Comparision of Charecters in the Poisonwood Bible and the Mosquito Coast

Comparison of characters from ‘The Poisonwood Bible' and ‘The Mosquito Coast ‘The Mosquito Coast', directed by Peter Weir, is a movie quite similar in many aspects to the book ‘The Poisonwood Bible', written by Barbara Kingsolver, one of those aspects being the similarities between the setting and the characters. In both books, the figure-head of the family, Allie Fox (in ‘The Mosquito Coast') and Nathan Price (from ‘The Poisonwood Bible') both have similar characteristics, however, different approaches to their ideas. For example, Nathan believes in forcing on his views and ways onto the Congolese people, however, Allie believes in cooperation with them to succeed in his goals. Both also seem incredibly lifelike as they seem like determined men who are willing to get to their goals at the beginning, however, they seem somewhat more lifelike when they loose something that is close, and become obsessed with their goals, forgetting the welfare of their own families. Both stories are about two families who leave America, their home country, to go to a foreign land. The two ‘heads', however, leave for very different reasons, but they do somewhat leave their families with no choice but to go with them. In ‘The Mosquito Coast', Allie takes his family to the Central American rain forests as a means to ‘escape' America and it's fate with the Atomic Bombs. Allie also believes that his scientific research is not of any value in America, and believes that his inventions would be more valued if they where taken into areas that have barely been touched by civilization. Nathan, however, leaves his family with no choice when he says that they are moving to the Congo as part of his missionary work. He was actually offered this job, and took it in good stride, believing that he should take his message to places which are less civilized. Nathan Price is a Baptist Minister who lives his life by the Bible. He believes that he is a coward for having escaped the fate of being killed in the Battaan Death March, where his whole team died, but he survive due to prior injuries. After that incident, Nathan became quite obsessed with the idea of God hating him for his cowardice. He vowed never to be a coward again and devoted his life to saving as many souls as he could. Nathan becomes so obsessed with his work that he believed that every obstacle in his way was a ‘test by God' to see his resilience. Allie, on the other hand, is an inventor, so claimed by his son, Charlie. He seems to be obsessed, yet thinks quite morally. Allie believes that America is dying, so he decides to leave as he thinks it is too ‘painful' for him to watch something he loves die. He gave the example of his mother, who was in hospital when she said ‘†Why don't you just give me rat poison? ‘†, whereupon Allie said that he left, as he could not bear watch loosing someone close. Both Nathan and Allie share the same obsession of getting to their goals. So much so, in fact, that they forget about their families welfare and safety almost completely. Even when There is a sudden turn of events, they seem undeterred by what they call their ‘destiny'. Nathan was unmoved by the death of Ruth-May as he sees the rain as an opportunity to baptize the locals, instead of mourn for his daughters loss. Nathan blames the fact that Ruth-May was not actually baptized, hence making her death somewhat ‘acceptable' to him. Allie believes the destruction of his machine was somewhat supported by Reverend Spellgood. Allie seems to be a very non-religious person, however, he does know the quotes of the Bible. This shows that Allie explores a few possibilities, yet he only decides to expand on those that he likes. In that manner, Nathan is somewhat unwise in his approach to helping the people. He decides, as soon as he arrives at his house in Kilanga, to set up an ‘American Garden', whereby he will make food for his family as well as show the the people of Kilanga his prosperity just because he does not worship false idols. Nathan attempts to almost force his ways and ideas onto the Congolese people. He seems unbent on his determination to show no cowardice, yet he does not seem willing to accept other ideas. At a point, he does see that Mama Tataba's technique to plant his beans seem to be more appropriate, and does actually implant those ideas. As time passes by, and he sees not much crowd in the Church, he slightly looses his mind and then decides that all his obstacles where placed by God to deter him and to test him. This is very contrary to what Allie does at the beginning of the movie. Although he may have moved from the USA and dragged his family along, he decides to take a different approach into making his way into the locals hearts. Where Nathan attempted to force his ways onto the locals and believed that he was superior, Allie decided to work with them. He said before the project began ‘†If I don't work hard enough, you tell me. I am not your boss, I am your friend, and I want to work for you†¦ ‘†. He may have planned out the project, but he certainly did work as though he were under instructions to do what he was told. He seemed very cooperative, and whenever Mother Fox got any materials to share, she enhanced her husbands popularity by sharing those goods, for example the cloth she was given by the missionaries. She made clothes for her daughters and noticed that Mr. Haddy, a local, was eying the cloth, she decided to make one for him. In the next scene, it shows that everyone on that small island was wearing the same yellow piece of cloth in some shape of form. Had Nathan been in this situation, he would probably have told his wife of for giving away their resources to the ‘unsaved' souls, yet he might also see it as a tactical move to make them go to Church. Allie took this in stride and made the most out of the people's gratitude towards their family by still making them work hard. Nathan and Allie both seem very lifelike characters in their own environments and also in the real world, they could be anywhere amongst us. Their obsessive and arrogant attitudes can be seen in quite a few people who seem quite determined to get what they want. Nathan seems very lifelike and rationale at the beginning, where the image of a determined Baptist Minister is portrayed. As the story progresses, that image becomes a haze and a more arrogant and devoted trait comes to light, towards the end, he seems possessed by his work, whereupon he forgets the welfare of his own family, remaining undeterred by the death of one of his own children. This, towards the end, seems slightly unrealistic and immoral. However, the presence of this possibility is definitely strong. Allie seems like a genuinely outgoing and friendly person at the beginning, and this is completely believable. Many people use the same cover of saying that they are all equal in order to get work done. His depression also seems very lifelike as he seems to be completely shattered when he sees his beloved Ice Machine blow up. Yet, towards the end, he does seem also obsessed with the idea of exploring new possibilities. He does go paranoid, thinking that his family is against him, so he forces them to sit on their home-turned-boat and decides to go upriver. When the rotor breaks away from the main engine, Allie goes underwater to get it. Due to his extended period underwater, his family worries and Charlie gets the idea of heading back downriver to get help from Mr. Haddy, and quite possibly also return to America. As soon as this idea is shared, Allie comes up and realizes that his own kids are conspiring against him, and punishes them for it. This seems extreme, yet absolutely possible for a man who seems to be addicted to his goal. Not only do Nathan and Allie share similarities, but also their wives. Both Orleanna and Mother always seem to be following their husbands orders, yet at a point, they both realize that what they are doing is wrong. Towards the beginning, both wives are happy to see their husbands working outside, Nathan in the garden and Allie in the jungle clearing space for his house. Orleanna seems to realize quicker on in the story that Nathan could potentially get them hurt, and decides to speak up. This, comparing to Mother's timing, seemed quite early. This could very likely due to the fact that Nathan seems uninterested in his family and Allie cares a lot about them. Mother only decides to go against Allie when they reach the Ocean and the whole family is rejoicing with the thoughts of returning to America, when Allie destroys their enthusiasm by saying that America isn't there and that they weren't going back. This made Mother question Nathans morality, whereupon the lack of enthusiasm spreads across the whole family. Allie goes from being a friend to a leader almost spontaneously. Orleanna starts to make plans of escape immediately after she gets better from hearing the news of the Congo going into an election period and that her family was staying through it, due to her husbands arrogance. She does eventually leave him, however, Nathan changes slightly in a way one may perceive apologetic. Allie, after burning Reverend Spellgood's church bell, goes back to see his family leaving him, and says that they couldn't live without them. When he gets shot, their family escapes with his injured body on the boat. All the characters in both the book and the movie seem incredibly lifelike as the stereotypical family is put into extreme conditions. This causes the stereotypical families, which generally include of the male being the leader f the house, the bread earner, and the females being the followers, commanding her children to follow her father and herself. This changes very quickly when the two families go through some trouble in their respective environments, causing the males to get angrier and the females to look out for the welfare of her children more than anything. Both men forget about the opinion of their families (Nathan, ofcourse, not caring about their opinion any ways), and seem set on doing everything possible, except return to the life of luxury.

Career as Probation Officer

Career as Probation Officer Joseph P. Dupre Jr. Everest University Online Author’s Note Joseph P. Dupre, Introduction to Criminal Justice, Everest University Online Contact Email: [email  protected] com Becoming a Probation Officer How long have you known what you wanted to become when you grew up? Some people have had their minds made up about either what they wanted to become or study for a long time. I myself have just recently discovered my true calling in life; becoming a Probation Officer.For years, I have been trying to make my mind up about the career I wanted to pursue because I wanted to make sure I put my time into a field that I would be comfortable in and also do well in. The reason I believe that I would make a good Probation Officer is because I experienced a great deal of adversity in my life, and also grew up in an area that allowed me to gain great insight for a job like this.Probation Officers also make a good living and make a difference in their communit ies. Probation officers must have to have strong communication skills, because they will be working with offenders, judges, victims, their families, and many specialists. They must be prepared to handle high-stress situations, and must also be highly organized. Probation officers often write reports. That being said, they have to write a lot of reports and written documents (CriminalJusticeUSA. om, 2013). Probation Officers are in charge of monitoring convicted felons who are released from prison on probation or parole. They have a lot of duties that include: seeking treatment options, helping them find jobs, and monitoring their progress. They document the progress and conduct meetings to discuss different options for their probationers. Probation Officers act as mentors and guidance counselors to felons who are trying to get back on their feet.

Jit Application in Toyota Company

JIT Application in Toyota Company Toyota is one of very large company in automobile. In their production, Toyota Company has applied JIT (Just in Time) approach in their manufacturing. The advantages of using JIT approach is to reduce or minimize the waste of production, reduce hands-off, reduce re-work and any other delays on manufacturing process. One of characteristic in JIT approach is the flow of work. Parts or component of material will flow from one work center to many others with intermediate storage, and flow into work centers will also come from many work centers with intermediate storage.In the large company like Toyota, this approach is the most suitable to be applied. The derivative applications of JIT approach is karban system. Karban means â€Å"card† or â€Å"visible record† and refers to cards used to control the flow of production through a factory. Karban is useful system for company like Toyota that has many work centers. For example there are two wo rk centers with difference function, work center 1 is to producing component parts and work center 2 is to making assemblies. And there is an intermediate storage area for component parts.Let say Work Center 1 is producing component 101 and 102. After do production, that components will move to intermediate storage part and each component is labeled with kanban card 101 and 102 that contain component’s information. If Work Center 2 is need part 101 in assembly, the box 101 (labeled card 101) will moved to Work Center 2 and so on for box 102. Toyota uses a â€Å"two-card† kanban system. The first is transport or conveyance, card, which moves container of parts from one stock location to another. The second is a production card, which authorizes production.

