buy custom Chronic Obstructive Pulmonary Disease essay

buy custom Chronic Obstructive Pulmonary Disease essay Chronic Obstructive Pulmonary Disease is one of the major causes of death today. This is often translated into huge economic burdens in terms of the cost of treatment as well as the loss of productivity. Albuterol and levalbuterol are some of the drugs that are recommended for the treatment of COPD. It is worth noting that albuterol was introduced first and several studies conducted on this drug revealed that it contained several negative effects. This led to the approval of levalbuterol and indeed, studies have confirmed that this drug brings about less harmful effects compared to albuterol. However, these results are controversial, and thus, this paper intends to analyze the existing literature in order to assess which between the two drugs is appropriate. Based on the review of existing literature, this paper found out that levalbuterol produces less harmful effects, results in fewer hospitalizations, and the overall costs of treatment is cheaper, even despite the fact that albute rol is a cheaper drug compared to levalbuterol. This paper provides a good analysis of the two drugs, on the basis of which health practitioners can make their decisions when dealing with COPD. In addition, this write up provides important information that will build up on the existing literature in this filed. Basing on the advantages of levalbuterol over albuterol, this paper recommends that levalbuterol should be considered as the drug of choice when it comes to the treatment of COPD. In addition, the study recommends that further research should be conducted to provide support for the claim that levalbuterol contains a better efficacy compared to albuterol with regard to the drug composition. However, despite the differences between the two drugs, it is worth noting that levalbuterol and albuterol are actually similar in numerous aspects. Albuterol and levalbuterol are some of the drugs that are often used in the treatment of asthma and Chronic Obstructive Pulmonary Disease (COPD). These drugs are often confused, considering the fact that they have a similar classification and action as they are both classified as bronchodilators. Albuterol is often recommended as inhaled beta-2 agonist and can be used to deal with acute bronchospasm (Perrin-Fayolle et al., 1996). It is made up of a racemic mixture of (S)-albuterol that contains some slight or no bronchodilating action, and (R)-albuterol (levalbuterol), which is considered as an active pharmacological enantiomer in a ration of 50:50. It is worth noting that (R)-albuterol has been proved to exhibit a 100-fold more capability to bind to the beta-2 receptors compared to the (S)-albuterol (Perrin-Fayolle et al., 1996). Research studies show that albuterol has been in use for over 40 years and is still being used today (Ozminkowsk et al., 2007). However, it is worth noting that this drug has often been associated with various side effects, such as tremor. In 2005, levalbuterol was approved as a remedy for the same condition, and indeed, studies and even manufacturers have confirmed that using levalbuterol leads to fewer hospitalizations, improved respiratory parameters, fewer adverse effects, and thus, reduced overall costs of treatment (Perrin-Fayolle et al., 1996). However, these outcomes are not universal, considering the fact that some studies have confirmed that there are no distinctions when it comes to the clinical endpoints (Ameredes et al., 2009). This has, therefore, presented some controversies with regard to whether racemic albuterol or levalbuterol should be eliminated. This paper, therefore, seeks to analyze the literature on both albuterol and levalbuterol, examining what the studies suggest about these two drugs in order to make an opinion on what makes sense clinically and what does not. The paper will also look at its impact on the field as well as at the disease management. Description of the Disease Chronic Obstructive Pulmonary Disease (COPD) is a gradually progressive infection of the airways, often depicted by the lung function impairment. This basically happens when there is a co-occurrence of emphysema and chronic bronchitis, leading to the narrowing down of the airways. As a result, there is a limited airflow to the lungs and out, hence a shortness of breath, a condition that is medically known as dyspnea, is experienced (Perrin-Fayolle et al., 1996). However, it is worth noting that this condition is often irreversible and gets worse as times go by. COPD is normally caused by some noxious particles, particularly generated from smoking tobacco, hence prompting a response that leads to the inflammation of the lungs. It is important to note that some of the most common diseases that are associated with COPD include chronic bronchitis, emphysema, and chronic obstructive bronchitis along with the combination of highlighted conditions (Ozminkowsk et al., 2007). The diagnosis of COPD necessitates that tests are conducted regarding the functioning of the lungs. Some of the management strategies include the rehabilitation, vaccinations, drug therapy, smoking termination, and in some cases, patients are recommended to have lung transplantation. How the Drugs Work In the Body It is worth noting that both albuterol and levalbuterol contain the same properties, considering the fact that they both target the bodys beta-2 receptors. The two drugs serve to reduce the resistance in the airway as they are known to enlarge the diameter of the bronchi or the air passages (Ozminkowsk et al., 2007). In such a way, these drugs help to enhance the overall flow of the air both into the lungs and out. The drugs work on the beta-2 receptors resulting in the pulmonary smooth muscles relaxation. Research indicates that albuterol and levalbuterol work to increase the airflow and relax the pulmonary smooth muscle within a period of 30 minutes and are known to stay for between 4-5 hours (Perrin-Fayolle et al., 1996). Studiesthat have been conducted with regard to the metabolism of albuterol in the human tissues indicate a 5-11 fold better sulfoconjugation of the eutomer compared to the distomer within various human tissues (Perrin-Fayolle et al., 1996). A single dose of the a lbuterol dosage, whether taken orally or inhaled, results in a higher blood level within the distomer compared to the eutomer (Perrin-Fayolle et al., 1996). Perhaps, this indicates a predominance of the (s)-albuterol, an inactive product, after repeated dosing of the active (R)-albuterol. However, it is important to bear in mind that while albuterol helps in relaxing the smooth muscles and increasing the flow of air within the airways, they do not actually reduce the speed of the progression of the primary disease (Ozminkowsk et al., 2007). They only help in minimizing the signs and symptoms of exercise and wheeze limitations along with the shortness of breath, leading to a better life for the people living with COPD. Review of the Literature Albuterol is one of the most commonly recommended drugs for patients suffering from asthma and COPD (Perrin-Fayolle et al., 1996). However, due to the negative effects caused by the drug, levalbuterol was developed. This was based on various advantages, such as better tolerability, lesser cases of transient tachycardia, and in addition, it was noted to have a greater or similar efficacy with albuterol (Ameredes et al., 2009). However, some clinical studies indicate no significant superiority of levalbuterol, when compared to albuterol, though the effects of levalbuterol may be considered greater among the patients, particularly, when there is an overuse of albuterol (Ameredes et al., 2009). Nonetheless, Ameredes et al. (2009) highlight that numerous studies have been conducted to establish the difference between the two drugs, but the findings have always been to some extent heterogeneous. A study conducted by Purrin-Fayolle et al. (1996) found out that levalbuterol was more effectiv e in suppressing bronchospasm if compared to albuterol. The following studies indicated equivalencies of the two drugs, and some studies even found out that levalbuterols 1.25mg bronchodilatory effect was the same as that of the albuterol. Clinical trials in pediatric and adult patients who were diagnosed to have asthma have indicated a lower mean heart rate among the patients using levalbuterol compared to the ones using racemic albuterol. However, the degree of difference between these two drugs is modest, and thus, may be clinically significant for the patients suffering from cardiac conditions, which could even worsen in the case of tachycardia (Truitt et al., 2003). On the other hand, some studies have reported that there is no difference in the two drugs when it comes to the mean heart rate if these drugs are compared head-to-head (Ozminkowsk et al., 2007). This is because the negative result of increased heart rate is something that