Children, War and Education Essay Example | Topics and Well Written Essays - 1000 words

Children, War and Education - Essay Example This leads them into an intense mental trauma. 3. Children used as terrorists/soldiers:The scene grows even more gruesome when children are made a part of these wars. Their small hands are trained to hold and control the agents of deaths deadly weapons and their vulnerable minds are inculcated with norms of the terror culture where ruthless massacres are a way of life. Be it the Hamas in Gaza, the Taliban in Afghanisthan or the LTTE in Sri Lanka they extensively use children as terrorists."assessments by the Sri Lankan Directorate of Military Intelligence have estimated that as much as 60 per cent of the LTTE's fighters were below 18."(SOUTH ASIA TERRORISM PORTAL) and "LTTE terrorists used a 13 year old child suicide bomber against the advancing 55 Division troops in Chalai "( Thilakaratne 2009)The conditions are no different in Jammu and Kashmir where children are used as "terror tools". They are even trained in throwing grenades and planting IEDs.( GUPTA 2005).This affects a child's(terrorist) psychology in a very dangerous ma nner sometimes making it impossible to help them lead a normal life even after they have been freed/rescued. Their experience with terror creates a kind of crisis in their life - it's a crisis of life purpose and direction. Children Participation in armed conflicts, even voluntarily, is an offence as per the Geneva Convention (1948), its two amendments (1997), and as per Article 38 of the UN Convention on Rights of the Child. But one can definitely not expect the terrorist groups to abide by these laws. Even in cases where terrorist outfits were warned against the use of children or even when the terrorist groups promise not to use children (as in case of LTTE), there are hardly any productive or positive results. 4. Loss of children's education: In conditions like these it's not difficult to imagine what must be happening to the education of children. A country's civilian population is under a condition of constant stress when there is a war going on at the borders of the country and the education of children is often disturbed due to falling attendance as a result of fear, shutting down of schools due to govt. orders concerning safety or other such reasons. And the conditions worsen in countries where there are no defined battle fields and the civilian areas are frequently attacked. Terrorist attack on schools causes a great damage; and this damage is multidimensional. Not only is the property damaged but also many lives are lost and the entire education system completely disrupted and sometimes even uprooted. Attacking schools severs several purposes for the terrorist organisations: A. Schools are soft targets and can be attacked comparatively easily.(Ervin 2006) B. Attack on

Research report in the field of Web Development and emerging standards Essay

Research report in the field of Web Development and emerging standards - Essay Example ly, UH Solutions is Bizzolutions soft group that conduct their activities based on the latest innovative technologies and prior role of the development teams and engineers for keeping the performance up-to-date towards maintaining the competitive edge of the company in the global environment (Turnbull, 2013). In the real world, the continuous revolutionary approaches in all the spheres and dimensions of technology have imposed enormous impacts over the inhabitant’s lives. To be precise, significant development of Information Technology (IT) has strong impacts over the entire industrial sector especially in the software sector. The emergency of the internet evolves from development of electronic computers with the concept of packet networking. The concept of internet has also been linked to the development of ARPANET by the US Department of Defence’s Advanced Research Projects Agency (ARPA), which is packet-switching network designed to form communication among the ARPA terminals during 60’s. Besides, Paul Baran and Donald Davies have made the first stable linkage among the multiple computers with the use of ARPANET during the year 1969 after ten year of development of initial conceptual network that develop by Paul Baran and Donald Davies. Though at such time the com puter were highly expensive but with the significant development of IT, the use and benefits of internet has been recognise in every sphere of industries (New Media Institute, 2014; Computer History Museum, 2004). Initially, the development of internet has not resulted into the prevalence of the concept of web. Web has been developed with the use of three key protocols including HTML (Hypertext markup language), HTTP (Hypertext Transfer Protocol) and URLS (Uniform resource locator). Murray Leinster has initially developed this idea in 1946 but the real version has been developed earlier in 80’s when Tim Berners Lee work over the ‘Enquire’ project. ‘Enquire’ consist of database of