Open Source Software Essay Example | Topics and Well Written Essays - 1000 words

Open Source Software - Essay Example (Wheeler) Several peer-reviewed literatures suggest that using the OSS programs in many cases offers superior user interface and approach in contrast to their proprietary competitors. (Wheeler) Even with the above background review, many software users still are unaware of the very many user options that this utility presents. It is against this information that this paper examines two open source software (Neo Office 3.0 and Open Office) solutions as an alternative to Microsoft office 2010 applications. The paper examines the Open Source Software. The discussion compares the Open Source Software on grounds of the platform on which they are available, their affordability, available technical support, major features to meet the standards of a commercial product and arguments for and against the Open Source Software as a Commercial alternative to Microsoft Office 2010. Wheeler suggests that whatever the program, there are universal procedures for their evaluation. These steps are; iden tification of the candidates, examining existing literature reviews, applicability of the desired program to one’s personal needs, and analysis of the top candidates. Wheeler sums up the four sequential steps as â€Å"IRCA†; identify, review, compare and analyze. (Wheeler) Review of Microsoft Office 2010 Microsoft Office is a commercial workplace utility quite popular with most workplaces. The Office 2010 has a ribbon interface modification different from the traditional Office 2003 interface, additionally it has a file menu back into the tool bar making it easier to save and open files. Minimal system requirements for the program include 700MHz and a 512MB RAM with windows 7, XP or vista to be fully functional. Microsoft Office enjoys unlimited technical support: Microsoft Company, people with licenses from Microsoft, professional call centers and numerous books and websites that offer on time assistance to users with tips on configuration, modification and using Micr osoft Office with free resources especially for non-profit uses. Document sharing is simplified for this program because Microsoft has created standard file formats such as .doc, .docx. (For word) and .xls (for excel files). Microsoft also has enabled easier remote access using â€Å"Skydive† with standard file security if procedures adhered through allowing users to install Microsoft updates; firewalls, antivirus management and antispyware (Bonfield and Quinn). Equally, through the utilization of Microsoft outlook users are able to receive and send emails from Microsoft office. Other in built features includes; grammar checking, view document options, and pre-posted document formatting. (Bonfield and Quinn) Review of alternative Open Source Software to Microsoft Office 2010 OpenOffice.org OpenOfice.org 3.1 is the latest version of OpenOfice.org with the former being 3.0. The OpenOfice.org is versatile with Windows, Mac, Linux, and free suite being a preferred alternative to Microsoft Office suite. Additionally it is able to read and write to Microsoft Office supported formats and supports the Open Document Format (ODF) 1.2 standard. The suite is inbuilt with a word processing application, spreadsheet, presentations,

Case analysis statoil IT case Study Example | Topics and Well Written Essays - 750 words

Analysis statoil IT - Case Study Example Scandinavian countries are known for their high labor taxes and keeping your workforce expenses under control is one of the key elements of successful long term growth. The company also has to stay on top of modern achievements in technology and engineering. Having said that, it is not very critical to use every bleeding edge technology that comes on the regular bases. The company operations mainly depend on heavy machinery and large scale construction projects that have a long life. Therefore, the preferences go to more stable and time-proven technologies when it comes to drilling, mining and explorations. However, the communication between different teams, ways that information can be spread between employees are updated more frequently than oil business related hardware. That is why one of the current tactical objectives is to align your workforce with the current technological advancements that are already used successfully in other industries, but is not yet know by Statoil staf f. It is clear that a simple introduction of the new technology would not bring desired benefits on the long run. Statoil seeks a fundamental transformation of the way employees approach some of their daily activities. The belief is that modern technology, such as Internet, private PC etc. would provide great collaborative tools for the whole Statoil’s workforce.... It also adds a nice perk on top as a free multimedia tool that the whole household can benefit on. Although, the short term objective is very clear, Statoil needs to put some success measures in place to avoid transforming a business improving initiative in a nice free gift from the company that does not provide any improvement in individual productivity. In the next section we try to define exact measures that would help Statoil to focus on their short term goals and clearly define the measure of the outcome. It is difficult to directly connect the productivity of employees and the time they would spend with their new toys. Also the choice of location of the new media PC has two sides. On one side it extents the work related matters into the private household space, but on another it offer new ways to entertain and spend free time. Statoil has to also keep in mind European attitude towards clear separation between work and private time. It is exceedingly difficult to ask your employ ees to put extra effort outside of normal working hours. There is another way of indirectly controlling or measuring changes in the way the employees approach certain business activities. One way is to define some metrics that reflect the level of collaboration achieved through new connectivity tools, such as conferencing. For example, one can devise a metric of how many meetings have been done online compared to offline ones. Offline meeting in a global company with many distributed office require a lot of time spent in commute, not to mention extra budget that goes with it. The number of offline conferences/meetings that were transformed in pure virtual remote participation ones will provide a clear indication

History and Political Science in Novels Jubilee by Margaret Walker and Essay

History and Political Science in Novels Jubilee by Margaret Walker and Gone With the Wind by Margaret Mitchell - Essay Example In the novel Jubilee by Margaret Walker, the transformation of Southern Society has been described comprehensively. The novel defines so many aspects of the life in the South till the time slavery ended. There are a number of factors that influenced the southern life after the Civil War and the resulting reconstruction. One of the most influential factors was the economy. Another factor that caused the transformation of the southern society was the change in social structure and the government. During the Civil War, the economy was very weak and the people in the South were hugely impacted by the shrinking economy. The novel provides an explanation of the damage caused by the war to the society (Walker, 268). After the end of the Civil War when the reconstruction was initiated, the economy of the region recovered at a rapid pace. The agriculture of the region also grew and it also added to the recovery of the economy. Due to the growth in agriculture, the Southern Society was able to deal in the agricultural products with other regions and the inflow of the revenue was at the highest at this point. In the novel Jubilee, the transformation of the Southern Society is explained through its characters when Vyry and her family ultimately acquire a good place to live and a place for carrying out planting and this enables them to earn more money. On the other hand, in Gone with the Wind, the transformation of Southern Society has been explained through the character Scarlett. Before the war, Scarlett is bound to follow all the rules of the high-class Southern society, however during the war Scarlett breaks free from the confines of the rules and uses her instincts to lead her. During the era of reconstruction, Scarlett acquires a factory and ignores the rules that existed in the Old South. The journey of the character of Scarlett reflects the transformation of Southern society through the time span before, during and after the Civil War. After the era of Reconstructio n, Scarlett tries to connect to the old culture of South but in a new way and this reflects the regain of the control of the political structure by the society. The novel Jubilee emanates the theme of ‘overcoming of adversity with willpower’ through the character Vyry. The way the character of Vyry develops throughout the novel represents this theme. The novel covers the life of Vyry through three major periods which are; slavery, Civil War and Reconstruction and in each of these periods, Vyry remains strong only because of her willpower. In the period of slavery, despite the overly depressing circumstances, Vyry responds to her surroundings in a strong manner and she does not let her circumstances add to her adversities. During Civil War, the character of Vyry shifts from that of a slave to a protector of the property that is threatened to be damaged due to the war. She remains strong during the war as well and due to her willpower avoids any adversity that comes her w ay. After the war, she works the crops and waits for her husband to return. Even though she learns that her husband is dead and this news devastates her for a short span of time, she soon recovers and does not let adversity take the most of her. Vyry’s life gets better when she gets married again and gets a new home and a farm to work in. On the other han

Discuss the Moral Considerations Relevant to the Killing of Human Essay

Discuss the Moral Considerations Relevant to the Killing of Human Being - Essay Example According to those who oppose this  practice, they argue that the foetus is a human being or a person from the time of conception. Hence terminating it is the same as killing a human  being  which in itself is not  moral.  The foetus acquires  human  characteristics remarkably early in its  life  such that by the tenth week, it already has acquired a  face, arms,  and also  fingers and toes.  Also, the internal organs and the brain activity can be detected by this time. As every human has the right to life, also does the foetus. Every woman has the right to decide what should be happening in her body, but the foetus's right to life always outweighs her right to  make  a  choice  as to what happens in her body (Thompson 45). Many people who support abortion have  various  premises to support their arguments. One is pregnancy due to rape. They argue that this is reason enough to terminate the pregnancy. However, one cannot say that those who  wer e conceived  through rape have less  right  to live than others. Pregnancy due to rape results in the conception of a  baby  that also has the equal right to life just like all the other conventional methods of conception (Thompson 56). Hence Judith wonders what will happen when the mother's life  is threatened  by the pregnancy, whether it is morally relevant to  abort  the pregnancy or not. ... This means that abortion is morally permissible in some situations while in others it is not (Thompson 58). Judith's considerations on the  morality  of human  killing  are similar to the argument of Dan Brock who argued about the  morality  of voluntary, active euthanasia. Provision of  relieve  from suffering is among the many ways doctors take care of the patient`s wellbeing (Brock 30). Yet from a third-person point of view, it  is not known  whether an individual`s quality of life is extremely low that it  is burdensome  for the individual. Hence an  individual  might  regard  the continuation of his life to be unbearable because of the severity of his suffering; and  want  a doctor to end his suffering  immediately  by ending his life. This means that an individual acting on his values is morally permissible if his doing so is consistent with permitting others to the same freedom. This is  mostly  self-determination and the  value  of  equal  liberty. Hence an individual`s  choice  of  voluntary, active euthanasia is  more  consistent with permitting others the same freedom. Therefore, an individual  choice  of  voluntary, active euthanasia and the doctor's fulfilment of this request are morally permissible. However, voluntary, active euthanasia involves the deliberate killing of individuals, which is wrong. Hence voluntary, active euthanasia is also wrong. Removing life-sustaining  treatment  also amounts to deliberate killing of innocent people yet it  is thought  as morally permissible (Brock 32). This  is only done  when it is  consistent  with the well-being of the patient and his  self  determination. Hence voluntary, active euthanasia is morally permissible when it is  consistent  with the autonomy and the well-being of the patient (Brock 35). According

Pfizer Essay Example | Topics and Well Written Essays - 1000 words - 1

Pfizer - Essay Example The company is in a continuous process of investing in the area of healthcare in order to advance the health and wellbeing of the members of the society. In order to meet its mission of advancing health and wellbeing, during the period of 2000 the company opened one of the largest structures throughout the globe and this structure is devoted towards making discovery of new and improved drugs that will be assistive in advancing the health and wellbeing of both animals as well as human beings. This structure is located in the region of Groton, Connecticut where the organization is already operating a highly efficient research comp. With the introduction of this building the company has become one of the first drug development companies to invest more than $4 billion and aims and continuing to increase its investments to develop better products (Pfizer.com(a), 2014). Pfizer’s main aim and objective throughout the course of its existence has been to be involved in the process of continuous improvement in order to develop various therapies that can be helpful in improving the health of patients throughout the world. The company believes that it can only achieve its objectives if it is continuously involved in the process of research and development. They believe that with the help of research and development, the company can identify and then transform up-to-date technological and scientific advancements into remedies that can be of immense importance to patients suffering throughout the world. The president of the company, Mikael Dolsten, who is the president of the company’s Worldwide Research and Development area, believes that the company has experienced a novel situation in the area of innovating biomedicine (Dolsten, 2014). It has been almost over a period of ten years since the human genome experimentation and decoding started taking place and now the

