KTG leader ship Essay Example for Free

KTG leader ship Essay Introduction An environmental analysis in strategic management plays a very important  role in businesses by pinpointing current and potential opportunities or threats outside the company in its external environment. The external environment includes political, environmental, technological and sociological events or trends that can affect the business directly or indirectly. The main objective in this report is an environmental analysis using all the factors and analyzing tools , generally conducted as part of an analysis of strengths, weaknesses, opportunities, and threats (SWOT) when a strategic plan is being developed. Managers practicing strategic management must conduct an environmental analysis quarterly, semi-annually, or annually, depending on the nature of the businesss industry focusing on the followings: Analyzing factors effectiveness on our organization as one of the biggest group in the healthcare services in the region. Organization sources and competitors. Organization values chain construction. SWOT analysis evaluation. Ref: http://www.wisegeek.com/what-is-the-role-of-environmental-analysis-in-strategic-management.htm , 2014 3.ANALYSING FACTOR EFFECTIVENESS: 3.1 Macro Environment Analysis: One of the best tools for considering trends in the Macro environment is the PESTEL analysis. (Figure 1) Figure 1 3.1.1Political factors: Since we are located here in the UAE, we have no taxation and this is one of the strength point we are depend on. but at the same time our administration team not recognizing that the minimum wages should be increased comparing with the other facilities and hospitals in our region as a big competitors. 3.1.2Economic: Economic factors include economic growth, interest rates, exchange rates and the inflation rate. These factors have major impacts on how businesses operate and make decisions. For example, interest rates affect a firms cost of capital and therefore to what extent a business grows and expands. Exchange rates affect the costs of exporting goods and the supply and price of imported goods in an economy. And since our organization as privet health care facility, based on the profit rate it takes in the consideration all these factors especially after it involved in the stock market last year. Beside that the new plan is to minimize the expenses that related to the interest exchange rate by following the centralization policy. ex. making one laboratory for all branches with a very controlled transportation system for sending the patients samples to the centralized laboratory instead of having a separate laboratory in each branch 3.1.3Social: Our organization as one of the privet hospitals in the region , is giving all the healthy activities, health care providing, never giving any changing as a demographic trends. We are doing outside activities supporting some certain people those who have a chronic disease like the diabetic patients to have more and more knowledge about themselves and how to take care about it. Ref(CBS course , topic 2 , page # 5) 3.1.4Technology: We are depending on the development of new technology to maintain competitiveness. Ex(opening new department of the Nuclear medicine for early Cancers diagnostics ) 3.1.5 Environment: factors include ecological and environmental aspects such as weather, climate, and climate change, which may especially affect industries such as tourism, farming, and insurance. Furthermore, growing awareness of the potential impacts of climate change is affecting how companies operate and the products they offer, both creating new markets and diminishing or destroying existing ones. Ref http://en.wikipedia.org/wiki/PEST_analysis According to our national regulations and environmental roles ,we are following the EHSMS(Emirates Health Safety Management System). 3.1.6 Legal  include discrimination law, consumer law, antitrust law, employment law, and health and safety law. These factors can affect how a company operates, its costs, and the demand for its products. The services in the hospital is the same for all patients and the priority is only for the urgent and emergency cases only not according to the nationality, color or any other discrimination issues. And on the other side there is a special track for the VIP patients ,giving the best quality to be the first choice in the region as a privet hospital. 3.2 Micro Environment Analysis: One of the best tools for considering trends in the Micro environment is the porter analysis. (Figure 2) Figure 2 Porter five forces analysis is a framework for industry analysis and business strategy development. It draws upon industrial organization (IO) economics  to derive five forces that determine the competitive intensity and therefore attractiveness of a market. Attractiveness in this context refers to the overall industry profitability. An unattractive industry is one in which the combination of these five forces acts to drive down overall profitability. A very unattractive industry would be one approaching pure competition, in which available profits for all firms are driven to normal profit. This analysis is associated with its principal innovator Michael E. Three of Porters five forces refer to competition from external sources. The remainder are internal threats. 3.2.1 Threat of Substitute Products or Services: A substitute is a product that performs the same or similar function as another product. Microeconomics teaches that the more substitutes a product has, the demand for the product becomes more elastic. Elastic demand means increased consumer price sensitivity which equates to less certainty of profits. For example, public-transportation is a substitute for driving a car, and e-mail is a substitute for writing letters. Conditions that increase the threat of substitutes are: 1.2.1.1 An attractive price of substitutes: Our organization as a privet health care facilty depends on the insurance companies in how much they are fixing the prices of the services and products, but they are trying to do some marketing using special prices for the labors in some company by doing full checkup examination for those people who don’t covered by insurance. 1.2.1.2 Increased quality of substitutes: Our facility is trying to give the best quality to be the first choice in the region in the privet health care sector. Focusing more and more to follow the highest international standards like the JCIA (Joint Commission of international accreditation) ,CAP(Collage of American Pathologist) and the ISO ..Etc 1.2.1.3 Low switching costs to consumers: our Administration is not switching the cost to the consumers since they are covered by health insurance. But sometimes they are switching the costs to the staff by minimizing the staff without enough study to the work load or stopping the annual increments. 