is common among all the drugs classified as beta-agonists (Ameredes et al., 2009). Therefore, the equimolar doses of both racemic albuterol and levalbuterol would probably lead to an equal magnitude of tachycardia, implying that the transient tachycardia that is often experienced with regard to these drugs is more dependent on the dose (Perrin-Fayolle et al., 1996). Additionally, the claim that levalbuterol is more tolerable compared to albuterol is also controversial. The harmful effects of racemic albuterol, particularly with regard to its overuse, include tachyphylaxis, hypokalemia, as well as the increased rates of mortality (Qureshi et al., 2005). It is worth noting that (S)-albuterol does not contain the bronchodilator activity, and when compared to levalbuterol, it is considered to be metabolized at a 10-fold slower rate (Qureshi et al., 2005). With this regard, some studies have theorized that it may also contain harmful effects, for instance, the pro-inflammatory effects or airway reactivity (Ameredes et al., 2009). This might lead to the preferential buildup of the (S)-isomer compared to (R)-albuterol, hence resulting in the condition known as paradoxic bronchospasm within the lungs (Qureshi et al., 2005). One study was conducted among the hospitalized patients suffering from the chronic obstructive pulmonary disease in an aim to compa re the effects of racemic albuterol (2.5 mg) treatment (every 1-4 hours) with that of nebulized levalbuterol (1.25 mg) treatment (every 6-8 hours) (Qureshi et al., 2005). Apparently, fewer levalbuterol nebulizations were needed, and the call for the rescue aerosol did not increase during the study period of hospitalization, which was basically 14 days. However, it is worth noting that the study findings highlighted that the outcome measures between the two groups being studied were alike, including the pulmonary function and costs studies (Qureshi et al., 2005). Furthermore, Truitt and his colleagues carried out a retrospective chart review of the patients diagnosed with COPD and hospitalized and came out with the same conclusions, highlighting that the outcomes of the two drugs are similar (Truitt et al., 2003). Ameredes et al. (2009) highlight that the advantage of levalbuterol over albuterol can be considered greater among the patients that have been subjected to the overuse of a lbuterol. It is also important to bear in mind that cost is one of the major factors highlighted when conducting a comparison of the two drugs (Quinn, 2004). Initially, the metered-dose inhalers, considered to be a generic formulation of albuterol, were widely used, regarding the fact that they were considered to be cheaper compared to the branded albuterol versions. However, the metered-dose inhaler formulations were banded on the grounds that most of them contained chlorofluorocarbons and were thus faced out of the market (Quinn, 2004). The branded albuterol cost is nearly the same as that of the levalbuterol. In addition, it is noted that the cost of levalbuterol nebulization is still higher than that of the generic albuuterol nebulization (Gawchik et al., 1999). Nonetheless, one study indicated that the overall cost savings related to the reduction in the number of days that the patients spend in hospital is less in those using levalbuterol compared to the ones using albuterol (Quinn, 2004 ). Generally, it is worth noting that levalbuterol is considered to slightly enhance the pulmonary function and lasts longer than albuterol. Basically, the pulmonary function improvement caused by 0.625 mg of levalbuterol is the same as that caused by 2.5 mg of albuterol. However, despite the differences present between the two drugs, it is worth noting that levalbuterol and albuterol are actually similar in numerous aspects, such as glucose levels, impact on blood potassium, and climax of drug action among other aspects (Quinn, 2004). What Makes Sense and What Does Not Make Sense Clinically Despite the fact that differences between levalbuterol and albuterol are rather controversial, it is worth noting that there are few aspects which make sense clinically while others are clearly senseless. However, it is important to note that levalbuterol is considered as a safer form of albuterol (Ameredes et al., 2009). Albuterol is most commonly associated with various negative effects, such as an increased heart rate and shakiness, and despite the fact that levalbuterol generates similar effects, most of the studies have noted that they are just minimal (Ameredes et al., 2009). Another important aspect to note is the fact that albuterol contains a shorter period of action, estimated to be 4-6 hours, while levalbuterol works for about 5-8 hours (Qureshi et al., 2005). Perhaps, this can be the reason behind the relatively higher cost of levalbuterol compared to that of albuterol. It is also important to bear in mind that when it comes to the period of hospitalization, levalbuterol is considered to be cheaper as its use is highlighted to result in lesser days of hospitalization compared to the use of albuterol. However, what does not make sense is the claim that levalbuterol contains a better efficacy compared to albuterol. Based on the composition of the two drugs, it is highlighted that albuterol contains both (R)-albuterol and (S)-albuterol in the ration of 50:50 (Qureshi et al., 2005). In addition, it is suggested that levalbuterol is purely made up of (R)-albuterol that gives it the bronchodilation effect. It, therefore, remains unclear with regard to how levalbuterol contains a better efficacy when compared to albuterol. It is important that more studies are conducted in this area in order to establish the truths behind these claims. Impact on the Field This paper is of a great important, considering the fact that it has expanded the available literature regarding the topic. This paper has highlighted some of the clinical issues that have to be considered with regard to the use of albuterol and levalbuterol. In addition, the paper has highlighted an area that requires more research. This is in consideration with the fact that several studies have highlighted that levalbuterol contains a better efficacy compared to albuterol, basing on the drug composition, while, in essence, there is no solid proof to support this claim. Thus, it is important that further research is conducted in this field to establish the fact behind this claim. Potential Impact on the Disease Management It is worth noting that COPD is today considered as one of the major causes of deaths globally (Quinn, 2004). However, it is feared that the rates might escalate, especially with the increase of smokers as well as major lifestyle changes. Thus, this results in huge economic burdens in terms of the loss of productivity as well as the costs of healthcare. This, therefore, explains the main reason as to why COPD has to be managed. It is important that the correct and effective medication is identified to ensure that the disease is put under control. This paper has, therefore, provided an analysis of the existing literature with regard to the two drugs that are most commonly used in dealing with the disease. From the analysis, it is clear that albuterol is considered to have a shorter duration of action, be cheaper, and to generate more negative effects if compared to levalbuterol. Therefore, health practitioners can consider these aspects when dealing with COPD. From the review of the existing literature in this field, the paper recommends that levalbuterol should be considered as the drug of choice when dealing with COPD. This is based on the facts that levalbuterol exerts fewer negative effects, causes fewer hospitalizations, and generates better respiratory parameters if compared to albuterol. Furthermore, it is highlighted that the use of levalbuterol is cheaper considering the fact that its use leads to fewer hospitalizations. However, this paper recommends that further research should be conducted to support the claim that levalbuterol contains a better efficacy than albuterol, basing on the composition of the two drugs. Most of the clinical studies aimed at determining the relative safety of albuterol and levalbuterol have often generated varied results. The conflicting results have even made it difficult to rule out which one among the two drugs should be administered in the treatment of COPD. This paper has analyzed some of the existing studies to come up with a recommendation as to which drug should be used. Most of the studies highlight that levalbuterol brings about less negative effects, results in fewer hospitalizations, and has lower overall cost of treatment. Based on the highlighted advantages, the paper recommends that levalbuterol should be opted for as a remedy for COPD. However, the study recommends a further research to support the claim that levalbuterol is more effective than albuterol basing on the drug composition. Buy custom Chronic Obstructive Pulmonary Disease essay