The factors that led to change in Apple Inc Research Paper

The factors that led to change in Apple Inc - Research Paper Example A brand of innovations, â€Å"Apple†, was established in the year 1976 on April Fools’ Day (1st April), though it was incorporated only on January 3rd, 1977 with a brand name of Apple Computer. After 30 years, the word â€Å"Computer† was removed from its branding as it shifted its traditional focus from computers to consumer electronics. It was founded by three budding entrepreneurs, Steve Jobs, Steve Wozniak and Ronald Wayne, though the latter moved out of the company by selling his shares to the other two for US $800. The first inaugurated model was the Apple I which was hand made by Steve Wozniak. It was sold as a motherboard consisting of CPU, RAM and basic video chips.As times gradually passed and moving into the 20th century, a lot of products have been designed and created by the company. The products that the company possess at present are, Mac and accessories, iPad, iPod, iPhone, Apple TV and different software. Apple has spread its business over 10 cou ntries with over 300 retail stores and workforce of 60,400 permanent."Apple’s annual worldwide sales had grown to US$108 billion in 2011. They say that impressions are constant and that’s why first impression is the last impression. Apart from all the latest electronic gadgets, the logo has also made lots of designer think â€Å"why on earth would a bitten apple be a company’s logo†. The former President Michael M. Scott was once found to quote, â€Å"the most expensive bloody logo ever designed†.... Apple’s annual worldwide sales had grown to US$108 billion in 2011. They say that impressions are constant and that’s why first impression is the last impression. Apart from all the latest electronic gadgets, the logo has also made lots of designer think â€Å"why on earth would a bitten apple be a company’s logo†. The former President Michael M. Scott was once found to quote, â€Å"the most expensive bloody logo ever designed† (Linzmayer, 1999). Drivers to Change Since the resignation of Steve Jobs in the year 1985, the company tried to identify, the factors that could be the reasons for the ups and downs of their business. The factors were: Inadequate Financial Performance: Not meeting the demands according to the supply turned out to be a financial loss to the company. The delay made the investors furious that resulted in a lot of unsold products. The debt to the supplier of raw materials increased and the company was in the edge to file bankrupt cy (O’Grady, 2008). Change in Strategic Objectives: Apple started to focus more on the consumer electronics rather than computer electronics. They started to experiment more on the consumer oriented products like portable CD, audio players, digital cameras and video consoles. This sudden re-orientation resulted in huge finances in order to bring in the new resources required to manufacture the products (O’Grady, 2008). Competitors Market Invasion: The re-orientation of the company helped companies like IBM and Microsoft to substitute the shortages that Apple could not deliver. They brought in same products with much cheaper costs and attracted disappointed and confused customers (O’Grady, 2008). Later after the return of Steve Jobs

Foundations of Critical Care Essay Example | Topics and Well Written Essays - 3000 words

Foundations of Critical Care - Essay Example Since this involved events surrounding a complex decision making at higher level where I am being guided by my mentor consistently, I felt John's model of structured reflection will be useful, and I will follow that in this reflective process (Johns, 1995, 226-235). Consequently, I will pay greater attention to my thoughts and emotions surrounding this event of my recent past experiences. This is the story of a patient whom I cared for in my placement in the critical care unit. In my placement in the critical care unit, my mentor assigned this patient to me. This is a middle-aged female patient who had abdominal surgery for her Crohn's disease and had been transferred to the intensive care unit for stabilization in a critical condition following anaesthesia. The intention of admission was to stabilize her and help her complete recovery form anesthesia so she can be extubated in the intensive care unit (Adam and Osbourne, 2005, 1-11). At assignment, I assessed her to find that she was sedated, was having very poor spontaneous breathing response, and intubated. She was connected to monitors, and a central venous pressure (CVP) line was inserted. A separate IV line was there, and it was running frusemide infusion at 2 mg/h since she was quite edematous. She was also advised hydrocortisone 50 mg intravenously three times a day along with her medications (Evans, 1998, 8-1 2). They diagnosed her to be in acute renal failure, and the management was expectant in that it would lead resolution of renal failure quickly. On my systematic assessment on assignment, my examination revealed that she has moderate oozing from her abdominal wound. However, her urine output was less than 40 mL/h, and from the urine in the bag, I thought that her urine was very concentrated. This is unlikely in an edematous patient with frusemide infusion. She was connected to ventilator at a PEEP of 10 to support her breathing. The striking feature was that her CVP was falling (Fitzpatrick and Donnelly, 1997, 271-279), and at the time of my care it was at 6. This was an obvious incongruence, and I discussed this with the Junior Doctor about her situation and requested him to reassess the condition. The doctor refused to relook at the situation and told that it was going fine. I felt frustrated since this patient needed to be assessed immediately for revising the management plan, an d I had hardly anything to do (Dowling et al., 1996, 1211-1214). Significant Issues From my academic learning, I knew that acute renal failure is not uncommon in a patient with prolonged and mutilative surgery. However, the care management must be collaborative in the critical care setting, since nurses remain closely attached to the patients during care delivery monitoring the patient on a minute-to-minute basis. Therefore, I felt I have a chance to know her progress or deterioration better than anyone else (Hudak & Galo, 1997, 16-26). Quite frequently, acute renal failures in postoperative patients are results of fluid depletion or dehydration, since the volume loss in the intraoperative period can be inadequately noticed. As the nurse in charge of her care, I felt the urge to actively participate in her care, and my input from that angle was to reassess her fluid status once again and to

Drug Use in Sports Research Paper Example | Topics and Well Written Essays - 1250 words

Drug Use in Sports - Research Paper Example Performance-enhancing drugs may come in the form of dietary supplements, prescripted medication, or illegal drugs (Gomez, 2005). Among the common ergogenic drugs use for to enhance athletic performances includes anabolic-androgenic steroids (AAS) a.k.a. â€Å"Dianabol† – commonly used to improve the physical structure of athletes’ body, steroid precursors like the androstenedione and dehydroepiandrosterone, creatine, ephedra or ephedrine alkaloids a.k.a â€Å"ma huang†, erythropoietin, and growth hormones among others (Wiefferink et al., 2008; Calfee & Fadale, 2006; Dhar et al., 2005; Gomez, 2005; McDevitt, 2003). These drugs are available in the market in oral or injectable form. Since a lot of our young athletes desire to improve their physical appearance and athletic abilities within the shortest possible time, a lot of them ends up being tempted to experiment with the use of ergogenic drugs (Wiefferink et al., 2008; Elliot et al., 2007; Calfee & Fadale , 2006; Gomez, 2005).The presence of ergogenic drugs can be traced through the athletes’ blood samples. Although there are medical ways that can be used in determining whether or not each of the sports athletes is taking ergogenic drugs, several authors explained that some athletes are aware on how they can receive a negative drug testing test after taking these drugs (Calfee & Fadale, 2006; Gomez, 2005). In line with this, Calfee & Fadale (2006) explained that it is difficult to detect the presence of steroids substances days before the Olympic game in case the athletes have taken the steroids during the off-season.

Facing Harsh Realities Essay Example for Free

Facing Harsh Realities Essay The recognition and acceptance of truth and reality is a recurring theme in Literature because it is such an enigmatic issue in human life. A highly discussed subject of human experience, our perception and acceptance of reality defines and determines how we see our life, and how we choose to live our life. This very subject is revealed and discussed in the novel written by Ralph Ellison entitled, â€Å"Invisible Man. †Ellison introduces the protagonist as an unnamed character who insists calling himself an â€Å"invisible man,† (page ) struggling to discover truths and realities about his life as an African-American. In the beginning of the story, he is portrayed as a naive young man who believes that being meek and submissive are the key characteristics needed by an African-American to better his life. His first struggle with this dilemma is illustrated in the cruel scene when the protagonist is forced to take part in a game called â€Å"battle royal† wherein he is pitted against other young African-Americans in a boxing match. The game is imposed upon the boys, who are degraded into being fighting beasts eager to please their master, the dominant white man. Despite the circumstances, the protagonist moves on to please the white men. At the end of the cruel event, the reward of a scholarship makes the protagonist feel content and happy on the surface; and yet, his mind struggles with the moral and racial injustice done to him by the white men, as revealed in his dream of his grandfather’s mockery and warning. This is the first instance that the protagonist is struggling with the reality that the seeming kindness of white men is actually a masked transgression against the African-American race, and against his very own person. His encounter with this harsh piece of reality is just the beginning of his awakening, because as the novel unfolds from this â€Å"battle royal† scene, the struggle for recognizing and accepting the truth may be surely won, but from this very point, it is a long way off.

