy: IHGs strategy has seen significant development through 2009 as it moved to make its core purpose a reality, despite challenging economic circumstances. In 2009, IHG took a hard look at its operations and capabilities to focus on what really matters most to deliver Great Hotels Guests Love. It has backed this up with a major effort to align its staff and measure the most important drivers, resulting in a clear, target-based programme within the hotels to motivate teams and guide behaviors. IHGs strategy encompasses two key aspects: Where does it choose to compete; and How will it win where it competes? The Groups underlying Where strategy is that IHG would grow a portfolio of differentiated hospitality brands in select strategic countries and global key cities to maximise the scale advantage. The How aspect of our strategy flows from our core purpose and our research at the hotel level as to what really makes a difference for guests. In support of this overall strategy there are key priorities like Where we compete and How we win. To help IHGs hotels and corporate staff measure their efforts in achieving Great Hotels Guests Love, IHG provides clear metrics aligned with the four How we win priorities against which progress is gauged. The Group strategy also translates into specific regional objectives and priorities. . IHGs Delivery System:C:UsersdDesktopUntitled.png Driving demand IHGs operating system is made up of all the things we do to drive demand for our brands. This includes our advertising and marketing campaigns, our 10 global call centres, 13 local language websites, an 8,000-strong sales force, Priority Club Rewards the worlds largest hotel loyalty scheme which has 48 million members and all the advantages that IHGs global hotel distribution and scale brings to brand awareness. Hotel distribution IHG has over 4,400 hotels in over 100 countries worldwide. Our brands are in the top 3 in 7 of the 12 largest hotel markets in the world. When people travel, they look for familiar brands they know from home, increasing the demand for hotels that operate under our brands around the world. Advertising and marketing Each year, IHGs franchisees pay a fee into a central fund. This fund is used on their behalf for marketing and promotions to drive guest demand for IHGs brands. Brand sponsorships, television and print advertising campaigns and public relations activity across the globe are all ways in which the fund can be used. Priority Club Rewards IHGs Priority Club Rewards is the largest hotel loyalty scheme in the world, with 48 million members. Web presence The 13 local language websites take over 7.4 million bookings a year theyre a shop window for the hotels across the world under IHG,s banner, 365 days a year. www.holiday-inn.com is one of the industrys most visited websites, notching up 75 million site visits in 2005. The websites operate in the following languages: Arabic, Chinese, Dutch, English, French, German, Hebrew, Italian, Japanese, Korean, Portuguese and Spanish. Reservation system IHG,s 10 global reservation offices are available to take hotel bookings from guests 24 hours a day in 26 languages including Arabic, Cantonese, Dutch, English, French, German, Hindi, Italian, Japanese, Mandarin, Portuguese, Spanish, Tagalog and Thai. They deal with 700 transactions per minute. Sales force IHG have a global sales force of more than 8,000 professionals throughout the world, talking about and selling the booking of hotels under our brands to individuals and companies. Considering the future strategy which is goin to be used to the growth achievement of IHG are as follows: Consumer understanding: As one of the worlds largest hotel groups, IHG has gained valuable insights into where and how consumers seek hotel information and make reservations across various channels and from various local, regional and global sources. This information has shaped the way we engage with our customers and enabled us to drive up returns for owners. Global Reservations System All IHG hotels benefit from the worlds most advanced reservation system Holidex Plus.The system links more than 230,000 terminals worldwide and processes over 130 million stays a year thats about 700 transactions per second. This is serviced by our 12 worldwide reservation centres which receive up to 14 million calls annually in 15 different languages. Global Distribution Systems (GDS) Our reservation systems also link with all the major GDS, the channel of choice for travel professionals and large corporate buyers. This gives us global around the clock access to the travel trade. IHG online Our websites continue to be a fast-growing reservation channel. They offer a comprehensive, customer-friendly and secure booking service in 13 languages and provide a low cost of sale. We receive more than 5 million unique web visitors per month and also benefit from the lowest clicks-to-book rate in the industry. Worldwide sales IHGs worldwide sales team is more than 8,000 strong. As well as generating new revenue, the team also manages key corporate and agent accounts and provides local hotel sales support to maximise revenue and keep IHG hotels top of mind. 6 (IHG.com) Some Of the Future Milestones to be achieved: à ¢Ã¢â€š ¬Ã‚ ¢ Continue international roll-out of Staybridge Suites and Hotel Indigo; à ¢Ã¢â€š ¬Ã‚ ¢ Execute growth strategies in agreed scale markets; à ¢Ã¢â€š ¬Ã‚ ¢ Continue to leverage scale and build improved strategic position during the economic downturn Increase global sales force effectiveness; à ¢Ã¢â€š ¬Ã‚ ¢ Continue further procurement programmes to identify efficiencies; à ¢Ã¢â€š ¬Ã‚ ¢ Begin migration to next-generation revenue management IT systems; à ¢Ã¢â€š ¬Ã‚ ¢ Continue focus on owned and managed estate margins and return on capital employed (ROCE), especially in our key InterContinental assets. à ¢Ã¢â€š ¬Ã‚ ¢ Drive greater efficiency and simplicity through better use of technology; à ¢Ã¢â€š ¬Ã‚ ¢ Focus on developing skills to support the key goals for responsible business, guest experience and financial returns. à ¢Ã¢â€š ¬Ã‚ ¢Complete Holiday Inn repositioning roll-out; à ¢Ã¢â€š ¬Ã‚ ¢ Continue to simplify brand standards process to improve owner returns without impairing guest experience; à ¢Ã¢â€š ¬Ã‚ ¢ Continue to enhance experience for PCR members in hotels and across global reservations channels; increase IHG business from PCR members à ¢Ã¢â€š ¬Ã‚ ¢Continue to roll out the Green Engage sustainability management system to 100% of our owned and managed hotels and expand into the franchised estate in all three regions; and à ¢Ã¢â€š ¬Ã‚ ¢ Focus on innovation within new and existing brands to deliver valued green related hotels and services to guests. (IHG annual report) 6 http://www.ihgplc.com/index.asp?pageid=293 BIBLOGRAPHY: 1http://www.ihgplc.com/index.asp?pageid=16 2http://www.ihgplc.com/files/reports/ar2009/files/pdf/2009_Annual_Report.pdf 3 http://www.ihgplc.com/index.asp?pageid=40 4http://www.ihgplc.com/files/reports/ar2009/files/pdf/2009_Annual_Report.pdf 5http://www.ihgplc.com/index.asp?pageid=40 6 http://www.ihgplc.com/index.asp?pageid=293