[WATCH] How women can advance in their careers despite failure

[WATCH] How women can advance in their careers despite failure Daily Fuel sat down with the President and CEO of one of the nation’s leading women’s business organizations; Terry Barclay of Inforum.   Terry shares the best advice she can offer to any aspiring professional, and provides some fascinating statistics involving women and their ability to advance in their careers.And while Terry is specifically speaking to women, her insights apply to everyone.   Listen as she talks about the importance of courage and how our ability to summon it at crucial moments at work can often determine whether we will lead the lives we imagine for ourselves.Source: [DailyFuel]

International strategy operation Coursework Example | Topics and Well Written Essays - 1250 words - 2

International strategy operation - Coursework Example As a small-scale company in Austria, AGRANA had to compete with other larger and similar companies. Prior to 1989, AGRANA encountered a lot of business challenges before it was able to successfully compete in the global markets. Regional integration is referring to the process in which companies located in different regional states are actively interacting with one another in order to promote both economic and political security1, 2 whereas global integration is pertaining to the process in which the company is able to benefit from the act of combining the different business activities that are located in different countries around the world3. Through regional and global integration, AGRANA was not only able to gain benefits from economies-of-scale but also created more competitive advantage. Ever since the CEE decided to open its market to other regions and in the world market, the scope of AGRANA’s target market also increased significantly. Through foreign direct investment (FDI), AGRANA took the opportunity to expand its manufacturing plants in different regional and international sites4. Since AGRANA was selling homogenous products, its target buyers can easily purchase the same item from other companies. Back when the scale of AGRANA was small, the bargaining power of its buyers was high. Therefore, the company was determined in searching for ways on how they can effectively cut down its operational costs without sacrificing the quality of the products. To compete in the market, the company had no other choice but to improve its marketing and production strategies to create cost and differetiation advantages5. It means that through product differentiation, market segmentaion, the use of generic strategies, and continuous reduction in the actual fixed costs of the busienss6, AGRANA was able to keep up with the tight market competition. For example, instead of

Animal welfare Research Paper Example | Topics and Well Written Essays - 1000 words

Animal welfare - Research Paper Example ey use physiological measures such as plasma cortisol, endorphins, and the heart rate to determine the ability of the animal to cope with the environment. Seeing animal welfare in terms of the body has limitations such as (a) environment and genetics can create wanted physical outcomes but the animal’s mental state is in jeopardy, (b) some physical parameters such as plasma cortisol and heart rate are difficult to interpret because they can be influenced by the negative and positive experiences (Hewson 496). Animal welfare thus integrates the state of the animal’s body and the feelings. Feelings such as fear and frustration form the basis of the animal welfare; if the animal is feeling well then it is faring well. Feelings in animal welfare measures the outcomes like behavior; behavioral outcomes entail things such as the willingness to work and behavioral signs such as frustration and fear (Hewson 496). One of the biggest problems in the animal welfare is how animals are transported and slaughtered. For many years people have been transporting and slaughtering animals. Animals have provided everything mankind has needed like food, and clothing. The modes of transport and slaughter have been inhumane with some of the people subjecting the animals into situations that were unbearable. The animals are left or die in devastating situations; terror, exhaustion, and injury are the outcome of such brutality (Council of Europe 55). It is very difficult and tiresome to convince large animals to go into a certain direction particularly up in a ramp. On the other hand, smaller animals such as the chicken are not exceptional and they can be frustrating. Bone fractures and bruises are common when the meat birds are being harvested for slaughter; they are usually grabbed by the legs and a number of them get injured or bruised in the process (Spedding 51). The major problems in the slaughtering of animals are the lack of pre-slaughter stunning in kosher (schechita) and