A Look At Three Types Of Price Searchers Economics Essay

A Look At Three Types Of Price Searchers Economics Essay A monopoly is a firm producing a commodity for which there is no close substitute. There are usually some forms of barriers of entry. It is difficult to define a pure monopoly as close substitutes are difficult to define. For example, there are no close substitutes for cigarettes, but there are many substitutes for Marlboro. 1.1 Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ Features (a) Only one seller. (b) Restricted entry by barriers. (c) Market information is not free and perfect. à ¢Ã¢â€š ¬Ã‚ ¢ Barriers to entry (a) Legal barriers create legal monopolies. (i) Public franchise: exclusive right to run a business, e.g. TVB. (ii) Government licence: exclusive right to entry into a business, e.g. taxi licence. (iii) Patent: exclusive right to use an invention, e.g. right to produce a drug. (b) Natural barriers create natural monopolies. (i) The average cost falls over a large volume of output before it rises. LRAC would be lower if an industry were under monopoly than if it was shared between two or more competitors. (ii) Control the supply of an essential raw material, e.g. most diamond mines in the world are controlled by De Beers Ltd. (iii) Economies of scale: The large fixed cost of production requires a large output to pull down the average cost, e.g. electricity generated by China Light Power Ltd. 1.2 Output And Price Decisions Definition A single-price monopoly is one that charges the same price for every unit of output it sells. The monopoly must decide how much to produce and what price to charge. It is a price-searcher. Definition A price searcher is a seller with sufficient market power to set its price by adjusting supply. Since there is only one firm in the industry, the demand curve of the firm is also the demand curve of the industry, and the seller faces a downward sloping demand curve. Table 1 illustrates the demand function of a petrol station. The marginal revenue is less than and falls faster than the price charged. The price is also equal to average revenue (AR). Table 1: Demand and marginal revenue Price (P, $/Litre) Quantity Demanded (Q) Total Revenue (TR = P x Q, $) Marginal Revenue (MR = ΆTR = ΆQ) ($/Extra Litre) 18 0 0 16 1 16 16 14 2 28 12 12 3 36 8 10 4 40 4 The monopoly maximises its profit by producing the level of output to MR = MC. Given the total cost as in Table 2, we can find that the best output level to maximise profit is at three litres, where both MC and MR are equal. The price charged is $12. Table 2: Demand and marginal cost Price (P, $/Litre) Quantity Demanded (Q) Total Revenue (TR=P x Q, $) Marginal revenue (MR = ΆTR / ΆQ, $/Extra Litre) Total Cost (TC, $) Marginal Cost ($/Extra Liter) 18 0 0 15 16 1 16 16 18 3 14 2 28 12 22 4 12 3 36 8 30 8 10 4 40 4 41 11 Graphically, the same conclusion can be derived in Figure 1. Figure 1 A monopolys output and price The price is determined by demand curve corresponding to the equilibrium quantity at which the MR equals to MC. The profit or loss is again determined by the ATC with reference to the quantity sold and the price charged. Owing to barriers to entry, economic profits will not be eliminated away in the long run. The only difference between short-run and long-run equilibrium is that in the long run, the firm will produce where MR = LRMC. 1.3 Single-price Monopoly Versus Perfect Competition A monopoly and perfect competition are two completely different market structures leading to different price and output decisions. We can summarise their differences as follows: Perfect Competition Monopoly à ¢Ã¢â€š ¬Ã‚ ¢ Price-taker à ¢Ã¢â€š ¬Ã‚ ¢ Monopoly influences its price à ¢Ã¢â€š ¬Ã‚ ¢ Produce where MR = MC à ¢Ã¢â€š ¬Ã‚ ¢ Produce where MR = MC à ¢Ã¢â€š ¬Ã‚ ¢ P = MR = MC à ¢Ã¢â€š ¬Ã‚ ¢ P > MC; P > MR à ¢Ã¢â€š ¬Ã‚ ¢ No barriers to entry à ¢Ã¢â€š ¬Ã‚ ¢ Restricts output, charges a higher price In terms of output, a monopoly is always accused of restricting output in order to push the price above the marginal cost. This is known as allocative inefficiency, leading to loss in social welfare. In Figure 2, PM and QM are the price and output decisions of a monopoly, which are less than the corresponding output and price decisions in perfect competition. We can see that the PC and PM for perfect competition are set at P = AR = MR = MC. Figure 2 Price and output decisions in a monopoly and in perfect competition Similarly, the output level is reduced from QC to QM, which will hurt both consumers and producers in terms of loss in consumer surplus and producer surplus. The sum of such loss is known as deadweight loss. Definition A deadweight loss is a loss to society that cannot be recovered. Figure 3 Inefficiency of a monopoly In Figure 3, some of the losses of consumers have been captured by the producer as monopoly gain. However, there is still deadweight loss as illustrated by the area of the triangle. In this respect, a monopoly reduces the potential gain to society in term of social welfare. 1.4 Shortcomings Of A Monopoly A monopoly has the following shortcomings: à ¢Ã¢â€š ¬Ã‚ ¢ Higher price and lower output than under perfect competition in both short run and long run. à ¢Ã¢â€š ¬Ã‚ ¢ Possibility of higher cost due to lack of competition. à ¢Ã¢â€š ¬Ã‚ ¢ Unequal distribution of income as income concentrates on monopolies. à ¢Ã¢â€š ¬Ã‚ ¢ Lack of incentive in invention and innovation. 1.5 Advantages Of A Monopoly A monopoly has the following advantages: à ¢Ã¢â€š ¬Ã‚ ¢ Economies of scale. à ¢Ã¢â€š ¬Ã‚ ¢ Possibility of lower cost curve due to more research and development and more incentives. à ¢Ã¢â€š ¬Ã‚ ¢ I nnovation and new products. 2. Monopolistic Competition The second type of price-searcher is monopolistic competition. Definition Monopolistic competition consists of features of perfect competition and monopoly. A firm in such a market structure is also referred to as open market price-searcher as it is not protected by barriers. 2.1 Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ Large number of sellers (a) Each firm has a small market share. (b) This implies independence of firms. à ¢Ã¢â€š ¬Ã‚ ¢ Freedom of entry à ¢Ã¢â€š ¬Ã‚ ¢ Product differentiation Each firm has some market power over its loyal customer. à ¢Ã¢â€š ¬Ã‚ ¢ Each sellers product is a close substitute for many other sellers products (a) Products are made slightly different from others, i.e. differentiation. Definition In differentiation, products are made slightly different from others by brand, packaging, sales location and services. (b) Non-price competition is common. 2.2 Demand Curve Because of product differentiation, a firm can raise its price without losing all its customers. Therefore, the demand curve is downward sloping because a price rise results in the loss of some, but not all customers. The demand curve is relatively elastic because of substitutes from other firms. However, the actual elasticity depends on the degree of product differentiation. Generally, the less differentiated the product is, the more elastic the demand will be, and vice versa. 2.3 Price And Output Determination 2.3.1 Short run A firm in monopolistic competition faces a downward sloping demand curve. The marginal revenue (MR) curve of the firm in monopolistic competition is downward sloping. The profit is maximised where marginal revenue equals marginal cost. The profit-maximising output level is determined by the intersection of MR and MC curves. The profit-maximising price is determined by the demand curve. The firm can make a normal profit, an economic profit or a loss, depending on the difference between the price and the average total cost. Since each firm is small and has market power, no single firm can effectively influence what other firms do. If one firm changes its price, this action has no effect on the actions of the other firms. Figure 4 Monopolistic competition in the short run 2.3.2 Long run Economic profits in the short run will attract new entrants. When new firms enter, they share the market demand. The existing firms demand curve shifts inwards, representing less demand. This process continues until all economic profits are exhausted. When only normal profits remain, there is no incentive for new entrants. In Figure 5, the price and quantity are $140 and 60 units respectively. As the price is just equal to ATC, there is no economic profit. Figure 5 Monopolistic competition in the long run The long-run equilibrium will be a position where the downward sloping demand curve is tangent to the LRAC curve. However, the demand curve will never be tangent to the bottom of LRAC because it is downward sloping. The profit-maximising output is 60 units and price is $140. The firm in monopolistic competition has excess capacity as it does not produce at the optimum level of output where the LRAC is the lowest. Figure 6 Excess capacity in monopolistic competition 2.4 Shortcomings Monopolistic competition has the following disadvantages: à ¢Ã¢â€š ¬Ã‚ ¢ Owing to monopoly power, long-run equilibrium brings a higher price and lower output than perfect competition. à ¢Ã¢â€š ¬Ã‚ ¢ Owing to downward sloping demand curve, the firms demand curve will never be tangent to the bottom of the LRAC curve, implying that it will not produce at the least-cost point. Therefore, product differentiation in monopolistic competition creates excess capacity (i.e. creates inefficiency). à ¢Ã¢â€š ¬Ã‚ ¢ Less scope for economies of scale as share among many sellers. à ¢Ã¢â€š ¬Ã‚ ¢ Lack of economic profits in the long run for research and development. 2.5 Advantages Monopolistic competition has the following advantages: à ¢Ã¢â€š ¬Ã‚ ¢ Demand curve is highly elastic due to the large number of substitutes. à ¢Ã¢â€š ¬Ã‚ ¢ Diversity of products is available. (However, it has been argued that the cost of diversity is excess capacity which is a type of inefficiency.) à ¢Ã¢â€š ¬Ã‚ ¢ Greater freedom of entry when compared with monopoly. à ¢Ã¢â€š ¬Ã‚ ¢ Absence of economic profits in the long run helps to keep prices down for consumers. 3. Oligopoly Definition An oligopoly occurs when only a few firms share a large proportion of the industry. 3.1 Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ Few number of sellers Competition among a few, e.g. two to 20. à ¢Ã¢â€š ¬Ã‚ ¢ Products may be identical or differentiated à ¢Ã¢â€š ¬Ã‚ ¢ Barriers to entry Entry may be relatively difficult or impossible (e.g. petroleum). à ¢Ã¢â€š ¬Ã‚ ¢ Interdependence of firms Oligopolists react to the pricing policy of rivals. The outcome is that there is no single generally accepted theory of oligopoly. Firms may react differently and unpredictably. A firms policy will depend on how it thinks its competitors will react to its move and the consequence depends on how its competitors really react. 3.2 Collusion And Competition The interdependence of firms in an oligopoly drives firms into one of the following two incompatible policies: à ¢Ã¢â€š ¬Ã‚ ¢ Collusive oligopoly: Oligopolists have formal or tacit agreement to limit competition among themselves to reduce uncertainty. For example, they may set output quotas, fix prices and limit product promotion. The typical collusive oligopoly is a cartel price leadership. à ¢Ã¢â€š ¬Ã‚ ¢ Non-collusive oligopoly: There is no formal agreement among oligopolists. Firms compete for bigger shares of industry profits. 