Arguments Against India As A Single Nation Religion Essay

Arguments Against India As A Single Nation Religion Essay I have tried to understand this topic and share my insights for the same. I have tried to deconstruct the topics in different subject areas. I tried getting an opinion on those subject areas and then link them to have a holistic view of the topic. Before I share my comments on the dictum Unity in Diversity , lets look at India in general. India is imagined in a plethora of ways. The political ideology always has an impact on the nation. A nation exists because of the people. The pathos and ethos which binds them together and makes them move towards an ideal state of affair is long and testing. There are moments of glory in the history of a nation when all political parties rejoice and encourage activities which benefit the image of a nation. For instance, The Nobel prize awarded to Amartya Sen in 1998 when he transformed economics into a moral science in which he targeted many public policies like education and hunger. The same policy has been adapted to the framework of India and used for development by ruling politics. There is need of Innovators and entrepreneurs like Sen who can lead India to a state of absence of malnutrition, illiteracy and poverty. Behind the deathly blows of caste rivalries and religious feuds is a stark reality of limited resources. Behind the demand of a separate land is the desire for reco gnition and growth opportunities. Only, if the political system could design policies to combat it! I strongly believe in the dictum Unity in Diversity. I would like go about in a theoretical and later, practical way in justifying the same. India is a vast country in which people belonging to different religions, castes and creeds live together. Though usually they live in harmony and co-operation with each other, sometimes the harmony is disturbed and disturbance creates many social problems. In order to bring the people belonging to different religions together and in a bid to bridge the gap in cast differences, the countrys social reformers have made positive attempts to forge unity in diversity. India is the cradle of many cultures. In this ancient land, the people belonging to different cultures are living together preserving their own culture and cultural unity, In spite of the fact that there is an apparent disunity in the country, basically there is cultural unity which is visible in every walk of life. It is on this account that it is said that in India there is unity in diversity. India is a land of many religions. There might be different factions and sub sections from the main streamline and that might prima facie give an idea of religious disunity, but on the whole there is unity in so far as each religion is concerned. We basically believe in the theory of dharma and karma. The theory of rebirth and purification of soul, salvation and the philosophy of hell and heaven hold s good every where. Respect for mosques, temples churches, Gurudwaras and religious gods and goddesses is prevalent. A multitude of gods and religious practices, the existence of hundreds of groups called castes, variety of foods and clothing and different types of kinship organization, which one finds in India, create an impression of a bewildering variety impossible to classify and of a society divided into innumerable tiny compartments. Many anthropologists, especially those dealing with the phenomenon of casts, have described this a illustrating the fissiparous tendency of the Indian society, while others have called it horizontal segmentation of the society. Indian philosophy is a product of the Indian society, and reflects the various cultures which have blended together after the time the Aryan entered India. The developed and elaborate rituals on the one hand, and the monistic philosophy on the other, are not an evolution of purely Aryan tradition, but a product of the fusion of the Aryan and the non-Aryan. While the region west of Punjab and including the present Delhi region seemed to be the region of the development of early Aryan thought, the central and the eastern Gangetic plain to the north of the river Ganga was the region of the rise of new specta, culture -contact, culture-confilict and final fusion. Changes have occurred in the overall conception of the gods and modes of worship, and ideas of purity. There are also in existence different modes in different regions. These changes are not due merely to internal evolution. Neither are they due to continuous fission of religious bodies. Independent groups living in the same continent were practicing different modes of religion. The overall changes are due to gradual ascendance of new , non-Vedic ideas, and the existing differences are due to interaction of independent groups who kept their separateness and reacted to each others cultural capital in different ways. The early Aryans themselves racially mixed, and showed a certain catholicity in taste, but the later conquerors, like the Mughals and the fairer British, have made public preference to fairness of complexion in women, though extreme fairness of skin in men is not valued much, at least in the south. Details of formal art forms, like rhyming, are different for different regions. In classical poetry there was no end-rhyming. In Prakrit poetry, especially in Marathi and sometimes in Ardhanagadhi, one finds the end-rhyme. Apparently, this practice influenced Marathi poetry, too. In the neighboring Karnataka, however, we have line which have a rhyme in the beginning and not at the end. All these differences, and also those in dress, ornaments, decoration of house, and food are partly regional, and partly found also in different castes of the same region. It is necessary to study this multiplicity region by region, and it will unfold a tale of cultural conservatism as also cultural borrowi ngs and changes due to cultural adjustments between separate ethnic groups. The peculiarity of Indian social life is that ethnic groups have lived separately from one another. They have devised a mode of inter-group behavior which avoids mutual interference or merging so that the identity of the original group is not lost. There has been fusion. There has also been fission within large groups, but the main cultural feature is the retention of group integrity. This type of social organization made it possible for certain groups to progress while certain other groups became progressively primitive. Although Indias present Constitution has many flaws like separate provision for different castes and creeds, particularly those who are backward and are schedules in the Constitution, the recent industrialization processes and agrarian reforms have brought about a new secular outlook which has given rise to the promotion of a new culture. The new generations of all cases, communities, religions, and sects are getting chance to come together in farms, factories, educational institutions, universities and government bodies for employment. This coming together has caused a blending of different cultures, emanating from difference communities or tribes, under the impact of modernization. Traditional rituals of the older generation are no more in vogue in the new secular communities which are coming up. The unity of interests and attitudes in economic, social and political fields is helping to accelerate the social processes which are giving common values, cultural traits, art forms, arch itecture, music and dramatics. All modern art activity is assimilating the basic cultural values of all tribes, and giving rise to what may be called national culture. However, our national problems lie in inability to distinguish between cultural imperatives and administrative and economic necessities to find out how a nation be built up from the foundation of cultural multiplicity. Each religion preaches purity of character, benevolence and piety along with honesty. Religious books are shown respect and honor by all. The people go on pilgrimage with respect and reverence. There is always devotion in prayers and so on. Basically all religions believed in religious toleration. In this way there is religious unity in the country. In India there is now great cultural unity. Indian philosophy of life, literature, customs and traditions are basically the same. The institutions like those of marriage etc. are found throughout the country. There are certain rituals and sanskaras which are observed throughout the country. Similarly there are many festivals which are celebrated with great zeal and vigor throughout India. We find a kind of emotional unity in the country. The very name of India or Bharat Mata brings us emotionally closer to each other. Though in India there are different languages and each language has its own literature, yet Sanskrit brings all emotionally together. We treat and consider Sanskrit as the mother of all Indian languages and that brings us emotionally together. Permanent elements of Indian culture are: Maximum stress is laid on spirituality and not just on the earning of wealth. Maximum stress has been laid on religion. Dharma or righteousness is promoted. A dharma or injustice should be checked. We are also reminded that even gods take birth as human beings to check the spread of a dharma and kill those who stand in the way of dharma. All along India culture has taught us to follow religious toleration. It implies that every religion must be given an opportunity to observe its ideology and viewpoint. It also means that every other religion must be shown respect for what is good in that. There should be no violence in religious affairs. Capacity to absorb all good cultures should have that capacity. Hinduism comes to the forefront in this respect. It has always either completely absorbed them or largely influenced all cultures. Indian culture is very wide I its approach to every problem. It lays stress on religion, spiritualism and salvation, without ignoring material and married life. It has always said that the people should be led according to Dharma. Stress on freedom of thought and expression, Hindu culture has always believed that culture becomes rich when the people have freedom of expression. Thoughts and expressions will enrich the culture and that will become dynamic. The unity to the desired extent is not achieved as there arise serious hindrances to national unity. Regionalism is not great hindrance. It implies that the region is above the nation. It should only be developed and the people of that region along should be given the benefits of their development. The region should have maximum autonomy in running its own administration. Regionalism should promote love for the region as well as for the nation as a whole. Now coming to the arguments put forth by Ramchandra Guha in his thoughts about India being an unnatural nation , or being a single divided nation. I think he does have enough examples to illustrate the fact that , yes India is a divided nation after all. The main aspect to understand here is , which factor is more overbearing. Nations are made of two things- Memories and Amnesia. The forgotten memories are best buried together by opposing groups and the good memories must be shared and cherished. Only then is kinship born .However, reality is different. Even if some people forget misfortunes, the rest never do. They pass it on to their successors, shaping their minds to avenge it. In India, secularism made its appearance not only as a concomitant of modernity and nationalism but also as an answer to communalism, another mode political with its pretentions to nationalism. The Hindu nationalism was a natural growth from the soil of India Jawaharlal Nehru wrote in the secular, modernist position and Muslim nationalism it inevitably comes in the way of the larger nationalism which rises above differences of religion and creed. While an ideal nation has images, policies and practices and its state continues to be debatable the nation state now has a powerful and tangible material, intellectual and spiritual force. Whenever an independent nation state is established, the connect with nationalism takes a backseat. This is due to the availability of resources for the oppressed, minority or unheard part of the population. Both Gandhi and Nehru believed that the idea of a nation as a singular space. Inspired from thinkers like Leo Tolstoy, Thoreau and Ruskin, Gandhis impeachment of modern civilization was a political project on behalf of India as a nation. An Important historical moment is the round table conference in London 1931-32, held for drawing the constitution for a future independent India. Gandhi went on a fast unto death in protest at Ambedkars attempt to have untouchables recognized as a minority community like the Muslims and Sikhs. This period is of great significance because it reflected the competing ideas about the legitimate place the citizenship of the community and the minority within what it meant to be Indian. Notions of fossilized communities, a majority Hindu population as well as liberal democratic ideals, had existed side by side in India for much of the nineteenth century. Prior to the insidious entry of the British, India was a wealthy nation also known as sone ki chidiya. The garments, the jewels and the food items were in surplus and of extremely good quality. India was imagined to be a prospering entity under rulers. The political instability gave way to British Raj, with the set up of the East India Company. The 200 years of British raj, had new systems introduces in the society like the land revenue system and postal system. These changed the lifestyle of Indians. Although the British did not consider Indians as civilized but the belief was that India is a close-knit nation and so they came up with the system of divide and rule. The much touted Swayamwar (selection of spouse by a princess in an open forum) is indicative of this deficiency and our total disregard for forging unity. Whereas matrimony amongst the royals in the Europe has always been an instrument of forging strategic alliances, Swayamwar invariably created more enemies than friends. All rejected princes and kings felt insulted, nursed a grudge and waited for an opportunity to take revenge to redeem their self-esteem. History bears testimony to the fact that every Swayamwar was followed by acrimony and internecine wars. Reverting to the role of the British, they never divided us to rule, simply because they did not need to. We have always been and continue to be a divided lot. Formation of states on linguistic basis was never attempted by the British. The Mandal Commission was not constituted or implemented by them. Nor was the Babri Masjid demolished by the British. The current agitation in Maharashtra has not been initiated by the East India Company. Caste based reservations and quota system, the prime splitter of the Indian body politic, were not invented by the erstwhile rulers. Nor are they preventing us from enacting a uniform civil code. The list is endless. We have a knack and penchant for generating innovative issues to divide ourselves. We are doing our best to ensure that we remain embroiled in petty bickering and internal dissentions. To us, our region, religion, caste and sub-caste are more important. Worse, we flaunt this narrow identity and give it precedence over nationalism. If after 60 years of independence, Kashmir and the North East are still not emotionally integrated with the country, the failure is ours.  Ã‚   Undoubtedly, the politicians are the fountainhead of all fissiparous tendencies. One does not have to be a visionary to predict the danger of abetting illegal migration from  Bangladesh  for garnering votes. North Indians in Mumbai are not welcome but illegal Bangladeshis can stay. If political leaders can imperil national security for the sake of power, they can stoop to any level. Sadly, they cannot be expected to change as they believe in the ends and not the means employed. To them, vote bank politics preclude letting countrymen stay united. Additionally, spineless and politicized bureaucracy simply follows their dictates and cannot be expected to deliver either. Immense damage is also being inflicted on the unity of the country by the media through its irresponsible and thoughtless reporting. For the sake of cheap sensational news, petty vandals are given the coverage befitting a mass leader. Every news item is reported with a religious, caste or creed slant a dalit girl molested in a Delhi bus (as if other women are not molested in Delhi buses) or church guard killed (in reality an argument between two security guards had turned violent) or Muslim driver runs over a boy (his being a Muslim is of no relevance). Thus I think , With all its problems and troubles, India always finds a way to hold itself together. India now has become extremely mature and practical about things. It does wait for a Cricket World Cup , Or a patriotic Bollywood movie to express its feeling of oneness , but the realization that being together , united , is the only way to progress and prosper has been established. So though I agree with M. Guhas arguments of India not being a single nation , I think thats essentially how India has been and will be. But the truth lies in the fact that we find our won ways to display unity and move ahead in our attempt to progress. India has learned to live with the fact that its a nation full of diversity and the tolerance levels hence created have made sure the diversity camouflages under the spirit of accepted oneness or uniqueness.

Privacy in work :: essays research papers

The Privacy of the individual is the most important right. It supports human dignity and other values such as freedom of association and freedom of speech. It has become one of the most important human rights of the modern age. Privacy is recognized around the world in various regions and cultures. Almost every country in the world includes a right of privacy in its constitution. Without privacy, the democratic system that we know would not exist. According to the Australian Privacy Charter â€Å"A free and democratic society requires respect for the autonomy of individuals, and limits on the power of both state and private organizations to intrude on that autonomy. The government we have today maintains and organizes our society. The elements of control are often viewed as violations of privacy. These elements are meant to protect us from irresponsible people and from hurting themselves. The laws that are in place still give privacy without invading personal lives or maybe they do invade in our lives? For some people violating into their personal life doesn’t mean anything but for other people it’s a huge problem. â€Å"Privacy is only violated when people feel they are being violated† â€Å"If people feel comfortable in their environment then privacy is not a worry† Privacy in the workplace is also becoming a problem. In American, more and more employers are monitoring their workers at job. In fact, according to the American Management Association, nearly tree quarters of U.S. companies now electronically monitor employees in several ways. Your employer can monitor your Internet usage, what sites you visit, how often, and for how long, as with e-mail. Telephone can also be a threat. If you are on the phone at work, your boss can listen in; your voice mail is also subject to monitoring. Employers own the phone system, so they can generally monitor it as they see well. Your boss can keep a record of the numbers you dial and how long you talk, and can listen to your voice mail messages, although there are some laws preventing companies from listening to employees personal calls. Furthermore Privacy can be divided into the following separate but related concepts: First of all we have the information Privacy or Data protection, which involves the establishment of rules governing the collection and handling of personal data such as credit information, and medical and government records. The second one is the Bodily privacy, which concerns the protection of people's physical selves against invasive procedures such as genetic tests, drug testing and cavity searches.