Charlie’s Wedding, A Play in One Act Essay Example for Free

Charlie’s Wedding, A Play in One Act Essay Gertie, a black woman, dressed in elegant black satin, stands at the window, her back to the audience. She may be polishing the glass or she may be eves-dropping on the two fashionably dressed white ladies, Mona and Sheila, who sit on a divan directly behind her, facing the audience. Mona: What on earth did he say then, Sheila? Sheila, (smiling coyly): He said he wants to marry me, of course, silly. Mona: But he can’t do that†¦can he? I mean†¦(a pause) Well†¦ you know what I mean. Men like him†¦ Sheila: That’s just the point†¦ men like him†¦they can do whatever they want. Mona: Well, I’m just saying†¦they don’t buy a cow when the milk is so cheap. Sheila: Well, he might buy the cow that gives milk as good as this one does. Mona feigns embarrassment, her hands going to her face as she buries her head in her hands for a moment. Gertie moves to the right and looks at pictures in frames on the mantle of the fireplace, now obviously listening, cocking her head to hear better. Mona: Girl, you have no shame. (Giggles) But you are about to graduate from here anyway. You don’t have to marry, you don’t have to do anything but pack your bags and run, girl. Sheila: But I might just want to get married. Isn’t it what every young lady is reared to do? Aren’t we born and bred to be the wives and ornaments of powerful men? Isn’t it my duty as a woman? Isn’t it my calling? My raison d’etre? (Misprounounces the words) Mona: If it’s what you want, then by all means you should do it. Be my guest. I will dance at your wedding with a cow-bell on. But it’s not going to be to that two-timing Charlie O’Brian, I surely do hope, child. Gertie moves until she is standing at the side of Sheila, picks up a small bowl from the end table and is wiping it slowly. Sheila: Well how can you be so presumptuous? I mean, what do you know about it anyway? And why do you say he is a two-timer? If you know some gossip that I don’t then you are bound by your duty as a woman to tell me. Gertie puts down the bowl and speaks: Yes, Miss Mona, do tell all you know about this two-timing Charlie O’Brian. Do you have some reason to suspect he may not be as morally upright and Christianified as he purports to be? Is he, perhaps†¦a†¦man of low degree? The three women laugh and Gertie takes a seat in the chair, in profile to the audience, putting her feet up on a ottoman and fanning herself from her labor. Gertie: Let me tell you about men all men. They are idiots†¦all idiots, and Charlie O’Brian is their Lizard King. They are all just big boys. They never grow up and they never think with the head they have on their shoulders. I know you can guess which head it is that they do think with, without me having to say. But they control the money and politics and they control the laws and we have to work around them to get what we want. Now, as for this Charlie O’Brian, he has proposed to half the women in this sorority and that is a natural fact. He got big drunk last Christmas and asked me to run off with him. I told him that for twenty dollars I would run into the pantry with him for a spell, but that is all of the running I meant to do. Child, no man is ever faithful to no woman and I will tell you how you can be sure of what a man is up to. If you think he is faithful to you then he is most likely cheating on you. But if you think he is cheating on you, then he is positively cheating on you. And you can take that to the bank, honey. Sheila: We all know how men are. But Charlie is different. He loves me. He really does Gertie: Sugar, last year he loved Abbie, and the year before that he loved Sara Lynn. He loves a lot of ladies. And lots of ladies love him. But ain’t none of them ever got a brand on his li’l narrow behind. Mona laughs: Gertie, you are such a romantic soul. But you are wrong about Charlie boy. He loves a lot of women but he don’t love any of them. We all know about commercial affection. That’s why there are sporting houses and sporting ladies who can be found in them, and men know all them and they go sow their wild oats and then pray for a crop failure. Charlie O’Brian haunts sporting houses. He is a sporting man. He is going to leave you crying. Sheila looks at Mona, irritated: Well Miss Know It All, that just proves my point, because men don’t marry sporting ladies do they? They marry good girls, from good families. They marry ladies of wit, breeding and sagacity. They go sow those wild oats but then when nesting time comes around they look for a woman who is better than any sporting lady. They look for someone who can entertain for them, can give them sons and can keep their home for them. I don’t care where my man gets his kicks so long as he kicks his boots off at home with me. I am a pragmatic person. I understand the ways of the world. I did not just fall of no turnip truck, and believe it or not, I did not come to this town riding two to the mule. Mona looks at Gertie who shrugs her shoulders, then speaks: Honey, you are missing one very important point. You are too good for Charlie O’Brian. He is beneath you and that’s a fact. You will never be happy with someone like him. He is common as dirt. He is in the trades. He will keep you filled up with a belly-full of children and leave you barefoot and pregnant. He is not good enough for you. Get him out of your pretty little empty head. Now, lets discuss this party, we have to finish these plans. We are really getting short of time now. Christmas will be here before you know it and we can’t wait til the very last minute. Gertie stands and picks up her dust cloth and moves behind the divan, facing the audience, looking down at the other two girls: This party is going to be such a bore. Boy girl, boy girl, boy girl†¦so boring. We should invite some transvestites and some of them folk what you call hermaphrodites of both sexes and let everyone try to guess who is who and who has what and just see how that messes up the seating arrangements. (Laughs) Mona: That would make it a party to remember. Do you know any real transvestites? Oh, I’m sure you do. You are so worldly, Gertie. (Mona and Sheila laugh) Sheila: Well, I’m more interested in making wedding plans than Christmas party plans. I want the wedding to be here. Right in this room. We’ve all have had so much fun here, and there are so many good memories associated with this room. Yes, I’ve made my mind up. I want to come down those stairs (points off stage, left) and I want all my friends to be here and see me on the happiest day of my life. Gertie: Girl, you are serious? You said yes to Charlie O’Brian? Sheila nods and speaks: I told him last night. He said he wants to marry me on New Year’s Eve. I told him I was going to go away for the holidays but he asked me to stay in town. It’s official. I told him I will marry him on New Year’s Eve, just like he wants me to. Mona: Sheila, please, listen to me. Charlie O’Brian is no good. I would never say a word to harm you but I can’t sit here and watch you just dash headlong off of no cliff. He is not the man you think he is. He is not a good person. He is a liar and a fake and he will end up dead or in prison and he will drag you down with him. You are too fine a person to make such a terrible match. You just can’t let yourself sink to his level. Sheila: Mona, please. Why are you doing this? What have I ever done to you that you would disrespect me so much? Charlie is the only man who has ever treated me with any of the common courtesies. He doesn’t paw me, or try to kiss me when we are alone. He behaves like the perfect gentleman. Gertie puts down her dust cloth and moves back to her chair, She pulls it closer to the divan and sits down, leaning forward conspiratorially: Sheila, child, I may be out of place to say this, but Mona is right. That Charlie O’Brian is bad news. Don’t you know he got into a fight with a man over a card game? In a public place? He is one step from disaster all the time. He is a common ruffian when he is drunk and he is drunk most all of the times. He can’t be trusted any further than you could toss a bull by the tail. He is a daddy’s boy and won’t ever be nothing that his daddy don’t let him be. Hasn’t your schooling here taught you anything? It seems at least you would have learned to read men. Child, I’m saying this for your own good, Mona is right, you can’t marry that Charlie