3.3 Collusive Oligopoly A typical collusive oligopoly has these features: à ¢Ã¢â€š ¬Ã‚ ¢ Cartel Firms acts like a monopoly to maximise industry profits. (a) Cartel by non-price competition: Market price is set by joint profit maximisation and each firm observes that price. However, they compete for customers in the form of non-price competition. (b) Cartel by quotas: Another way is to set the price by joint profit maximisation. Each firm observes that price, but each firm will take its share or quota of the total quantity demanded at the controlled price. Thus, both cases require adherence to the price-setting by joint profit-maximisation among oligopolists. The only difference is whether the quantity demanded at the controlled price is competed among the firms in the form of non-price competition or is divided among themselves in the form of quotas. à ¢Ã¢â€š ¬Ã‚ ¢ Price leadership The demand curve of price leader represents the market share of the leader. The leader first maximises its profits at the point where leaders MC = MR. The corresponding price of leaders demand curve becomes the market price which every other firm has to follow. The leader supplies at its equilibrium quantity and the followers supply the rest representing the difference between market demand and leaders supply. 3.4 Kinked Demand Curve Model There are many theories to explain different kinds of phenomena in oligopoly. One such theory, the kinked demand curve, is put forward by Paul M. Sweezy to explain the price rigidity or sticky price in an oligopoly industry. Assumptions: à ¢Ã¢â€š ¬Ã‚ ¢ If a firm raises its price, others will not follow. Thus, the demand curve will be more elastic in this range. à ¢Ã¢â€š ¬Ã‚ ¢ If a firm cuts its price, so will the other firms. The demand curve in this range will be less elastic. These assumptions result in the kinked demand curve. In Figure 7, because the demand curve has kinked, the MR has broken as is illustrated by the gap between a and b on the graph. And the output and price would be the same even though the MC rises due to the same level by the equality of MR and MC. Thus, the price will be sticky when the cost increases within a certain range. Figure 7 The kinked demand curve 3.5 Shortcomings An oligopoly has the following disadvantages: à ¢Ã¢â€š ¬Ã‚ ¢ Shares all the same disadvantages of monopoly, as discussed earlier in this chapter. à ¢Ã¢â€š ¬Ã‚ ¢ Less scope for economies of scale than monopoly. à ¢Ã¢â€š ¬Ã‚ ¢ More extensive advertising than monopoly, e.g. non-price competition. 3.6 Advantages An oligopoly has the following advantages: à ¢Ã¢â€š ¬Ã‚ ¢ Economic profits: returns for research and development. à ¢Ã¢â€š ¬Ã‚ ¢ Incentive for innovation: for capturing larger market share. à ¢Ã¢â€š ¬Ã‚ ¢ Greater choice: non-price competition through product differentiation. 4. FACTOR MARKET For the production of goods and services, a firm has to acquire factors of production. The markets for factors of production are similar to those of the product market, as they can be categorised into perfect or imperfect markets. The demand for a factor of production is dependent upon the demand of goods that use the factor. Hence, the demand for factors of production is a derived demand. Definition Derived demand is demand for a productive resource that results from the demand for the goods and services produced by the resource. Figure 8 Illustration of the factor and product markets Factor payment is the income for the owner of the factor of production for use of the factor over a period of time. The factor income for labour, land, capital and entrepreneurship are wages, rent, interest and normal profit respectively. In a perfectly competitive factor market, the factor payment is determined by the forces of demand and supply. Figure 9 Demand and supply in the factor market 5. MARGINAL PRODUCTIVITY THEORY This theory explains that the demand for a factor depends on the marginal revenue product (MRP) of the factor. Definition Marginal revenue product (MRP) is the additional sales revenue resulting from employing an additional worker. Marginal product (MP) is the extra output produced by the additional worker. The MP curve is downward sloping because of the law of diminishing returns. MRP = MP (factor) x MR (goods) The MRP curve is downward sloping from left to right. It is identical in shape to the MP curve because MR (i.e. price of a good) is constant under perfect competition in the product market. Figure 10 Marginal product for labour and marginal revenue product 6. DEMAND FOR A FACTOR Marginal cost (MC) is the extra cost of employing an additional unit of factor of production. In a perfectly competitive factor market, a firms MC graph for a factor is horizontal because the firm is facing a perfectly elastic supply of the factor. Therefore, MC = Price of the factor (i.e. MC of labour = Wages) 6.1 Profit Maximisation The firm maximises profits when: Marginal cost of hiring an extra unit of labour = Marginal revenue from the labours output to the firm In equilibrium, MC (labour) / Wages (factor price) = MRP Hence, the firms demand curve for labour is identical to its MRP curve. Figure 11 Demand for labour The market demand curve for labour is the sum of quantities of labour demanded by all firms at each wage rate. Chapter Review à ¢Ã¢â€š ¬Ã‚ ¢ A monopoly is a price-searcher who is a seller with sufficient market power to set his price by adjusting supply. à ¢Ã¢â€š ¬Ã‚ ¢ The monopoly maximises its profit by producing the level of output to MR = MC. à ¢Ã¢â€š ¬Ã‚ ¢ A monopoly restricts output in order to push price above the marginal cost. Such allocative inefficiency leads to a loss in social welfare. à ¢Ã¢â€š ¬Ã‚ ¢ Because of product differentiation, a firm in monopolistic competition can raise its price without losing all its customers. à ¢Ã¢â€š ¬Ã‚ ¢ The firm in monopolistic competition has excess capacity as it does not produce at the optimum level of output where the LRAC is the lowest. à ¢Ã¢â€š ¬Ã‚ ¢ Due to the interdependence of firms, oligopolists react to the pricing policy of their rivals. à ¢Ã¢â€š ¬Ã‚ ¢ The kinked demand curve explains that the price will be sticky when the cost increases within a certain range. à ¢Ã¢â€š ¬Ã‚ ¢ A firm will maximise profits when the marginal cost of hiring an extra unit of labour = the marginal revenue from the labours output to the firm What You Need To Know à ¢Ã¢â€š ¬Ã‚ ¢ Monopoly: A firm producing a commodity for which there is no close substitute. à ¢Ã¢â€š ¬Ã‚ ¢ Deadweight loss: Loss to society that cannot be recovered. à ¢Ã¢â€š ¬Ã‚ ¢ Single-price monopoly: Monopoly that charges the same price for every unit of output it sells. à ¢Ã¢â€š ¬Ã‚ ¢ Monopolistic competition: This market structure consists of features of perfect competition and monopoly. à ¢Ã¢â€š ¬Ã‚ ¢ Differentiation: Products are made slightly different from others by brand, packaging, sales location and services. à ¢Ã¢â€š ¬Ã‚ ¢ Oligopoly: Only a few firms share a large proportion of the industry. à ¢Ã¢â€š ¬Ã‚ ¢ Derived demand: Demand for a productive resource that results from the demand for the goods and services produced by the resource. Work Them Out 1. Which of the following is NOT a characteristic of a monopoly? A The monopolist faces an inelastic demand for its product B There is only one seller in the market C Barriers of entry exist D The monopolist can influence the price 2. Which of the following statements is NOT true? A As an oligopolist responds to competitors actions, it can be considered a perfectly competitive firm. B Products in an oligopoly may be differentiated. C A cartel is like a monopolist with power to maximise industry profit. D Oligopoly is a market structure favourable to collusion. 3. The characteristic of a monopoly is A its large scale of production B the existence of barriers to entry C the huge initial investment D the necessity for a large market 4. A natural monopoly exists when A a franchise is granted to a firm B economies of scale are necessary C a firm can prevent the entry of competitors D a firm specialises in natural resources extraction 5. The monopolist can make economic profits because A entry is prevented B it charges a high product price C it has low promotion costs D it has a large market share 6. Economic profits earned by a monopolist are most likely due to A barriers of entry B an unexpected rise in the price of its product C good luck D the rate of return allowed by the government 7. Which of the following is NOT a feature of oligopoly? A Only a few firms dominate the industry. B There are no barriers to entry into the industry. C The product may be either homogeneous or differentiated. D Firms in an oligopoly face downward-sloping demand curves. 8. Which of the following is NOT a characteristic of monopolistic competition? A A single price exists for similar goods. B Only normal profit exists in the long run. C Products are differentiated. D Excess capacity exists in the long run. 9. Which of the following statements is NOT true? A There are numerous sellers in perfect competition. B Products are differentiated in monopolistic competition. C Firms in perfect competition maximise profits. D Information is perfect in monopolistic competition. 10. What is the likely market structure of coffee shops in Hong Kong? A Monopoly B Oligopoly C Monopolistic competition D Perfect competition SHORT QUESTIONS What factor(s) enable(s) a monopoly to earn economic profits in the long run? Why do perfectly competitive firms maximise their profits by producing so that their marginal cost equals the price, but monopolists maximise their profits by setting a price that is greater than marginal costs? What are the characteristics of a market that allows a monopolist to successfully price discriminate between groups? Explain how a firm in an oligopoly can differentiate its product. ESSAY QUESTIONS 1. Peters Toy Factory, a single-price monopoly, has the following demand schedule and total cost for luxury toys: Quantity (Toys) Price ($/Toy) Total Cost ($) 0 10 1 1 8 3 2 6 7 3 4 13 4 2 21 5 0 31 Calculate Peters total revenue schedule. Calculate Peters marginal revenue schedule. Calculate Peters profit-maximising levels of : (i) output (ii) price (iii) marginal cost (iv) marginal revenue (v) profit 2. Mr Ma started a recycling business in Hong Kong this month. He employs students to sort and collect bottles, paying 10 cents for each bottle collected. The students can sort the following number of bottles in an hour. Number Of Students Number Of Bottles 1 200 2 450 3 750 4 1,150 5 1,450 6 1,700 7 1,900 8 2,050 9 2,150 (a) Why does the students marginal product decline? (b) If all other firms pay the students $25 an hour to collect bottles, how many students will Mr Ma hire? If the fee for each collected bottle rises to 12.5 cents and the students wages increases to $37.50 an hour, (c) Calculate and show the changes to the students marginal revenue product in a table. (d) How many students will Mr Ma hire?