Culture and Imperialism, a Review of Edward Said Essay

Edward Said remains one of the best selling and well known of the social and literary theorists that deal with identity and nation in the post-colonial global setting. This field is saturated with work dealing with culture and identity formation, post-modern â€Å"epistemic communities,† and most importantly, the relationship between context (ethnic, religious or economic) relative to the formation of such communities. There can be no question that the reading of Said’s book must take place within the context of the American neo-conservative drive to dominate the planet in the name of a vaporous â€Å"democracy,† or even â€Å"free markets. † And for this reason, it is important for the author to establish his view on the United States as a â€Å"conqueror† power primarily, as her early history can be reduced to the â€Å"settler mentality. † Transplants from the imperial center to the imperial hinterlands, for Said is basically the same as the slave societies functioning in the Carribean Islands, as his understanding of Austin shows. America is a slave power and a conquering power in that her development cannot be separated from the systematic pillaging of native traditions and lands. What makes America more interesting is her ability to absorb many traditions, and, from that, to create an identity in a rather counter-intuitive sort of way. Even further, the claim is that such an imperial power has the ability to create unity out of disunity; of creating an identity out of cacophony. Austria, Russia and the Ottomans are just three other examples of predatory powers creating unity out of disunity, or, even more strangely, creating the imperial idea precisely from the materials of disunity, both ethnic and religious. This kind of dialectic, i. e. identity from opposing elements, is central to Said’s concept of identity formation in the context of domination and exploitation. The central argument here is that identity formation has been poorly treated in the historiographic tradition both of the west and of the post-colonial world. Authors have tended to target the functional, â€Å"static† aspects of identity and culture, without understanding, as a whole, the nature of the social context. In other words, social and economic exploitation is as much a part of post-colonial identity as the more static elements of language. In his own ethnic identity, that of the Palestinian, Said can competently say that his own identity exists not in a vacuum, but as intrinsically part of the cultural formation deriving from Turkish, British and Jewish forms of colonial rule. Hence, there is no â€Å"Palestine,† as a cultural formula outside of the multi-ethnic scope of domination and violent colonialization. There is a culture, but it is a culture of â€Å"resistance,† a culture whose very formation exists in a matrix of humiliation. Hence, Said creates a dialectic of his own, following the more common Hegelian logical notion of the conclusion being manufactured though opposition. Identity, as a thesis, is a dialogue deriving from resistance to power. But even more, the antithesis, this identity formation derives at least in part from the â€Å"literary† (speaking broadly) production of the post-colonial center. In other words, after the experience of colonialism, the former metropole continues to dominate the subject peoples from the point of view of literature itself, in fact, a form of identity formation often overlooked in the historical literature. Lastly, as a synthesis, Said holds that a post colonial idea of identity of a formerly subject people is a creation whose final end is indeterminate, and even in general strokes, is vulnerable to critique. The synthesis here is itself an extremely pessimistic concept of identity that leaves the formerly dominated to be forever controlled by the mass-language modes of communication. Communication itself is a form of political power and colonial domination. It is a common idea, driving in modern times from Benedict Anderson and Eric Hobsbawm, that the â€Å"nation† or â€Å"ethnos† is a contrived entity. This does not negate its use as a variable in analysis, but it does show some light on the nature of â€Å"tradition† considered very broadly. In short, Anderson has famously made the argument that the ethnos is a â€Å"imagined community† where the individual envisions himself part of a heritage and a history he had no part in making, and cannot ever hope to â€Å"experience† as a single entity. It is a series of mental images rather than as a set of incontrovertible facts. Hobsbawm, for his part, holds that the ethnos or nation is the synthetic creation not merely of a series of images, but that these images are the direct creation of elites who have a specific interest in development a sense of â€Å"unity† among a formerly disunified people. Mass media, standardized language and an industrial economy are all necessary for such basic cultural standardization to take place. Hence, the idea of a nation, while still useful to the social sciences, remains an entity without actual substance; a monstrous creation rather than a natural growth (cf. 15-18). Said holds to these views, but of course, provides the reader with the more general and inclusive category of international exploitation. While this is a broad category, it remains concrete, since, given the identity of any specific ethnic group, close analysis of its history shows not a â€Å"development† of an ethnic â€Å"idea,† but rather a life of domination, exploitation and manipulation that has forced a hasty and uncritical sense of self that is itself a distortion and the worst form of image manipulation. It is â€Å"unnatural† to the extreme, and hence the global context is highly alienated, since the bulk of the human population subscribe (passively, to be sure) to a sense of self that is a mere reaction of the ethnic immune system (210).

Better Teaching Through Provocation Essay

The quest for an effective pedagogy differentiates the teacher from the researcher. Within the humanities and social sciences, we are constantly confronted with the challenge of communicating complex material in a novel and effective manner. Active teaming is bolstered by an approach that emphasizes creative problem solving, and critical thinking. And active learning often begins with a question. Despite those techniques, philosophical inquiry can sometimes lead to esoteric, pedantic, or even banal approaches to teaching that leave the neophyte intellectually lost or detached from the learning process. As a discipline, philosophy itself is intrinsically provocative. In the spirit of Nietzsche’s infamously provocative style, the use of stimulating techniques in teaching introductory college courses can be immensely beneficial. Goals of Provocation The goals of provocative teaching are grounded in a conceptual framework of critical thinking as well as in an understanding and appreciation of the many psychological processes that influence mental life. The teacher’s strategy should be designed to provoke or pique students to think; that is, to analyze the grounds of their beliefs, which can be directly applied to their personal lives. Stirring questions and statements should challenge (and respectfully critique) the method and rationale by which students arrive at conclusions and reexamine the grounds for their beliefs and attitudes. Guiding Principles Guiding principles in formulating provocative teaching techniques as follows: 1. Orient the technique toward the entire class, not just one student. 2. Allow an appropriate pause time for class response.  3. Respond to all students’ responses. 4. Validate and confirm student attempts to respond or offer an explanation. 5. Use the discussion to launch into a formal presentation of the material or to augment existing didactic strategies. Classroom Examples Provocative techniques combined with systematic questioning may be applied arbitrarily to any topic. Through provocative systematic questioning, the student realizes that this type of reasoning is an informal fallacy based on an appeal to authority that became conditioned and serves as the grounds for his belief. It is better to focus questions toward the entire class, in a case like this, by focusing on one student, others join in to offer competing arguments or supportive rationale that are further examined by the class as a whole. That generally leads to an inclusive process rather than an exclusive centering on one student. Parenting and Corporal Punishment Students believed that corporal punishment was immoral. Most students believed it was morally acceptable, and some even made a case that it was immoral not to physically discipline children when they commit transgressions, because physical punishment teaches them morals. Provocative exercises may provide a personal utility for self-discovery that departs from the traditional procedures of pedantic pedagogy. Risk of Provocation When we examine controversial issues in class, we should be respectful of individual and cultural differences that may influence certain beliefs and practices, while we still maintain intellectual integrity. It should be a tacit assumption for students that acts of provocation are designed to bring rational and emotional constructs under the rubric of knowledge. No provocation should be executed merely for â€Å"shock value.† Because some students may feel intimidated by philosophical questions, the professor should try to be sensitive to the students’ cognitive acumen as well as their emotional development. Sometimes, students who are overly emotional, rigid, or vulnerable to a particular topic simply need to be reminded that the discussion at hand is only an object of intellectual investigation and certainly not a personal attack. Conclusion  We must find a method that suits our personalities and didactic styles. Instead of traditional lecturing, the combined use of provocative questions and statements that force the class to respond to a particular issue may have more impact and personal meaning than fort-formal approaches. Furthermore, the use of probing and systematic questioning gears students toward an introspective analysis of their personal beliefs, not only grounded in reason, but also linked to emotional and psychological motives that influence their perception of cause and effect. One will notice progress in their critical thinking skills over the length of the course. Rather than professing an impetuous position based upon unreflective conditioning, students offer more solid argumentation with developed rationale for their beliefs and attitudes.

buy custom Laptops and Netbooks Review essay

buy custom Laptops and Netbooks Review essay Technology has allowed computer companies to design cheaper computers to cater for the low end of the market. The cheap computers come with limited capability as some of the technological advances present in expensive computers lack in them. Hp is a key player in the computer business and produces a wide variety of product to cover the segmented market. This review will cover one of their cheapest products in the market which is the hp 620. The product that retails for around 479.99$ is among the cheapest 15.5 computers on the market (Bentley, 2010). Alex Bentley reviews the product by giving its strengths and weaknesses in the market (Bentley, 2010). The product hp 620 may be a good product but not a perfect product. Contrary to the great product the hp 620 as per Alexs opinion, the laptop is experiencing some technical problems that need rectification. The issue of the bluetooth device needs to be rectified for the product to fit this description. The computers bluetooth device seems to be lacking from the device, this is a deviation from the review that states that the product has a bluetooth device. Connection to other devises is problematic and troubleshooting of the device does not help the issue. Although the laptop is compact in size, carrying the product around requires a bigger bag compared to 14 laptops. The computer is not relatively light as the 2.5 kilos may have an effect on young customers. The top has a sleek design which is the highlight of the computer; the back however, lacks the aesthetic value to attract the customer. The design of the audio jack is not appealing. The jacks have been installed facing the user, a point that Bentley supports regardless of the fact that the user interferes with the cables while using the computer. A better design would consider locating the audio jacks to the computers rear (Bentley, 2010). The review focuses on the key factors that the original review omits in the evaluation of the product. The opposing review may appeal to the other customers that own the product as they experience the problems highlighted in the opposing review. Buy custom Laptops and Netbooks Review essay

The Polis essays

The Polis essays During the Archaic Period of Ancient Greece, many communities segregated themselves into small, subdivided city-states. Such cities were small, but managed to establish the very roots of democracy today. The term polis can be defined as an independent state governed by its population. Such a definition is accurate, however also could be considered broad and constricted. In deeper aspects, the polis was an organized state or community that worked together in upholding equivalent rights with an effort to prevent tyranny, or a state governed by one person. The polis went through extensive political efforts to maintain its unity and natural rights. Such qualities of a state led to other enhancements of the polis such as the social, religious, and economic aspects of joined community. The polis developed shortly after Cultural Revolution of ancient Greece during the early Archaic Period. During this time period almost every aspect of life went experienced a major change. Socially and politically Greece began to develop greater stability. Unlike other areas, which developed mostly into personal leadership, Greece followed an antagonistic political principle of unity and basic equality. The polis emerged from such political ideology to form a state of equal natural rights and the absence of tyranny. Some of the major reasons why Greece did not develop single rulers were because of financially weak kings, weapons which made war chiefs obsolete in strategic commanding, geographical isolation, and a simplicity of Greek life which withheld principles of equality. Such conditions helped curve the development of the polis. Politically, the polis was known to be well established. The political structure of the polis was based upon its value of equal representation and natural rights. Therefore the major office was filled with different officials managing different aspects of the community. One official might conduct...

