The American colonization, on the eve of Revolution Essay

The American colonization, on the eve of Revolution - Essay Example A few years later, the parliament passed the Tea Act to save the East Indian Company from bankruptcy. It removed all the duties on tea exported by the British thus giving them undue advantage over other exported tea to America. On the day, the first shipments of the tea arrived in Boston, three members of the Sons of Liberty dressed as Indians boarded the ships and threw all the tea into the sea later known as the Boston Tea Party. For the first time, leaders of the twelve colonies, excluding Georgia met in Philadelphia and convened the First Continental Congress to create a single unified stand and response to the laws and policies passed by the British Parliament. Through the congress, they filed a petition called the Declaration of Rights and Grievances to the British king. At the height of the revolution, all of the thirteen colonies convened again as Second Continental Congress. An Anglo-American philosopher in the name of Thomas Paine wrote a pamphlet entitled â€Å"Common Sense† and asked whether â€Å"a continent should be ruled by an island†. Only a few Loyalist Americans then were ready and willing to defend Great Britain. This was due to the continuing clashes between the Patriots and British troops. The Patriots then were the primary army who are fighting against the British. These clashes further advanced the growth of American patriotism. The Second Continental Congress took the ultimate steps. They organized an army to continue the fight called the Continental Army with George Washington as the commander-in-chief. The Patriots then were the staunch supporters of the continuing revolution while the Loyalists would still want to be part of the British Empire. Most of the Loyalists then were wealthy and politically powerful people in the American society. These include the merchants, lawyers and landowners. And the Patriots were

Reigniting Your Passion for God Essay Example for Free

Reigniting Your Passion for God Essay The creative force behind all great art, all great drama, all great music, all great architecture and all great writing is passion. Nothing great is ever accomplished in life without passion. Nothing great is ever sustained in life without passion. Passion is what energizes life. Passion makes the impossible possible. Passion gives you a reason to get up in the morning and go and say, I’m going to do something with my life today. Without passion life becomes boring. It becomes monotonous. It becomes routine. It becomes dull. God created you with the emotions to have passion in your life and He wants you to live a passionate life for Him. Passion is what mobilizes armies into action. Passion is what causes explorers to boldly go where no man’s gone before. Passion is what causes scientists to spend late night hours trying to find the cure to a dreaded disease. Passion is what takes a good athlete and turns him or her into a great athlete where they’re breaking records. You’ve got to have passion in your life. One day a man walks up to Jesus and he says, Lord, what’s the most important thing in the Bible? And you know what the Great Commandment is. We’ve talked about it many times. Jesus said, I want you to love God with all your heart and soul and mind and strength. Nothing matters more than that. That’s the number one thing in life. I want you to love Me passionately. Nothing else matters in life if you don’t love God with passion. God doesn’t want you to love Him half-heartedly. He wants you to love Him with all your heart and all your soul and all your mind and all your strength. I love the paraphrase of that verse, Mark 11:30, from The Message Jesus said, ’Love the Lord God with all your passion and prayer and intelligence and energy. Circle the word passion. That word, in Greek, is the word heart. God is saying I want you to put some muscle into it, put some energy, put some emotion into your relationship with Me. Don’t be a wimp about your relationship with Me. Don’t be namby-pamby. Don’t be half-hearted. Give it all you’ve got. Jesus is saying, If you’re going to follow Me, you’ve got to go it with passion. You’ve got to give it some oomph, some spark, some zip, some enthusiasm, some zest. In other words I want you to live your life with me passionately. In fact, this truth is all through the Bible. The Bible tells us that we’re to seek God passionately. We’re to love God passionately. The Bible says that we’re to serve and obey God passionately. We’re to trust God passionately. Then as if you didn’t get the message, in Colossians 3:23 He says Whatever you do, do it with all of your heart as unto the Lord and not unto men. He says I want you to do everything passionately when it comes to loving Me, serving Me, living for Me. Here’s the amazing thing. In America it’s ok to be passionate about anything except God. That is not politically correct to be passionate about God. I can be passionate about movies. I can be passionate about sports. I can be passionate about politics. I can be passionate about fashions and clothes. I can be passionate about restaurants. But I cannot be passionate about God. That’s a no-no. I typed in the phrase a passion for into Amazon.com and found a couple hundred books with that title. There’s a book call A Passion for Birds, A Passion for Books, A Passion for Cactus, A Passion for Chocolate (that’s understandable), A Passion for Fashion, for Fishing for Flying, for Gardening, Golf, Hunting. There’s even a book called A Passion For Mushrooms. A Passion for Needlepoint, Pasta, Ponies. There’s a book called, A Passion for Potatoes, for Roses, for Shoes. There’s even a book called A Passion for Steam. I can’t figure out what that one’s all about! I don’t know why you’d get passionate about steam. But in our culture today it’s ok to be passionate about anything except your religion, except your faith, except your relationship with God. I can go to a concert, or a political rally or a baseball game and I can shout my head off. I can get excited. I can get hoarse from yelling so loud. When my team loses I could cry. Nobody thinks that’s a big deal. When my team wins I can jump up and dance around and wave my hands in the air. If I do that at a game people go, He’s a real fan! But if I do that in church people say, He’s a fanatic! He’s a nut case. You don’t want to get too emotional about your faith. Its ok about anything else but not that. Romans 12:1 Never be lacking in zeal, but keep your spiritual fervor. Keep the fires going in your life. Circle the word keep. Notice, it’s not automatic. It’s a choice. It’s a discipline. It’s something you must maintain. You are not by nature passionate about God. It’s something that you must choose to do. You get distracted and everything in life conspires to keep you from being passionate about God. So He says keep your passion going. Keep the fires going. It’s a discipline. It’s not just automatic. This kind of thing being passionate about God has nothing to do with either your personality or your age. Our churches are filled with hundreds if not thousands of senior believers who have walked with God a long, long time and are still passionate. But everything in life conspires to keep you from being passionate. And it dissipates your energy. When you first become a believer and you really understand what a good deal you’ve got you get excited about it, This is quite a big deal! All my sins were forgiven. I now have a purpose for living, and I now have a future home in heaven. What a deal! And you get excited about that when you give your life to Christ and you’re pretty passionate. But as time goes by you begin to lose your steam. You begin to lose your zip, your zest, your enthusiasm. What happened? Why does that happen? That’s what we’re going to look at today. As we go through God’s word we’re going to look at seven passion killers, things that rob the joy out of your life. I thought this would be a very appropriate message, right in the middle of winter, when nobody feels very passionate about much of anything. You want the warmth of summer back. So this morning we’re going to look at these passion killers together. I want you to use it as a checklist. Because God says, I want you to love Me with all of your heart.