3.2.2 . Threat of Entry: Profitable markets that yield high returns will attract new firms. This results in many new entrants, which eventually will decrease profitability for all firms in the industry. Unless the entry of new firms can be blocked by incumbents (which in business refers to the largest company in a certain industry, for instance, in telecommunications, the traditional phone company, typically called the incumbent operator), the abnormal profit rate will trend towards zero (perfect competition). The following factors can have an effect on how much of a threat new entrants may pose: The existence of barriers to entry (patents, rights, etc.). The most attractive segment is one in which entry barriers are high and exit barriers are low. Few new firms can enter and non-performing firms can exit easily. Government policy Capital requirements Absolute cost Cost disadvantages independent of size Economies of scale Economies of product differences Product differentiation Brand equity Switching costs or sunk costs Expected retaliation Access to distribution Customer loyalty to established brands Industry profitability (the more profitable the industry the more attractive it will be to new competitors) Rivalry Between Established competitors: Rivalry refers to the degree to which firms respond to competitive moves of the other firms in the industry. Rivalry among existing firms may manifest  itself in a number of ways- price competition, new products, increased levels of customer service, warranties and guarantees, advertising, better networks of wholesale distributors, and so on. The degree of rivalry in and industry is a function of a number of interacting structural features: Rivalry tends to intensify as the number of competitors increases and as they firms become more equal in size and capability. Market rivalry is usually stronger when demand for the product is growing slowly. Competition is more intense when rival firms are tempted to use price cuts or other marketing tactics to boost unit volume. Rivalry is stronger when the costs incurred by customers to switch their purchases from one brand to another are low. Market rivalry increases in proportion to the size of the payoff from a successful strategic move. Market rivalry tends to be more vigorous when it costs more to get out of a business than to stay in and compete. Rivalry becomes more volatile and unpredictable the more diverse competitors are in terms of their strategies, their personalities, their corporate priorities, their resources, and their countries of origin. Rivalry increases when strong companies outside the industry acquire weak firms in the industry and lunch aggressive, well-funded moves to transform their newly-acquired firms into major market contenders. Two principles of competitive rivalry are particularly important: (1) a powerful competitive strategy used by one company intensifies competitive pressures on the other companies, and (2) the manner in which rivals employ various competitive weapons to try to outmaneuver one another shapes the rules of competition in the industry and determines the requirements for competitive success. Since our hospital is the biggest hospital in the area, it depends in the competition on increasing the branches in all areas inside and outside the city for more than 8 branches directed by the corporate office in the Capital. 3.2.4 Bargaining Power of Customers: 3.2.4.1 Markets for Outputs: Selling goods or services to customers (distributors, customers or other manufacturers) Customers’ influence dependent upon importance of products to them their bargaining power We have a marketing team of 4 members working under the supervision of the corporate office , handling all the outputs issues like : the chronic patients disease health care activates offering free of charge checkup (ex. diabetic patients..) 3.2.4.2 Markets for Inputs: Purchasing raw materials, components and financial labor services. The same team also cooperating with the purchasing department together working to get the best quality materials for the lowest prices in order to minimize the costs. And that will allow the hospital to give more best services more than the other competitors. 3.2.5 Bargaining Power of Suppliers: The power balance between organization and supplier is similar to the relationship between organization and customer The organization becomes the customer and the producer of the inputs it requires are the suppliers Some small groups of suppliers may form cartels or cooperatives to increase their bargaining strength Suppliers use leverage such as threats to raise prices or reduce quantity or quality of goods they supply We are depending on the process comparison in the market and to services the suppliers will provide to us. In the opposite side, we are a customer for the suppliers and since we are the biggest customer in the privet sector we can manage the deal according to our needs. 3.3 Formulating: Formulating is phase one in the strategic planning process and according to  the diagram below We can see that it plays a very important in taking the best decisions and actions to achieve the objective of the organization. In our hospital there are many plans in how to make all these decisions become a real. At the beginning of each new year , we are making our plan projects for the next 12 months And everyone have to achieve his planed objectives as individual under the umbrella of the administration and corporate office objectives. And at the end of the year will have an assessment to check how many objectives he reached , according to his work assessment will get his increment , so that will let him work harder during the year to achieve the organization objectives. Figure 3 Ref(CBS course , topic 1 , page #12). 3.3.1 Organization sources and competitors : Our hospital sources is strong enough to be a strong competitor in the market depending on: Best medical companies as materials providers.  Best marketing plans based on the corporate marketing plans. Patients (as a customers ): Accepting all the insurance cards at the time that some other hospitals don’t accepting all patients. 3.3.2 Organization value chain construction Value chain is a template that identifies the activities of a company from raw materials to customer, the value added by each activity and the cost of each activity, and that facilitates implementation of business-level strategy . Ref ( CBS Strategic Management Topic 3 Page#6) The axiom is true that you never get a second chance to make a good first impression, and hospitals have many opportunities to do so. Or not. At several junctures along the trek of accessing services, the patient confronts a series of opportunities to continue in the system or not, based on the success of the interaction. These touchpoints are not created equal, and it is important to know which has the greatest impact. Here, we can focus the Service Line Growth strategy. As a tool to understand the impact  of each touchpoint, value-chain service analysis maps the process to help us decide where to focus strategic intent. Hospital business planning adapts a model developed by Michael Porter, who defines the value chain as a means to analyze an organization’s strategically relevant activities to understand how to influence performance