Review of literature on Postoperative Pulmonary Complications

Review of literature on Postoperative Pulmonary Complications According to Polit and Hungler (1999) the task of reviewing research literature involves the task of reviewing research literature involves the identification, selection, critical analysis and written description of existing information on the topic. Related literature which was reviewed is discussed under the following headings. Studies related to overview of the postoperative pulmonary complications. Studies related to chest physiotherapy and incentive spirometry. Studies related to overview of postoperative pulmonary complications Soledad Chumillas (1998) posited that pulmonary function is commonly altered after surgery, particularly in patients who have had chest or upper abdominal surgery. The physiological changes observed are directly related to anaesthesia (general or regional) and to the type of incision and surgical technique employed, and are reflected by decreases in total pulmonary capacity and pulmonary volumes and by a parallel decrease in Pa02. Yoder (2009) said that thoracic and upper abdominal surgery is associated with a reduction in vital capacity by 50% and in functional residual capacity by 30%. Diaphragmatic dysfunction, postoperative pain, and splinting make these changes. After upper abdominal surgery, patients shift to a breathing pattern with which ribcage excursions and abdominal expiratory muscle activities increase. Postoperative patients maintain adequate minute volume, but the tidal volume is very low and the respiratory rate increases. These abnormal breathing patterns, along with the residual effects of anesthesia and postoperative analgesics, inhibit cough, impair mucociliary clearance, and contribute to the risk of postoperative pulmonary complications. David Warner (2005) described that many factors responsible for PPCs are related to disruption of the normal activity of the respiratory muscles, disruption that begins with the induction of anaesthesia and that may continue into the postoperative period. The effects of anaesthesia can persist into the postoperative period, though via different mechanisms, as the effects of surgical trauma come into play. These are most pronounced following thoracic and abdominal surgery, and arise from at least three mechanisms. First, functional disruption of respiratory muscles by incisions, even after surgical repair, may impair their effectiveness. Postoperative pain may cause voluntary limitation of respiratory function. Finally, stimulation of the viscera, such as provided by mechanical traction on the gallbladder or esophageal dilation, markedly decreases phrenic motor neurone output and changes the activation of other respiratory muscles, in general acting to minimize diaphragmatic descent. Other factors that may contribute to PPCs include: 1) Reflex stimulation during surgery, and release of inflammatory mediators by drug administration, increasing airway resistance and limiting expiratory gas flow from the lung; if severe this can produce hyperinflation with risk of barotrauma and gas exchange abnormalities. 2) Impairment of normal mucociliary transport by anaesthetic gasses and endotracheal intubation which may delay clearance of pathogens and promote retained secretions 3)Impairment of lung inflammatory cells function by prolonged anaesthesia and surgery, which could increase susceptibility to postoperative infections 4) Impaired upper airway reflexes postoperatively, with may increase the risk of aspiration, and 5) Incomplete reversal of neuromuscular blockade. Rochelle Wynne and Mari Botti (2004) postulated that the pathogenesis of postoperative pulmonary dysfunction is associated with anomalies in gas exchange, alterations in lung mechanics, or both. Abnormalities in gas exchange are evidenced by a widening of the alveolar-arterial oxygen gradient, increased micro vascular permeability in the lung, increased pulmonary vascular resistance, increased pulmonary shunt fraction, and intrapulmonary aggregation of leukocytes and platelets. Variations in the mechanical properties of the lung lead to reductions in vital capacity, functional residual capacity, and static and dynamic lung compliance. Woerlee (2009) listed certain performance criteria for the respiratory system of a surgical patient. They are: The lungs must have sufficient oxygen to oxygenate the blood. The pulmonary circulation must eliminate carbon dioxide from the body to prevent carbon dioxide accumulation. The client must be able to generate a productive cough, otherwise mucus accumulation will occur resulting in atelectasis and/or lung infection or pneumonia. The client must be able to significantly increase their respiratory minute volume to compensate for factors such as increased postoperative metabolic rate, elevated body temperature, possible infections, pneumonia, etc. Poor performance in significantly raising and sustaining an elevated respiratory minute volume results in exhaustion and respiratory failure. Postoperative pulmonary complications account for a substantial portion of the risks related to surgery and anaesthesia and are a source of postoperative morbidity, mortality and longer hospital stays. The current basis for our understanding of the nature of Postoperative pulmonary complications is weak; only a small number of high quality studies are available, a uniform definition has not emerged, and studies have focused on specific patients and kinds of surgeries. Current evidence suggests that risk factors for Postoperative pulmonary complications are related to the patients health status and the particular anaesthetic and surgical procedures chosen. Age, pre-existing respiratory and cardiac diseases, the use of general anaesthesia and overall surgical insult