The Work Life Balance In Nestl International Management Essay

The Work Life Balance In Nestl International Management Essay Work/life balance is a very broader term and often referred to finding the right equilibrium between the different aspects and roles in a life of a person. Although there are different views and concepts about work/life balance but it is generally coupled with maintaining an overall balance in different aspects of life. During the last decade technological revolution has stormed all aspects of life and there were different debates about the future of work. Different scenarios predicted a rising trend in un-employment and economic insecurity. Industrial restructuring and emergence of latest technology no only affected the importance of workforce but it was also felt that employees will be treated as superfluous overheads. In this study of work/life balance the main objective will be to examin the ability of employees to handle concurrently the versatile demands of life at Nestle International. Work/life balance demands the right balance and equal amount of time devoted to official as well as personal life. The theory of this concept is not that simple and requires many developments and additional components to be incorporated. There are three different levels of equilibrium that affect the work/life balance. CHAPTER 1 Introduction History of Work/Life Balance: During the 1960s and 1970s, the concept of work/life balance was a new one and was basically used for those working mothers who usually struggle to cop up the requirements of their jobs as well as raising their children. However during the 1980s the importance of work life balance acknowledged all over the world and many multinational companies introduced the policies and measures to secure the rights of the workers and tried to maintain a right balance in their culture. By the end of the decade, work-life balance was seen as more than just a womens issue and male workers also raised their voices. By the mid of the 1990s work-life balance became a fundamental issue for individuals and it became a necessary part of the strategies of all the organizations all over the world. This growing awareness of the central importance of the issue resulted in major growth in attempted work-life solutions during this decade and many new studies and ideas emerged. As for today the situation has changed drastically and many changes have been made in labour law regarding the protection of rights of the workers and these changes in laws also have a significant affect on HRM policies and strategies of the organizations. Why Work/life Balance so Important? Over the past few decades, there has been substantial increase in work which is felt due to a very stiff competition in global markets and ever increasing pressure and demands from the organizations that expects more and more from their employees yet offers a very little security and compensations in return. For many employees today including both male and female their lives are becoming more complex and difficult with an increased burden of family and other personal responsibilities and interests. Therefore, in an effort to retain employees and maximize their performance, it is increasingly important for organizations to recognize this balance. This increased pressure has affected the life of worker at Nestle International in many ways. It is not only harming the social norms but also causing many physical and psychological diseases such as heart problem, weak immune system, stiff muscles, exhaustion and jumpiness etc. Increased working hours means there will be very less time to be spend with family and community. If an employee is not mentally satisfied or balanced, he will not be able to perform his duties with due diligence and care. Now, however, things have taken altogether a different turn. Employees quality of work-life is becoming a burning issue all over the world. For a growing number of employers, human resource challenges are their biggest concern. Leading employers are recognizing that positive work-life outcomes for employees from achieving work-life balance to the satisfactions of challenging work and career development are key ingredients of a successful business strategy. In practice, improving the quality of work life remains a tough challenge. Naturally, many managers see the important links between the quality of work life and organizational performance. Yet they face barriers to progress. So it is necessary to update the case for taking action to improve the quality of jobs and work environments. A happy and well balanced employee will not only perform his daily operation with utmost care but will also be able to avoid different complex social problems. Work/life programs will not only help to boost employees morale, reduce absenteeism, preventing the outflow of valuable information of the organization in difficult economic situations but will also reduce the cost and affect the overall performance of the company. It is very important for the human resource professional to understand the critical issues of work/life balance. Be it employees whose family members and/or friends are called to serve their country, single mothers who are trying to raise their children and make a living. Objectives of the Research To understand the concept of work/life balance. To understand the importance of a good and happy relationship between employer and employee. To evaluate the importance of work/life balance from the perspective of both the employer and employees. To explore the work/life balance at Nestle International. To evaluate the strategies of management at Nestle International and their role in maintaining work/life balance. To find out the solutions of different problems faced by the Nestle management in maintaining work/life balance within the organization. Importance of Work/life Balance from the Perspective of Employer: A balanced culture/environment in any organization will not only be helpful for employees in different ways but it will also provide many tangible benefits to the business. Implementing work/life balance provides an excellent opportunity to consult with staff to review the job design and develop innovative and supportive work practices. This sort of consultation will ensure the needs of individuals are met and a more agile workplace is achieved. It will also lead to a greater level of employee commitment to the success of the business. By minimizing the employees turnover in organization you will not only boost your repute as a good employer but it will also help to achieve the quality standard of products out prevent the outflow of valuable inside information to other organizations because if a skilled worker will leave the organization it will take a hell lot of time any money to replace him with some other suitable person. Importance of Work/life Balance from the Perspective of Employee: The For human being, home is a shadow of heaven on earth where he goes and takes rest but due to imbalance structure between work and life it has become an additional place of work with plenty of office tasks and assignment. Any human being will be able to perform his duties and tasks deliberately only when he/she has a right balance in between his/her official and personal life. A balanced and happy employee is more likely to perform better at work and can provide many tangible benefits for a business. There are new ways to make work work that benefit both employers and employees. In fact, research shows that flexibility is a critical component of workplace effectiveness and that employees who work in flexible and effective work places are more likely to: Be engaged in their jobs and committed to helping the company succeed. Plan on staying with their employers. Be satisfied with their job, which translates to good customer service. Exhibit better mental health and wellbeing. CHAPTER 2 Literature Review Introduction: Nestle is a Switzerland based company, founded by Henri Nestle in 1866. The success story of transforming a single mans idea into a giant corporation started from developing a milk food formula for infants by Mr. Henri in 1866. Soon the Nestle products became a success and more and more businesses wanted to merge or start a partnership with Nestle. In 1905 Henri Nestle joined hands with a Swiss milk company and the companys name became Nestlà © Anglo-Swiss Condensed Milk Co. Then in 1929, Peter-Cailler-Kohler Chocolats Suisses S.A. merged with the company. The name was then changed to Nestlà © Anglo-Swiss Holding Co. Ltd. In December 1947, company acquired all the shares capital of the Alimentana S.A. Company in exchange for fifteen Nestlà © shares and fifteen Unilac shares for each of Alimentana S.A. share, and the name was Nestlà © Alimentana S.A. And then finally, the last name change that the company would endure was in 1977, where it adopted the name Nestlà © SA (www.nest le.com). Today Nestle is one of the biggest giants in the food and beverage market of the world and it is marketing its products in almost 130 countries of the world. The company is manufacturing roundabout 10,000 different products and employing over 250,000 people all over the world. The company is selling almost a billion products everyday. The headquarters of Nestle are situated Vevey, Switzerland, but the operational facilities of the company are spread all over the world. The company not only increasing its size year by year but also increasing its product varieties. Nestlà ©s Greatest Asset are its Workers The slogan of Nestle that its people are their greatest asset is very much true as they care a lot about their people and encourage them to bring out the best in them. At Nestle it is made sure that people benefit maximum from their work at Nestle. What binds together the over 250,000 people across the world is a universal culture and a high degree of loyalty to the Company and to each other. The employees are encouraged to contribute in the company success by introducing new and innovative ideas. Above all, Nestlà © is genuinely international. One simple example is that around 80 different nationalities are represented among the 1,600 people in our Head Office. Each year a thousand people from all over the world come to our Training Centre in Switzerland. The corporate values of Nestle are: Trust Respect Involvement Pride The Concept of Work/life Balance at Nestle International Nestle is following the United Nations Global Compacts (UNGC) guiding principles that insures the human and labour rights and aim to provide an example of good human rights and labour practices throughout our business activities. At Nestlà © it is truly believed that there must be a good and healthy balance between the private and professional life of an employee. This thing not only increases the reputation of Nestle as a good employer but also helps to retain the most valuable people of the organization and reconciles economical essential with welfare. Employees who wish to take part in community welfare programs voluntarily are supported at Nestlà ©. In the same character, Nestlà © encourages flexible and friendly working conditions so that stress factor can be reduced up to the minimum level. Everyone has to find their own balance between work and other activities, but as a company we encourage all our employees to pursue interests outside the workplace. As football is the natural favourite Sports in European region so most Nestlà © units sponsor at least one football team. Nestle supports many cultural activities and home study programs in countries all over the world. One of the biggest evidence of good work/life balance at Nestle is that it enjoys one of the highest percentages of employees retention among the top multinationals of the world. Pre-retirement classes and facilities for retiree activities are available in many countries. Nestle also supports one of the largest retiree club with more than 1,000 members actively participating in events ranging from climbing, skiing and cycling to foreign travel, fitness and computer classes at its headquarters at verve, Switzerland. In addition, several of them take part in local volunteer projects such as delivering meals to other Nestlà © retirees in the region. Role and Strategies of Management in Maintaining Work/life Balance at Nestle One of the greatest debate is who bears the biggest responsibility in maintain equilibrium between official and personal life of a person? But according to the given circumstances the major burden definitely falls on the employer and those who are the part of senior management because these are the people who demand as much as work from their employees and tries to minimize the cost on the verge of a limited work force. Things have changed a lot now because different research works have showed the physical and mental health effects of heavy work load which ultimately affects the productivity and profitability of the company in the long run. At Nestle it is made sure by the management that an appropriate work-life balance exists in organizational culture which means employee will be at less risk for many serious health conditions that result from overwork and stress. Overworked employees not only exposed to many serious physical and mental diseases but also face many problems and issues in their social and family lives. This is a very alarming situation because those employees who spent the most of their time at work are usually error prone. On the other hand those employees who spend most of their time at off-work activities will usually be un-productive and not reliable. Such individuals are found in every office and they are major concern for the management. So it is the responsibility of the Nestle management to address the problems of these individuals. Management should encourage these individual to contribute more towards productivity. If an employee spend four hours working at home and solves more problems by working at home than at office , he should be encouraged by the Nestle management. At Nestle International top management offer different workshops and informative seminars to employees about work-life balance, and should make sure that the policies regarding these issues must be followed strictly. Different technologies have been introduced to employees, which help them in creating the right balance between their lives. Here are some of the strategies used by the Nestle management to enhance work/life balance in organizational culture. Employee Assistance Program (EAP) At Nestle International the introduction of Employee Assistance Programs (EAP) provide easy, free and confidential access to professionally trained counsellors to help the employees to overcome a large variety of professional and personal problems. Conveniences at Work Employees at Nestle International are offered different features in order to make their work convenient and easy such as: Fitness center Mothers lounge On site parking Bonuses at all levels Day care Cafeteria Parental Leave Parental Leaves are available for female and male workers to help them to see off their social responsibilities. Benefits Package Nestlà © offers medical and other visionary benefits packages to meet the health needs of not only their employees but also their families and domestic partners. Benefits of Maintaining Work/life Balance at Nestle International Talented and highly valued employees are the most important corporate resource of any company and it is not very difficult to get such talented employees so in order to retain them a flexible and balanced environment must exist within organization and organizational culture at Nestle fully demonstrate such features. If the employees will be satisfied they will be more focused and confident towards their work and by providing a right balance between the personal and professional lives Nestle ultimately enjoys a constant product quality and customer satisfaction. A balanced employee not only enjoy a happy personal life, avoids different risks relating to physical and mental heath but also add up to the reputation of Nestle as a good employer. By employee retention Nestle not only saves the outflow of very valuable information of the organization but also minimizes the additional cost required to train the new employee to bring him up to the level of expertises of the existing employee. CHAPTER 3 Methodology The main objective of this research is to create an understanding of the importance of work/life balance in the lives of employees as well as in the progress of the organization. General method to collect information for the purpose of conduct a Research Following are some of the method to collect information in order to carry on research. Questionnaire It is a method used to collect the information directly from people. It is consider as a realistic source of information which provide an opportunity for analysis. Moreover it provides more current information as compare to other source. it is considered to be the primary source of information. It also contain different options Interview Interview is another way of collecting data for conduction research. We can conduct different kinds of interview to find out the reasons of any problem. it is a direct face to face communication through which one can receive direct feedback on any issue under consideration. It is also one of the realistic sources of information. Studying the different documents and Survey Reports It is also an effective way to develop an understanding of different topic related documents and surveys which enable us to carry the research in an effective manner. These surveys enable us to develop an understanding on that specific issue in wide scope. Observation Observation is also an effective tool to collect information regarding customer expectations and factors which boost up customer expectation. Observation also helps to collect information regarding customer taste, marketing trends and rival competitive policies Discussion with expertise Carrying on discussions with those who have a vast expertise of understanding customer behaviours and mental situations. Through this we can extract very important information for the real purpose. Case Studies Studying different kind of case study is also enable us to enhance our understanding with the real topic and provide us very valuable information and clears the idea of main concept. The data collected through a questionnaire circulated and interview conducted at Nestle will form the base of this research work. The above mentioned questionnaire will consist of different questions relating to the work/life balance and it will target a group of 20 workers selected through random sampling representing the population as a whole. For the purpose of reference and other historical information different books, journals, articles and websites will be consulted. Time frame for completion of research is as under: No. Task Description Start Date Completion Date 1 Proposal Submission 2 Literature Review 3 Questionnaire Designing 4 Data Collection (Primary Secondary) 5 Data Analysis 6 Drafting Composing 7 Proof Reading 8 Submission

The Future is here :: essays papers

The Future is here The idea of being able to choose the gender of a child has not always been around. This controversy did not come about until recently because now we have the technology to perform this act of sex determination. Some say that we should be able to choose the gender of our children. However, other people think that we shouldn’t be able to because they say that it is experimenting with nature. Also, that it is unnatural. I used to think the way of the second viewpoint, but not anymore. There is absolutely nothing wrong with couples being able to choose whether they want to have a baby girl or a boy. According to an article in Newsweek called The Brave New World of Sex Selection by Thomas Hayden, this is possible. The article states how it is done. To do this, scientists measure DNA in sperm cells and pass the millions of them through a tiny tube in a single file. They then separate the â€Å"girl sperm† from the â€Å"boy sperm†. They can tell the difference because â€Å"girl sperm† has more DNA. The separated sperm cells are then used, one or the other, to impregnate a woman to have a girl or a boy. In a study, fifteen out of seventeen women with the â€Å"girl sperm† had girls. Getting the Girl by Lisa Bellkin, an article in the New York Times Magazine, states a 93% success rate. Some mothers might only want a girl when others might want a boy. If a couple has a strong opinion that one sex is easier to raise over the other, such as a boy, they might not want the hardship of trying to raise a girl. A family could also want a boy to carry on the family name. In my opinion, I would go through this process to have a girl. I think that since obviously I am a girl, I could do a better job of raising a girl than a boy. A parent could think that they know more about one sex than the other and choose to raise that sex. Another reason that I think people should be able to choose the gender of their child is because if you already have three boys in your house, it could be time for a change.

Essay Composition

Writing an essay requires an orderly and careful process, however, the pre-writing process is as important as the writing process. This paper will outline the process that has been used in writing the essay on raising the minimum legal driving age. In the pre-writing process, I had a list of topics that I had interest in and narrowed down my choices of topics. (The chosen flow of topics has been highlighted).Once the topic on minimum driving age was taken, a preliminary topic sentence was created. The topic sentence is: The regulation of the minimum driving age should be changed. Following this topic, the following questions have been formulated:?  Ã‚  Ã‚  Ã‚  Ã‚   What are the issues on the current minimum driving age  Ã‚  Ã‚  Ã‚  Ã‚   What are the relationships between the minimum driving age and motor-vehicular accidents  Ã‚  Ã‚  Ã‚  Ã‚   Would changing the minimum driving age increase road safety?I took statistics, books and periodicals to increase knowledge on the topic an d be able to answer the questions that have been presented above. I took into consideration certain criteria that would help me choose the best sources possible. The criteria that were used were the following:?  Ã‚  Ã‚  Ã‚  Ã‚   Reliability of the author- Knowledge on the topic (educational background, etc.)?  Ã‚  Ã‚  Ã‚  Ã‚   Recency of the source (date of publication)For example:  Ã¢â‚¬Å"†¦Those common factors emerged when USA TODAY examined all the deadly crashes involving 16-to-19-year-old drivers in 2003. About 3,500 teenagers died in teen-driven vehicles in the USA that year — a death toll that tops that of any disease or injury for teens. The South proved to be the deadliest region.[1]† After reading and rereading my sources, the specific topic that came was about raising the minimum driving age. This topic was chosen since this is an outstanding issue in the state of Massachusetts. Using the sources that I have gathered, I took down the pros and cons of raising the minimum driving age. I wrote the arguments and counter arguments in tabular form so as to look at which arguments were strong.Pros –  Lessen driving accidents,  Teenager's brain can fully developCons   Ã¢â‚¬â€œÃ‚  Might increase illegal drivers My decision on a stand was based on these arguments as well as the reliability of the given sources. The final thesis statement now stands: The minimum legal driving age should be raised. After which an outline was created in order to serve as a guide for writing the paper. From the sources taken in the previous part of the research process as well as personal experiences, my position was determined: The legal age for driving should be raised from its current age to a higher age level. The reason for choosing such was based on facts and statistics. The facts were based on medical research, as well as experiences in the field of psychology.BibliographyCrossman, D;R. Sixteen is too young to drive : taking control when your teen's behind-  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   the-wheel. Scotia, NY : Footnote Pub. 2002.Landsberger, J. Writing Position Papers. The Study Guides and Strategies (02 June, 2006). 20 February 2007. O' Donnell,J. â€Å"Deadly teen auto crashes show a patt ern.† USA TODAY, (1 March 2005).McAleese, D. â€Å"Rethink of legal driving age urged by church moderator. â€Å"Financial Times Ltd.† (09 October, 2006). 20 Feb., 2006. ;http://solutions.cengage.com/gale/apps/,M. Teenage Roadhogs. New York : Alpha Reference. 1997.Schnell, D. Characteristics of Adolescence. Minneapolis: Minn.,Burgess Pub.Co.1946.