Effective Speech Writing, Inspirational Public Speaking

Effective Speech Writing, Inspirational Public Speaking Writing speeches for graduation, class assignments, or other purposes consists of a lot more than finding a few inspirational quotes and possibly a funny story or two. The key to writing good speeches lies in using a theme. If you always refer back to this theme, the audience will respond positively and remember your words. This does not mean that inspirational quotes are not important, but they should be integrated into your speech in a way that makes sense. Choosing a Theme The first task that a public speaker needs to focus on before they do any actual writing is the message they are trying to convey. My inspiration for this idea came from the speeches of John F. Kennedy. In his Inaugural Speech, he chose to focus on freedom. He addressed many different topics, but always came back to this idea of liberty. When asked to be the guest speaker at a National Honor Society induction recently, I decided to focus on how an individuals daily decisions add up to reveal that persons true character. We can not cheat in the small things and expect these blemishes to never surface. When the real tests in life occur, our character will not be able to withstand the pressure because we have not chosen the harder path all along. Why did I choose this as my theme? My audience consisted of Juniors and Seniors at the top of their respective classes. They had to meet stringent requirements in the areas of scholarship, community service, leadership, and character in order to be accepted into the organization. I wanted to leave them with one idea that might make them think twice. How does this relate to you? First, you must decide who will make up your audience. In a graduation speech, you are addressing your fellow classmates. However, parents, grandparents, teachers and administrators will also be present. While you will be focusing on people your age, what you say must be in line with the dignity of the ceremony itself. Remembering that, think of the ONE thought with which you want to leave your audience. Why only one idea? Mainly because if you reinforce a single point instead of focusing on a number of different ideas, your audience will have a greater tendency to remember it. A speech does not lend itself to having many themes. Stick with one really good theme, and use each point you make, your theme reinforcers, to bring that idea home. If you would like some ideas for possible themes, look at the world around you. What are people concerned about? If you are speaking about the state of education, find one central idea that you feel strongly about. Then return to that idea with each point you make. Write your individual points to reinforce your idea. To return to the graduation speech, check out these top ten themes to use when writing your speech. Utilizing Theme Reinforcers Theme reinforcers are simply the points that a speechwriter uses throughout his or her speech to reinforce the central idea they are trying to get across. In Winston Churchills famous commencement address to Westminster College in 1946, we find him emphasizing over and over again the need for cooperation against tyranny and war. His speech covered serious problems with which the post-war world was faced, including what he termed as the iron curtain that had descended across the European continent. Many say that this speech was the beginning of the cold war.  What we can learn from his address is the importance of continually reiterating one idea. The effect that this speech had on the world is almost incalculable. On a more local note, I used the four requirements necessary to become a member of NHS as my four points. When I discussed scholarship, I returned to my idea of daily decisions and said that a students attitude towards learning is increased positively with each personal decision to focus on the task at hand. If a student enters a class with the attitude that they want to learn what is being taught, then their efforts will shine forth in true learning. I continued in this vein for each of the other three requirements. Of course, this does not mean that throughout the speech the same words are repeated over and over. The hardest part of writing any speech is to approach the main theme from many different angles. Wrapping it All Together Once youve picked your theme and chosen the points you want to emphasize, putting the speech together is fairly simple. You can organize it first in outline form, remembering to return at the end of each point to the theme you are trying to get across. Numbering your points sometimes helps the audience remember where you are and how far you have left to travel before the climax of your speech. This climax is the most important part. It should be the last paragraph, and leave everyone with something to think about. One great way to bring your ideas home is to find a quote which aptly embodies your theme. As Jean Rostand said, Certain brief sentences are peerless in their ability to give one the feeling that nothing remains to be said. Quotes, Resources and an Unconventional Idea Find great quotations and other speech writing resources. The tips found on many of these pages are awesome, especially the strategies for giving the speeches themselves. There are also many unconventional ideas that can be incorporated into speeches. A great example of this occurred during a graduation speech by a Valedictorian which incorporated music throughout. She picked three different songs to represent the students elementary, middle, and high school years and played them softly while she went through memories for the class. Her theme was a celebration of life as it was, is, and will be. She ended with a song of hope and left students with the idea that there was a lot to look forward to in the future. Speech writing is all about knowing your audience and addressing their concerns. Leave your audience with something about which to think. Include humor and inspirational quotes. But make sure that each of these are integrated into the whole. Study the great speeches of the past to find inspiration. The joy that you will feel when you have given a speech that has inspired people is amazing and worth the effort. Good luck! Inspiring Speech Example The following speech was delivered during an induction to the National Honor Society.   Good Evening. I am both honored and flattered to have been asked to speak for this wonderful occasion. I congratulate each of you and your parents. Your achievements in the realms of Scholarship, Leadership, Community Service, and Character are being honored here tonight by your induction into this prestigious society. An honor such as this is a wonderful way for the school and community to recognize and celebrate the choices, and sometimes the sacrifices, you have made. But I believe that what should make you and your parents the most proud is not the actual honor itself, but what you had to do to get it. As Ralph Waldo Emerson said, The reward of a thing well done is to have done it. Any recognition is just the icing on the cake, not to be expected but definitely to be enjoyed. However, I challenge you not to rest on your laurels but to continue to strive towards even loftier goals. The four requirements for membership in which you have excelled: scholarship, leadership, community service, and character were not chosen at random. They are the core of a fulfilled and fulfilling life. The most important thing to remember is that each of these characteristics are the sum of many individual decisions. They embody a positive attitude backed by purpose. The only way to achieve your purpose is to take small actions everyday. In the end, they all add up. My hope for you is that you will cultivate this attitude backed by purpose in your own life. PAUSE Scholarship is much more than just getting straight As. It is a life-long love of learning. In the end it is a sum of small choices. Each time you decide you WANT to learn something, the experience will be so rewarding that the next time becomes easier. Soon learning becomes a habit. At that point, your desire to learn makes getting As easier while taking the focus off of grades. The knowledge can still be hard to gain, but knowing youve mastered a difficult subject is an awesome reward. Suddenly the world around you becomes richer, full of learning opportunities. PAUSE Leadership is not about being elected or appointed to an office. The office does not teach someone how to be a leader. Leadership is an attitude cultivated over time. Are you one to stand up for what you believe in and face the music even when that music happens to be unpleasant? Do you have a purpose and follow that purpose to get the ends you desire? Do you have a vision? These are all questions that true leaders answer in the affirmative.But how do you become a leader? Each small decision you make takes you one step closer. Remember the goal is not to get power, but to get your vision and your purpose across. Leaders without visions can be likened to driving in a strange town without a road map: you are going to wind up somewhere, it just might not be in the best part of town. PAUSE Many see community service as a means to an end. Some might see it as a way to get service points while socializing, while others may view it as an unfortunate (and often inconvenient) necessity of high school life. But is that true community service? Once again true community service is an attitude. Are you doing it for the right reasons? Im not saying there wont be Saturday mornings when you would rather sleep your heart out than paint your heart out. What Im talking about is that in the end, when it is all done, and you are once again well-rested, you can look back and realize that you did something worthwhile. That you helped your fellow man in some way. Remember as John Donne said, No man is an island entire of himself. PAUSE Finally, character. If there is any one thing that is evidenced by your daily choices it is your character. I truly believe what Thomas Macaulay said, The measure of a mans real character is what he would do if he knew he would never be found out. What do you do when no ones around? The teacher steps out of the room for a moment while you are taking a test after school. You know exactly where in your notes the answer to question 23 is. Do you look? Minimal chance of being caught! The answer to this question is the key to your true character. For while being honest and honorable when others are watching is important, being true to yourself is tantamount. And in the end, these private day-to-day decisions will eventually reveal your true character to the world. PAUSE All in all, are making the tough choices worth it? Yes. While it would be easier to slide through life without a purpose, without a code, it would not be fulfilling. Only by setting difficult goals and achieving them can we find true self-worth. One final thing, each persons goals are different, and what comes easy to one may be difficult for another. Therefore, do not squash others dreams. This is a surefire way to know that you arent working towards fulfilling your own. In conclusion, I congratulate you for this honor. You are truly the best of the best. Enjoy yourself, and remember as Mother Teresa said, Life is a promise; fulfill it.