and cost. He breaks the activities of the firm into primary and support activities. Primary activities—which, for most firms involves inbound and outbound logistics, operations, sales and marketing—are supported by an infrastructure of underlying support activities, including HR, IT, and purchasing. How the product or service is ultimately developed and delivered to the customer depends on the effective interaction of these variable activities. The hospital value chain is diverse and complex. Our service offerings are far from clear cut, varying sharply between service lines. Each specialty and disease category has a distinct value chain to be flowcharted and analyzed prior to understanding where we can impact choice by creating value. In most cases this is at the physician referral point where patients make initial decisions. This may be a primary care physician or a specialty care physician who is directly involved in managing the hospital encounter. In most cases, it is the loyalty of the physicians and their attitude towards the hospital that determines the direction of the process. This analysis is a good tool for getting stakeholders on the same page. It helps focus planning efforts and gets to the key issue of where to go and what to do. This leads us to the question—what business are we in, and where do we strategically want to focus our efforts, which is the essence of strategy. Figure 4 4.1 Strengths (Internal Factors) The hospital key strengths are the following: Long Standing Reputation – was the previous monopoly Company in the industry Government Affiliated – trusted in the Market Most skilled employees in the industry – generated good client relations 4.2 Weaknesses (Internal Factors) The main functional areas of weakness are the following: Production Costs in comparison to competitors Profit Margins – in comparison to competitors Service Delivery – poor operational functions Loss of Contracts – lack of continual Contract retention Company Culture – disconnected, divided, tall organisation structure HR Policies Procedures – poor employee retention, lack of career development, low morale Lack of MIS – no common management information systems in place across functions. Brand Identity/Image – lack of Marketing department Conclusion: The main objective is the consideration of the external and internal analyzing factors, using all the analyzing tools and studies like: PORTER, SWOT and all other analyzing international methods. This report explained clearly the essential required methods for analyzing using the practical example of my organization (Privet Hospital), how to make the competitive advantages and how to use all the efforts to get the best analyzing results. After the analyzing how can we use our strength points to be the first choice in the market and how to correct the weakness points to avoid any problem in the future. In the light of the above there are essential factors which might be affecting in any organization , so we have to cover all the points that I mentioned about it before like : Analyzing factors effectiveness on our organization as one of the biggest group in the healthcare services in the region. Organization sources and competitors. Organization values chain construction. SWOT analysis evaluation. 6. References http://www.wisegeek.com/what-is-the-role-of-environmental-analysis-in-strategic-management.htm , 2014 (http://en.wikipedia.org/wiki/PEST_analysis) , 2014 CBS course , topic 2 , page # 5 , 2014 http://en.wikipedia.org/wiki/PEST_analysis , 2014 http://www.oshad.ae/en/sectors/healthsector/Pages/ehsmsrequirements.aspx, 2014 http://www.dineshbakshi.com/igcse-business-studies/external-environment/revision-notes/63-external-environment-factors, 2014 http://en.wikipedia.org/wiki/Porter_five_forces_analysis ,7 March 2014) http://en.wikipedia.org/wiki/Porter_five_forces_analysis#Threat_of_new_entrants, 2014 http://www.strategy-formulation.24xls.com/en114 CBS course , topic 2 , page #17 , 2014 CBS course , topic 2 , page #20 , 2014 CBS course , topic 1 , page #12 , 2014 CBS Strategic Management Topic 3 Page#6 , 2014 http://healthcarestrategicadvantage.blogspot.ae/2007/11/value-chain-analysis.html , 2014 Strategic Management Unit 306 (CBS) , 2014

Consider how and why Shakespeare Essay Example for Free

Consider how and why Shakespeare Essay Consider how and why Shakespeare uses natural images in Sonnet XVIII, Shall I compare thee and act two, scene two, of Romeo and Juliet. In my coursework I am going to analyse two works of Shakespeare, these will be Sonnet XVIII and Romeo and Juliet. Both of these poems show share similarities, the main one being the theme love. In Sonnet XVIII, a man is talking about a woman, and is trying to find a comparison to her, that will do her beauty justice, whilst Romeo and Juliet follows a love story, between these two characters, it is a romantic play, which ends in tragedy. Another shared feature of both plays is Shakespeares use of Natural Imagery. This is a technique that is often used by writers, and is a favoured method of writing used by Shakespeare. Natural imagery is used in writing for description and/or comparison. In these two instances, it compares characters and feelings to that of nature. In Shakespeares era, nature was enjoyed by most people, as it was all around them it was something that everybody understood, Shakespeare used natural imagery as something that people could relate to they knew that the Sun was warm, that the night was mystical, and that fire was passionate, therefore if something or someone was compared to one of these, they knew exactly what was meant. Act two, scene two in Romeo and Juliet is set in Capulets orchard. This setting is full of natural beauty plants, flowers, insects this reflects Romeo and Juliets natural love for each other. When he enters into the orchard, he talks about Juliet; he says that Juliet is the Sun. This is the first of many natural images within this scene. His comparison of her to the Sun shows very strong feelings the Sun is essential to life, it gives light and warmth to the world Romeo is saying that without Juliet, he could not live and that she is the light of his life. Stars are an amazing part of nature; they light up the night skies, they are bright and beautiful. Romeo compares Juliets eyes to Two of the fairest stars in all the heaven. This describes the beauty of her eyes, how they are bright and vivid. The way that stars give light also describes his illuminate feelings for her. Stars also were thought to speak to people (Astrology). Romeo feels that Juliets eyes are so beautiful and complex that they tell him a story of love and passion. O speak again, bright angel. Romeo refers to Juliet. This statement is very ironic. Romeo states this as a positive comparison angels are beautiful, they are angelic. They show immortality, just like his love for her. However, the bright angel that he speaks of, is Gods bright angel, named Lucipher, this bright angel fell from heaven to hell, just as Juliet will fall from life, or love, to death. Whilst on the balcony, Juliet