The eNotes Blog Not At This Time Rejection Letters to FamousWriters

Not At This Time Rejection Letters to FamousWriters Why is dad so sad?   Probably because he just checked his mail and found his self-addressed stamped envelope in his box, his manuscript inside, and the dreaded form letter saying, We are sorry, but your manuscript does not currently meet our specific needs.   The first dozen or so times, Dad wanted to believe the closing line promising to review his work in the future but Dr. Seuss (aka Theodore Geisel) knew the feeling.   His now-classic childrens book   And to Think I Saw It on Mulberry Street  was rejected a whopping twenty-seven times before it was finally accepted by Vanguard Press.   This may be your fate as well. Putting your work out in the world is scary. Rejection sucks. It can make you afraid to do it again.   But you have to try.   Because the twenty-seventh or twenty-eighth time might just be the one. Novelist Barbara Kingsolver (The Poisonwood Bible, The Bean Trees)  offers this advice to writers feeling wounded:   This manuscript of yours that has just come back from another editor is a precious package. Don’t consider it rejected. Consider that you’ve addressed it ‘to the editor who can appreciate my work’ and it has simply come back stamped ‘Not at this address’. Just keep looking for the right address.† To give you hope, here are ten rejections of famous writers as well as a some of their reactions and advice about coping with rejection: 1.   The  Left Hand of Darkness  Ã‚  by Ursula Le Guin 2.   Saul Bellow   â€Å"I discovered that rejections are not altogether a bad thing. They teach a writer to rely on his own judgment and to say in his heart of hearts, ‘To hell with you.’â€Å"   (Source) 3.   Tim Burton     Ã‚   A ripe, 18-year-old Burton, still in high school, submitted his illustrated children’s book to Walt Disney Productions for consideration. That was 1976, and T. Jeanette Kroger, author of his rejection letter, didn’t see inThe Giant Zlig  what the Academy of Motion Picture Arts, BAFTA, Cannes, and, it’s fair to say, the majority of humanity saw in him in later years. Kroger thanked Burton for his mail and made no mention of the possibility of publication but did give the artist some tips.   (Source) 4.   Anita Shreve â€Å"To ward off a feeling of failure, she joked that she could wallpaper her bathroom with rejection slips, which she chose not to see as messages to stop, but rather as tickets to the game.†   (Source) 5.   Sylvia Plath    Plaths novel  The Bell Jar  was also rejected: The Knopf editor â€Å"jbj† knows all too well what difference a name drop can make; Plath originally submitted her novel under the pseudonym Victoria Lucas, whose work received the original, terse in-house review printed below. When it was revealed that Victoria Lucas was in fact Sylvia Plath, an embarrassed jbj took a greater interest in the work, although he ultimately still rejected it. Plath’s only novel eventually became an American classic and staple of every high school curriculum, but before that, the rest of the Knopf staff seem to have agreed with jbj - unpublishable.   (Source) 6.   Ã‚  Chuck Wendig Rejection has value. It teaches us when our work or our skillset is not good enough and must be made better. This is a powerful revelation, like the burning UFO wheel seen by the prophet Ezekiel, or like the McRib sandwich shaped like the Virgin Mary seen by the prophet Steve Jenkins. Rejection refines us. Those who fall prey to its enervating soul-sucking tentacles are doomed. Those who persist past it are survivors. Best ask yourself the question: what kind of writer are you? The kind who survives? Or the kind who gets asphyxiated by the tentacles of woe?   (Source) 7.   Hunter S. Thompson Expresses His Displeasure to His Biographer, William McKeen    8.   Neil Gaiman â€Å"Remember: when people tell you something’s wrong or doesn’t work for them, they are almost always right. When they tell you exactly what they think is wrong and how to fix it, they are almost always wrong.†   (Source) 9.   Kurt Vonnegut     Ã‚   A decade and a half later, a writing sample by Vonnegut would have been accepted without a look beyond the author name, but in 1949, Kurt Vonnegut was a nobody, and the editors at  The Atlantic Monthly  had no big plans to lift him out of anonymity. After mailing the magazine three samples of his work, he received the above letter of rejection from editor Edward Weeks, which now hangs, framed, in Kurt Vonnegut Memorial Library in Indianapolis. The following decades of Vonnegut’s career were characterized by a prolific output of award-winning novels, including  Cat’s Cradle  and  Slaughter-House Five, the latter of which is rumored to have developed out of one of the rejected samples. (Source) 10.   On the Road by Jack Kerouac Now heralded as the beat bible, Jack Kerouac’s magnum opus  On the Road  was finally published by Viking Press in 1957, six years after it was written. But in 1951, given its provocative content and untraditional style, publishing houses wouldn’t touch it. Knopf was just one of many whose editors reviewed the manuscript harshly and reported it as untouchable to their editors.   (Source)

Tenzing Norgay Biography

Tenzing Norgay Biography 11:30 am, May 29, 1953. Sherpa Tenzing Norgay and New Zealands Edmund Hillary step onto the summit of Mount Everest, the worlds tallest mountain. First, they shake hands, as proper members of a British mountaineering team, but then Tenzing grabs Hillary in an exuberant hug at the top of the world. They linger only about 15 minutes. Hillary snaps a photo as Tenzing unfurls the flags of Nepal, the United Kingdom, India and the United Nations. Tenzing is unfamiliar with the camera, so there is no photo of Hillary at the summit. The two climbers then begin their descent back to high camp #9. They have conquered Chomolungma, the Mother of the World, 29,029 feet (8,848 meters) above sea level. Tenzings Early Life Tenzing Norgay was born the eleventh of thirteen children in May of 1914. His parents named him Namgyal Wangdi, but a Buddhist lama later suggested he change it to Tenzing Norgay (wealthy and fortunate follower of the teachings). The exact date and circumstances of his birth are disputed. Although in his autobiography, Tenzing claims to have been born in Nepal to a Sherpa family, it seems more likely that he was born in the Kharta Valley of Tibet. When the familys yaks died in an epidemic, his desperate parents sent Tenzing to live with a Nepalese Sherpa family as an indentured servant. Introduction to Mountaineering At 19, Tenzing Norgay moved to Darjeeling, India, where there was a sizable Sherpa community. There, the British Everest expedition leader Eric Shipton noticed him and hired him as a high-altitude porter for a 1935 reconnaissance of the northern (Tibetan) face of the mountain. Tenzing would act as a porter for two additional British attempts on the northern side in the 1930s, but this route would be closed off to westerners by the 13th Dalai Lama in 1945. Along with Canadian mountaineer Earl Denman and Ange Dawa Sherpa, Tenzing snuck over the Tibetan border in 1947 to make another attempt on Everest. They were turned back at about 22,000 feet (6,700 meters) by a pounding snow-storm. Geopolitical Turmoil The year 1947 was a tumultuous one in South Asia. India achieved its independence, ending the British Raj, and then split into India and Pakistan. Nepal, Burma, and Bhutan also had to reorganize themselves after the British exit. Tenzing had been living in what became Pakistan with his first wife, Dawa Phuti, but she passed away at a young age there. During the 1947 Partition of India, Tenzing took his two daughters and moved back to Darjeeling, India. In 1950, China invaded Tibet and asserted control over it, strengthening the ban on foreigners. Luckily, the Kingdom of Nepal was beginning to open its borders to foreign adventurers. The following year, a small exploratory party made up mostly of Britons scouted the southern, Nepalese approach to Everest. Among the party were a small group of Sherpas, including Tenzing Norgay, and an up-and-coming climber from New Zealand, Edmund Hillary. In 1952, Tenzing joined a Swiss expedition led by the famous climber Raymond Lambert as it made an attempt on the Lhotse Face of Everest. Tenzing and Lambert got as high as 28,215 feet (8,599 meters), less than 1,000 feet from the summit before they were turned back by bad weather. The 1953 Hunt Expedition The following year, another British expedition led by John Hunt set out for Everest. It was the eighth major expedition since 1852, including more than 350 porters, 20 Sherpa guides, and 13 western mountaineers, including once again Edmund Hillary. Tenzing Norgay was hired on as a mountaineer, rather than as a Sherpa guide - an indication of the respect his skills engendered in the European climbing world. It was Tenzings seventh Everest expedition. Tenzing and Edmund Hillary Although Tenzing and Hillary would not become close personal friends until long after their historic feat, they quickly learned to respect one another as mountaineers. Tenzing even saved Hillarys life in the early stages of the 1953 expedition. The two were roped together, making their way across the ice-field at the base of Everest, the New Zealander leading, when Hillary jumped a crevasse. The icy cornice he landed on broke off, sending the lanky mountaineer tumbling down into the crevasse. At the last possible moment, Tenzing was able to tighten the rope and prevent his climbing partner from smashing onto the rocks at the bottom of the crevasse. Push for the Summit The Hunt expedition made its base camp in March of 1953, then slowly established eight higher camps, acclimatizing themselves to the altitude along the way. By late May, they were within striking distance of the summit. The first two-man team to make the push was Tom Bourdillon and Charles Evans, on May 26, but they had to turn back just 300 feet short of the summit when one of their oxygen masks failed. Two days later, Tenzing Norgay and Edmund Hillary set out at 6:30 am for their attempt. Tenzing and Hillary strapped on their oxygen masks on that crystal-clear morning and started kicking steps into the icy snow. By 9 am they had reached the South Summit, below the true summit. After climbing the bare, 40-foot vertical rock now called the Hillary Step, the two traversed a ridge and rounded the last switchback corner to find themselves on top of the world. Tenzings Later Life The newly-crowned Queen Elizabeth II knighted Edmund Hillary and John Hunt, but Tenzing Norgay received only the British Empire Medal rather than a knighthood. In 1957, Indian Prime Minister Jawaharlal Nehru threw his support behind Tenzings efforts to train South Asian boys and girls in mountaineering skills and provide scholarships for their studies. Tenzing himself was able to live comfortably after his Everest triumph, and he sought to extend the same path out of poverty to other people. After the death of his first wife, Tenzing married two other women. His second wife was Ang Lahmu, who had no children of her own but looked after Dawa Phutis surviving daughters, and his third wife was Dakku, with whom Tenzing had three sons and a daughter. At the age of 61, Tenzing was selected by King Jigme Singye Wangchuck to guide the first foreign tourists allowed into the Kingdom of Bhutan. Three years later, he established Tenzing Norgay Adventures, a trekking company now managed by his son Jamling Tenzing Norgay. On May 9, 1986, Tenzing Norgay passed away at the age of 71. Different sources list his cause of death as either a cerebral hemorrhage or a bronchial condition. Thus, a life-story that begins with a mystery also ends with one. Tenzing Norgays Legacy It has been a long road...From a mountain coolie, a bearer of loads, to a wearer of a coat with rows of medals who is carried about in planes and worries about income tax. ~ Tenzing Norgay Of course, Tenzing could have said, From a child sold into servitude, but he never liked to talk about the circumstances of his childhood. Born into grinding poverty, Tenzing Norgay quite literally reached the summit of international fame. He became a symbol of achievement for the new nation of India, his adoptive home, and helped numerous other South Asian people (Sherpas and others alike) gain a comfortable lifestyle through mountaineering. Probably most importantly to him, this man who never learned to read (though he could speak six languages) was able to send his four youngest children to good universities in the United States. They live very well today but always give back to projects involving the Sherpas and Mount Everest. Sources Norgay, Jamling Tenzing. Touching my Fathers Soul: A Sherpas Journey to the Top of Everest, New York: Harper Collins, 2001. Norgay, Tenzing. Tiger of the Snows: The Autobiography of Tenzing of Everest, New York: Putnam, 1955. Rizzo, Johnna. QA: Biographer on Everest Pioneer Tenzing Norgay, National Geographic News, May 8, 2003. Salkeld, Audrey. South Side Story, PBS Nova Online Adventure, updated Nov. 2000.