fellow. He is not good enough for you. I beg of you to reconsider your answer and tell that Mister O’Brian that you have reconsidered and you find that you cannot become his wife. Sheila buries her face in her hands sobbing Mona leans forward to comfort her, but Gertie gestures for her to stop Gertie: Child, I am sorry that I have made you feel bad but the simple fact is that you have to recognize that what Mona and I are telling you is for your own good and it is the gospel truth. Sheila stands: I don’t want to hear anymore of this. I don’t know how you figure that Charlie is not good enough for me. He has a good position in his father’s business and he can take care of me. I know that it’s not considered proper but he and I have discussed finances. I have agreed to put my trust money into a business proposal which he has become interested in. He is sure it will put us on easy street and I believe in him and I believe in his ideas. His father will finance half of it and I am going to put in the balance. But most importantly, ladies, he loves me passionately. We have spoken of our future together and we have decided to marry quickly without any long engagements. You ladies know I was orphaned and this sorority is what I reckon as my family. It’s the only family I have ever really had. You are all as close to me as blood sisters could be and I do appreciate you trying to look out for my best interest. But you just don’t know Charlie O’Brian like I know him. He wants me for the rest of his life and I want him the same. Sheila walks slowly out of the room, stage left: Gertie, to Mona, in a soft voice: What are we to do? Mona: What can we do? Gertie: Has she lost her mind or is she just yanking our chain? I swear I can’t get a fix on what she is thinking. But I’m prone to think she is believes this. That he is going to marry her. My god, this will destroy her if that is the case. Can we get Miss Edith to ban him? Keep him out of here? Mona: Miss Edith? Ban a paying customer? Are you a crack ho? Gimme a taste of what you is using. I don’t want no whole one†¦ just gimme a li’l taste, girl. Gertie laughs, then speaks: If he came in here and beat her up†¦if he broke her ribs, Miss Edith would ban him. Why let him break her heart? Mona: How long has she been here? Seriously? How can she believe anything a john tells her? She has served her indentures and is going to leave inside of six months with a nice piece of change. Hasn’t she learned anything? This has to be some kind of elaborate joke, don’t you think? You know how she has always been. How she calls us her sisters†¦how she call the house a sorority. She isn’t serious, and she isn’t putting on airs. It is just her way of coping with being a prostitute. But, lordy, what if she is smitten? What if she has fallen for the no good scalawag? Gertie: You want to know what Charlie O’Brian has in mind for a business deal? He wants to buy this house. Do you think he plans to get some funds out of her by saying he will marry her? Maybe we should tell Miss Edith all about this plan. Mona: No, I just had an inspiration. Why don’t we go the other way? Why not talk it up. Go overboard, all out in favor of it? Make it a matter of public record? Announce the engagement. Announce a big wedding right here on Christmas Eve? Let young Mister O’Brian put up or shut up? We just pretend we accept it as a done deal. We just go on with the wedding plans. Gertie giggles at the thought, then speaks: No! Wait†¦We are goin’ to be all decorated up for Christmas. We get Miss Edith to announce the imminent wedding when Charlie gets a few under his belt this coming Saturday night? We tell Miss Edith its just all a big joke on Charlie. We get the piano player to play Here Comes the Bride and let Sheila come down them stairs right there in a white gown. Charlie is all hat and no cattle but we can fix that. I know how. It looks like a win-win situation for us. He either backs out, and looks like a liar and a fool, or he goes ahead and marries a lady of the evening, which will cause his daddy to cut his manhood off so he can’t reproduce. (laughs) It would be so appropriate to have him look like a four-flusher or a fool in front of all his peers. We can get Parson Maybury to hang around just in case we need a few appropriate words†¦in case Charlie is drunk enough to do it. Oh my god, what I wouldn’t give to see him wake up the next morning married to Sheila. Mona: Miss Edith would never let us jack with a customer like that. Gertie: Not if she thinks we’re serious. But so long as we put it to her as an elaborate joke done in good honest fun It will be perfect for the holidays. We can convince her its entertainment and will bring in some new customers just to watch Charlie O’Brian marry a working girl. Arnie Harris works at City Hall. He will get me a blank marriage license if I ask him sweetly. We have good ol’ Harry on the piano. Todd Baker can take the wedding photos. Most of the men in this town dislike the O’Brians and would enjoy a good laugh at Charlie’s expense. You know, probably fifty per cent of the men in this town have gone up those stairs right there at some time in their life. (points) Then there is forty per cent of the men in this town who wish they could. Which leaves us with about ten percent who would like to take care of the 40 per cent who can’t make it, but that’s another story, but about ninety-five per cent of them do not like the O’Brians. Mona: Oh my god, girl, that would be the funniest thing I ever saw, to have spoilt, rich, pampered goodie two-shoes Charlie O’Brian married in the parlour of the finest House in all of New Orleans. And see the pictures spread all over the Sunday Times- Picayune†¦in the society section. We can make up a guest list. Include the governor’s name. Oh my god†¦girl, you’re a genius. (laughs). We don’t have to say they came, just say they was invited. Every man in town who is not an actual customer is fair game. Miss Edith would have our heads for revealing the names of actual customers but there ain’t no social taboo against revealing names of customers of the competition is there? Gertie: No, I would reckon they are fair game. Mona: We got to let Cloonie in on this. He can get some of the guys to go along with this. Bring in some tuxedos for the wedding party, for the pictures. Get a pen and paper, Gertie, we got to make a list of everything we need. I want it to be just perfect for Mister Charlie O’Brian’s wedding. What do you call them little fancy flowers men wear in their button hole? Well, we even want to get some of them. Oh yes, we have to do this up right. Charlie’s momma may want to send these pictures out to all the relatives who couldn’t actually make it to her son’s social event of the season, a whore-house wedding. Gertis: I’ll check to make sure, but Beaulah usually keeps some of that laudanum on hand for her croupe. If she is out she can get Doc Baines to send over a fresh bottle. Charlie will go to ordering his fancy little stemware glasses full of brandy and benedictine†¦he thinks that’s so posh†¦then he slips into that god-awful fake English accent and goes to calling himself Mister B and B. That sweet mess has such an odor about it that I could pour in a cup of creosote and he wouldn’t ever come close to tasting the difference. He sure won’t notice no dab of laudanum poured in. After a couple of shots of that stuff he will be cocked and primed. He will do what ever he is told to do, and smile while he is doing it. Mona: You know, there aren’t many of our customers who are disliked enough for us to pull this off on them. But Charlie O’Brian is pretty much universally thought to be a piece of human detritus. Everyone thinks he is a smarmy low life. This is perfect. Gertie: well, not totally perfect. We still aren’t sure where Sheila fits into all of this. What she is really thinking. Does she believe Charlie or is she just blowing smoke up our dresses to pass a cold winter day? Mona: Well†¦what difference is it? If she wants to marry him, she is going to end up married, with a ring and a license and she legally owns half his property as well. If she doesn’t, then we tell her it’s just all one big practical joke and we laugh about it. Gertie and Mona stand, Gertie speaks: That’s the thing I miss most about being in the sporting life. I miss the weddings. This is going to be some good fun. (Both women exit the stage, loudly humming The Wedding March)