is talking about her love for Romeo, but how he is a Montague. She says how a name is only a name, and not a person. That which we call a rose by any other word would smell as sweet. A rose is a beautiful flower; it both looks beautiful and smells sweet. This natural image shows Juliets feelings for Romeo he is beautiful, calm and kind. With this comparison the audience can relate more towards how Juliet feels, and her way of thinking, that Romeo is the same, loving person, whatever his name may be. However this comparison is also an example of dramatic irony. A rose is born; it flourishes with beauty, but then withers and dies; just like their love, at this point there love is just being born, but by the end of the play they die. The audience are aware of a tragedy in the end of this play, as the prologue suggests this, however at this point the characters are completely oblivious to this. At the opening of this scene, the envious moon is portrayed as a negative thing (the Sun is much more beautiful than the Moon, and only the Sun can conquer the Moon, by spreading light onto the night). At this point in the scene, the moon is again described negatively. Romeo tries to swear by the moon of his love for her. However Juliet then speaks, O swear not by the moon, th inconstant moon. The moon is forever changing; Juliet wants their love for each other to stay the same; they are already feeling true love for each other, why would they want that to change? Juliet now speaks of how quick their meeting has been, too like the lightening, she describes it as. Lightening is quick but beautiful, just like their meeting. It is also bright and powerful, like their love for each other. However lightning also symbolises danger, it is destructive, just like their relationship. The meeting that they have just had is the beginning of all of this: they declare their love for each other and so the destruction of their lives begins, their love is quick but beautiful. Juliets comparison to the meeting is more accurate than she thinks, again showing dramatic irony. On their parting, Juliet compares Romeo and their love like a wantons bird, this is a caged bird, reflecting how their love should be freed, and how it is forbidden. She goes on to say that were Romeo a bird she would kill thee with much cherishing. This statement is incredibly ironic and foreshadows events, as their love for each other does end up in killing them both. Romeo then says to Juliet, Sleep dwell upon thine eyes,. This again foreshadows events that are to come. Romeo is wishing Juliet to go to sleep. This is ironic as Juliets sleep later on in the play ends in the suicide of Romeo. In Sonnet XVIII, the narrator of the poem is trying to compare a beautiful woman to something that will do her justice. He begins to compare her to a summers day, but then realises that she is much better than that. The initial comparison to a summers day is the first and most obvious example of natural imagery summer is beautiful and warm, much like the woman he speaks of. He goes on to say how Rough windes do shake the darling buds of Maie. This shows how summer is vulnerable, the woman is not. The word buds also represents new life, or new love. Shakespeare then goes on to describe the negative aspects of summer, lease hath all to short a date. This states how summer is short it begins and ends. The womans beauty is ongoing, it does not begin, nor end, it is eternal. The sun is now personified, to make it easier for the audience to compare it to the woman; it is described as the eye of heaven, with often is his gold complexion dimd. This presents another difference of the woman to the sun the sun brightens and dims but, once again, the womans beauty is constant, it is forever the same. The word gold in this phrase also symbolises wealth and beauty, much like the woman. Nor shall death brag though wandrst in his shade, The writer has previously stated how her beauty is immortal, it will defeat death. In this line the write personifies death wandrst in his shade. This makes the task of defeating death seem much easier if death is actually mortal. The final two lines, which are also a rhyming couplet, are like a conclusion to the poem and the writers thoughts. He explains how her beauty is immortalised through the poem. So long lives this, and gives life to thee. The word this within the line is once again, personification, this time of the poem itself. It is stating that the womans beauty has been trapped and kept alive within the poem. The personification of the poem makes it much easier for the audience to understand how her beauty is immortalised through it if the poem lives, so does the womans beauty. To conclude, I have found a lot of natural imagery in both of the works that I have read. In Romeo and Juliet, the natural imagery is used mainly to compare the feelings they have for each other to nature. However, the way it is used is very ironic almost every use of natural imagery has a double meaning, e. g. Rose, Juliet means this to be beautiful, however it also shows how, just like a rose, their love will begin, flourish, and eventually die. At the time of the meeting that Romeo and Juliet have, they are not aware of the tragedy that is about to occur. In Sonnet XVIII, the natural imagery is used to compare beauty. It is used to show how beautiful the woman is, as she is portrayed better than nature, or a summers day. This poem seems to be negative throughout, but is, in fact, just reflecting upon how beautiful the woman in the poem actually is. I can see from both of these texts that natural imagery is an effective way to describe thoughts, feelings, and things. The audience of the time would have easily been able to relate to each of the natural images that Shakespeare presented to them.

The Kawasaki disease

The Kawasaki disease Kawasaki disease is an intense systemic paediatric vasculitis disease that is seen commonly in childhood. Kawasaki disease is one of the most common heart diseases. It is the inflammatory disorder but the aetiology of Kawasasaki disease is unknown. It first appeared in 1967 by report of Tomisaku Kawasaki who was a Japanese paediatrician. He also called Kawasaki disease as mucocutaneous lymph node syndrome. There is no diagnostic test; therefore, doctors are using the clinical criteria that were proposed by Dr. Kawasaki 45 years ago to diagnose the Kawasaki disease. There are many different diagnosis of Kawasaki disease such as viral infections, genetic predisposition or environmental factors. Many research proposed that Kawasaki disease is an infectious disease that may be caused by Epstein-Barr virus, measles, adenovirus, enterovirus. However, there is no confirmed evidence. Usually, KD can found more in Japanese society but it keep spread to western countries and the incidence of K D in western countries are increase dramatically. There are typical symptoms that can be seen in KD such as rash, edema, and mucosal membrane changes. But there are more symptoms that are involved which are not typically found from every KD patients. Therefore, it