Nature of Intervention essays

Nature of Intervention essays An ancient Roman expression states, Igitur qui desiderat pacem, praeparet bellum; Therefore whoever wishes for peace, let him prepare for war. Throughout much of the twentieth century, nations have attempted to resolve conflicts and ensure peace. The most preeminent conflicts include the First World War, the Second World War, and the War in Vietnam. The underlying causes of these conflicts were national, cultural, and religious. Current conflicts around the world are the result of demands for self-determination, unification, and political rivalries. Intervention by developed countries, since the beginning of the twentieth century, has created the very factors which could lead to war. Intervention is defined as interfering with political situations by governments of nations. This could be mean the employment of military force, or the act of colonization in developing nations. There are many examples of such actions spread throughout the course of the twentieth century. A few examples include the First World War, the Second World War, the Cold War, and the conflict in Vietnam. Specifically, this paper will deal with intervention in Vietnam, Germany, and the Middle Eastern nations. The insecurity of Vietnam was shown through the actions of the French early in the twentieth century. The Hanoi Exposition was Frances attempt to implement imperial rule in its colonies, and to solidify French rule in Indochina. During the Hanoi Exposition, France made numerous decisions that greatly affected Vietnams economics, government, and political position. Paul Doumer, the founder of the Hanoi Exposition explains: Its purpose was to forge a united and coherent political and economic entity out of the five French possessions in Indochina (Doumer 140, 1930). This meant that France was attempting to secure Indochina for its own economic, and political purposes. The Exposition was mutually beneficial in t...

Project Managment Essay Example | Topics and Well Written Essays - 2000 words

Project Managment - Essay Example I will be discussing some salient points relative thereto project management and will also discuss how these key points will contribute to the enhancement and achievement of targeted company goals. The matter will be answered in accordance to the lessons learned from the module of this course which provided us learners the opportunity to work, plan, and manage a project using standard theoretical precepts. Some project management tools and techniques will also be used to introduce a technique in resolving organizational issues and concerns with sensitivity to available budget allocation and dynamics of the organization. In this questionnaire, I am expected to also use the tools for negotiations, teambuilding and quantitative estimation that can be drawn from the lesson using the case presented as my springboard for analysis. 2.0. Introduction Project management refers to the strategic capacity of an organization to put direction and implement programs and projects in accordance to sp ecific goals and objectives set by the company with a purposive end in mind (Lock, 2007). The outcome could either be about gaining profit, about organizational strengthening, attaining performance efficiency or developing a collaborative action with potential partners, venture-interest, or with possible business associates (Dinsmore, & Brewin, 2011). 3.0. Discussion 3.1. Case study Johnsons is a major player in the UK dry cleaning industry. Management has decided to move operations to a new site. The new site will allow Johnsons to expand its operational base by 50% and bid for new public sector contracts. Currently at its site, Johnsons has a capacity to deal with 20,000 kg of laundry. However, management prefers to work at 80% of its capacity. At a recent board meeting, the HR manager has been asked to explain the reason for poor workforce planning and lack of discipline which has reduced the working capacity to 60%. The above information can be used to define various terms. 3.2. Designed Capacity This is the average allowable level of capability, fitness and power of competence in the performance of services. In the case cited, the Johnson Company has a capacity to deal with 20,000 kg of laundry but considering some variables in the organization, e.g. human resource availability, laundry machines, spaces, and resource operational availability. 3.3. Effective Capacity This refers to an organizational design and value chain analysis pertaining to effective capacity management (Capacitas, 2013, p. 1). Often this correlates to the nature of organizational structure, model or framework of operation, the available resources with services, repository of service, information and system of reporting, scope of managerial function, and the training or educational capacity of the company’s human resources (Capacitas, 2013, p. 1). From the cited case, what is clear here is that from its designed capacity, the management agreed that it can only effectively delive r and perform 80% services. From the allowable percentile of work production, the company can only perform or produce services at a rate of 16,000 kg of laundry. It is further unclear, given the many variables, if these 16,000kg constitute the daily laundry operation of the company or in a weekly status or in a month. The case given have not expressly cited the time and days that such 60,000 kg average laundry service is attained. It’s also unclear about the technology that will be used for laundry operation and neither is the case clear

Applied data management Essay Example | Topics and Well Written Essays - 1250 words

Applied data management - Essay Example The steps for quality assurance of data included maintain electronic records backed by registers, reviewing the records on a periodic basis and validating the records. The compliance with the set standards was effected with the help of a feedback system both internal and external to the organization. It has been evaluated that the research findings indicate the role of information provided by the consultants as well as the customers in identifying the gaps in the process of quality assurance. This information allows the company to take necessary steps in filling the identified gaps in the system and achieve the desired benchmark standards recommended under the Quality Assurance Procedures. The action of quality control is a part of the quality assurance strategy that focused on producing outputs which are in line with the set standards. The highest standard of data management helped the company to provide excellent services to the customers and in the process meet the expectations of the customers. When the customer service exceeded the desired expectation, the standards of data management were raised in the process. The evaluation of the reports suggests the contribution of quality assurance strategy in data management to achieve continuous improvement by leveraging on technology, recycling of wastes, optimal utilization of resources, etc. Benefits of Quality Assurance Procedures The Quality Assurance Procedures in the company helped to put in place, a systematic sequence of activities that are aimed at improving the standard of operations, the presence of a feedback loop aimed to provide inputs on the prevailing gaps between the actual activities and the set standards. The benefits of the Quality Assurance Procedures are also applicable in the field of storage and maintenance of documents in the company and it largely impacts the way in which the documents are produced by the members of the company. The series of systematic activities under the Quality Assura nce Strategy provides the members a plan of action for developing and implementing the best standards of maintenance of documents in the company and improving on the quality control stage for removing the errors in the process (Chorafas, 2012, p.49). This internal activity of the company helps the members to deliver excellent level of professional services to the customers who form the external environment. The members are able to meet the expectations of the customers through data maintenance and service delivery of the highest quality. The point at which the members are able to apply the data management techniques at a level that exceeds the customer’s expectations, the company would be able to better the standards of data management on a higher scale. The various standard practices of keeping back-up data for electronic records, reviewing the data on a periodic basis and updating the records, retaining documents and completing service delivery within a finite duration, val idating the recorded data are all important data management techniques that would help the company to provide high quality of customer service on a timely basis (Watson, 2008, p.41). The Quality Assur

How might ttemperature differ between urban & rural areas Essay

How might ttemperature differ between urban & rural areas - Essay Example faces such as pavement store heat from the Sun during the day, which is then released at night, keeping cities hotter for longer periods of time† (Gillette & Hamilton, 2011, p. 74). Which setting tends to be warmer on a given day and why? On a given day, therefore, it could be warmer in rural areas because heat is immediately reflected back in the form of energy; as compared to urban areas which absorb heat during daytime, but releases the heat at night. Also, are there any factors other than albedo that might affect the temperature differences between the two settings? Aside from albedo, other factors that affect the temperature differences between urban and rural settings are: â€Å"weather conditions, urban thermophysical and geometrical characteristics, and anthropogenic moisture and heat sources present in the area† (Taha, 1997, p. 99). The findings from the author revealed that the capacities of urban areas to address albedo through effectively harnessing albedo of roofing in homes and buildings, as well as in paving materials, in conjunction with efforts to plant trees enable urban areas to reverse the immense heat and could therefore have greater potentials to affect and reverse temperatures in their

Patient Presentation with COPD Essay Example | Topics and Well Written Essays - 3000 words

Patient Presentation with COPD - Essay Example COPD is partially irreversible and its symptoms are associated with hyper-responsiveness of the airways. The aforementioned conditions are recognized as a major disability causing a progressive chronic airway obstruction or narrowing that frequently occur as one entity. In the United Kingdom (UK), the prevalence of COPD affects both men and women more commonly in their fourth decade of life. Differential diagnosis of COPD includes asthma, congestive heart failure, bronchiectasis, tuberculosis, obliterative bronchiolitis, and diffuse panbronchiolitis. Nonpharmacological and pharmacological management are considered in treating the patient. Other treatments include rehabilitation, oxygen therapy, and ventilatory support. Patient Presentation with COPD A Brief Introduction: This paper discusses chronic obstructive pulmonary disease (COPD) and its significance in the family and community settings, its socio-economic and cultural background, past medical history, differential diagnosis, and current guidelines relating to pharmacological and nonpharmacological patient management. The analysis of psychosocial impact of COPD to the patient and her family as well as strategies for patient education, and the context of multidisciplinary care team are also will be discussed in the paper. Short Background on COPD: ... Nursing Assessment: Patient, JC, is a 76 year old female patient with a ten year history of chronic obstructive pulmonary disease (COPD). JC, white female, now 76 years old was 66 year old when diagnosed with COPD in 2002. In the United Kingdom (UK), the prevalence of COPD affects both men and women more commonly in their fourth decade of life (NICE, 2010). It is associated with high rate of mortality and significant healthcare system cost (Raherison and Girodet, 2009). Epidemiological studies note a close association between chronic bronchitis prevalence and low socioeconomic status (Viegi, et al., 2001). COPD is classically thought to be a combination of chronic bronchitis and emphysema, even though in COPD patients, only one of the previously mentioned conditions is present (MayoClinic, 2011; CDC, 2011; and British Medical Journal, 2012). Sharma (2012) defined chronic bronchitis as persistent productive cough for more than three months each year in a period of two consecutive year s. The mucous glands in lungs of individuals with chronic bronchitis are enlarged, the airways are inflamed, and the bronchial walls are thickened with subsequent changes and loss of supporting alveolar connection, which results to narrowing and deformity of the lumen of the airway and eventually causes limitation of airflow (Sharma, 2012). On the other hand, emphysema, one of the causative agents of COPD is defined as an abnormal and permanent alveolar enlargement of the terminal bronchioles that results to destruction of the airspace wall (Sharma, 2012). The patient has her own home; she is married with two children and one grandchild. Prior to her diagnosis, the patient worked in an office for most of her working life. She was a known cigarette

Social Psychology paper Essay Example | Topics and Well Written Essays - 750 words