Gender Identity and Sexual Orientation Essay -- sexuality, biology, ch

In today’s day in age, different sexualities and gender identities are quickly becoming more accepted in mainstream society. Despite this change, there are many people who believe that having a different sexual orientation or gender identity is a choice that is frowned upon. In order to refute this belief, research and biology of the brain is necessary. Researching the brain on the basis of sexuality is a fairly new topic of discussion because it is somewhat difficult and confusing. This paper will explore the different identities of gender, sex and sexual orientation and the main biological reasons behind these. There is also some validity of different sexual orientations and identities through the evidence of sexual disorders like Klinefelter’s and Turner’s Syndrome and gender dysphoria. In order to discuss the biology of gender identity and sexual orientation, it is necessary to first examine the differences between multiple definitions that are often mistakenly interchanged: sex, gender, sexual orientation, and gender identity. Sexual orientation is defined by LeVay (2011) as â€Å"the trait that predisposes us to experience sexual attraction to people of the same sex as ourselves, to persons of the other sex, or to both sexes† (p. 1). The typical categories of sexual orientation are homosexual, heterosexual and bisexual. Vrangalova and Savin-Williams (2012) found that most people identify as heterosexual, but there are also groups of people that identify as mostly heterosexual and mostly gay within the three traditional categories (p. 89). This is to say that there are not three concrete groups, but sexual orientation is a continuum and one can even fluctuate on it over time. LeVay (2011) also defines gender as â€Å"the ... ...ved October 9, 2015 from http://www.mayoclinic.com/health/klinefelter-syndrome/DS01057. Swaab, D. F. & Garcia-Falgueras, A. (2009). Sexual differentiation of the human brain in relation to gender identity and sexual orientation. Functional Neurology, 24(1), 17-28. Turner Syndrome Society. (2011). Learn about TS: Fact Sheet. Turner Syndrome Society of the United States. Retrieved October 9, 2015 from http://turnersyndrome.org/learn-about-ts/fact-sheet Vrangalova, Z., & Savin-Williams, R. C. (2012). Mostly heterosexual and mostly gay/lesbian: Evidence for new sexual orientation identities. Archives of Sexual Behavior, 41, 85-101. doi: 10.1007/s10505- 012-9921-y. Zhang, S., Liu, Y., & Rao, Y. (2013). Serotonin signaling in the brain of adult female mice is required for sexual preference. Proceedings of the National Academy of Sciences, 110(24), 9968-9973.

Essay --

Review of Literature We live in a world where academic succession leads to better opportunities and a prosperous life. But in order to obtain academic language and understanding, a person has to be successful in reading. It is said you cannot do well and achieve in Science, Social Studies, and Math if you cannot read and apprehend what you read. How could you understand a Science lab report, how could you analyze a History article, and how could you solve a multiplication word problem if you cannot read? Reading is crucial. Learning to read begins at home. â€Å"Parents play a key role in their children’s literacy development and school success† (Piper, 2010, p.48). In a national survey of 22,000 public schoolteachers, 90 percent indicate that a lack of parental support is a problem (Carnegie Foundation for the Advancement of Teaching, 1988). In order for students to succeed academically in reading it is important for parents to get involve and assist their child with endless effort and time. Schools are required to educate a child, but teachers cannot do the job alone. More burdens are placed on teachers with less support from home (Lickona, 1991). This literature review was embarked on in an effort to investigate the question: how does parent involvement at home with reading fluency strategies affect students’ performance with automaticity and prosody? Researchers focus on ways to encourage and engage parents to get involve in their child’s education and disseminate what effects of parental involvement in reading have on the improvement of students’ reading fluency. This literature review scrutinize: ways to overcome obstacles or barriers of parental involvement, the importance of... ...hols, W. D., & Rickelman, R. J. (2000). Effects of parental involvement in developing competent readers in first grade. Reading Psychology, Vol.21 Issue 3, p. 195-215. Mapp, K. L. (2003). Having their say: parents describe why and how they are engaged in their children’s learning. School Community Journal, Vol.13, No.1, p. 35-64. Lincoln, USA: Academic Development Institute. Morrow, L. M., Kuhn, M. R., & Schwanenflugel, P. J. (2006). The family fluency program. The Reading Teacher, Vol.60, No.4, p.322- 333. Musti- Rao, S. & Cartledge, G. (2004). Making home an advantage in the prevention of reading failure: strategies for collaborating with parents in urban schools. Preventing School Failure, Summer 2004, Vol. 48, Issue 4, p. 15- 21 Piper, L. E. (2010). Parental Involvement in Reading. Illinois Reading Council Journal, Spring 2010, Vol. 38, No.2, p. 48-51.