Congestive Cardiac Failure: Causes and Effects

Congestive Cardiac Failure: Causes and Effects Analyse Health Information – Case study The scenario relates to Mr Alby Wright who has been admitted into your ward. His patient history and admission form is available for you to review. Mr Wright’s admission states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder? Congestive heart failure is a condition where the heart muscle becomes less strong and is unable to pump as well as it usually would. The ventricles which most important pumping chambers become bigger or thicker and aren’t able to squeeze or relax as well as they should be able to. This makes it easy for fluid retention to occur especially in the legs, abdomen and lungs (better health channel. 2013). This is all usually caused by diabetes, coronary heart disease, previous heart attack, high blood pressure and or other conditions that have damaged the heart and made it weak. Sometimes the fluid that gets in the lungs and it makes it uneasy to breathe and causes shortness of breath when the person is lying down on their back. This is called pulmonary oedema and can cause other respiratory issues if it not treated (American heart association. 2012). Generally if someone was to have heart failure, it would occur on the left side first mostly but can occur in both sides. If someone is experiencing left side heart failure, the left ventricle doesn’t fully empty and is unable to distribute enough oxygen rich blood around the body which causes heightened pressure in the upper chambers of the heart and the veins that are close to the area which is called systolic failure. Because of the build-up of blood in there, it can cause oedema in the legs, lungs and abdominal organs. The kidneys are affected by this hinders the way that they work and it leads to salt and water retention which causes further oedema. In some cases of heart failure, instead of not being able to pump blood around properly out of the left ventricle there is also unsuccessful relaxation of the left ventricle because the muscle has gone stiff which leads to blood pooling (better health channel. 2013) and also that the heart isn’t able to fully fill with blood during the resting period between each heartbeat (American heart association. 2012). Right sided heart failure usually happens because of left sided failure. When the left ventricle has failed, more fluid pressure is then transferred back through the lungs which damages the right side of the heart. When the right side of the heart loses the strength to properly pump, blood builds up in the veins and that causes swelling in the legs and ankles. The cardiovascular system is affected the most by congestive heart failure. The heart has been weakened and is unable to pump blood efficiently and doesn’t function properly in general and the muscle is also weakened. The respiratory system is affected because of the fluid in the lungs which is also known as pulmonary oedema. This can affect your breathing and leave you short of breath. Fluid may also build up in the liver resulting in an impaired capability to get rid of the body’s toxins and to produce the proteins that the body needs to live. The intestines can become not as good at absorbing nutrients and medicines as that would have when they were healthy (providence health network. 2014) Give a brief overview of the normal function of the body systems affected by this disorder. Cardiovascular system is most affected by this disorder. The functions of this system are to basically keep the blood running and pumping through by the arteries, veins, and capillaries (cliffs notes. 2013). The blood carries important nutrients around the body and helps to remove metabolic waste. The heart, blood vessels and blood help to regulate body temperature by controlling the blood flow to the surface of the skin. The white blood cells help to protect the body from foreign toxins and pathogens. Platelets help to clot blood so that you won’t have excessive blood loss and stop bleeding (cliffsnotes. 2013). Respiratory system function is so you can breathe and supply oxygen to your whole body (how stuff works. 2014). This works by breathing; inhaling oxygen filled air and exhaling carbon dioxide air. First you breathe in air through your nose and mouth and it travels down the windpipe and through the bronchial tubes then into the lungs. The diaphragm and abdominal muscles and make the lungs contract and expand so that you are able to breathe in and out. The bronchial tubes connect to blood vessels which carry blood through your body and exchange gases. The digestive system absorbs and moves the nutrients around the body that it needs to work well and gets rid of what the body doesn’t need as waste. First there is ingestion which is when eaten and then makes its way down into the stomach to be stored and waits for digestion. It then moves into the small intestines where the enzymes and bile work to break down the food where the body can absorb more nutrients that it needs and it continues on its way to the large intestine where it absorbs more fluid to make the solid faeces and moves through and gets excreted as waste (how stuff works. 2014). The liver aids in breaking up fats, absorbing them and digesting them. Urinary system works along with other parts of the body such as skin, lung and intestines to keep up the stability of chemicals and water in the body (live science. 2013).This system’s role is to filter and excrete. Kidneys work at reducing blood pressure by reducing the blood volume. The body filters blood to create urine which goes into the bladder and the bladder fills up until it is full and ready to excrete waste that the body does not need which is urination (live science. 2013). 3. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur. Breathlessness or shortness of breath is a symptom because when the heart starts failing, the blood in the veins gets backed up in the pulmonary veins because it cannot cope with the supply while trying to carry oxygenated blood from the lungs to the heart. At this point, the fluid is starting to pool in the lungs which hinders regular breathing. A person suffering heart failure may suffer with breathlessness upon exertion including exercise or other activities. As the condition progresses, breathlessness or shortness of breath may even be present while at rest or even sleeping which may cause the person to wake up (USCF medical center. 2014). Fatigue occurs when heart failure develops and worsens; the heart cannot pump the adequate volume of blood that is needed to meet all of the body’s needs. To make up for this, the blood is taken away from less vital such as the limbs to supply the heart and brain. Because of this, people suffering with heart failure usually feel tired, w eak and have difficulty doing normal tasks such as walking, going up stairs, or even carrying items. (USCFmedicalcenter.2014). Someone suffering shortness of breath as a symptom of heart failure will also experience fatigue if they are being woken up with breathing difficulties while they are sleeping. Chronic coughing and wheezing is a symptom because of the fluid backup in the lungs which may cause a thick, whitish mucus like substance called phlegm to be coughed up from the lungs which may even be tinged pink from traces of blood (USCFmedicalcenter.2014). Rapid or irregular heartbeat is a symptom because it may speed up to make up for its inability to pump blood around the body properly. People suffering this in heart failure may experience a fluttering sensation of heart palpitations, or a heartbeat that they are aware of and seems irregular or out of the normal rhythm. It may feel like the heart is racing or pounding hard (USCF medical center. 2014). Lack of appetite/ nausea be cause the digestive system isn’t as vital as the heart or brain so the blood has been pulled away from the digestive systems to these areas instead which means there will be problems with digestion including the feeling of fullness or sickness even though they have not eaten anything (USCF medical center. 2014). Confusion/ impaired thinking because unusual sodium levels in the blood and lessened blood flow to the brain can cause bafflement or memory loss even know the person suffering with this may not even realise, and someone else may pick up on this sign before they do (USCF medical center. 2014). Oedema or swelling due to restricted blood flow to the kidneys which means that they produce hormones which lead to the retention of salt and water. This causes swelling of (most often) in the legs, ankles, and feet. Oedema may also cause weight gain (USCF medical center. 2014). Rapid weight gain can occur as a result of oedema and the fluid retention (USCF medical center. 2014). Heart grows in size because it wants to make its pumping power greater so the muscle mass in the heart gets bigger to make this happen. The chambers inside of the heart also grow larger and stretch so that they can fit more blood in. While the heart grows in size, the cells that control its contractions also grow with it. An enlarged heart does not function as well as a normal sized one and the added muscle mass puts stress on the whole cardiovascular system (USCF medical center. 2014). The heart pumps faster as it tries to circulate more blood around the body. If the heart pumps blood too fast for a long period of time, it can damage the heart muscle and hinder its regular electrical signals, which can cause an unsafe heart rhythm disorder (USCF medical center. 2014). Blood vessels narrow because less blood is flowing through the veins and arteries and that means blood pressure can drop to seriously low levels. Because of this, the blood vessels narrow which keeps the blood pressure higher while the hearts power decreases. Narrowing of the blood vessels also limits the amount of blood that can flow through which may contribute to other conditions such as heart disease, clogged or blocked vessels in the legs or other body parts, or stroke (USCF medical center. 2014). Blood flow is diverted away from less vital areas such as the limbs when there is not enough of it to meet the body’s needs and gets given to more crucial organs such as the heart and brain which are the most important for survival. This can cause limb weakness due to lack of blood in the areas. The areas where the blood is diverted from may deteriorate over time from a lack of oxygen (USCF medical center. 2014). Increased urination at night because if the patient suffering heart failure lays down all day, the fluid that has been accumulating in their legs all day may move back up into the blood stream and gets taken to the kidneys and is excreted as urine (heart failure matters. 2014). Low blood pressure because the hearts power has decreased and the veins have narrowed. Chest pain if your heart failure is due to a heart attack. List the information taken on his admission that demonstrates these signs and symptoms. Cyanotic Appetite loss Confusion and anxiety Low blood pressure Temperature below 35.8 degrees Sa02: 87% on air Respirations: 32 Low blood pressure Constipation Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain. Yes. High blood sugar levels in diabetic patients damage nerves and blood vessels which results in poor circulation to the feet and may cause ulcers, infection, and amputation. This is more likely to happen if the patient has had diabetes for a long amount of time, they smoke, they don’t move around much, or their blood glucose levels have been high for an extended period of time (diabetes Australia. 2014). One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. Lasix is a diuretic. It increases the amount of urine that is made in the kidneys and excreted as waste (c health. 2014). It is also used to regulate and control slight to moderate high blood pressure. It affects the urinary system because it involves the kidneys and the cardiovascular system because it involves the heart. I think that Mr. Wright is ordered Lasix to get rid of the excess fluid that would be built up in his body and to lessen the oedema. List three conditions in Mr Wright’s relevant medical history that are commonly associated with ageing. Glaucoma Type 2 diabetes Arthritis Using Mr Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home. Hypotensive- low blood pressure He needs a walking stick because he is unsteady on his feet He gets anxious, especially about his dog. This can sometimes cause an asthma attack. He gets confused His vision is impaired and gets blurry after he has eye drops and he also needs reading glasses. What other health professionals will be involved in his care and what services can they provide for Mr Wright. Paramedics will care for Mr Wright in the ambulance and pass him over to emergency. Mr Wright needs a doctor to in emergency to diagnose him. General Nurses will be involved to provide care for him and to care for his wounds. A diabetes educator can be involved to help him to understand the needs of his condition and set up an action plan and give him support. A dietician can also help with this condition and set up meal and nutrition plans etc. Exercise physiologist assists patients to have a physical lifestyle to prevent and manage chronic conditions. A pharmacist will dispense his prescriptions so he can have medications and to give information on them. He may be able to talk to a psychologist to improve his anxieties, especially about his dog (better health. 