Social Psychology paper - Essay Example This makes this theory applicable only to higher mammals, including human beings. The theory is especially helpful in understanding the core processes of everyday human interactions. Say, a boss goes out to lunch with a female colleague; this is a typical scenario that falls within the application range of Causal Attribution theory. In this case, the boss orders food for his colleague while not being cognizant of her food allergies. Causal Attribution theory will help us answer such questions as â€Å"How much causal responsibility can we assign to the boss, for this apparent mistake†? etc. The theory is also useful in controlling levels of pain or joy. Since the cognitive mechanism that results in sensations of pain or joy is a matter of anticipation and expectation, painful experiences can be mitigated and joyful experiences amplified if the individual sees events from a favorable perspective. As a result, Causal Attribution theory is also useful for psychotherapists who deal with cases of chronic anxiety and depression. The techniques learned to control levels of pain/joy can also help athletes in managing niggling injuries or competitive pressure when participating in a major sport event like the Olympic Games. A few other phenomena associated with Causal Attribution theory are â€Å"The Self-Serving Bias and The Fundamental Attribution Error† (from the Presentation). Seminal work on these components was done by Jones and Harris in 1967 and by Ross and his team in 1977. Jones and Harris studied Fidel Castro’s public image and the causal mechanisms at play. Ross and his team studied game shows and found that participants â€Å"fail to see the inherent disadvantages in people† (from the Presentation). Daniel Gilbert proposed a precautionary measure to avoid Attribution Errors. He recommended against weighing behavioral and situational information at the same time. The other area where distinction

Colony colapse disorder Case Study Example | Topics and Well Written Essays - 1000 words

Colony colapse disorder - Case Study Example The queen is also present meaning that the hive is not dead. Before the actual CCD takes place, the colony members always become reluctant to eat the food (protein supplement and sugar syrup) provided. CCD is if great global significance because a very high percentage of agricultural crops are pollinated by bees. Background information on miticides, antibiotics, and neonicotinoid pesticides Neonicotinoid pesticides are commonly used in various parts of the world. This group of pesticides assume the model of nicotine which is a natural insecticide. Neonicotinoid pesticides act on the central nervous system (CNS) of insects causing excitation of nerves and finally, paralysis. Evidence from research has revealed that the use of pesticides like neonicotinoid pesticides and nicotine-based pesticides greatly affects the functioning and learning abilities of honeybees. This is very critical to the workers since they are the most active and dependable members of a colony. According to Gary e t al (2009), it has been documented that neonicotinoid pesticides levels that are able to affect the ability learning of bees occur in pollen hence they affect bees that feed on such pollen. There is an increasing threat on honeybees and their hives by mites and this has increased the dependence on miticides in order to control the situation. Basically, miticides are used in agriculture, to control the spread of mites. This is important because mites have a key role to play in the loss of good health among honeybees. However, the intensive use of these miticides has led to the development of their resistance by mites. To add an injury to this, toxicity tests conducted on bee hives have revealed that the levels of miticides in many bee hives has greatly increased (Mullen et al, 2010). Miticides are destructive to colonies of bees because they accumulate in bees wax. Bees wax is a least renewable resource in the hive hence it provides a base on which persistent pesticides can accumula te and cause toxic house syndrome (Mullen et al, 2010). In modern medicine, antibiotics are among the medications that are prescribed most frequently. Antibiotics are important for both animals and plants because they kill or injure disease-causing bacteria. However, it has been found that their use contribute to deficiencies of the immune system while their prolonged use lead to antibiotic resistant diseases and super-pests. Many commercial beekeepers administer antibiotics on regular basis as a protective measure against brood diseases hence honeybees have not been exempted from the effects of prolonged use of antibiotics. It has been found out that the major bacterial diseases that attack bees have also developed resistance to antibiotics. Resistance to pesticides has triggered the development of genetically modified crops that are thought to be producing pollen that also cause CCD (Gary et al, 2009. Potential Causes of Colony Collapse Disorder (CCD) The causes of CCD are still u nder investigation and almost every realistic and conceivable cause is a possibility. Four areas of research focused on by scientists in early times included bee management stresses such as poor nutrition, environment-related stresses, parasites and pathogen, and pesticides and chemicals. In the early studies, scientists had ruled out some conditions and practices from being probable causes of CCD. They include chemicals used by the

Patient Presentation with COPD Essay Example | Topics and Well Written Essays - 3000 words

Patient Presentation with COPD - Essay Example COPD is partially irreversible and its symptoms are associated with hyper-responsiveness of the airways. The aforementioned conditions are recognized as a major disability causing a progressive chronic airway obstruction or narrowing that frequently occur as one entity. In the United Kingdom (UK), the prevalence of COPD affects both men and women more commonly in their fourth decade of life. Differential diagnosis of COPD includes asthma, congestive heart failure, bronchiectasis, tuberculosis, obliterative bronchiolitis, and diffuse panbronchiolitis. Nonpharmacological and pharmacological management are considered in treating the patient. Other treatments include rehabilitation, oxygen therapy, and ventilatory support. Patient Presentation with COPD A Brief Introduction: This paper discusses chronic obstructive pulmonary disease (COPD) and its significance in the family and community settings, its socio-economic and cultural background, past medical history, differential diagnosis, and current guidelines relating to pharmacological and nonpharmacological patient management. The analysis of psychosocial impact of COPD to the patient and her family as well as strategies for patient education, and the context of multidisciplinary care team are also will be discussed in the paper. Short Background on COPD: ... Nursing Assessment: Patient, JC, is a 76 year old female patient with a ten year history of chronic obstructive pulmonary disease (COPD). JC, white female, now 76 years old was 66 year old when diagnosed with COPD in 2002. In the United Kingdom (UK), the prevalence of COPD affects both men and women more commonly in their fourth decade of life (NICE, 2010). It is associated with high rate of mortality and significant healthcare system cost (Raherison and Girodet, 2009). Epidemiological studies note a close association between chronic bronchitis prevalence and low socioeconomic status (Viegi, et al., 2001). COPD is classically thought to be a combination of chronic bronchitis and emphysema, even though in COPD patients, only one of the previously mentioned conditions is present (MayoClinic, 2011; CDC, 2011; and British Medical Journal, 2012). Sharma (2012) defined chronic bronchitis as persistent productive cough for more than three months each year in a period of two consecutive year s. The mucous glands in lungs of individuals with chronic bronchitis are enlarged, the airways are inflamed, and the bronchial walls are thickened with subsequent changes and loss of supporting alveolar connection, which results to narrowing and deformity of the lumen of the airway and eventually causes limitation of airflow (Sharma, 2012). On the other hand, emphysema, one of the causative agents of COPD is defined as an abnormal and permanent alveolar enlargement of the terminal bronchioles that results to destruction of the airspace wall (Sharma, 2012). The patient has her own home; she is married with two children and one grandchild. Prior to her diagnosis, the patient worked in an office for most of her working life. She was a known cigarette

Colony colapse disorder Case Study Example | Topics and Well Written Essays - 1000 words

Colony colapse disorder - Case Study Example The queen is also present meaning that the hive is not dead. Before the actual CCD takes place, the colony members always become reluctant to eat the food (protein supplement and sugar syrup) provided. CCD is if great global significance because a very high percentage of agricultural crops are pollinated by bees. Background information on miticides, antibiotics, and neonicotinoid pesticides Neonicotinoid pesticides are commonly used in various parts of the world. This group of pesticides assume the model of nicotine which is a natural insecticide. Neonicotinoid pesticides act on the central nervous system (CNS) of insects causing excitation of nerves and finally, paralysis. Evidence from research has revealed that the use of pesticides like neonicotinoid pesticides and nicotine-based pesticides greatly affects the functioning and learning abilities of honeybees. This is very critical to the workers since they are the most active and dependable members of a colony. According to Gary e t al (2009), it has been documented that neonicotinoid pesticides levels that are able to affect the ability learning of bees occur in pollen hence they affect bees that feed on such pollen. There is an increasing threat on honeybees and their hives by mites and this has increased the dependence on miticides in order to control the situation. Basically, miticides are used in agriculture, to control the spread of mites. This is important because mites have a key role to play in the loss of good health among honeybees. However, the intensive use of these miticides has led to the development of their resistance by mites. To add an injury to this, toxicity tests conducted on bee hives have revealed that the levels of miticides in many bee hives has greatly increased (Mullen et al, 2010). Miticides are destructive to colonies of bees because they accumulate in bees wax. Bees wax is a least renewable resource in the hive hence it provides a base on which persistent pesticides can accumula te and cause toxic house syndrome (Mullen et al, 2010). In modern medicine, antibiotics are among the medications that are prescribed most frequently. Antibiotics are important for both animals and plants because they kill or injure disease-causing bacteria. However, it has been found that their use contribute to deficiencies of the immune system while their prolonged use lead to antibiotic resistant diseases and super-pests. Many commercial beekeepers administer antibiotics on regular basis as a protective measure against brood diseases hence honeybees have not been exempted from the effects of prolonged use of antibiotics. It has been found out that the major bacterial diseases that attack bees have also developed resistance to antibiotics. Resistance to pesticides has triggered the development of genetically modified crops that are thought to be producing pollen that also cause CCD (Gary et al, 2009. Potential Causes of Colony Collapse Disorder (CCD) The causes of CCD are still u nder investigation and almost every realistic and conceivable cause is a possibility. Four areas of research focused on by scientists in early times included bee management stresses such as poor nutrition, environment-related stresses, parasites and pathogen, and pesticides and chemicals. In the early studies, scientists had ruled out some conditions and practices from being probable causes of CCD. They include chemicals used by the