Beneficiary of the Financial Liberalization Essay

Beneficiary of the Financial Liberalization - Essay Example Financial liberalization involves reduction of regulations and involvement of regulatory agencies in the financial system of a given country or region. It refers to the ‘deregulation of domestic financial markets and the liberalization of the capital account’ (Ranciere, Tornell & Westermann, n.d, p.1). The financial system broadly refers to the lending system in a given country and includes the players like banking institutions, the central bank, the treasury in a country, or the money markets authorities. Financial liberalizations will have varying effects on the players in different industries at the national, regional, or international levels. While some economies may suffer the negative consequences of financial liberalizations, other players in the economy will benefit from the initiative. This paper focuses on the likely beneficiary/beneficiaries of financial liberalization. Some financial reforms Financial liberalization measures can comprise both internal regulat ions (imposed by the central banks within a country) and external regulations effected by the regional and international agencies or the regulatory agencies in foreign countries. Internal FL measures are many. ... ludes a state’s withdrawal from involvement in financial intermediation (Ghosh, 2005), which is characterized by the transformation of development banks into regular financial institutions and privatization of publicly owned banking system. Financial liberalization also involves creating a relaxed environment for investors and firms to participate in the stock market through dilution of the listing conditions as well as relaxed regulation on the financial instruments to be used or acquired within a given financial system (Ghosh, 2005). A liberalized economy will also be characterized by better access to financial sources. Thus, internal financial liberalization also includes improving access to funds by the financial agents and firms and removing regulations on the kind of investments that can be made by these financial agents (Ghosh, 2005). External financial liberalization may include steps like allowing foreigners to own domestic financial assets, allowing domestic resident s to own foreign financial assets, or allowing free trade of foreign currency asset within the domestic economy (Ghosh, 2005). Who gains from financial liberalisation? Financial liberalization has positive and negative impacts on the economic development in a given country. While it can promote financial deepening and increased economic growth of a country, it can also lead to financial crisis in other countries resulting from increased macroeconomic volatility and excessive risk taking (Ranciere, Tornell, & Westermann, N.d). Financial repression, caused by governments’ interventions in the financial sector, leads to low economic growth and poor allocation efficiency in countries with negative interest rates and vice versa for positive interest rates (Caprio, Honohan & Stiglitz, 2006, p.5).

Impact of culture on globalization strategies Essay - 2

Impact of culture on globalization strategies - Essay Example ly discussed the extent of corporate obligations of MNCs through a presentation of traditional theories popularized by Adam Smith (Theory of Moral Sentiments), Bentham and Mill (concept of utilitarianism), Smith’s ethical nature of political economy, and Milton Friedman’s minimalist approach to corporate obligations. According the Friedman, the only social responsibility of a business is to enhance the wealth of the firms stockholders (1962). However, Cobb concluded that â€Å"while there is no firm agreement on the extent of corporate responsibility, most discussions move beyond this minimalist approach† (2000, 2). The model which examines corporate responsibility is the stakeholder model which was defined as â€Å"firm managers must recognize the legitimate rights of the firms claimants in making decisions. The claimants include not only stockholders and employees but also others who can influence or are influenced by the decisions of a firm (Pearce & Robinson, 1982). Claimants commonly include customers, suppliers, governments, financial institutions, unions, competitors, local communities, and the general public.† (Cobb, 2000, 3) As stakeholders increase in number and become more diverse due to globalization, the more those cultural and ethical norms should be incorporated in international transactions. A discussion on the moral philosophy delved into identifying its three parts: value, the good and duty; and different societies view moral philosophy differently. Likewise, Cobb emphasized that â€Å"cultures are constantly evolving and the ethical and cultural norms of a society will change over time† (2000, 4). Trade, on the other hand, has an effect in adapting the cultural and ethical norms of MNCs. Cobb clearly explained that â€Å"when there is a long history of peaceful coexistence between countries, social interaction will develop, and some cultural norms of the countries will be accepted by the other country. Along with the acceptance of the cultural

Demand-side and Supply-side Policies on Economic Growth Case Study

Demand-side and Supply-side Policies on Economic Growth - Case Study Example These policies are either expansionary (catalyze spending in a recessionary economy) or contractionary (reduce spending in an inflationary economy). Also, supply side policies are those policies employed by the government to increase the country’s productivity hence shifting the aggregate curve outwards. They also are designed to affect an economy’s ability to produce goods and services. They increase the country’s aggregate productivity over time and improve the potential of the economy to produce. These policies are always expansionary with an aim increasing an economy’s production capacity which translates into increased living standards (Sloman, 2006). Demand side policies are further broken down to fiscal and monetary policies. Fiscal policies are those policies that are aimed at bringing changes in the government spending or taxes collected while monetary policies aim at bringing changes to the money supply engineered by the central bank. Expansionar y policies are then defined as those policies designed to stimulate economic growth through changes in real Gross Domestic Product (GDP) and the potential output of the economy (Economics Online, 2013). The policies are characterized and implemented in the demand side by any of the four categories of expenditure i.e. consumption expenditure, investment expenditure, government expenditure, or net export expenditure that constitutes the Gross Domestic Product (GDP). On the supply side, the expansionary policies are designed to add flavor to the capacity of production of the economy through labor policies (education, immigration, retirement), capital accumulation, research and development (seeking technological improvements), or promotion of resource availability. Monetary policies lower rates of interest that accompany an increase in money supply hence affecting investment expenditure. A monetary policy would increase the amount of local currency available in the exchange market which will then weaken the rates of exchange with other currencies. Also, the lower rates of interest will make the economy unattractive to investors when compared to other economies which will lead to a capital overflow resulting in the sale of domestic assets and the currency in the exchange market resulting in an ultimate weak currency. A weaker currency makes exports relatively cheaper to foreign buyers hence will stimulate the demand for the local goods while at the same time imports will be more expensive to domestic buyers leading to a reduced demand for imported goods (Pettinger, 2011). This will result in an increase in Net Export expenditure. In times of large deficits in the budget, fiscal policies tend to be missing from the policy maker’s ideologies. These policies are easy to legislate as they are politically popular and supported. Monetary expansionary policies are ineffective and unpredictable compared monetary contractionary (Sloman, 2006). In a case where the wea k economic growth or high level of unemployment worries the Federal Reserve, the policy will react by increasing bank reserves by open market purchase (where the central bank buys or sells government bonds on the open market to manipulate the short term interest rate and supply of base money in an economy) prompting banks to convert their reserves into loans to their customers.  

Ass4 Coursework Example | Topics and Well Written Essays - 250 words

Ass4 - Coursework Example This mountain later came to be known as â€Å"Mount Kailash†. To some people, the similarity between Mount Meru and Mount Kailash has a spiritual aspect. Shiva Samhita says that their lies a Mount Meru in one’s body and only a true yogi can identify it. Certain religious pilgrims, who visit Mount Kailash, view it as a spiritual, and not a cosmological centre. A ‘kora’ is a religious practice in Tibetan. In this practice, one has to go around Mount Kailash to wash your sins and to gain enlightenment. Hence, the word pilgrimage, ‘nekorwa’, in Tibetan, means ‘making circles about holy places’. Various different ways of doing a ‘kora’ are adopted. Some people sponsor a ‘kora’ for the person who actually travels around Kailash and the blessings of this act are shared by both. Some people may complete the ‘kora’ in a day. But to gain enlightenment, you must be, spiritually, in contact with God. Answer- Hindus believe that the act of completely immersing oneself in Lake Manasarovar leads to one’s incarnation as God. Tibetans, on other hand, do not bathe in Lake Manasarovar because they do not like to dirty the holy water. Dolma La is the highest point in Kailash kora. Along the path to Dolma La, stones are stacked by pilgrims. These stones represent Mount Kailash. ‘Dolma’ is said to be the one who guided the first person to reach Dolma La. A boulder is worshipped at the place where she

Discussion Questions Assignment Example | Topics and Well Written Essays - 500 words - 1

Discussion Questions - Assignment Example Methods used to achieve this are development and research theory. Disciplinary power is extremely influential and power full; it is used in influencing groups and individuals to produce an effect of their habits, conduct and attitude. Large percentage of nurse’s focus on holistic models of nursing which are centered on health experience and challenges, professional and cultural life comprises of cluster of symbolic practices (Rogers, 67). In order to promote evidence based practices, they have to attempt to change nursing culture. This is necessary for revitalization. It needs to take account of factors such as; locus of power and decision making. Nursing culture is expected to exhibit outcomes and behaviors of reflection within their day-to-day practices. Through critical reflection, they are able to examine the historical and developmental circumstances which help in shaping the nursing culture. Knowledge and understanding the community is vital in improvement of educational and quality health care. Having complete knowledge about a community will also help in eradicating of diseases that may attack residents in a community. Over the past years, community health workers have been offering door to door medical services; this is to prevent the spread of diseases and also addressing issues concerning a healthy living (Mat lack, 89). Community health practices are the activities that help in improvement of health status, prevention of epidemic diseases such as chorea, tuberculosis is and many other chronic ailments. Influencing public health policy can be done by community campaigns’; this is to educate different communities on who to live a healthy life and more on how to deal with diseases which cause epidemics. Illiteracy in some communities affects the public health policy; it is the main cause of spread of some chronic diseases. In some communities may be having

Market Orientation Essay Example | Topics and Well Written Essays - 500 words

Market Orientation - Essay Example Different departments within the organizations are completely oriented towards identifying and designing methods to meet these changing customer demands. According to Naver and Slater (1990), organizations that follow marketing orientation tend to follow five key strategies namely customer orientation, competitor orientation, interfunctional-coordination, organizational culture and focus on long-term profits. Most well-known market-oriented organizations are Sony, Dell, Toyota, General Electric, etc (Day, 1999). These organizations are customer-focused and use marketing information to develop strategies that enhance customer satisfaction. Several benefits have been identified with market orientation. A market-oriented firm can focus and retain its loyal customers that are of more value to the firm’s business. These firms usually have higher employee satisfaction because of greater customer satisfaction and vice versa. This further enhances employee commitment and their product ivity.