2013). List the nursing documentation you would expect to be used in the care of Mr Wright. Progress notes Medication chart Vital signs chart Nursing history and assessment Care plan Asthma action plan FBC- fluid balance chart Wound monitoring chart Falls risk assessment (tafesa. 2014) UCSF medical center. 2014. heart failure signs and symptoms. [ONLINE] Available at: http://www.ucsfhealth.org/conditions/heart_failure/signs_and_symptoms.html. [Accessed 04 April 14]. heart failure matters. 2014. need to urinate at night. [ONLINE] Available at: http://www.heartfailurematters.org/en_GB/Understanding-heart-failure/Need-to-urinate-at-night. [Accessed 08 April 14]. better health channel. 2013. congestive heart failure. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_%28CHF%29. [Accessed 08 April 14]. American heart association. 2012. types of heart failure. [ONLINE] Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp. [Accessed 08 April 14]. c health. 2014. drug factsheets. [ONLINE] Available at: http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=210#Indication. [Accessed 09 April 14]. providence healthcare network. 2014. congestive heart failure. [ONLINE] Available at: http://providence.net/facilities/heart-failure.html. [Accessed 09 April 14]. pt direct. 2014. major functions of the cardiovascular system. [ONLINE] Available at: http://www.ptdirect.com/training-design/anatomy-and-physiology/cardiovascular-system/major-functions-of-the-cardiovascular-system-2013-a-closer-look. [Accessed 09 April 14]. diabetes australia. 2014. diabetes and your feet. [ONLINE] Available at: https://www.diabetesaustralia.com.au/Living-with-Diabetes/MindBody/DiabetesYour-Feet/. [Accessed 09 April 14]. TafeSA, 2014. Acute Care Flow Charts. In: Flow Charts. s.l.:Government of South Australia. better health . 2013. allied health. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Allied_health. [Accessed 10 April 14]. cliffs notes. 2013. functions of the cardiovascular system. [ONLINE] Available at: http://www.cliffsnotes.com/sciences/anatomy-and-physiology/the-cardiovascular-system/functions-of-the-cardiovascular-system. [Accessed 10 April 14]. how stuff works. 2014. what is the function of the respiratory system?. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/respiratory/function-respiratory-system.htm. [Accessed 10 April 14]. how stuff works. 2014. how the digestive system works. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/digestive/digestive-system2.htm. [Accessed 10 April 14]. live science. 2013. urinary system. [ONLINE] Available at: http://www.livescience.com/27012-urinary-system.html. [Accessed 10 April 14]. Chikungunya Fever: A Review Of The Literature Chikungunya Fever: A Review Of The Literature The Newala and Masasi Districts of the Southern Province, Tanzania, reported its first dengue-like outbreak in 1952-1953, on the basis that this epidemic involved debilitating joint pains and shorter incubation period, thereby excluding dengue (Robinson 1955). The infection was called chikungunya; a word from the Makonde dialect describing patients contorted posture (Lumsden 1955). Chikungunya is an arthropod borne virus (arbovirus) of the genus: Alphavirus from Togaviridae family. It is transmitted to humans mainly by the day biting mosquito species Aedes aegypti and Aedes albopictus (Townson and Nathan 2008). Moreover, Aedes aegypti eggs collected from the Tanzanian outbreak were used for the first isolation of Chikungunya virus (CHIKV) (Ross 1956). CHIKV contains a positive-sense single stranded RNA genome, enclosed in an icosahedral nucleocapsid, all enclosed in a phospholipid bilayer envelope. Embedded in the envelope are multiple copies of two encoded glycoproteins E1 and E2, a small glycoprotein E3, and a hydrophobic peptide 6K (Strauss and Strauss 1994). However, the roles of these glycoproteins are not elucidated, but it can be assumed that it could facilitate the attachment of the virus to host cell. History Subsequent to the Tanzanian epidemic, several outbreaks have been reported worldwide, including the Indian Ocean Islands; La Reunion (Renault et al. 2007), Mayotte (Sissoko et al. 2008), and the Maldives (Yoosuf et al. 2008). There were outbreaks whereby Chikungunya had concurrence with other infections; with Dengue (Ratsitorahina et al. 2008, Yoosuf et al. 2008) and with Plasmodium falciparum infection (Pastorino et al. 2004). Moreover, Chikungunya have been imported into several European countries; United Kingdom (HPA 2007), France (Hochedez et al. 2007), Germany, Switzerland, Denmark, Poland (Panning et al. 2008), with Italy witnessing its first CHIKV outbreak in 2007 (Rezza et al. 2007). Aim of review The Italian outbreak has demonstrated that only one viraemic person was required to instigate an outbreak and due to increased population movement worldwide, CHIKV could extend to pandemic proportions (Rezza et al. 2007). Furthermore, the outbreaks could have been underestimated due to its concurrence with other infections. Thus, this literature review will demonstrate to the reader that the Western medicine should be planning for CHIKV outbreaks which are becoming increasingly possible due to world climate change. Clinical Features Chikungunya is a mild and self limiting infection (Rezza et al. 2007) with incubation period of 2-7 days (Robinson 1955). Patients usually presents with a number of clinical features, with fever, fatigue, joint pain, anorexia, and nausea presenting as common clinical features (Table 1). Arthalgia and myalgia mainly involves the extremities of wrists, ankles, hands, feet and phalanges, while skin rash and petechiae are manifestations of haemorrhage (Kannan et al. 2009). During the La Reunion outbreak, Gà ©raldin et al. (2008) observed vertical transmissions from mother to child, with newborns presenting with chikungunya infection without prior mosquito bites. These neonates became symptomatic between 3-7 days postpartum, with presentation of fever, pain, poor feeding, disseminated intravascular coagulation (DIC) with gastrointestinal and cerebral bleeding, petechiae, and distal joint oedema. Encephalitis, thrombocytopenia and haemorrhagic fever were presented as severe neonatal infec tions; however, no fatalities were reported (Gà ©rardin et al. 2008). Transmission of CHIKV CHIKV requires two types of hosts to complete its replication cycle. Firstly, Aedes mosquito species transmits the virus to animals, and act as definitive hosts. Secondly, humans and other animals become infected with the virus and act as intermediate hosts. The transmission between the natural hosts (primates, birds, rodents and others) and the definitive hosts involves the sylvatic (main) cycle (Pardigon 2009). By disrupting this cycle, humans became incidental hosts, resulting in urban transmission cycles yielding epidemics. These humans could transmit CHIKV directly to domestic mosquitoes (Gould and Higgs 2009) and indirectly to domestic animals such as fowl, pigeons and goats (Lumsden 1955). When an Aedes mosquito ingests viraemic blood meal, CHIKV replicates in the salivary glands and ovaries, sites where it can be excreted. Upon another blood meal, the mosquito injects the viraemic saliva into a susceptible host. Contrary, within the ovaries, CHIKV is transmitted to the mosqui toes eggs by vertical transmissions (Figure 1). The desiccated nature of these eggs enables it to survive longer periods in the environment, where they are hatched during the rainy season (Gould and Higgs 2009). Figure 1. The overview of CHIKVs transmissions cycle in mosquito and human (Evenor 2010). Aedes mosquito becomes infected after taking a blood meal from an infected intermediate host Upon another blood meal, the Aedes mosquito injects viraemic saliva into a susceptible host The viraemic blood travels to the gut, where CHIKV undergoes replication within the gut wall The egg later developed into a mosquito infected with CHIKV CHIKV travels to the ovaries, where it is transmitted to the mosquitos eggs by vertical transmission The intermediate host becomes viraemic with presentation of clinical features CHIKV penetrated the gut wall, where it is disseminated through the bloodstream CHIKV travels to the salivary glands, where it undergoes replication Distributions of Aedes albopictus and Aedes aegypti Aedes aegypti was the predominant vector during earlier outbreaks in Africa (Lumsden 1955), and it has been implicated in some recent outbreaks in Africa (Gould et al. 2008) and Indonesia (Laras et al. 2005). However, Aedes albopictus have been described as the main vector implicated in a number of recent outbreaks, between 2005 to 2007 (Leroy et al. 2009, Pagà ¨s et al. 2009, Ratsitorahina et al. 2008, Renault et al. 2007, Sissoko et al. 2008). In the Gabonese outbreak involving both vectors, Vazeille et al. (2008) hypothesised that Aedes albopictus is a more suitable vector for CHIKV than Aedes aegypti, as it has a higher susceptibility for the virus. The two vectors have been recovered from several breeding sites with some overlap (Table 2). Tyres have been the main source of Aedes albopictus larval importation into Italy, in 1992, from Atlanta, USA. Consequently, the trade of these used tyres within Italy had caused large infestations of Aedes albopictus in Linguria, Veneto, Lom bardy and Eimlia-Romagna regions, by the end of 1995 (Knudsen et al. 1996). Aedes aegypti larvae predominate inside home, whereas Aedes albopictus larvae predominate outside home (Preechaporn et al. 2006). Table 2. The natural and artificial breeding sites for Aedes aegypti and Aedes albopictus larvae. Natural and artificial breeding sites Incidence of Aedes aegyptilarvae Incidence of Aedes albopictus larvae References Barrels X Gould et al.2008 Drums X X Gould et al.2008, Ratsitorahina et al.2008 Buckets X Ratsitorahina et al.2008 Flower pots X Gould et al.2008 Discarded cans X X Preechaporn et al.2006, Ratsitorahina et al.2008 Coconut shells X Preechaporn et al.2006, Ratsitorahina et al.2008 Clay water jars X Gould et al.2008 Mango tree holes X Lumsden 1955 Wetlands X X Vazeille et al.2008 Discarded tyres X X Preechaporn et al.2006, Ratsitorahina et al.2008 Plant pots X X Preechaporn et al.2006, Ratsitorahina et al.2008 Gardens X Adhami and Reiter 1998 Discarded plastic bottles X Adhami and Reiter 1998, Preechaporn et al.2006 Wet containers X Ratsitorahina et al.2008 Banana trees X Preechaporn et al.2006 Plant axils X Preechaporn et al.2006 Animal pans X X Preechaporn et al.2006 Plastic containers X X Preechaporn et al.2006 Cement tanks X X Preechaporn et al.2006 Ant guards X Preechaporn et al.2006 Preserved areca jars X Preechaporn et al.2006 Small and large earthen jars X X Preechaporn et al.2006 Key: (X):- present, (-):- absent. Effect of climate change Outbreaks have been associated with climatic conditions such as temperatures and high rainfall. Temperatures influence the developmental rate of Aedes albopictus larvae to adult mosquitoes, with the rate optimising at temperatures between 25 to 30oC (Straetemans 2008). Thus, Tilson et al. (2009) argued that mean monthly temperatures above 20oC are required to initiate an outbreak, as illustrated by the Italian outbreak that was initiated in June and subsided in September when the monthly average temperatures were 22oC and fell below 20oC. Mean annual rainfalls over 500mm is required (Straetemans 2008) to provide suitable breeding environment for the mosquitoes to expand their population (Lumsden 1955); as a result, most outbreaks have been associated with high rainfall (Lumsden 1955, Pastorino et al. 2004, Renault et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2009) as illustrated in Table 3. In 2009, the UK Met office (2010) recorded a mean annual rainfall and temperature of 1201.3 mm and 9.2oC, respectively. The rainfall is sufficient to initiate an outbreak; however, the low temperature is insufficient to support the mosquitoes life cycle. Therefore, the question is what would the impact be to the UK if the climatic condition changes to favour this mosquito? Table 3. Mean temperature and the amount of rainfall that were reported during several outbreaks. Country Duration of the outbreak Mean monthly Temperature (oC) Months mean monthly temperature were collected Amount of Rainfall (mm) Months high rainfall were recorded Reference Tanzania 1952 1953 21.8 28.5 Jun Nov 1203 Jan Dec 1952 Lumsden 1955 Bogor Aug Dec 2001 24 26.2 Jan 2000 Dec 2001 NA Laras et al.2005 Bekasi Jan 2002 26.2 29.6 Jan 2001 Dec 2002 1931 Jan Feb 2002 Laras et al.2005 Maldives 2006 2007 NA NA 970 Nov Dec 2006 Yoosuf et al.2009 Key: NA- not available Distribution of Chikungunya outbreak Mayotte (French Overseas Territory), an island of the Comoros archipelago, encountered its first CHIKV outbreak imported from Grand-Comore in mid-April 2005 (Renault et al. 2007), with 6346 reported cases (in two waves), observed by the surveillance system implemented throughout the island by the local French Health Authority, Dass (Direction des affaires sanitaires et socials) Mayotte. The first (minor) wave commenced in April 2005, it later peaked in week 18 and the infection rate diminished in June, with the virus maintaining low levels thereafter, during the temperate and dry season. However, the second (major) wave began during the first week of May 2006, peaked during the hottest and rainiest months around March/April 2006 and reduced to control levels by July 2006 (Sissoko et al. 2008). In March 2005, a chikungunya infection which started in Grande-Comorre was