is hard to diagnosis patients if they have KD or not. The treatment of KD is different depends on if patients are complete or incomplete KD and also, the susceptibility of IVIG will make treatment different along patients. The etiology is not certain but there are several researches shown that KD is caused by infectious agents, genetic factors, or immune system disorder. Current knowledge on the subject   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several symptoms that can be found in patients with Kawasaki disease. When patients have more than 5 days of fever for more than 38C and have more than 4 symptoms such as bilateral nonexudative conjunctival injection, polymorphous exanthem, nonvesicular rash, strawberry tongue, edema of hands and feet, bilateral non-suppurative cervical lymphadenopathy, and mucosal membrane changes, patients will diagnosis as KD. Kawasaki disease can be divided into complete Kawasaki disease and incomplete or atypical Kawasaki disease depending on the number of symptom that are present in the patient. When patients have more than four symptoms or have developed coronary artery abnormality, patients will be diagnosed as complete Kawasaki disease. In contrast, patients who have less than four of the diagnostic criteria and still develop coronary artery abnormality is diagnosed as atypical or incomplete KD. Because of the cause of Kawasaki disease is unknown, di agnosis of Kawasaki disease in infants are very challenging. Kawasaki disease can be divided into three phases. First, from one week to two weeks from onset is called acute phase. Typical symptoms are highly febrile, irritable and the fever approaches more than 39 Celsius. Oral changes occurs and also rash can be found in perineal area. Secondly, from two to eight weeks from onset is called subacute phase. In this phase, fever start to decrease slowly and the perineal area, soles, and periungual areas start to peel off. Lastly, from months to years from onset, it is called convalescent phase. In this phase, laboratory value gets normal but there may be severe consequences. For example, patients who had aneurysms may continuously have, for rest of their life, persistent cardiac dysfunction, or myocardial infarction.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Coronary artery aneurysm can be highly found in incomplete Kawasaki disease patients. It is defined as coronary dilatation that the diameter of coronary vessel gets enlarged 1.5 folds. It can be diagnosed by angiographically and it is similar to patients with coronary artery disease. The end-diastolic pressure, end-diastolic volume, and ejection fraction levels are not normal and the left ventricular contraction is not normal. The coronary artery aneurysms are mostly caused by atherosclerosis.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several associated symptoms that can be seen in Kawasaki patients. Diarrhea and abdominal pain and patients may develop arthritis. Also, myocardial dysfunction can be found in early phase of Kawasaki disease such as pancarditis which is the inflammation of all three layers of heart. Another symptom is periarteritis nodosa which is disease in connective tissue that is blocked by nodules in arteries thereby causing blood to not circulate properly. When Kawasaki disease shows periarteritis nodosa, other symptoms cannot be found.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Kawasaki disease can be diagnosis by physical exam but also it can be diagnose by laboratory exam and imaging technique. First, complete blood count test should be performed to look at the amount of white blood cell in blood. Complete blood count is the calculation of white blood cells, red blood cells, and platelet. The number of white blood cell increased to more than 15,000. Also, the erythrocyte sedimentation rate and C-reactive protein increase. After 2 weeks from onset of disease, the platelets level dramatically increases up to 1 to 2*106. There are other abnormalities such as sterile pyuria, increases of hepatic transaminases, hypoalbuminemia. In patients who have KD will have higher level of transaminase than normal person. Also, they will have higher level of ALAT and GGT than other patients who have other febrile diseases. When ALAT level increases, it will lead to coronary artery disease. Research proposed that almost 50% of incomplete KD p atients had pyuria in bladder urine. Pyuria can cause different diseases depends on where it is. When pyuria is in bladder, it can cause tubulointerstitial nephritis but when it is in voided urine, it will cause urethral inflammation. Another symptom to diagnosis incomplete KD is to look at acute anterior uveitis after the onset. Patients who have anterior uveitis do not have pain, photophobia, nor visual impairment. By using ophthalmological evaluation, it can detect if patients have different disease which have similar symptoms with anterior uveitis. One of the research in 2006 showed that there were 40% of KD patients had hyponatromia. It is caused by incorrect hormone secretion by cerebral vasculitis, dehydration, or tubular dysfuction. It is hard to diagnosis KD since there is no diagnosis test. To treat incomplete KD, the principle clinical criteria should be renewed in order not to miss out some patients who did not have principle symptoms. By missing out patients will develo p severe other diseases and will not be able to give proper treatments.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  KD also can be found out by using imaging technique. At acute phase, chest x-ray or echocardiography (ECG) are used to look at heart problem. Patients may develop coronary artery abnormalities in acute phase and this can be showed by ECG. When patients are very severe, heart specialists sometimes use single photon emission computed tomography to look into bloodstream of patients. SPECT will provide an image in 3D by using gamma rays. Epidemiology Kawasaki disease is new disease that is predominantly found among Asian children1,2,3. It was first found in Japan by Dr.Kawasaki in 1961. In early 1970s, Pathologist Eunice Larson and Benjamin Landing at Los Angeles recognized it as a new disease. Still today, there is no evidence of how Kawasaki disease emerged but some researchers proposed that Kawasaki disease emerged from Japan and spread to Western countries through Hawaii after World War II. Kawasaki disease was nationwide epidemics but now it is more likely a regional outbreak. The mean annual incidence rate is different in variety of countries and districts3. There are 90 to 112 per 100,000 in Japan, 8.0 to 47.7 per 100000 in US, and 3.6 to 3.7 per 100000 in the United Kingdom and Australia for children who are less than 5 years old. Research in China indicates that the incidence rate is 18.2 to 18.6 per 1000003. The statistics shows that Japan predominantly has highest incidence rate among Asian. Kawasaki disease can be fou nd commonly in males than females and the reoccurrence rate is less than 1%3. The incidence of Kawasaki disease has been increasing annually. In 2000, the