A View from the Bridge Essay Example for Free

A View from the Bridge Essay Marco is married and has got two children whilst Rodolfo is still single. When, both Catherine and Rodolfo see each other, it is almost like love at first site. Catherine uses flirtatious procedures to convey to the audience that she feels somewhat of him. When she starts using these actions, High heels Eddie does not like this and so sends her back to the room to get changed, Do me a favour, will you? Go ahead. This makes Catherine undergo embarrassment as Rodolfo was at the scene. I would want the audience to observe that both Catherine and Rodolfo have got feelings for each other and that Eddie is in the surroundings being jealous. Due to the relationship between Eddie and Catherine, Beatrices relationship is suffering as he is paying attention more towards Catherine then Beatrice. Another crucial scene/turning point in this play is when both, Rodolfo and Catherine are left unaccompanied in the apartment. Whilst in the room, Catherine questions Rodolfo about his motives, in which he is traumatized and was wondering if Eddie thought that too. This is because Eddie warns Catherine that he is after an American citizenship. She asks him, Would you still want to do it if it turned out we had to go live in Italy His reaction was, No; I will not marry you in Italy. I want to be a citizen. At this instant I would want the audience to become conscious that Rodolfo wants to marry Catherine just to be an American Citizen and that they could change their minds later on. Catherine replies to this and says that she does not want to leave Eddie after what he has done for her (Eddie has treated her as a daughter and paid for her to go to extra classes of her interest after leaving high school. ) She makes it sound that Eddie was an ex-lover or ex-husband of her, You thinks its so easy to turn around and say to a man hes noting to you no more? As a director I would want the audience to realize that Catherine is aware that she needs to grow up as she gets advice from Beatrice saying, Beatrice says to be a woman. At this point Catherine gets aggravated as she makes it sound as if she has to choose between Rodolfo and Eddie, I know him and now Im supposed to turn around and make a stranger out of him. She takes in mind what Beatrice suggested to her about being a woman which leads to her having sex with Rodolfo. This is a turning point to the audience and to Catherine. At this turning point I would want the audience to reconsider their views on Rodolfo about wanting to be an American citizen. No one would sleep with a woman and not have feelings for her. The light rises on Eddie. He enters the flat drunk and sees a glimpse of Catherine adjusting her dress and coming from the bedroom. At this particular moment, Eddie senses what the two have been up to. Rodolfo appears in the bedroom doorway. Eddie sees him and his arm jerks slightly in shock. He does this action as he wants to hit Rodolfo as he knows what they have been up to and that he is jealous and cannot bear it. He can not handle that Catherine is taking responsible of her own life. When a pause appears, as a director I would want to create tension in the audience as the characters are all hiked up. Shortly after the build up of tension, Eddie switches his actions and tells Rodolfo to Pack it up and Get out of here. Eddie gets dominant over Catherine by grabbing her and stopping her from following Rodolfo to her bedroom. She frees her arm, which indicates her rebelling against him and her wanting his approval. Eddie, at his point is jealous following what Rodolfo and Catherine have been up to and knows that he cannot have her. Soon after there is a sudden breakthrough of Eddies feelings as he, reaches out suddenly, draws her to him and as she strives to free himself he kisses her on the mouth. He kisses her to provoke Rodolfo and to see how she and he react. This all leads to violence in which, Rodolfo flies at him in attack. At this point Eddie kisses Rodolfo to show Catherine he is gay and to show her that Rodolfo did not prevent this from happening. The last crucial scene in this play is the last scene where Eddie gets killed. This consequence was created when Eddie did a very unintelligent thing of phoning the immigration bureau to report the two illegal immigrants, Rodolfo and Marco. He then regrets phoning the bureau up and tells them to move as they moved with more illegal immigrants which had a very violent family. This way Rodolfo and Marco would not get caught and would remain safe whereas the other illegal immigrants wouldnt. Soon after they decided, they did not have enough time to move, as the officers came to pick Rodolfo and Marco up. Eddie had begged Beatrice to tell them to move and soon after, she had realized what Eddie had done. She turned against Eddie and used harsh language against him, Hes a rat. At this time I would want my audience to turn against Eddie. This then lead to more violence of Eddie getting killed by Marco as he has suffered from his family being without food and money. I would want my audience to feel more sympathy for Marco rather than Rodolfo. The culture of this play is all in relation to a child who grassed his uncle to the immigration bureau seeing that he was an illegal immigrant. The kid was completely beaten up by his family and no-one wanted to know him after what he did. In an Italian family, the families need to be loyal to each other and if something goes wrong outside the family, the Sicilian community requires the law to be taken in hand and that justice should be done. I would want the audience to relate back to this during the last scene and keep this in mind as this is a sort of thing that Eddie had done but the consequences were much worse. If I was directing A View from the Bridge I would want my audience to see that there is a mixed relationship portrayed in this play. This is because of the actions, dialogue and motives used between the two characters. Throughout the play, I would want the audience to change their views on what they thought of the character of Eddie as he did some good quality things however he also did horrific things. The relationship between Eddie and Catherine would have never been further than an uncle and niece. Two relationships between, Eddie and Beatrice and Catherine and Rodolfo both got disturbed due to the actions undertaken by Eddie which affected the characters. I would want my audience to keep on re-evaluating their views on the relationship between Eddie and Catherine as this would make the play more interesting. Coming to the end of the play, the audience would have found out that Eddie did have feelings for Beatrice as his last words were My lovely B. BY JULAN SHAH Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Arthur Miller section.