imported into La Reunion (French Overseas Territory), becoming its first severe reported case involving two waves of outbreak, as observed by the epidemiological surveillance system implemented by the islands local Health Authorities (Renault et al. 2007). Firstly, a (minor) wave commenced in March 2005, peaked in May 2005 and decreased at the beginning of July to approximately 100 cases where the level was maintained during the austral winter. By December 2005 the second (major) wave began; however, the capacity of the surveillance system at the time was insufficient to evaluate the number of cases, as the number of cases was increasing exponentially. This resulted in an underestimation of the number of reported cases with possible misdiagnosis with Dengue fever which circulated the island the previous year (Renault et al. 2007). By April 2006, the Regional Health and Welfare Office reported 203 deaths that w ere directly (due to low immune status) or indirectly (in associations with other underlying conditions) attributed with chikungunya infection, with a low mortality rate of 0.3/1000 people (Renault et al. 2007). The Maldives encountered its first CHIKV outbreak involving 11879 confirmed and suspected cases on 121 of the 197 inhabited islands, observed by the surveillance system implemented by the Epidemiology Unit of the Department of Public Health (DPH), from December 2006 to April 2007 (Yoosuf et al. 2008). The outbreak commenced at the beginning of December 2006, peaked in week 6 and subsided to control levels by week 11 before halting in April 2007. The epidemic was thought to be associated with post-tsunami construction activities which provided breeding sites for mosquitoes. Moreover, approximately five to six elderly patients died as result of co-morbidity and other conditions (Yoosuf et al. 2008). Figure 2: Global Distribution of chikungunya virus, 1952 to 2009. The cases represented on the map are either confirmed cases or suspected cases (Evenor 2010). References: 1 Krastinova et al. 2006, 2 Rezza et al. 2007, 3 Pastorino et al. 2004, 4 Sissoko et al. 2008, 5 Lumsden 1955, 6 Tamburro and Depertat 2009, 7 CDC 2009, 8 WHO 2008, 9 Yoosuf et al. 2009, 10 Leroy et al. 2009. Importation into Europe England In 2006, the United Kingdoms (UK) Health Protection Agencys (HPA) Special Pathogens Reference Unit (SPRU) reported 133 imported cases of chikungunya (Table 4). The majority of these tourists had travelled to the Indian Ocean islands (68), between March and August 2006, where outbreaks were circulating, with Mauritius being the main destination site involving 58 imported cases, followed by 6 in the Seychelles, and 4 in Madagascar. However, when the outbreaks were in decline, only one case was detected in December (HPA 2007). Between August and December, 44 cases were imported from India and 10 cases were imported from Sri Lanka, between November and December; countries with reported recent chikungunya outbreaks. Also imported into the UK, where one case from Nigeria, one from Tanzania, one case from Kenya, and one case from Australia. There had been no mention of chikungunya outbreak in these countries. However, the article did not state whether there had been reported sightings of Ae des mosquitoes in UK (HPA 2007). Table 4. The number of cases was identified by different methods from the 133 imported cases, in the UK. Identification of the imported cases Number of cases Laboratory confirmed case 45 Probable case 30 Suspected case 35 Past exposure 23 France The Pitià ©-Salpà ªtrià ¨re Hospital in Paris, France, reported 80 cases of Chikungunya infection imported by tourists who recently visited the Southwest Indian Ocean region, between March 2005 and August 2006. The majority of cases (52) were imported from La Reunion (Hochedez et al. 2007), a popular destination site for French tourists (HPA 2006). Other destination sites reported were; Mauritius with 18, Comoros with 4, Madagascar with 3, and Mayotte with 2 cases (Hochedez et al. 2007). Within the same period, Metropolitan France reported 766 imported cases, which correlated with the two waves of the La Reunion outbreak (Figure 3). At the peak of the first La Reunion outbreak, an average of 20 cases was imported to France monthly. However, between August and November 2005, during the Southern Hemisphere winter, the cases decreased (Krastinova et al. 2006). A month after the peak of the second outbreak, the number of imported cases drastically increased. It can be argued that Fran ce is at risk of future outbreaks, in view that some of its inhabitants are constantly visiting the Southwest Indian Ocean regions (Hochedez et al. 2007), mainly La Reunion and also due to the inhabitation of Aedes albopictus (Krastinova et al. 2006). Figure 3: Correlation between imported cases of Chikunugunya in metropolitan France to the estimated number of cases in the La Reunion outbreak (Krastinova et al. 2006). Italy Chikungunya was apparently imported into Italy by a male tourist coming from the Kerala province in India, who developed febrile illness two days into his holiday. The region he visited was Castiglonia di Cervia in June 2007. This was recorded by Ravenna provinces local health unit in the Emilia Romagna region, northeastern Italy where 205 people developed CHIKV infection (Rezza et al. 2007). The vector, Aedes albopictus, was implicated in the spread of the virus which was then imported from Castiglione di Cervia into Castiglione de Revenna two villages separated by a river. Mosquito control measures implemented in the area resulted in a reduction in chikungunya infection. However, the control measure was not implemented in other villages and therefore a new wave occurred. The virus isolated from the outbreak contained the same mutational change (Ala226Val) in the membrane fusion E1 glycoprotein as the Indian Ocean variant, thereby suggesting that the Kerala strain could have origina ted from the Indian Ocean outbreak (Rezza et al. 2007). Other European Countries Tourism has been one of the main methods of CHIKV distributions worldwide, including its importation into several European countries. In 2006, the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany examined 720 samples from 680 European patients who became symptomatic upon return to Germany, Belgium, Switzerland, Denmark, and Poland from several destinations (Table 2) (Panning et al. 2008). The majority of patients had recently visited countries in the Indian Oceans; Mauritius, the Seychelles, La Reunion and Madagascar, and other countries; Bali, Indonesia, Sri Lanka, India, Malaysia, Kenya and Thailand. Moreover, most of these countries have been implicated in recent CHIKV outbreaks. No outbreaks were reported in these European countries; however, future outbreaks can be hypothesised (Panning et al. 2008). Table 5. The country of origin and the holiday destinations of patients presented at the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany. Exact destinations were only available for 27.8% of patients, and exact itinerary were not available (Panning et al. 2008). Country of origin Number of patients Germany 515 Belgium 99 Switzerland 42 Denmark 22 Poland 2 Total Nos. of patients 680 Holiday Destinations (Regions with Chikungunya Epidemic) Number of patients Mauritius 92 The Seychelles 23 La Reunion 18 Madagascar 9 Bali 2 Indonesia 6 Sri Lanka 5 India 28 Malaysia 2 Kenya 1 Thailand 3 Concurrence with Dengue Fever and Malaria In 2006 and 2007, Madagascar and Gabon reported co-infections between Chikungunya and DENV-1 or DENV-2 respectively (Ratsitorahina et al. 2008, Leroy et al. 2009). Contrary to CHIKV, dengue virus (DENV) is of Flavirivirus genus from Flaviridae family; consisting of four antigenically distinct but closely related serotypes (DENV1-4). It is transmitted by Aedes aegypti and Aedes albopictus, also CHIKV transmission vectors (Cook and Zumla 2009). DENV and CHIKV have similar clinical features (Yoosuf et al. 2008). However, the only difference is that CHIKV has arthalgia (). The extended incubation period of DENV (5-8 days) differentiated it from CHIKV (2-7 days); however, the difference is insignificant (Cook and Zumla 2009). Thus, serological diagnosis can be used to differentiate DENV to CHIKV (Ratsitorahina et al. 2008). Ratsitorahina et al. (2008) and Leroy et al. (2009) confirmed Aedes albopictus as the predominating transmission vector of both CHIKV and DENV1 or 2. However, neither study stated whether the vector could simultaneously harbour both viruses. Moreover, the study by Vazeille et al. (2008) demonstrated that Aedes aegypti has a higher susceptibility to DENV-2 virus and a lower susceptibility to CHIKV; whereas Aedes albopictus is a more efficient vector for CHIKV than DENV-2 (Vazeille et al. 2008 and Moutailler et al. 2009). Leroy et al. (2009) further demonstrated this theory in the Gabon outbreak, as the majority of the patients had CHIKV compared to DENV-2. In May 1999 and February 2000, the Matete and Kingabwa quarters of Kinshasa in the Democratic Republic of Congo (DRC) reported two Chikungunya outbreaks. CHIKV was the main contributing factor in the first outbreak; however, during the second outbreak, evidence confirmed possibility of co-infections between CHIKV and Plasmodium falciparum (Pastorino et al. 2004). Malaria is a parasitic infection, of the Apicomlexa phylum, that mainly infects hosts red blood cells. It is transmitted by Anopheles species, whereas CHIKV is mainly transmitted by Aedes species. Plasmodium falciparum is one of the four species of Human Malaria (including Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale). However, Plasmodium falciparum is the most severe form of Malaria (Cook and Zumla 2009). Pastorino et al. (2004) hypothesised that co-infections could be due to long term latency of Plasmodium falciparum, the presence of both transmission vectors in the area or the pathogens sharing the same vec tors. An experimental investigation by Yadav et al. (2003 as cited by Pastorino et al. 2004) demonstrated that urban Anopheles stephensi (Plasmodium falciparum vector) could transmit CHIKV. Lack of Research We are still in the preliminary stages of understanding the interaction between CHIKV and host immunity (Kam et al. 2009), despite increasing number of reported outbreaks, there are insufficient evidences of up-to-date quality research (Panning et al. 2008). Therefore, outbreaks should be utilised to implement entomological and epidemiological system in improving our poor knowledge of the virus (Pialoux et al. 2007). Chretien and Linthicum (2007) argued that the Italian outbreak should provide opportunities for developed countries to strengthen the public-health system of developing countries in order to reduce the worldwide spread of outbreaks. These can be done by implementing Entomological and Virological surveillance in Aedes albopictus infested areas (Charell et al. 2008). Renault et al. (2007) utilised Deltamethrin insecticides to eradicate adult mosquitoes, whereas Rezza et al. (2007) utilised synergised pyrethrins. Furthermore, both authors utilised the biological larvicide, Bacillus thuringiensis israelensis, to destroy breeding sites (Renault et al. 2007, Rezza et al. 2007); however, Renault et al. (2007) later utilised Fenitrothion and temephos. Other control measures include educating the community on personal protection (Ratsitorahina et al. 2008). Although, no commercial vaccine has been approved, several candidates have been tested including the Formalin inactivated CHIKV vaccine for the Indian strain, DRDE-06, ECSA genotype (Tiwari et al. 2009). Therefore, the author believes that future outbreaks can be avoided if more research on CHIKV is undertaken, and a worldwide surveillance system is implemented. Conclusion This review has demonstrated that tourism is one of the main methods of CHIKV distributions worldwide, as it was the reason of several outbreaks. CHIKV was transported throughout the Southwestern Indian Ocean islands by viraemic tourists visiting different islands (Figure 2) and Kerala, India, which was then imported into Italy (Renault et al. 2007, Rezza et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2008). However, outbreaks require temperatures above 20oC and annual rainfall over 500mm to maintain Aedes mosquitoes populations (Straetemans 2008, Tilson et al. 2009). Therefore, England is one of the least at risk country, as Aedes albopictus is not present, and the temperature is unfavourable to maintain mosquitoes life cycle (HPA 2007, Met Office 2010). Countries such as France and Italy are at high risk, due to the presence of Aedes albopictus and the introduction of CHIKV; although, Italy is the most at risk due to a recent outbreak (Krastinova et al. 2006, Rezza et al. 2007). T he eminent climatic changes could result in rising temperatures and increased rainfall that would favour the establishment of Aedes albopictus worldwide. All these emphasises the need for Western medicine to plan for future CHIKV outbreaks, by implementing a worldwide surveillance system in order to monitor outbreaks and to perform vector control measures (Charell et al. 2008). Chikungunya have concurrence with Malaria and Dengue Fever (Leroy et al. 2009, Ratsitorahina et al. 2008); furthermore, evidence suggests wrong classification of Chikungunya due to its resemblance to Dengue fever. CHIKV is constantly mutating, thus constant development of a new vaccine is required (Tiwari et al. 2009). Thereby, further researches are needed.