incidence rate was 73.7 per 100000 but in 2002, the number of occurrence increased to 95.5 per 1000003. There are relationships between season and occurrence of Kawasaki disease3. But there are variations among different countries. From Japanese reports, there were more patients in winter but in American data shows that patients will develop KD more in the spring and winter. For female the occurrence appeared to be high in March, and highest in July. For boys, the highest occurrence rate was in May and the lowest occurrence rate was in February. As the research indicated, the season and climates have relationship with the susceptibility to Kawasaki disease3. Genetics   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Patients with Kawasaki disease may develop coronary artery abnormalities (CAAs) if patients are not treated early. Usually patients are treated with high amounts of intravenous gamma-globulin (IVGG) as well as aspirin which are used to reduce the possibility of developing CAAs2. However, 10-20% of Kawasaki patients do not response to induced intravenous gamma-globulin. Coronary artery abnormality will develop more frequently to patients who are not responding well to IVGG than patients who respond well to IVGG. Recent research reported that matrix metalloproteinase-9 (MMP-9) is involved in formation of CAA in acute phase of Kawasaki disease patients2. From research, the level of MMP-9 in serum who have Kawasaki disease have much higher than serum from children who does not have KD and patients who have other kinds of febrile diseases2. Using MMP-9 inhibitors might prevent the formation of CAA. However, MMP-9 inhibitors are not used clinically. MMP-9 is endopeptidase that depends on zinc that has zinc at the active site. MMP-9 have major role in tissue remodelling of extracellular membrane (ECM) 2. It can be seen in cardiac remodelling after myocardial infarction, plaque destabilization of atherosclerotic lesion. The mechanism of angiotensin-converting enzyme (ACE) inhibitors is involve with the bind zinc to the active site and stabilize by hydrogen bonds and hydrophobic interactions in the active site. The ACE inhibitor can inhibit the activity of MMP-9 and MMP-2, which have major role in neointimal formation and angiogenesis. The effect of the ACE inhibitor on MMP-9 can be measure by using captopril to the enzyme2. Involvement of the immune system From the studies by Satoshi Sato, Kawasaki disease is commonly found from patients who are younger than 5 years old1. The average age of occurrence of this disease is 2 years. Kawasaki disease does not occur frequently from children who is less than 6 months and can hardly find patients who are less than 3 months1. Kawasaki disease usually does not occur for adults who have immunity to common infectious disease. This result explains that children are more susceptible to Kawasaki disease because they might not produced antibodies to common infectious viruses, and bacteria1. Mannose bind lectin (MBL) is an important component of the innate immunity and is a reactant for hepatic origin which can bind to multiple lectin domains1. MBL has very important role in complement activation and opsonization. Complement activation refers to as the biochemical activity that helps to get rid of pathogen from animal and opsonization have similar activity to complement activation that plays role of pa thogens to get rid of the organism by ingestion and destruction by phagocyte1. It is usually found in bacterial cells, fungus cells, and viruses. It has repeating pattern of mannose and N-acetylglucosamine sugar. There are three single polymorphisms in chromosome 10 for MBL gene at codon 52 (CGT to TCT), codon 54 (GGC to GAC), and codon 57 (GGA to GAA). This mutation will lead to reduction of the level of MBL concentration but polymorphism of the promoter region of MBL will lead to increase the level of MBL concentration in the serum1. When the base changes from glycine to aspartic acid in codon 54, it will distract the interaction between MBL and MBL-associated serine protease. The interaction between MBL and MBL-associated serine protease defend against infection when patients are young. But when patients become older, the interaction of these two molecules will not have impact on the innate immunity1. Because, the patients will develop the mature lymphocytes and immunoglobulins a nd they will engulf the invaded pathogen. Therefore, this research proposes the susceptibility of the Kawasaki disease will be influenced by the MBL polymorphism1. Children who have Kawasaki disease develop endothelial dysfuntion in early phase after onset of disease and this will caused by the production of nitric oxide (NO)5. As described earlier, the primary innate immune system is very important feature for Kawasaki disease. Tumour necrosis factor alpha, IL-1, 6, 8, monocyte, chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) will be activated to produce cytokine storm5. After cytokines are produced, it will release iNOS (inducible nitric oxide synthase) in neutrophils, endothelial cells, and smooth muscle cells. Nitric oxide is produced by two enzymes which are endothelial NOS and iNOS5. Recent research found out that patients who developed Kawasaki disease have higher level of iNOS concentration in neutrophils in acute phase. Also, children have high level of nitric oxide metabolites such as NOx, NO3-, and NO2-. After production of Nitric Oxide, it will react with Reactive Oxygen Species (ROS) to give more bi ochemical reactions. This will be measured by new device called fluorescent indicators5. There are new devices used to measure the concentration of NO and ROS. First, Hydroxyphenyl fluorescence (HPF) was used to measure the concentration of ROS. Another device is called Diaminofluorescin-Flu Diacetate (DAF-FM DA) which is used to measure the concentration of intracellular Nitric Oxide5.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are significant evidences that the production of ROS and NO by neutrophils were much higher in Kawasaki disease patients in compare to people who have non-KD febrile children or non-febrile children5. By treating with IVIG, NO level will decrease. But, the production of NO can be beneficial or harmful. Usually, NO is cytotoxic but sometimes, it can protect cells from toxic materials. NO may react with hydroxyl radicals to produce much higher toxicity. To control the influence of NO, the duration, the amount of NO synthesis should be controlled. Therefore, in acute phase of Kawasaki disease, NO and ROS is highly produced and will cause damage to endothelial cells5. Treatment and future research   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  When patients are diagnosis as complete or incomplete KD, treatment should be induced right away. Because when patients have more than 10 days of fever will develop CAA. Major treatment that doctors use to treat KD is intravenous immunoglobulin (IVIG). Intravenous immuglobulin induced into bloodstream which contains immunoglobulin antibody G that is brought from other control blood donors. IVIG is still a major recommended treatment but some patients do not response to this treatment. The effects of IVIG last for 2 weeks up to 3 months. The typical amount of IVIG is a dose of 1000mg per kg of patients bodyweight. High amount of IVIG with aspirin will reduce the rate of coronary artery abnormalities (CAA) which includes coronary artery dilatation or aneurysms from 20% to 3 to 5%. Also, depends of patients, IVIG can also used with acetylsalicylic acid to treat KD.