Pain Sensation: Nociceptive receptors and transduction

Pain Sensation: Nociceptive receptors and transduction Pain is a subsystem of somatic sensation which includes a wide range of unpleasant sensory and emotional experiences usually associated with actual or potential tissue damage (Das et al., 2005). Over the years, by means of the evolutive process of natural selection, nature has made sure that pain is a bodily signal we cannot ignore. As a matter of fact, sensitivity and reactivity to noxious stimuli are essential to the well-being and survival of an organism. In dangerous circumstances pain tells the subject to get out of that situation immediatly, this is its main function. Without these attributes provided by pain mechanisms, the organism would have no means to prevent or minimize dangerous circumstances (individuals congenitally insensitive to pain are easily injured and most of them die at an early age1). While most of the sensory and somatosensory modalities are primarily informative, pain is a protective modality. Pain perception (also called nociception) doesnt come from excessive stimulation of the same receptors that generate somatic sensations, as someone could even think, it is a properly devoted subsystem. Nociception (from the Latin nocere, to hurt) in fact depends on specifically dedicated receptors and, due to its vital importance, this kind of information travels through redundant pathways. Pain also differs from the classical senses (hearing, smell, taste, touch, and vision) because it is both a discriminative sensation and a graded emotional experience. In the big picture, pain appears as a more complex whole experience than simple somatic sensation; that is why there are still many obscure aspects not completely understood, especially in the field of pain physiology and pharmacology. For this and other reasons, even nowadays, nociception remains an extremely active area of scientific research. 2. Pain Sensation Nociceptive receptors and transduction Pain sensation begins with relatively unspecialized free nerve cell endings called nociceptors. Like other somatic sensory receptors, they transduce a variety of noxious stimuli into receptor potentials, which in turn trigger action potentials in the pain nerve fibers (afferents). These action potentials are transmitted to the spinal cord and then, through the brainstem, to the thalamus and the somatic sensory cortex according to specific pathways2. Nociceptors are widespread distributed, they also show different degrees of sensitiveness and specialization. There are nociceptors in the skin, in the joints and also in visceral organs, but none of them is found inside the central nervous system (CNS)1. In contrast with somatic sensory receptors (responsible for the perception of innocuous mechanical stimuli), the axons associated with nociceptors conduct relatively slowly, being only lightly myelinated or, more commonly, unmyelinated2. Thus, according to the different kind of axon, there are faster or slower pain pathways. In particular, pain receptors can fall into four major categories depending on their response to the different types of stimulation caused by the damage: mechanosensitive nociceptors: respond to mechanical stimulation and have A-delta fibers, bigger axons with faster conduction velocity; mechanothermal nociceptors: respond to thermal stimuli, A-delta fibers; chemical nociceptors: respond to chemical substances, A-delta fibers; polymodal nociceptors: respond to high intensity stimuli of the previous three types and have C fibers, smaller and unmyelinated axons with slower conduction velocity. The cell bodies of these primary pain-neurons are located in the dorsal root ganglia (for body afferents) and in the trigeminal ganglia (for face afferents)1,2. The transduction of nociceptive signals, which starts with the nociceptive receptors, is a complex task. Tissue damage results in the release of a variety of chemical substances which triggers the response of nociceptors. Some of these substances activate the transmembrane transient receptor potential (TRP) channels, which in turn initiate action potentials2. Another characteristic feature of nociceptors is their tendency to be sensitized by prolonged stimulation, making them respond to other sensations as well in certain circumstances. This prolonged stimulation increases the release of chemical substances, making nociceptors sensitized and reducing their response threshold. Actually, within a few seconds after the injury, an area of some centimeters around the injured site shows reddening caused by vasodilation. This inflammation becomes maximal after about ten minutes and this region shows a lowered pain threshold (hyperalgesia) in response to additional noxious stimuli. This effect is also referred to as peripheral sensitization, in contrast to central sensitization that can occur at higher levels in the dorsal horn1. Although it is still unknown whether nociceptors respond directly to the noxious stimulus or indirectly by means of one or more endogenous chemical intermediaries released from the traumatized tissue, the activation of nociceptors initiates the process by which pain is experienced: these receptors relay information to the CNS about the intensity and location of the painful stimulus. Pain classification The result of sudden painful stimulation can be divided into two categories of sequential sensations separated by a short time interval. A sharp first pain, immediately after the damage, its followed some seconds later by additional, diffuse and longer-lasting second pain sensation. The temporal interval between these two separate sensations is due to the difference between fast transmitting A-delta fibers and slow transmitting C fibers. This phenomenon is also known as double pain sensation. Pain has also been classified into three major types1: Pricking pain: is also called fast pain or sensory pain (first pain) and arises mainly from the skin, carried by A-delta fibers which permit discrimination and localization of the pain. Burning pain: is caused by inflammation, burned skin and is carried by C fibers. This type of pain is a more diffuse, slower to onset, and longer in duration (second pain). Like pricking pain, burning pain arises mainly from the skin, but it is not distinctly localized. Aching pain: is a sore pain which arises mainly from the viscera and somatic deep structures. This pain is carried by the C fibers from the deep structures to the spinal cord and is not distinctly localized. Pain pathways The neural pathway that conveys pain (and temperature) information from the periphery of the body to the higher centers of the CNS is often referred as the anterolateral system (or ventrolateral column). This pathway is physically separated from the system that conveys mechanosensory information like touch and pressure (dorsal column-medial lemniscus pathway). However, even though the dorsal route has been always considered a touch pathway functionally separate from the anterolateral pathway, recent reports indicate that the dorsal column can carry noxious information from the viscera and widespread skin regions as well1. Anyway, the main difference between these two systems remains the site of decussation: while the dorsal column is an ipsilateral tract until the medulla (where synapses and decussates), the anterolateral system makes early synaptic connections and decussates right away in the spinal cord, becoming a contralateral tract. Composing the anterolateral system, there are three major ascending tracts: the neospinothalamic tract (the main, central pain pathway, phylogenetically younger, with few synapses), the paleospinothalamic tract and the archispinothalamic tract (which constitute minor parallel pain pathways, phylogenetically older and multisynaptic tracts)1. Every pain tract is made of three kinds of pseudounipolar neurons: first-order, from free nerve endings (nociceptors) to the dorsal horns of the spinal cord; second-order, from the dorsal horns to the thalamus; and third-order, from the thalamus to the primary somatic sensory cortex. The cell bodies of first-order neurons are located in the dorsal root ganglia (DRG) for all three pathways. a) The neospinothalamic tract (central pathway) constitutes the classical anterolateral system. This pathway is responsible for the immediate awareness of a painful sensation and for the understanding of the exact location of the painful stimulus. The first-order nociceptive afferents enter the spinal cord via the dorsal roots of the DRG and, when these projecting axons reach the dorsal horns of the spinal cord, they branch into ascending and descending collaterals, forming the tract of Lissauer2. Once within the dorsal horn, these afferents make synaptic connections with second-order neurons located in Rexeds laminae (layer I to V). Axons of these second-order neurons then cross the midline of the spinal cord, decussating in the anterior white commissure, and ascend to the brainstem in the contralateral (anterolateral) quadrant. Most of the pain fibers from lower extremities of the body and below the neck terminate, through the brainstem, in the ventral posterior lateral nucleus (VPL) of the thalamus. The VPL, which serves as a relay station, is thought to be mainly concerned with discriminatory functions1. Finally, here axons of second-order neurons synapse with third-order neurons that send the signal to the primary and secondary somatosensory cortex (SCI and SCII, respectively). Unlike the rest of bodily afferents, first-order nociceptive neurons from the head, face and intraoral structures have somata in the trigeminal ganglion. Trigeminal fibers enter the pons, descend to the medulla (forming the spinal trigeminal tract) and make synaptic connections in the spinal trigeminal nucleus, then cross the midline and ascend as trigeminothalamic tract (or trigeminal lemniscus). Axons from the second-order neurons terminate in a variety of targets in the brainstem and thalamus, but the discriminative aspects of facial pain are thought to be mediated by projections to the ventral posterior medial nucleus (VPM) of the thalamus and by projections (from here) to primary and secondary somatosensory cortex2. All of the fibers terminating in VPL and VPM are somatotopically oriented and still here the information supplied by different somatosensory receptors remains segregated. Axons from the thalamus synapse with third-order neurons of the SCI, which includes Brodmanns Areas 3a, 3b, 1 and 2. Each of these cortical areas contains a separate and complete representation of the body: they are somatotopically organized maps representing the human body (from the foot up to the face) in a medial to lateral arrangement2. b) The paleospinothalamic tract is a parallel pathway where the emotional response to pain is mediated1. This tract also activates brainstem nuclei which are the origin of descending pain-suppression pathways which regulate the sesation of noxious inputs at the spinal cord level. In the paleospinothalamic tract the majority of the first-order nociceptive neurons make synaptic connections with second-order neurons in Rexeds layer II (substantia gelatinosa). These second-order neurons also receive input from mechanoreceptors and thermoreceptors, and thats why the anterolateral system is also responsible for temperature perception1. The nerve cells that compose the paleospinothalamic tract are multireceptive or wide dynamic range nociceptors. Most of their axons cross and ascend in the spinal cord primarily in the anterior region and thus form the anterior spinal thalamic tract (AST). These second-order fibers contain several tracts and each of them makes a synaptic connection in different locations: in the mesencephalic reticular formation (MFR) and in the periaqueductal gray (PAG), forming the spinoreticular tract; in the tectum, also known as the spinotectal or spinomedullary tract; in the midline thalamic nuclei, forming the spinothalamic tract. Altogether these three fiber tracts are thus known as the paleospinothalamic tract, which is in part bilateral, because some of the ascending fibers do not cross to the opposite side of the cord1. Finally, from the thalamic nuclei, these fibers synapse bilaterally in the somatosensory cortex. Pain is a complex experience processed by a diverse and distributed network of neurons and brain regions. In addition to the sensory-discriminative aspects (carried by the neospinothalamic tract) there are also affective-motivational components of pain2. In the paleospinothalamic pathway there are extensive connections between the thalamic nuclei and the limbic areas such as the cingulate gyrus and the insular cortex. The insular cortex integrates the sensory input with the cognitive components. The limbic structures (amygdala, superior colliculus) project to the hypothalamus and initiate visceral responses to the pain. The thalamic nuclei also projects to the frontal cortex, which in turn is linked to the limbic structures involved in processing the emotional components of pain1. c) The archispinothalamic tract is another parallel pathway, phylogenetically the oldest that carries noxious information1. The characteristics of this tract are very similar to the ones found in the previous pathway. First-order nociceptive neurons make synaptic connections in Rexeds layer II (substantia gelatinosa). From here, second-order fibers ascend and descend in the spinal cord surrounding the grey matter to end synapsing with cells in the reticular formation and in the periaqueductal gray. Further diffuse multisynaptic pathways ascend to the diverse nuclei of thalamus and send collaterals to the hypothalamus as well as the limbic system nuclei. These fibers, like for the paleospinothalamic tract, mediate visceral, emotional and autonomic reactions to painful stimuli. In short, because of the importance of warning signals of dangerous circumstances, several nociception pathways are involved to transmitting these signals and some of them are redundant. The neospinothalamic tract conducts fast pain (via A-delta fibers) and provides information of the exact location of the noxious stimulus. The multisynaptic paleospinothalamic and archispinothalamic tracts conduct slow pain (via C fibers), a pain which is chronic and harder to localize. Through these patways, pain activates many different brain areas which link together sensation, perception, emotion, memory and motor reaction1. 3. Pain Modulation When talking about pain, we always have to consider and keep in mind the discrepancy between the objective reality of a painful stimulus and the subjective rsponse to it. Modern studies have provided considerable insight into how circumsatnces affect pain perception-interpretation and, ultimately, into the pharmacology of the pain system2. For many years it has been suggested that somewhere in the CNS there should be some neuronal circuits modulating incoming painful informations. Evidence for an intrinsic analgesia system was demonstrated by intracranial electrical stimulation of certain brain sites1,3. The circuit consisting of the periaqueductal gray matter (PAG), the raphe nuclei (RN), the locus coeruleus (LC) and the caudate nucleus (CN) contributes to the descending pain suppression mechanism, which inhibits incoming pain information at the spinal cord level6. Stimulation of such areas produce analgesia without behavioral suppression; indeed, touch, pressure and temperature sensation remain intact1. At the interneuronal level, opiate receptors activation causes hyperpolarization of the neurons, which in turn results in the inhibition of firing and in the release of substance P (a neurotransmitter involved in pain transmission) that blocks pain transmission1. In addition to descending projections, also local interactions between mechanoreceptive afferents and neural circuits within the dorsal horn can modulate the transmission of nociceptive informations to higher centers2. Observations by Melzack and Wall led to the idea that concomitant activation of the large myelinated fibers associated with low-threshold mechanoreceptors can mediate the flow of pain. This mechanism, also known as Gate Control Theory13, predicts that (at the spinal cord level) non-noxious stimulation will produce presynaptic inhibition on dorsal root nociceptor fibers and thus blocking incoming noxious information from reaching the CNS1 (i.e. non-painful input closes the gates to other painful inputs, which results in prevention and suppression of pain sensation). This explains also why if you, for example, stub a toe, a natural and effective reaction is to vigorously rub the site of injury for a couple of minutes2. However, there are many different factors that can influence the way we understand pain. Doubtless, three of these are: drugs, prior injuries and, more broadly speaking, circumstances. a) Drugs The brain has a neuronal circuit and endogenous substances to modulate pain. There are two primary types of drugs that work on the brain: analgesics and anesthetics1. The term analgesic refers to a drug that relieves pain without loss of consciousness, whereas the term anesthetic refers to a drug that depresses the CNS. Anesthetics are characterized by the absence of perception for all sensory modalities, including loss of consciousness, but without loss of vital functions. The areas that produce analgesia when stimulated are also responsive to exogenously administered opiate drugs2. As a matter of fact, the most effective clinically used drugs for producing temporary relief from pain are the opioid family, which includes morphine and heroin1. Unluckily, several side effects resulting from opiate use include tolerance and drug dependence (addiction). In general, these drugs modulate the incoming pain information as well as relieve pain temporarily, and are also known as opiate producing analgesia (OA). Opioidergic neurotransmission is found throughout the brain and spinal cord and appears to influence many CNS functions: opioids exert marked effects on mood, cognition and motivation1 (e.g. producing euphoria). The analgesic action of opiates implied the existence of specific brain and spinal cord receptors for these drugs long before the receptors were actually found. Since such receptors are unlikely to have evolved in response to the exogenous administration of opium and its derivates, the convinction grew that endogenous opiate-like compounds must exist in order to explain the evolution of these receptors in the body2. Nowadays, three classes of opioid receptors have been identified: ÃŽÂ ¼ (mu), ÃŽÂ ´ (delta) and ÃŽÂ º (kappa). All three classes are widely distributed in the brain, and particularly in the PAG, which is the site for higher cortical control of pain modulation in humans8. Moreover, three major classes of endogenous opioid peptides that interact with them have been recognized in the CNS: ÃŽÂ ²-endorphins, enkephalins and the dynorphins. Enkephalins are considered the putative ligands for the ÃŽÂ ´ receptors, ÃŽÂ ² endorphins for the ÃŽÂ ¼-receptors, and dynorphins for the ÃŽÂ º receptors1. The opioid peptides modulate nociceptive input mainly in two ways: blocking neurotransmitter release by inhibiting Ca2+ influx into the presynaptic terminal; or opening potassium channels, which hyperpolarizes neurons and inhibits spike activity. The