Ancient Roman Government :: essays research papers

The city of Rome is located on the Tiber River in Italy. It has nearby volcanoes that spread ash across the city, promoting the arable land. Rome began about 1,000 B.C., and was founded by Romulus and Remus. The Etruscans were a people who conquered the early Romans in 616 B.C., and ruled over them for the next 100 years. Around 550 B.C., the Romans finally kicked the Etruscans out and began to rule themselves again. They came up with a new type of government called a republic. An Athenian democracy had one leader at the top and was elected by the citizens. After the election, all the citizens helped run the city because everybody voted. This is the type of government Rome had before the Etruscans conquered it. After that, there was a Roman Republic. The Roman Republic had a group at the top and was elected by the citizens as well. After the election, voters did not do much in terms of running the city. In the Roman Republic there were two consuls, or leaders elected by the voters. The citizens had representatives that voted for them. There was a senate, or a part of the government, which was made up of the representatives of the upper class. These representatives were called senators and the upper class was called patricians. There was also an assembly, or a part of the government that was made up of representatives of the common people. These representatives were called tribunes and the lower class was called plebeians. In addition to these, there was a forum. It was originally the main downtown area of Rome, but it later became the center of Rome?s government, religion, and arts. By 264 B.C., Rome was having problems with Carthage, the capital city of the Phoenician Empire. It was directly across from Rome in North Africa and both wanted control of Corsica and Sardinia. In 261 B.C., there was the first Punic war. Twenty years later, the Romans won, but they were losing the first ten years. Then they gained new ships and began to win. They gained control of Corsica, Sardinia, and Sicily. In 221 B.C., the second Punic war was started when Hannibal, a Carthaginian general, wanted revenge on the Romans because his father was killed in the first Punic war. In 202 B.C., there was the Battle of Zama when the Roman general Scipio went up against Hannibal.

Lord of the Flies: Human Nature Essay

â€Å"We are all murderers and prostitutes – no matter to what culture, society, class, nation one belongs, no matter how normal, moral, or mature, one takes oneself to be. † R. D. Laing British psychiatrist. R. D. Laing obviously backs up William Golding’s point of view that human nature is evil. Human nature is directly affected by the environment; and is constantly changing due to the experiences of the individual. Oscar Wilde once said â€Å"The only thing that one really knows about human nature is that it changes. Change is the one quality we can predicate from it. The systems that fail are those who rely on the permanency of human nature, and not on its growth and development. The error of Louis XIV was that he thought human nature would always be the same. The result of his error was the French Revolution. It was an admirable result. † Human nature depends upon the environment in which they are immersed. The idea that children, not humans in general, are swayed by the ideas and actions of their parental figures is also a central idea of the book, â€Å"The Lord of the Flies† by William Golding. Because of the war in England where the boys were from their human experience was one of war. If there was no war going on in England at the time they were evacuated from England, there would’ve been no deaths, no Lord of the Flies, and certainly no beast. Because if they had came with a good human nature then how would there have been a beast which Golding classified as the basic evil inside all of us. Another thing that ties in with this that children try to copy what they see adults do so if a child sees an adult smoke up or drink then he may believe that it is okay or it is right because their parents do it. As George Orwell once said â€Å"Part of the reason for the ugliness of adults, in a child’s eyes, is that the child is usually looking upwards, and the adults are rarely looking down. Yet no matter what they will always adore, look up to and love their parents. † But as was just said sometimes that can be a bad thing. So what must we do? Well for starters why not try to teach our children better and try at all costs to set good examples for our children so that our society will hopefully be salvaged from the god forsaken wrath of evil. Children who’s parents smoke have a 40% higher chance of smoking than children who’s parents don’t smoke. 1 Chances are it is a mix of two things, first the fact that they think that it is okay for them to do it since their parents do it, the second is because of the nicotine addiction could be passed on from adults to their offspring. Now of course there are exceptions to the thesis like kids who smoke because their parents don’t, but that is usually a small percentile of the population. Most children will not do it as a rebellious act just because they see their parents doing it so therefor it is okay. Now as was stated briefly previously kids will a lot of the time do what their parents do because they look up to them so why wouldn’t they copy what the adults are doing. So why can’t we just stop altogether because we have a lazy society who rejects change so this may take a lot longer than would be hoped for. â€Å"The only thing that one really knows about human nature is that it changes. Change is the one quality we can predicate from it. The systems that fail are those who rely on the permanency of human nature, and not on its growth and development. The error of Louis XIV was that he thought human nature would always be the same. The result of his error was the French Revolution. It was an admirable result. † So with this in mind why do people still rely on human nature to remain the same when it has been proven that human nature is constantly changing. That is why our country has not recently had a revolt because our forefathers had enough insight to know that things would not be the same 200 years from then. This idea was shown throughout the book by the kids changing their minds and revolting. First all the children agreed that rules were needed to keep order amongst themselves. Then when they felt the boring and unpleasant side of work and rules they changed their human nature to that of a slacker or a person who doesn’t follow society’s rules and doesn’t attempt to strive for excellence. Also after voting Ralph the president, people still later agreed and followed Jack. So basically al that can be gathered by this information is that never rely on human nature to remain the same. In conclusion, although it may no work due to the constant changing of human nature, we must try not to set bad examples for younger ones who look up to us, and also try to give our children the best life we can provide for them and teach them right from wrong and teach them the right morals. Basically, we should just try to do the best parenting job we can do and hope the information and things you taught him or her will help them through life.