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There is one example about the incorrect treatment will cause severe disease. When IVIG was induced, patients could not cure coronary artery lesion. When patients induced with corticosteroid, they developed more coronary artery lesion3. There are two therapies which are antiinflammatory and antithrombotic therapy which are to treat Kawasaki disease instead of using IVIG. In antiinflammatory therapy, methylprenisolone, prednisone, prednisolone, and infliximab are used to treat Kawasaki disease. For antithrombotic therapy, Aspirin, heparin, warfarin, exoxaparin, tissue plasminogen activator, clopidogrel, and abciximab are used. Recently, infliximab proved by US Food and Drug administration to cure not only Crohn disease but also used to treat Kawasaki disease patients. It was not used at all in 2001 but today, the administration of infliximab usage increased up to 2.3% of total number of therapies used. It became favourable because of two reasons. First, it only administer to patients only one time. Secondly, by not using infliximab more than once, it reduce the complication as seen in other therapies which are used more than once. Infliximab is an antibody to tumour necrosis factor alpha, and cytokine in inflammatory response. It binds to tumour necrosis factor alpha and blocks the T-cell receptors to block the biochemical cascade. It will decrease the coronary artery abnormalities in patients who developed Kawasaki disease in early acute phase. To treat KD much better way, there should be more research. First, there should be more laboratory and echocardiographic data. Second, more development of clinical criteria and symptoms should be proposed. Even today, there is no perfect evidence that can explain the cause of KD; therefore, there should be more research on genetic factors by looking at KD patients family. Lastly, after treatment of KD in childhood, complication may be developed after several decades and there is not much information about complication. Therefore, by monitoring and keep in touch with KD patients are good way to find out more about complication after initial treatment. References Sato, S., H. Kawashima, Y. Kashiwagi, T. Fujioka, K Takekuma, and A. Hoshika. 2009. Association of mannose-binding lectin gene polymorphisms with Kawasaki disease in the Japanese. I. Jour. R. Dis. 12:307-310. Inoue, N., S. Takai, D. Jin, K. Okumura, N. Okamura, M. Kajiura, S. Yoshikawa, N. Kawamura, H. Tamai, M. Miyazaki. 2010. Effect of angiotensin-converting enzyme inhibitor on matrix metalloproteinase-9 activity in patients with Kawasaki disease. Clinica Chimica Acta. 411:267-269. Huang, G.Y., Ma, X.J., Huang, M., Chen, S.B., Huang, M.R., Gui, Y.H., Ning, S.B., Zhang, T.H., Du, Z.D., Yanagawa H., and Kawasaki T. 2006. Epidemiologic Pictures of Kawasaki disease in Shanghai from 1998 through 2002. Journal of Epidemiology. 16:No. 1. Yeo, Y.K., Kim, T.Y., Ha, K.S., Jang, G.Y., Lee, J.H., Lee, K.C., Son, C.S., and Lee, J.W. 2009. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr. 168:157-162. Yoshimura, K., Tatsumi, K., Iharada, A., Tsuji, S., Tateiwa, A., Teraguchi, T., Ogino, H., Kaneko, K. 2009. Increased nitric oxide production by neutrophils in early stage of Kawasaki disease. Eur J Pediatr. 168:1037-1041 Perrin, L., Letierce, A., Guitton, C., Tran, T.A., Lambert, V., Kone-Paut, I. 2009. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine. 76:481-485. Son, M.B.F., Gauvreau, K., Ma, L., Baker, A.L., Sundel, R.P., Fulton, D.R., Newburger, J.W. 2009. Treatment of Kawasaki Disease: Anlaysis of 27 US Pediatric Hospitals From 2001 to 2006. Pediatrics. 124:1-8. Ugi, J., Lepper, P.M., Witschi, M., Maier, V., Geiser, T., Ott, S.R. Nonresolving pneumonia and rash in an adult: pulmonary involvements in Kwasakis disease. EUROPEAN RESPIRATORY JOURNAL. 35:452-454. Climaz, R., Sundel R. 2009. Atypical and incomplete Kawasaki disease. Best Practice Research Clinical Rheumatology. 23 (5):689-697.

The US Constitution Essays -- American History, Democracy, Equal Right

The US Constitution states â€Å"We The People of the United states in order to form a more perfect Union, establish Justice, ensure domestic Tranquility, provide for more common defense, promote the General Welfare, and secure the blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.† The main purpose of the U.S Constitution is to establish the basic rights of all American Citizens. This follows that every United States Citizens have equal rights. Belonging to a minority group because of culture, religion or race does not assert that one is unconstitutional. In times of war, evacuation of minority groups only in NOT constitutional; however, evacuation of ALL United States citizens for prescribes military areas is warranted. In the months immediately following the Pearl Harbor attack the minority group of Japanese Americans, who, held the same race as the enemy empire, were given an order to evacuate, â€Å"Civilian Exclusion Order No. 34†, their homes in the West Coast. In the case of â€Å"Korematsu V. United States† Korematsu fought for his constitutional right as a United Stated citizen; Korematsu was arrested under the Act of Congress exclusion order no. 34, he appealed his case all the way to the Supreme Court and lost. The Supreme Court held the decision of the Circuit Court of Appeals, justly highlighting key points with regard to war times which cannot be overlooked; however, the dissenting justices provides compelling support for Korematsu’s constitutional rights, the government’s disguised purpose to segregate and intern every-one of Japanese American descent, the political mishandling of the Japanese American’s and racial discrimination. The Supreme Co... ...d for health reasons. An American citizen regardless of race, culture, or religion falls under the same constitutional right as another American. Being of Japanese Ancestry during the war with Japan does not depict that that individual is an enemy. The facts are certain, on born to US soil is by birth a US citizen. Citizenship is not determined by race, culture, religion or even the origin of the individual’s birth parents. The disloyalty on an individual does not warrant disloyalty of the group. The government actions must have been well intentioned, being concerned about the nation’s safety; but, with their decision to exclude only Japanese Americans, the government portrayed impoverishment of constitutional right, political injustice, and racial discrimination to a minority group, none of which has any place in the US democracy, Constitution and way of life.