various types of opioid receptors are distributed differently within the central and peripheral nervous system and this can explain many unwanted side effects following opiate treatments1. (For example, ÃŽÂ ¼-receptors are widespread in the brain stem parabrachial nuclei, which is a respiratory center. Inhibition of these neurons elicits also respiratory depression). In addition to opiates, the other big family of analgesia producing drugs is represented by the cannabinoids. Like opiates, cannabinoids produce analgesia when microinjected in the PAG and pain itself serves as a trigger for endocannabinoid release3. Results from the study by Walker et al. (1999) indicate that anandamide (an endogenous cannabinoid) fulfills the requirements for a nonopiate mediator of endogenous pain suppression and these data support the existence of endogenous cannabinergic circuitry in the dorsal and lateral PAG. Even if the opiate and cannabinoid mechanisms partially overlap anatomically, the endogenous opiate system is activaetd by intense and prolonged stimuli (such as high threshold electrical stimulation), while endogenous cannabinoids occur mostly in tonic pain suppression, during tests that do not produce significant stress or fear3. Cannabinoids have been used to treat pain for centuries and cannabis is still used despite its illegal status in most parts of the world. The spontaneous and stimulated release of anandamide in a pain-suppression circuit suggests that such drugs may form the basis of a modern pharmacotherapy for pain, particularly in instances where opiates are ineffective3. b) Previous injury A curious effect, well known and documented in clinical literature, is referred to as phantom limb sensation. Following the amputation of an extremity, nearly all patients have an illusion that the missing limb is still present. Although this illusion usually diminishes over time, it persists in some degree throughout the amputees life, and can often be reactivated2. A reasonable explanation for this phenomenon is that the central sensory processing apparatus continues to operate indipendently of the periphery, giving rise to these bizarre sensations. Indeed, considerable functional reorganization of the somatotopic maps in the primary somatosensory cortex occurs immediately after the amputation and tends to evolve for several years2. Neurons that have lost their original inputs respond to tactile stimulation of other (near) body parts, and so it is not unusual for the patient to perceive a phantom limb as a whole and intact, but displaced from the real location. These and further ev idences suggested then that a full representation of the body exists indipendently of the peripheral elements that are mapped2. Anyways, the major problem following phantom limbs phenomena is constituted by the fact that up to 85% of the amputated patients develop also phantom pain4. The description of this common unease can vary from a tingling or burning sensation to some more serious and debilitating issues. Phantom pain, in fact, is one of the more frequent causes of chronic pain syndromes and is extraordinarily difficult to treat2. Neverthless there is no really effective treatment, a study by Jahangiri et al. (1994) demonstrated that preoperative epidural infusion of morphine, bupivacaine and clonidine significantly reduces the incidence of phantom limb pain and phantom limb sensation. Moreover, this kind of treatment has been shown as safe for use on general surgical wards with a low incidence of minor side-effetcs4. Other than amputations, pain perception may also be modulated in certain stressful situations. Exposure to a variety of painful or stressful events produces an analgesic reaction, and this phenomenon is called stress induced analgesia (SIA). It has been considered that SIA can provide insights into both the psychological and physiological factors that activate endogenous pain control and opiate systems1. (For example, soldiers wounded in battle or athletes injured in sports events sometimes report that they do not feel pain during the battle or game; however, they will experience the pain later after the battle or as game has ended). Some studies demonstrated in animals that electrical shocks cause stress-induced analgesia3 and it has been suggested that endogenous drugs, (opiates or cannabinoids) released in response to stress, inhibit pain by activating the midbrain descending system1. Based on these and other experiments, it is assumed that the stress experienced by the soldiers and the athletes suppressed the pain which they would later perceive. c) Circumstances The experience of pain is highly variable between individuals: this highly subjective perception has a complex and often non linear relationship between nociceptive input and pain sensation5. From human experimentation we know that a variety of pain modulatory mechanisms exist in the nervous system, and these systems can be accessed either pharmacologically or through contextual and cognitive manipulation7,6. Various mental processes such as attention, emotional state, past experiences, memories, beliefs and feelings have been shown to influence pain perception and bias nociceptive processing in the humain brain9. All these top-down factors can be grouped together in the category of circumstances that either enhance or diminish pain sensation in regard to dedicated modulatory circuits. Among the cognitive variables influencing pain, the brain mechanisms underlying attentional control have been probably the most extensively studied5. A number of reports show the important role of attentional state in modulating the activity of primary somatosensory areas7. Thus, pain is perceived as less intense when individuals are distracted from it, as proved in an interesting study by Das et colleagues (2005). This research provides strong evidence supporting virtual reality (VR) based games in providing analgesia and positive influence on children with acute burn injuries, with minimal side effects10. VR can be considered an intermediary between reality and computer technology, and its ability to immerse the user interacting with the artificial environment is central in this kind of approach. However, attentional processes interact with mechanisms supporting the formation of expectations about pain and reappraisal of the experience5. The ability to predict the likelihood of an aversive event is an important adaptive capacity11. Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information12 and this cognitive factor is important also for pain perception: positive expectations (i.e., expectations for decreased pain) produce a reduction in perceived pain that rivals the effects of a clearly analgesic dose of morphine12. These evidences provide also a neural mechanism that can, in part, explain the positive impact of optimism in chronic disease states. In fact, perceived control, attentional control and the descending pain modulatory system are involved in the placebo-induced analgesia, which is a clinical example of cognitive pain modulation that decreases pain intensity and cerebral responses to pa in5. Such top-down modulatory mechanism is a robust and clinically important phenomenon, which can be demonstrated in approximately one-third of the population9. Moreover, placebo analgesia requires the activation of endogenous opioid-mediated inhibition and neuroimaging techniques showed that there is also overlapping among brain sites activated by opioids and those that are activated during placebo analgesia9. Also the emotional state driven by the (experimental) context alters the attitude of patients and can produce powerful effects on pain perception7. In general, negative emotions increase pain, whereas positive ones decrease it14,7. Neverthless the brain mechanisms underlying these effects remain largely unknown, the prefrontal cortex, as well as parahippocampal and brainstem structures, are thought to be involved in the emotional regulation of pain14. According to Roy et al. (2009) cognitive and emotional processes induced by pleasant or unpleasant pictures interact with pain perception and modulate the responses to painful electrical stimulations in the right insula, paracentral lobule, parahippocampal gyrus, thalamus, and amygdala14. Not only, recent studies suggested that emotionally laden images representing human pain had a unique capacity to enhance pain reports15, in the suggestive perspective that search for the neural bases of human empathy with huge social implications. Thus, even though is well-established that mood selectively alters the affective-reactive response to pain (also called pain tolerance), the interpretation for some of these studies is sometimes difficult, since they do not always clearly dissociate changes in mood from changes in attention7. In fact, other studies showed that emotions can have a direct effect on attention to pain, leading to what is called attentional bias toward pain-related informations, which does not ensure the absence of covariate processes7. In the end, the available data indicate that emotion and selective attention may both interact modulating pain perception and cortical responses. But the observations that emotional manipulations alter pain unpleasantness more than pain sensation, while attention alters both pain sensation and unpleasantness, suggest that different modulatory circuits are involved7 and that they act through at least partially distinct mechanisms, which can be separated by appropriate experimental settings15. All this multiplicity of mechanisms underlying the emotional modulation of pain is reflective of the strong and reciprocal interrelations between pain and emotions, and emphasizes even more the powerful effects that emotions can have on pain perception14. 4. Conclusions In conclusion, in the CNS, much of the information from the nociceptive afferent fibers results from excitatory discharges of multireceptive neurons. The pain information in the CNS is controlled by ascending and descending inhibitory systems that can exert both facilitatory and inhibitory effects on the activity of neurons using endogenous opioids or other substances as mediators. In addition, a powerful inhibition of pain-related information occurs in the spinal cord. These inhibitory systems can be activated by brain stimulation, intracerebral microinjection of morphine, and peripheral nerve stimulation1. However, pain is an extremely complex perceptual and cognitive experience that is influenced also by many top down factors such as past sensations, expectations, the context within which the noxious stimulus occurs, the attentional and emotional state. Therefore, for all these reasons, the response to pain can often vary considerably from subject to subject. Case Report: Use of Valproate in Kleine Levin Syndrome Case Report: Use of Valproate in Kleine Levin Syndrome Successful use of Valproate in Kleine Levin Syndrome: a case report and review of cases reported from India Abstract Kleine-Levin Syndrome (KLS) is characterized by recurrent episodes of hypersomnia and other symptoms and it is a really challenging for the physician, since its causes are not yet clear, and available treatment options are not having adequate support. Here we are reporting a case with successful use of Valproate in KLS and also reviewing the cases reported from India. Introduction Kleine-Levin Syndrome (KLS) is a rare disorder which mainly affects adolescent boys and characterized by recurrent episodes of hypersomnia, and sometime along with hyperphagia, behavioral and cognitive disturbances, and hypersexuality (Yao et al., 2013). Several medications (stimulants, lithium, valproate, antipsychotics, antidepressants) have been reported to provide variable benefit in different symptoms, with lithium being the most widely used drug (Arnulf et al., 2005 2012). We are presenting a case of KLS, who had complete remission with valproate and also reviewing the cases reported from India. Case details: A 17 year old single male student of 12th standard, presented to our psychiatric outpatient clinic in September 2004 with hypersomnolence, low mood, decreased appetite and interest in studies, social and sexual disinhibition (such as singing obscene songs loudly at home, and touching unconsenting females’ including mother’s body parts- limbs, face and genitalia). Onset was acute, without any elicitable precipitating factor and course was episodic with average 7-10 days episode in every month for last four months and he maintained completely well in interepisodic period. Provisional diagnosis of recurrent depressive disorder (brief episodes) was kept and he was started on Sertraline (50 mg), on which he responded well. He remained asymptomatic for nearly nine months, but started having similar episodes again from mid 2005, due to which Sertraline was gradually hiked up to 150 mg/day, but of no use. Hence he was admitted in our inpatient setting in March, 2006 for diagnostic evaluation and further management. After detailed evaluation, it was found that his sadness was not pervasive and depressive cognitions and associated disturbances were not present and hypersomnia remained predominant complaint as initially he was sleeping 16-20 hours per day. He was also not responding with these medications, hence differential diagnosis of KLS vs. depression was kept and later finalized to KLS. His heamogram, renal functions, liver functions, blood sugar, routine urine, thyroid functions were within normal limits and chest X ray, ECG, EEG, and MRI brain were nor mal. In view of good literature support Lithium was started from 600 mg/day and hiked to 900 mg/day (serum level 0.8 mEq/liter). On which he has shown significant improvement initially for six month but later again started experiencing similar symptoms. He also had three episodes of fall, unresponsiveness and epileptiform discharge in EEG twice. Hence in view of seizure disorder and lack of response, Neurologist’s consultation was sought, who opined to start antiepileptic medication. Hence lithium was switched to Valproate (750 mg/day) in December 2006, on which he maintained completely well for 4 years, except brief reemergence of symptoms on discontinuing Valproate, which improved completely on resuming the medication. Valproate was gradually tapered and stopped in January 2011 on insistence of patient and family with discussing its pros and cons. Now index case has been maintaining well off Valproate for last three years without any episode of hypersomnolence, sexual disin hibition, sadness, or epileptic seizure. Discussion Based on historical reports by Kliene and Levin, KLS was essentially described and termed by Critchley (1962). Thereafter many researchers have reported their cases and reviewed cases with KLS (Arnulf et al., 2005 2012). Here we are reporting a case with KLS, who responded well with Valproate, after diagnostic dilemma and different psychotropic medications and also reviewing the other cases reported from India. In our electronic search for Indian studies on Kliene-levin syndrome, by using PUBMED and Google Scholar, we could find 15 cases reported from India (Aggarwal et al., 2011; Mendhekar et al., 2001; Prabhakaran et al., 1970; Shukla et al., 1982; Sagar et al., 1990; Narayanan et al., 1972; Agrawal Agrawal, 1979; Malhotra et al., 1997; Gupta et al., 2011). Of them 13 were males and 2 females, similar to male preponderance reported in the literature (Arnulf et al., 2005 2012). While presenting to psychiatric services their age was between 9 to 26 years and they had onset between 7 to 24 years of age. In two-third of patients (10 out of 15 patients) it was preceded with fever and their episodes of somnolence were lasted from 3 days to 10 weeks. Hypersomnia and hyperphagia were present in all, while two-third of patients also had social and sexual disinhibition (11 out of 15 patients). Other symptoms were cognitive disturbances (low intelligence quotient, impaired memory, confusion, and a cademic decline), irrelevant talk, and perceptual disturbances. Nearly one-third of patients improved spontaneously without any medication, while rest was given lithium, carbamazepine, methyl amphetamine, dextro amphetamine, and modafinil. Longest asymptomatic follow-up period is reported for 2 years (Aggarwal et al., 2011) (as depicted in table-1). Though literature supported lithium for higher response rate (Arnulf et al., 2005 2012), but index patient had remarkable response with Valproate, not with lithium, like earlier two reports (Crumley, 1997; Adlakha Chokroverty, 2009). Like earlier report (Adlakha Chokroverty, 2009), index patient also improved on lower dose of Valproate (divalproate 750 mg vs. 500 mg Valproate). Compared to other cases reported from India (Aggarwal et al., 2011; Gupta et al., 2011), index patient had longest follow-up (7 years) and remained asymptomatic in this period, except small exacerbation on discontinuation of Valproate treatment, which improved completely on resuming the drug. Similar to our patient, anticonvulsants (like Valproate) are the preferred treatment for KLS patient, and may also offer benefits in case of comorbid epilepsy (Yao et al., 2013). Valproate may be a good alternative to lithium in terms of efficacy as well as side effect profile. References Yao, C.C., Lin, Y., Liu, H.C., Lee, C.S., 2013. Effects of various drug therapies on Kleine–Levin syndrome: a case report. Gen Hosp Psychiatry. 35, 102.e7-102.e9. Arnulf, I., Zeitzer, J.M., File, J., Farber, N., Mignot, E., 2005. Kleine-Levin syndrome: a systematic review of 186 cases in the literature. Brain. 128, 2763-76. Arnulf, I., Rico, T.J., Mignot, E., 2012. Diagnosis, disease course, and management of patients with Kleine-Levin syndrome. Lancet Neurol. 11, 918-28. Critchley, M., 1962. Periodic hypersomnia and megaphagia in adolescent males. Brain. 85, 627–56. Aggarwal, A., Garg, A., Jiloha, R.C., 2011. Kleine-Levine syndrome in an adolescent female and response to modafinil. Ann Indian Acad Neurol. 14, 50-2. Mendhekar, D.N., Jiloha, R.C., Gupta, D., 2001. Kleine-levin syndrome : a report of two cases. Ind J Psychiatry. 43, 276-8. Prabhakaran, N., Murthy, G.K., Mallya, U.L., 1970. A Case of Kleine-Levin Syndrome in India. Br J Psychiatry. 117, 517-519. Shukla, G.D., Bajpai, H.S., Mishra, D.N., 1982. Kleine-levin syndrome: a case report from India. Br J Psychiatry. 141, 97-98. Sagar, R.S., Khandelwal, S.K., Gupta, S., 1990. Interepisodic morbidity in Kleine-Levin syndrome. Br J Psychiatry. 157, 139-141. Narayanan, H.S., Narayanan Reddy, G.N., Rama Rao, B.S., 1972. A case of Kleine-levine syndrome. Ind J Psychiatry. 14, 356-358. Agrawal, A.K., Agrawal, A.K., 1979. Kleine-levin syndrome: a case report. Ind J Psychiatry. 21, 286-287. Malhotra, S.M., Das, M.K., Gupta, N., Muralidharan, R, 1997. A Clinical Study of Kleine-levin syndrome evidence for hypothalamic-pituitary axis dysfunction. Biol Psychaitry. 42, 299-301. Gupta, R., Lahan, V., Srivastava, M., 2011. Kleine-Levin syndrome and idiopathic hypersomnia: Spectrum disorders. Ind J Psychol Med. 33, 194-8. Crumley, F.E., 1997. Valproic acid for Kleine-Levin syndrome. J Am Acad Child Adolesc Psychiatry. 36, 868-9. Adlakha, A., Chokroverty, S., 2009. An adult onset patient with Kleine-Levin syndrome responding to valproate. Sleep Med. 10, 391-3. Table-1: Reported cases with Kleine Levin syndrome from India