Altering the Landscape of Health Care Essay

The health care field is one of the fastest growing industries in the United States and other countries. The scope of changes suggests a consumer-driven environment and moving away from a provider-driven industry. Changes in technology and communication methods are allowing people to engage directly with their health care provider and not rely solely on the medical provider. We will discuss the modifications taking place in health care, current and potential challenges, and how the health care industry is adjusting to those changes. Modifications in Health Care The modifications taking place in health care involve the implementation of the Affordable Care Act (ACA) and changes in insurance coverages. A report from Mobile Health 2012 from the Pew Internet & American Life Project states that 45 percent of American adults own a smartphone (Khan, 2014). In addition, the report also states that 53% of smartphone owners use their phones to gain access to health care information (Khan, 2014). With this increase in technology, patients do not have to wait for the next appointment for laboratory results, access real-time data, or health information. They can have access to their medical records anytime they choose, including other methods of communication such as email or social media (Khan, 2014). Through the ACA, patients have choices about choosing health insurance exchanges that benefit their families and themselves, which includes choosing premiums, copays, and deductibles. Individuals have the benefit of choosing cost-effective insurance coverage that is affordable for them which give them direct power and actively engaging in their quality of care. Current and Potential Challenges in Health Care The current and potential challenges facing health care comes from the new mandates under the ACA. Health care employees are under tremendous stress with shortages in the workforce, and instability in the industry (Anderson, 2014). The average health professional’s level of stress is causing job dissatisfaction, burnout, and difficulty retaining quality health care providers (Anderson, 2014). Consumers expect to receive quality care with more choices under the ACA and have the freedom to monitor their health care expenses. Although patients can seek additional health care information through technology, it will take a strong workforce to provide optimum patient care to consumers (Anderson, 2014). The challenge to improve the quality of care without a strong, resilient, growing workforce is undeniable. Many health professionals are seeking other career interests because of the effects of ACA. The mandate that comes under the ACA increases the level of stress on workers, organizations, and the health system is increasing tremendously (Anderson, 2014). The complexity of implementing the rules of the ACA places extreme burden on health providers to fulfill professional obligation, adhere to legal requirements, and still provide quality patient care (Anderson, 2014). Instead of lifting the pressure off of workers it place enormous stress to perform with excellence daily. Another huge challenge in health care is the increase of medical errors because of overworked individuals, which creates fewer optimal outcomes, including patient death and health care disparities (Khan, 2014). The mandate on medical providers to implement electronic health records is creating workforce stress, increased workloads, and burnout among health providers and professionals (Anderson, 2014). In addition, there will be growth in the workforce because of the increase in the number of patients that will be insured under the ACA. Therefore, this will create overwhelming strain on existing medical workers and their ability to accomplish those goals. Solutions to Health Care Challenges The effort to remain competitive in the health care industry requires medical providers, such as physicians, hospitals, physician group practices, and numerous health care companies to integrate and merge businesses (Anderson,  2014). As stated in the article, mergers and acquisitions lower operating costs, but also keep an even distribution of financial safety and increases market share (Anderson, 2014). Consolidations now include many physicians selling their practices to join physician groups and working in hospitals. With these changes taken place, insurers, hospitals, physicians and stakeholders can have an increase in negotiation power (Anderson, 2014). In 2011, there were consolidations that include 432 mergers involving 832 hospitals (Anderson, 2014). As a result, many hospitals are not independent but are now major health care systems throughout the United States. The implementation of the ACA suggests more individuals by law will have to purchase insurance. The health care system is not prepared to handle the large quantity of cases, which will add significant stress among workers. Health care organizations will need an efficient workforce to accommodate the growing population and give patients the quality of care that they deserve (Anderson, 2014). According to Anderson, â€Å"Solutions to the existing problems will require innovation in medical education and training, improved delivery of care, and implementation of policies to retain the existing health care workforce† (Anderson, 2014, p.1). The shift taking place in health care will continue to change along with the implementations under the ACA and the mandate to obtain insurance coverage. Changing the landscape of health care includes the shift to mobile technology and consumer-driven industry. Consumers are more aware of technology that can assist in gaining access to medical information and are seeking alternatives to insurance coverages and reducing costs. Therefore, they are engaging directly with the medical providers and taking ownership of their health information and status. Health care professionals are seeking less stressful working environments, smaller workloads, and even other career paths. The operating costs of the health care system are astronomical and will continue to increase as health care becomes available to more consumers. References Anderson, A. (2014). The Impact of the Affordable Care Act on the Health Care Workforce. Re trieved from http://www.heritage.org/research/reports/2014/03/the-impact-of-the-afforda ble-care-act-on-the-health-care-workforce Khan, F. (2014). The Shift to Consumer Driven Healthcare. Advance Healthcare Network. Retrie ved from http://healthcare-executive-insight.advanceweb.com/Features/Articles/The-Shif t-to-Consumer-Driven-Healthcare.aspx

Writing Graduate School Entrance Essays

Writing Graduate School Entrance Essays If you are thinking about applying for graduate school, chances are you once applied (and were admitted) to undergraduate school. That being the case, Im certain you had to compose a personal statement to accompany your undergraduate application. Remember that? Wasnt it fun? No? Well, then youre out of luck. Because you have to repeat the process all over again with graduate school entrance essays. Lets face it: no one likes to write an entrance essay and/or personal statement composition for college admission. In addition to being personally revealing and creatively stifling, the things are just plain difficult to compose. Unfortunately, college admissions boards use these essays to separate the average from the above average applicants. So you might as well make the most of it. Graduate school application essays are, in my opinion, much easier to write than those for undergraduate school because youve already gone through the process once already. Heck, you might even want to locate and dust off your undergraduate statement for inspiration. After all, its not really plagiarism if youre copying from yourself. When writing your graduate school entrance essays, it helps to go easy on yourself. Allow for plenty of time and prepare for some frustration. In the end, your graduate school essay, whether its a nursing essay, a residency statement, or an MBA essay, is going to determine your future. So no pressure.