Discussion Questions Assignment Example | Topics and Well Written Essays - 500 words - 1

Discussion Questions - Assignment Example Methods used to achieve this are development and research theory. Disciplinary power is extremely influential and power full; it is used in influencing groups and individuals to produce an effect of their habits, conduct and attitude. Large percentage of nurse’s focus on holistic models of nursing which are centered on health experience and challenges, professional and cultural life comprises of cluster of symbolic practices (Rogers, 67). In order to promote evidence based practices, they have to attempt to change nursing culture. This is necessary for revitalization. It needs to take account of factors such as; locus of power and decision making. Nursing culture is expected to exhibit outcomes and behaviors of reflection within their day-to-day practices. Through critical reflection, they are able to examine the historical and developmental circumstances which help in shaping the nursing culture. Knowledge and understanding the community is vital in improvement of educational and quality health care. Having complete knowledge about a community will also help in eradicating of diseases that may attack residents in a community. Over the past years, community health workers have been offering door to door medical services; this is to prevent the spread of diseases and also addressing issues concerning a healthy living (Mat lack, 89). Community health practices are the activities that help in improvement of health status, prevention of epidemic diseases such as chorea, tuberculosis is and many other chronic ailments. Influencing public health policy can be done by community campaigns’; this is to educate different communities on who to live a healthy life and more on how to deal with diseases which cause epidemics. Illiteracy in some communities affects the public health policy; it is the main cause of spread of some chronic diseases. In some communities may be having

The effect of car usage on global warming Essay Example for Free

The effect of car usage on global warming Essay The author Tina Fanning in the newspaper article â€Å"cars no longer sustainable†, which was written in July 2007, contents the effect of car usage on global warming and the effect on the future of our children that proves the high level of harmfulness that global warming causes. The audience in this article is aiming at car users and state governors. the first argument that is used is that country people have â€Å"stopped coming to Melbourne for the big games, shopping, theater or the art galleries. † The technique that is used is reason and logic, as he uses a clear logical and rational argument to prove his point. The effect this particular argument has on the reader is that, it makes them realize one of the major negative outcomes of this issue, therefore, taking the issue less lightly and more seriously. The tone the writer has during the argument is anger, seriousness and sympathy for the people outside Melbourne who have the will to visit. the second argument involves the Victorian’s addiction to cars, and that they overuse it whilst being â€Å"dependent on cars for personal and individual status and comfort as much as for convenience.† This pushes the reader to feel a sense of guilt and shamefulness as he attacking them for being a factor of one the negative outcomes. A rhetorical question was used in order to make his point in this argument clear enough as he says â€Å"what warming signs can you see?† trying to remind the reader of the signs of global warming that accruing recently. The Tone of the writer during the argument is disappointment and accusation. The third argument in this article is that the effect of global warming is the same effect of smoking and alcohol and how it impacts on the future and the health of the people. Fanning proves this through her words â€Å"they are now on a par with social evils of smoking and alcohol†. Analogy was used, as the author compares two point of views which are smoking and alcohol with global warming trying to prove that they have same affect. The tone throughout the argument was fear and worry from the negative outcomes of this issue. The intention of the writer is persuade the readers to acknowledge the negative and harmful outcomes of the issue. Also, trying to make the reader take the issue seriously through arguments and techniques. Fanning has conditioned the reader to worry and question the negativity of global warming.