What drove Eliza to change? What does it mean to be high class? Essay

In George Bernard Shaw’s didactic, Victorian play Pygmalion, Linguistics Professor Henry Higgins’s perceptive ears are offended by the sound of Eliza’s lowly, Cockney accent, so he wishes to change it into a flawless, pleasant voice that would blend in among high society. Higgins is a sarcastic and rude character who treats Eliza badly throughout most of the play, sometimes not even acknowledging her presence. This brings up the question of why she tolerates his rudeness. What drove Eliza to change? Change is desired when we face conflicts that must be resolved. Another question this play presents is: What does it mean to be high class? Is it as Henry Higgins says it is, that it is just the proper way of speaking? Can the â€Å"right† sociolinguistics or money or heritage give someone high status? We can wish to change when wanting to improve ourselves, to satisfy others who we hold in esteem, to meet demands placed upon us, but most importantly, a successful change must come from self-motivated reasons. A change forced upon a person is like no change at all. After the pressure, the expectations, the possible threat of that comes with authority, have all been removed, a change can only last if the subject being changed had wanted to be changed in the first place. Initially, she wanted to improve her speaking voice so that she could find a better job, and with a better job, better prospects in every part of her life. She realizes that she can do this with Higgins’s help—she recognizes his expertise in this subject, but he is unwilling to help her until she pays him a high sum that she cannot afford. Higgins’s peer Colonel Pickering’s attention is brought to Eliza’s plight and he feels for her, so he strikes up a wager with Higgins and ... ...see any kind of challenge in Freddy, so he was not of so much interest to her. George Bernard Shaw’s message, though, is that affection for another person should not be disguised as distaste, for eventually, the person we love will move on to somebody else who treats him or her as he or she deserves to be treated. In a way, Eliza’s plan to marry Freddy is a type of poetic justice against Higgins, who, even though exhibits the proper grammar and speech of gentility, is not truly a gentleman. His behavior and attitude are just inexcusable for a heroine like Eliza. From this irony and dark humor in Pygmalion, we learn that we should be genuine and reveal our true feelings for a love interest eventually, even if it is slowly to keep ourselves from being hurt—we do not want to meet Higgins’s lonely fate. He could have had Eliza, but his caustic behavior kept them apart.

The History of Iwo Jima Essay -- Military History

Introduction The island of Iwo Jima is just one of the many islands in the pacific that make up the island chain of Ogasawara. The Ogasawara chain of islands are located approximately 750 miles south of Tokyo. In comparison to most of the other islands in the pacific Iwo Jima is relatively small, in fact it is only four and a half miles long by two and a half miles wide. The geographic layout of Iwo Jima consists of a dormant volcano on the northern side called Mount Suribachi and a flat stretch of land to the south. So why is such a small island so important? After the surprise attack by the Japanese on Pearl Harbor America needed a place to stage aircraft for conducting bombing runs on Tokyo, Iwo Jima provided the best place to host our fleet of bombers. History Before the war Iwo Jima was inhabited by the Japanese. There was a small fishing village and a very small military installation that consisted of a garrison of the Imperial Japanese Navy. All together there was only a population of 1018 people. However, through out 1944 the Japanese removed all the civilian population from the island and began a massive build up of the military stationed there, by the start of the war there were over 21000 Japanese soldiers on the tiny island. Planning/Preparation The Japanese commander in charge of Iwo Jima was General Kuribayashi. General Kuribayashi believed that America would attack Iwo Jima just the same as they had attacked every other target, with a massive aerial bombardment. Kuribayashi was ordered to build up Iwo Jima the same as every other Japanese base even though they had proven to be useless against the aerial bombing techniques that America used. Despite what other Japanese officers above General Kuribaya... ...olicy denying nuclear weapons on Japanese soil. REFERENCES Chen, Peter, C. (n.d.). Battle of iwo jima. Retrieved from http://ww2db.com/battle_spec.php?battle_id=12 O'Brien, Cyril, J. (n.d.). Iwo jima retrospective. Retrieved from http://www.military.com/NewContent/0,13190,NI_Iwo_Jima2,00.html Trueman, Chris. (n.d.). The battle of iwo jima. Retrieved from http://www.historylearningsite.co.uk/battle_of_iwo_jima.htm Miller, Kimberly, J. (n.d.). Battle for iwo jima: Wwii fact sheet. Retrieved from http://www.history.navy.mil/library/online/battleiwojima.htm Morison, Samuel, E. (1960). Victory in the pacific, 1945 – history of the united states naval operations in world war ii. (Vol. 14, p. 389). Boston: Little Brown. James Bradley. , & Ron Powers, (2000). Flags of our fathers. (p. 384). New York, Toronto, London, Sydney, Aukland: Bantam Books.

Outline for War of 1812 Essay

The War of 1812 is seen as a simple complication to the British. They figured that they had much more important matters on their hands fighting with Napoleon. The Canadians saw it as the Americans just being aggressive. However for us, the Americans we saw it as a confusion of loyalties and boundaries. The forces behind the Americans entering this war were for our personal interests and concerns. The political, geographical and nationalistic forces gave us the push to tell Britain they couldn’t do whatever they wished. Topic Sentence: The expansion of America 1) Supporting fact: the United States began expanding their territory shortly after the revolutionary war. 2) Supporting fact: a place that caused trouble was the Great Lakes 3) Supporting fact: as the British began taking their seamen, they Americans became angry and attacked Canada trying to occupy it. Topic Sentence: The British Navy began to seize American seaman and attack the home frontier 1) Supporting fact: Britain launched an attack on New York. But is saved by McDonough 2) Supporting fact: Washington D.C. was set on fire. The Capitol and the White house forcing the president to leave 3) Supporting fact: the approximated amount of men harmed or taken by the British was around 6,000 Topic Sentence: Economical forces dealt with the loss of the materials destroyed or taken by Britain. Political forces dealt with the â€Å"competition† between the presidential support of Jefferson and Madison. 1) Supporting fact: Hogshead and Molasses were aboard the ships. 2) Supporting fact: Jefferson could’ve gone to war with England with great support but instead decided to place embargos. 3) Supporting fact: Madison sent a message to congress that listed the complaints about England. It was barely approved. Conclusion: Even though the War of 1812 wasn’t as impacting as he others, it plays a significant role with the relationship between the United States and Great Britain known sometimes as the ‘’ Special relationship†. Just like every other relationship it has its ups and downs, the War of 1812 was just a minor bump. Without this minor bump though the United States could be very different. Our territorial boundaries wouldn’t have been altered. Our trade relationship with England probably wouldn’t be the same either.