A List of 50 Most Popular Expository Essay Writing Topics

A List of 50 Most Popular Expository Essay Writing Topics Look through the list of 50 best expository essay topics to choose one for your expository writing. If you are assigned to write an expository essay youll definitely need to get to know the main expository writing promps. Weve published a series of articles on the theme of expository writing: What Is an Expository Essay? 6 Steps of Expository Essay Writing Expository Essay Sample And below youll find a list of 50 most popular expository topics: Expository Essay Topics: Restaurant McDonalds uses pink slime mixture in Chicken McNuggets product McDonalds washing beef with ammonia solution Subway says Eat Fresh but doesnt slice their meat in-store Olive Garden uses bagged salad mixes and not fresh products for their signature salad Why do pizza chains, like Pizza Hut, use dough that comes in frozen? Taco Bells ground beef is actually only 35% meat Fast food chains charging $0.30 for a slice of tomato on a sandwich Fast food chains overcharging for substitutions such as sauce changes, adding cheese or extra sauces/veggies Expository Essay Topics: Politics Social Security will be obsolete by the time Generation X is old enough to retire Obama Care is still not affordable Government hides full details of the financial status of the country National news networks attack the government for answers with no replies Is the security of the nation really being protected? Is forcing health insurance on citizens actually legal? For those that cannot afford health insurance, is putting them in jail or fining them really the right answer? Why is the US Government unable to allow other countries to fend for themselves? Do the taxes you pay really go toward benefitting the country or just to satisfy the financial hardships of a mismanaged governmental system? Why are those without children forced to pay school taxes in the city they reside in? Why do states force residents to pay taxes in both the city they live in and the city they work in? Why does the Government cover up its mishaps instead of informing the public of the flaws? Tea party demonstrators’ protest only for the media attention The Government is failing by not being financially stable to support those that were injured serving the country Government agencies are protected from the law Expository Essay Topics: Medicine Health Insurance companies cannot deny you but that doesnt mean you can afford coverage How much does it really cost a doctor to spend 10 minutes with a patient for an office visit? Why are Emergency Room visits so expensive even for minor visits where no tests are done? Do you check your hospital bill? Many items are double billed. Does every misdiagnosis deserve a lawsuit? Is Fibromyalgia really a disease? Why are patients without insurance treated differently at hospitals than those with insurance? The hypocritical oath that doctors have to take does not apply to how patients are really treated Herbal supplements are used as pads for companies to profit without FDA studies being conducted Doctors push certain medications to increase profits for certain pharmaceutical companies Expository Essay Topics: Celebrities Paula Deen uses racial slur years ago and gets scrutinized and dropped by sponsors Justin Bieber plays a birthday song in the nude in front of an elderly person Celebrity crimes and why celebrities get lesser penalties Why are celebrities given lesser sentences for repeat crimes? Celebrities are offered options regarding punishments for crime that regular offenders are not Miley Cyrus and her change in personality The Cyrus family is in the middle of major controversy since with the pending divorce The real reason Jason Aldean chose to leave his wife and their previous marital problems What is the real reason that Lady Gaga dresses the way she does? Is it really for the attention? Is being a celebrity really all its cracked up to be? What life is really like with mass media attention Expository Essay Topics: General Issues Police officers do not follow the traffic laws they enforce Court systems in America are not hard on deadbeat mothers Dads seeking custody of children are denied more often than not even when mothers are dangers to their children Social Security is paid to those without real ailments, such as unprovable chronic migraines The elderly are living poorer in this decade than in the last century DUI offenders have rights, and why this is false Why do those that have committed serious or vile crimes serve less time than a violator of probation If you are working on an expository essay and found no topic that matches your needs in our list expository essay topics, we will help you to select the topic you require and work on it. Our support staff will assign you a writer with a suitable background and experience, which will result in a paper that is properly written and formatted.  Place your order  to start working with our essay writing service.

Blacks Assignment Example | Topics and Well Written Essays - 1000 words

Blacks - Assignment Example In the 1870’s about 80% of American Blacks lived in the southern rural American area where there was large scale exploitation of laborers by wealthy American land owners (Sampson 1464). This started to change in the late 1800’s when the Blacks in the south started to migrate to better cities in the south and to the north for a better life especially during the American industrialization. This change brought about a great change in the life of Black Americans in the Unite d States of America socially, politically and economically. The Black ghettos did not just emerge, but were occasioned by among other reasons, a systematic arrangement of the Whites to prevent the Blacks from acquiring proper urban housing in certain areas and to segregate them. Socially, Blacks were considered to be inferior to Whites and were created to serve the Whites, a mentality which was strengthened by the Jim Crow laws. Though small areas that were occupied mainly by Blacks had existed before, Black ghettos started to emerge in the north with the migration of Blacks to the United States of America during the First World War, the Second World War and the 1920’s. ... Blacks were systematically removed from areas considered to be White neighborhoods due to this ideology. There was also the scenario where people who engaged in communal violence were singled out and confined to certain places and for the Blacks; this was in the ghettos (Douglas and Nancy 17). This practice mostly targeted Blacks who were considered to be violent in nature. In the period around 1920, there was also what was referred to as targeted violence which was mostly directed to the Black middle class by their White counterparts, which also gave rise to the expansion of the Black ghettos and relegation of Blacks to what were considered as Black neighborhoods. The Whites would collect money to buy out middle class urban dwellers from their neighborhoods with threats of dire consequences for non compliance, which gave rise to the concentration of Blacks to certain neighborhoods. Those Blacks who could afford to live in White neighborhoods were attacked and their houses looted or burnt just because of the color of their skin. The neighborhoods especially in the south were characterized by large avenues which housed Whites and small streets and poor dwellings which housed Blacks, with the Blacks working as house helps and farmhands in the White neighborhood dwellings. The mentality of Master /slave had been replaced by master/servant relationship but the Black was still seen as subservient to the White. Incase of arrests for the offences, the culprits would be the Blacks instead of the White attackers. The Whites considered Blacks no matter their social, economic or educational standing to belong to the Black neighborhoods, with the support of the state through the Jim Crow laws and other segregate