COPD Case Study Assignment

COPD Case Study Assignment 1) CASE SUMMARY Mr TLT is a 58 year old taxi driver who was admitted to Hospital Batu Pahat due to newly diagnosed chronic obstructive pulmonary disease. He has had hypertension for the past one year and is taking T Amlodipine 5mg od. He is also a chronic smoker for the past 40 years who smokes about 20 sticks of cigarettes a day. Mr TLT presented with shortness of breath which progressively increased in severity for the past 4 days. The shortness of breath was associated with a wheeze. There was also cough with production of mucoid sputum. The dyspnoea occurred after an episode of upper respiratory tract infection. Mr TLT has been having intermittent chronic cough associtaed with mucoid sputum for the past 3 years. He has also been having persistent breathlessness for the past 1 year especially on exertion. He has not sought treatment prior to this admission. On physical examination, Mr TLT was tacypnoiec with a respiratory rate of 28 breaths per minute. There was no cyanosis. Repiratory system examination showed use of accesory muscles as well as increased anterior posterior diameter of the chest and reduced cricosternal distance. On auscultation, vesicular breathing was heard with generalised rhonchi and coarse early inspiratory crepitations at the lower zone of both lungs. The cardiovascular system examination was normal. There were no other abnormalities on physical examination. Investigations done include chest plain radiograph which showed a hyperinflated chest, tubular heart and absence of vascular markings at the peripheries. The ECG showed sinus rhythm with low voltage. No P pulmonale indicative of right atiral hypertrophy seen. A working diagnosis of acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection was made. Mr TLT was given nebulization of ipratropium bromide, salbutamol and normal saline for 2 times. His symptoms improved after being given the nebulization. He was discharged after three days when the dyspnoea had resolved. He was given metered dose inhaler of Ipratropium Bromide 40microgrammes tds and MDI salbutamol 200microgrammes PRN. He was given an appointment to assess his symptoms at the outpatient department in one month time. STUDENT NAME: Tan Hai Liang ID NO : M0409146 NAME OF SUPERVISOR : Prof Khin ROTATION: Internal Medicine PATIENTS DETAILS I/C NUMBER : 510912-01-6343 AGE : 58 SEX : Male DATE OF ADMISSION : 2 June 2009 R/N NUMBER : 1143451 2) CLINICAL HISTORY Chief complaint: Mr TLT is a 58 year old taxi driver who presented with shortness of breath for the past four days. History of present illness: Mr TLT is a chronic smoker for the past 40 years who has been smoking about twenty sticks of cigarettes a day. He had been diagnosed with hypertension for the past one year and is currently on T Amlodipine 5 mg od. Mr TLT has been having intermittent chronic cough for the past 3 years. The cough is productive at times. The sputum produced is mucoid in nature and about one tablespoonful in amount. There is no blood in the sputum. It is also not foul-smelling. Mr TLT then proceeded to have shortness of breath for the past one year. The dyspnoea is persistently present and described as requiring increased effort to breathe. It is worse on exertion and Mr TLT experinces reduced effort tolerance. He is now able to climb one and a half flights of stairs before becoming breathless. He has not consulted any doctors for these symptoms prior to admission. Mr TLT then developed symptoms of upper respiratory tract infection such as rhinorrhea and sore throat one week prior to admission. He had fever of 38 degress celcius at that time which resolved with paracetamol. He also had a productive cough with mucoid sputum at this time. Mr TLT then developed increasing shortness of breath 4 days prior to admission. The shortness of breath worsened over the 4 days and was associated with noisy breathing. He was breathless even at rest but was still able to speak in sentences. There was also an increase in cough as well as production of sputum. The sputum was mucoid and non purulent. He also did not notice any blueness around his lips or at his fingers. Systemic review: There was no loss of appetite or loss of weight. He had mild ankle oedema but no other signs of heart failure such as orthopnoea or paroxysmal nocturnal dyspnoea. Past medical history Mr TLT has not had any hospital admissions prior to this. He was diagnosed with hypertension last year as an incidental finding during a visit to the kilinik kesihatan for an upper respiratory tract infection. He is currently taking tablet Amlodipine 5 mg once daily. Family history Mr TLT is the eldest of 5 siblings. There is a strong family history of hypertension in that his mother as well as two other siblings are also hypertensive. There is no family history of asthma, diabetes or ischaemic heart disease. Social history Mr TLT used to work as a taxi driver but has stopped working full time 2 years ago. He still occasionally drives his taxi but spends more time at home with his family. He is a chronic smoker for the past 40 years and smokes about 20 sticks of cigarrettes a day. He drinks alcohol with his friends on weekends. He drinks one to two bottles of beer each time. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine ____________________________________________________________________________ 3) FINDINGS ON CLINICAL EXAMINATION On general examination, Mr TLT was well nourished and alert but was tachypnoiec. He was able to speak in sentences but there was use of his accessory muscles. There was no clubbing or cyanosis seen. There was also no peripheral oedema, pallor or jaundice. Vital signs: Pulse rate: 72 beats per minute, regular with good volume. No bounding pulse. Respiratory rate: 28 breaths per minute Blood pressure: 129/73 Temperature: 37 degrees Celsius SpO2: 95% under nasal prong oxygen 3 litres per minute Examination of the respiratory system: On inspection of the hands, there was no peripheral cyanosis or flapping tremors seen. There was also no clubbing, muscle wasting or palmar erythema seen. There was presence of nicotine stains. The jugular venous pressure is mildly elevated at 3.5 cm above the sternal angle. On palpation of the trachea, the trachea is central but the cricosternal distance is 2 fingers which is reduced. The apex beat could not be palpated. On inspection of the chest, there is an increased anterior posterior diameter giving rise to a barrel shaped chest. The chest moves equally with respiration and there is use of accessory mucles with intercostal, subcostal and suprasternal retraction. There are no chest wall deformities. On palpation, chest expansion is reduced on both sides. Tactile fremitus is equal on both sides. On percussion, there is hyperresonance over both lungs with loss of liver and cardiac dullness. On auscultation vesicular breathing is heard. There is generalised expiratory rhonchi. There is also fine early inspiratory crepitations heard at the lower zones of both lungs. Examination of the cardiovascular system: The apex beat could not be palpated. There were no parasternal heaves or thrills palpable. On auscultation, normal first and second heart sounds were heard. There was mild bilateral pitting oedema. Examination of the abdomen: On inspection, the abdomen is flat and moves with respiration. There was no guarding or tenderness. The liver and spleen were not palpable. There was no organomegaly. Examination of the neurological system was normal. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional diagnosis: Acute exacerbation of newly diagnosed chronic obstructive airway disease due to upper respiratory tract infection. Evidence for: Patients with chronic obstructive airway disease (COPD) usually present with a persistent dyspnoea and reduced effort tolerance which was present in the history given by Mr TLT. He is also at increased risk of developing COPD due to exposure to associated risk factors such as tobacco smoke. He has been a chronic smoker for the past 40 years. There is also the presence of chronic cough occasionally associated with mucoid sputum which further suggests COPD. Physical findings of a hyperinflated chest and vesicular breathing with generalised expiratory rhonchi also point to an obstructive airway disease. During this admission Mr TLT had increasing severity of shortness of breath even at rest. This was associated with a wheeze that was described as noisy breathing. Sudden worsening of symptoms suggest an episode of acute exacerbation. The history of upper respiratory tract infection symptoms suggest that it was the trigger for this episode of exacerbation. Differential diagnosis: 1) Congestive cardiac failure. Mr TLT may have developed congestive cardiac failure as a primary event or as a complication of chronic lung disease. There is history of reduced effort tolerance. Patients with congestive cardiac failure may also present with a wheeze and sudden increase in dyspnoea. Physical examination of fine crepitations at both bases of the lungs may also indicate congestive cardiac failure. There is also evidence of mildly raised JVP as well as mild pittint ankle oedema. Evidence against: There is no history of any cause of heart failure such as ischaemic heart disease or cardiac valve defect. Mr TLTs previous records during follow-up show well controlled blood pressure. Additional investigations need to be carried out in order to rule out this condition. A chest plain radiograph may be done in order to look for evidence of heart failure such as cardiomegaly. An ECG may be done to look for right atrial hypertrophy. An echocardiogram should also be performed in order to assess the function of the ventricles. 2) Bronchiectasis Patients with bronchiectasis have a history of chronic cough as well as production of copious amounts of sputum. They may also have persistent shortness of breath, reduced effort tolerance and wheeze. Evidence against: The sputum produced by Mr TLT is mucoid in nature and not purulent which is typical in bronchiectasis. It is also not copious and foul smelling in nature. On physical examination, coarse crepitations would be heard in bronchiectasis as opposed to the fine crepitations heard in Mr TLT. There is also no evidence of clubbing. Chest plain radiograph should be done in order to look for thickened bronchial walls or cystic shadows. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Shortness of breath and reduced effort tolerance Mr TLTs chief complaint is shortness of breath. This may be attributed to the increase in number of goblet cells and later on fibrosis of the bronchial walls causing airway obstruction seen in chronic obstructive airway disease. The shortness of breath may be partially relieved with the use of nebulization of ipratropium bromide, salbutamol and normal saline or with the use of metered dose inhalers. Chest physiotherapy may also be useful. Mr TLT also has had reduced effort tolerance and persistent dyspnoea for the past a year. As such he may require the use of ipratropium bromide in a metered dose inhaler upon discharge in order to feel less breathless due to the bronchodilator effect of the ipratropium bromide. 2. Upper respiratory tract infection Mr TLT may require antibiotics as he still has symptoms of upper respiratory tract infection such as sore throat. Furthermore patients who present with an acute exacerbation are at greater risk of having a bacterial infection. This is because of the depressed immune state that the patient is in as a result of the acute illness as well as due to any steroids that would be given as part of the management plan. The appropriateness of usage of antibiotics in chronic obstructive airway disease will be further discussed below. 3. Adequate inhaler technique Mr TLT would need to be taught about the correct technique to be used when using metered dose inhalers. He would probably require daily use of ipratropium bromide metered dose inhalers to reduce his breathlessness. In the event that he is unable to learn proper technique, he may be encouraged to buy an aerochamber. 4. Smoking cessation Mr TLT should be counseled on smoking cessation as it has been proven that smoking cessation would alter the course of progression in COPD and is associated with lower all-cause mortality. He should be counseled on the various options of smoking cessation which will be discussed further below. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1) Full Blood Count Justification: In order to view the total white count as well as the differential count to see if there is an infection which has caused this episode of exacerbation. There may also be secondary polycythemia if the patient has chronic pulmonary hypertension. Results: White cell count : 7.91 X 109/L Red blood cell : 4.48 X 1012/L Haemoglobin : 133.00 g/dl Haematocrit : 42.00 ratio Mean cell volume : 93.80 fL Mean cell haemoglobin : 29.70 pg Mean cell haemoglobin conc. : 317.00 g/l Platelets : 141.00 X 109/L Differential count Neutrophils : 60.10% 4.76 X 109/L Lymphocytes : 25.30% 2.00 X 109/L Monocytes : 13.80% 1.09 X 109/L Eosinophils : 0.50% 0.04 X 109/L Basophils : 0.30% 0.02 X 109/L Interpretation: This is a normal full blood count result with normal total white count as well as normal haemoglobin levels. 2) Plain chest radiograph Justification: Done in order to look for evidence of chronic obstructive airway disease such as hyperinflated chest or evidence of congestive cardiac failure such as cardiomegaly and prominent upper lobe vessels. Results: Hyperinflation of the chest with the 7th anterior rib crossing the diaphragm. No other abnormalities seen. Interpretation: Hyperinflation of the lung fields is consistent with the provisional diagnosis of chronic obstructive airway disease. 3) Sputum FEME, culture and sensitivity (not done) Justification: In order to look for any bacteria which may have been the cause of the exacerbation . If there any organism cultured, proper antibiotics can be given based on the sensitivity test. 4) Arterial blood gas (not done) Justification: May be necessary in severe cases of breathlessness to look for respiratory failure and associated changes in blood pH. 5) Blood urea serum electrolytes and creatinine Justification: To look for renal impairment which may be present due to Mr TLT having hypertension. Renal impairment may also affect the dosage and type of antibiotics used. Results: Urea : 3.7mmol/L Sodium : 135 mmol/L Potassium : 3.7 mmol/L Creatinine : 65 umol/L Interpretation: Normal result. There is no renal impairment 6) Electrocardiogram Justification: To look for evidence of right ventricular hypertrophy or right atrial hypertrophy which may be seen in chronic lung disease. Results: ECG with sinus rhythm. There is no P pulmonale seen. There is low voltage seen. No ischaemic changes seen. No left ventricular hypertrophy. Interpretation: Normal ECG with low voltage is seen in a hyperinflated chest such as in patients with COPD STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working diagnosis: Acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection My proposed plan of management is as follows: Acute management 1. Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90%. Arterial blood gas should be done in order to ensure adequate oxygenation without carbon dioxide retention of acidosis. 2. Close monitoring of vital signs and SpO2 hourly until the patients breathlessness improves. Nursing staff to inform if patient deteriorates such as increased respiratory rate or drop in oxygen saturation below 92%. 3. Give nebulization of Ipratropium Bromide:Salbutamol:Normal Saline in ratio of 2:2:1 every four hours until breathlessness decreases. 4. Oral prednisolone 40mg once daily for 10 days 5. Postural drainage and chest physiotherapy may be performed. 6. Oral antibiotics such as T. Cefuroxime may be given. This was not given in this patient with further discussion below. Long term management 1. MDI ipratropium bromide 40 microgrammes tds 2. MDI salbutamol 200 microgrammes PRN 3. Counseling on proper inhaler technique. 4. Couseling on smoking cessation. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Mr TLT was warded for a total of 3 days. His breathlessness improved after nebulization with ipratropium bromide, salbutamol and normal saline for one day. He no longer required nebulization after one day. Mr TLT was also able to ambulate without feeling breathless. He was able to eat and to sleep well without being bothered by the dyspnoea. His vital signs were also normal and his respiratory rate improved to about 20 breaths per minute. There was still some ronchi heard on auscultation but it was much reduced. He was afebrile during his stay. Mr TLT was discharged after 3 days of admission and educated on chronic obstructive airway disease. He was also counseled on the importance of smoking cessation. He was given an appointment with the medical outpatient department in one month time in order to review his symptoms after being given MDI ipratropium bromide. He was told to return to the hospital if he had similar episodes. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan 1. Medications: i. MDI Salbutamol 200 µg PRN ii. MDI Ipratropium Bromide 40 µg TDS iii. T. Amlodipine 5mg once daily iv. T. Prednisolone 20mg od for 7 days. 2. Counseling on COPD and use of metered dose inhaler Mr TLT should be taught about the correct technique in using a metered dose inhaler. The technique should then be assessed before discharge. In the event that Mr TLT is unable to coordinate well, he may be advised to purchase an aerochamber. 3. Counseling on smoking cessation The approach to counseling a patient on smoking cessation as well as various options will be further discussed below. 4. Education on the symptoms of an acute exacerbation and advise to return to the hospital if there is development of those symptoms. 5. For follow-up at the medical outpatient department for review of symptoms while on MDI ipratropium bromide. He should also be taught about pulmonary rehabilitation. A spirometry appointment may also be made. STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 10) REFERRAL LETTER (MANDATORY) Dr Tan Hai Liang Medical Department, Hospital Batu Pahat Family physician, Klinik Kesihatan Batu Pahat, 83000 Batu Pahat, 10 June 2009 Dear esteemed colleague, Patients name: Teo Lai Thing Patients I/c number: 510912-01-6343 Problem: Chronic Obstructive Airway disease Thank you for seeing this 58 year old gentleman who is hypertensive for the past 1 year currently on T. Amlodipine 5mg once daily. He presented to Hospital Batu Pahat with shortness of breath for 4 days that was increasing in severity. A diagnosis of chronic obstructive airway disease was made. He was discharged uneventfully on the third day of admission with the following medication: MDI Salbutamol 200 µg PRN, MDI Ipratropium Bromide 40 µg TDS and T. Amlodipine 5mg once daily. Mr Teo has been a chronic smoker for the past 40 years and smokes up to 20 sticks of cigarettes a day. We have counselled him about the benefits of smoking cessation while in the ward. He is currently considering it and would like to learn more about the various options of smoking cessation. Kindly assess the patients keenness for smoking cessation as well as provide him with additional information on the options available to quit smoking. Thank you. Sincerely ____________ (Tan Hai Liang) Medical Department Hospital Batu Pahat STUDENT NAME: Tan Hai Liang ID NO: M0409146 NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1) Communication skills What are the benefits of smoking cessation in COPD patients and how should counseling be done? Counseling for smoking cessation should play a significant role in the holistic management of a patient with chronic obstructive airway disease. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. One study of patients reviewed at 14.5 years after stopping smoking showed that smoking cessation intervention showed 18% reduction in all-cause mortality compared with usual care without smoking cessation intervention. Patients who had stopped smoking had lower rates of death due of coronary heart disease , cerebrovascular disease, lung cancer, and other respiratory disease as compared with those assigned to usual care who continue to smoke. [1] Fig. 4. Effect of smoking cessation on mortality cause at 14.5 years in the Lung Health Study. (A) Comparison of smoking cessation intervention with usual care. (B) Comparison according to smoking status. I therefore looked up for counseling methods for smoking cessation. The American College of Chest Physicians recommend that physicians should be the first line in introducing smoking cessation. [2] There are 5 As that a doctor should perform for a patient who is a smoker: †¢ Ask about tobacco use at every visit †¢ Advise tobacco users to quit †¢ Assess the willingness to attempt quitting †¢ Assist the patient with methods for quitting †¢ Arrange for follow-up contact via phone or face to face If the patient is not yet willing to quit, there are 5 Rs which should be identified together by the patient and the doctor: †¢ Relevance of quitting for the patient †¢ Risks of illness related to continued tobacco use †¢ Rewerds/benefits of smoking cessation †¢ Roadblocks for quitting, internal and external †¢ Repetition of the motivation intervention at each encounter There are two means of intervention in smoking cessation namely pharmacological and behavioural. The pharmacological means include nicotine replacement therapy or buproprion. Behavioural interventions include counseling programs that teach problem-solving skills and support groups. [3] In conclusion, I learned that doctors have an important role in actively encouraging patients who smoke to stop as there are many proven benefits of smoking cessation. The steps discussed above on techniques in the counseling of patients would be helpful to me in the future. 2) Professionalism, ethics and personal development Should antibiotics be given for episodes of exacerbation of chronic obstructive airway disease? Mr TLT was not given antibiotics during this episode of exacerbation. Certain quarters support the use of prophylactic antibiotics in all exacerbations due to the knowledge that most exacerbations are caused by the common organisms of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), Pseudomonas aeruginosa (P. aeruginosa) and Moraxella catarrhalis (M. catarrhalis). Sputum culture may not be useful as even in the clinical stable state, some patients have sputum positive for bacteria. As such a broad spectrum antibiotic is usually used to cover different bacteria. However, is this use of antibiotics justified in that do patients benefit from it or is the overjudicious use of antibiotics merely promoting antibiotic resistant bacteria? Current Global initiative for chronic Lung Disease guidelines [4] recommend that antibiotics should be given in: i) patients with exacerbations of COPD and the three cardinal symptoms of increased dyspnoea, increased sputum volume and increased sputum purulence. ii) patients with exacerbation of COPD with two of the cardinal symptoms if increased purulence of sputum is one of the two symptoms iii) patients with severe exacerbations of COPD that requires mechanical ventilation A meta-analysis by Ram et al [5] of 11 placebo controlled RCTs with 917 patients attempted to analyse the value of antibiotics in the management of acute COPD exacerbations. The results show that there is a decrease in short-term mortality, treatment failure and sputum purulence with antibiotic therapy compared to placebo. The authors concluded that antibiotics therapy is appropriate in exacerbations of COPD associated with increased cough and sputum purulence. They further found that antibiotics have the greatest effect for patients with severe exacerbations who are admitted to the hospital. They were unable to comment on exacerbations with non-purulent sputum, what antibiotics were the best to be used and also the duration of therapy due to the lack of RCTs done on these aspects. In conclusion, it was appropriate that Mr TLT was not given antibiotics as he did not have the cardinal signs as mentioned by the GOLD guidelines and further supported by the systemic review. 3) Self directed life long learning What are extrapulmonary manifestations of COPD and what are its therapeutic implications? Chronic obstructive lung disease has long been known as a localized pulmonary disorder. However new evidence have shown that COPD may be a systemic disease that involves pathology in several extra-pulmonary systems. An article by Remels et al [6] summarized the extrapulmonary manifestations as well as its implications on the holistic management of chronic obstructive airway disease. The article showed that there is skeletal muscle dysfunction as well as systemic inflammation in chronic obstructive airway disease. There is loss of muscle mass associated with impaired protein metabolism. The loss of muscle mass which is called sarcopenia may progress to cachexia. Studies have also shown that there is increased apoptosis of muscle cells at the cellular level. Independent of the loss of muscle mass is the reduced muscle endurance. This finding has been attributed to abnormalities in mitochondria or to hypoxia. These findings have significant implications on management of a COPD patient which will be discussed below. Systemic inflammation is also seen in patients with COPD. This is evidenced by elevated levels of the proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-a), interleukin-6, interleukin-8, and TNF-a receptors. The origin of the systemic inflammation is thought to be independent of the pulmonary manifestation of COPD. One postulation is the increase systemic inflammatory mediators such as neutrophils and lymphocytes in the circulation of patients with COPD. Another proposed mechanism is increased cytokine production due to chronic hypoxia. The therapeutic implications of these findings is that muscle atrophy should be prevented by resistance exercise as well as combined strength and endurance exercise. Current Malaysian guidelines on the management of COPD [7] recommend pulmonary resistance including lower and upper limb exercises as well as inspiratory muscle training. This concurs with a Cochrane metaanalysis by Lacasse et al [8] which strongly support respiratory at least four weeks of exercise training as part of the of management for patients with COPD. The authors found that there was clinically and statistically significant improvements in quality of life as measured by dyspnea, fatigue and emotional function. 4. Critical thinking and research What is the efficacy of systemic corticosteroids for acute exacerbations of chronic obstructive airway disese? The use of systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the management of acute exacerbations of chronic obstructive airway disease. However the patient, Mr TLT was not given any systemic corticosteroids. This could be because he merely had a mild exacerbation. I therefore looked up a Cochrane metaanalysis on the use of systemic corticosteroids for acute exacerbations of chronic obstructive airway disease [9]. The authors reviewed randomized controlled trials comparing parenteral or oral corticosteroids with placebo for the treatment of exacerbation of COPD. The primary outcomes measured were treatment failure (hospital readmission, return to emergency department), relapse and mortality. The authors reviewed 11 studies involving 1081 participants. The results show a statistically significant difference between placebo and use of corticosteoids. There was less treatment failure in patients given corticosteroids. Relapse within 30 days were also reduced. However there was no statistically significant reduction in mortality. As such the authors concluded that administration of oral or parenteral corticosteroids in the treatment of acute exacerbations of COPD reduces the likelihood of treatment failure. This is associated with early and continuing improvement during treatment with corticosteroids in lung function, breathlessness and blood gases and with a shorter hospital stay. This in turn has a positve impact on the economic cost of treating exacerbations, with fewer follow-up visits and hospital admissions. The authors also found that although there is an increased incidence of corticosteroid side effects such as fluid retention, hypertension and adrenal suppression, the effects are unlikely to persist after treatment ceases. EVIDENCE BASED MEDICINE WORKSHEET FOR REVIEW OF THERAPY STUDIES ASKING QUESTION Patient (P): Patients who present with stable COPD Intervention (I): Oral corticosteroids Comparison (C): Placebo Outcome (O): Effects on health status ACCESSING EVIDENCE THE SEARCH PATH How was the article identified: The Cochrane Library Search keywords : corticosteroids, stable COPD Citation: Walters JAE,Walters EH,Wood-Baker R.Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 3. 1. Is