are the most significant factors associated with complications. Election of anaesthetic technique, postoperative analgesia and chest physiotherapy seem to be the preventive measures that are best supported by evidence. (J.C anet, V.Mazo, 2010) J.C.Hall ., et.al (1991)evaluated the relationship between postoperative pulmonary complications and various putative risk factors in a prospective longitudinal study of 1000 patients undergoing abdominal surgery. Transient subclinical events were studied by defining postoperative pulmonary complications as positive clinical findings in combination with either positive sputum microbiology, unexplained pyrexia, or positive chest roentgenographic findings. The overall incidence of postoperative pulmonary complications was 23.2%(232/1000). These findings supplies clinicians and clinical nurse with a simple means of identifying patients who are at high risk of postoperative pulmonary complications after abdominal surgery. Postoperative pulmonary complications contribute significantly to the overall perioperative morbidity and mortality. Pulmonary complications occur significantly more often in patients undergoing elective surgery of the thorax and abdomen. These include atelectasis, infections including bronchitis and pneumonia, respiratory failure and bronchospasm. Sharma (2000). The study findings of Brooks-Brunn (1995) revealed that atelectasis and infectious complications account for the majority of reported pulmonary complications. Risk factors were thought to exaggerate pulmonary function deterioration, which occurred both during and after surgical procedures. 18 risk factors were reviewed regarding their Pathophysiology, impact on preoperative, intra operative and postoperative pulmonary function in this study. Identification of risk factor and prediction of postoperative pulmonary complications are important. Preoperative assessment and identification of patients at risk for postoperative pulmonary complications can guide our respiratory care to prevent or minimize these complications. Postoperative pulmonary complications were investigated in a total of 41 paediatric recipients who underwent orthotopic liver transplantation. Atelectasis was seen in 40 cases (98%) of the 41 recipients, and occurred in the left lower lobe in 28 cases (68%), and in the right upper lobe in 25 cases (61%). Radiographic pulmonary edema occurred on 23 occasions in 18 recipients (45%). Five recipients experienced two episodes of pulmonary edema during their ICU stay. Pleural effusions were observed in 21 cases (52%), of which 18 had right sided effusion and 3 had bilateral effusions. Pneumothorax occurred in 3 cases. Pyothorax, hemothorax, bronchial asthma and subglottic granulation occurred in one case each. The present study demonstrated that postoperative pulmonary complications are frequently observed in paediatric recipients undergoing orthotopic liver transplantation. (Toshihide et.al.,1994). Kanat et al., (2007) studied the risk factors for postoperative pulmonary complications in upper abdominal surgery. They concluded that pulmonary complications are the most frequent causes of postoperative morbidity and mortality in upper abdominal surgery. A prospective study on 60 consecutive patients was conducted who underwent elective upper abdominal surgery in general surgical unit. Each patients preoperative pulmonary status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry, blood analysis, anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time. Complications were observed in 35 patients (58.3%). The most complications were pneumonia followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. They recommend a detailed pulmonary examinations and spirometry in patients who will undergo upper abdominal surgery by ch est physicians to identify the patients at high risk for postoperative pulmonary complications, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely postoperative pulmonary complications occurrence. Serojo et al., (2007) in a prospective cohort study, studied risk factors for pulmonary complications after emergency abdominal surgery. Pertinent data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications were analyzed. 286 consecutive children were included and 75 (28.2%) developed postoperative pulmonary complications. Pulmonary complications are frequent among children undergoing abdominal surgery and lead to increased length of hospital stay and death rate. Kilpadi ,et al., (1999) in a prospective study of respiratory complications, conducted a study for a period of six months with total samples of 584 patients, who underwent elective or emergency surgery. He found that 81 of them had 13.9% of respiratory complications, 68% had pneumonia and others included pleural effusion, empyema and exacerbation of asthma. Felardo et al., (2002) investigated the postoperative pulmonary complications after upper abdominal surgery. Two hundred and eighty three patients were followed from pre to postoperative period. A protocol including a questionnaire, physical examination, thoracic radiogram and spirometry was used during preoperative period. Sixty nine (24.4%) patients had pulmonary complications in 87 events registered. Pneumonia was the most frequent event 34% (30/87) followed by atelectasis 24% (21/87), broncho constriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). Pulmonary complications occurs more frequently than cardiac complications. The complication rates for upper abdominal and thoracic surgery are the highest. A better understanding of the risk factors associated with postoperative pulmonary complications is essential to develop strategies for reducing these complications. In any individual patient the benefit from a surgical procedure should be weighed against the risks it imposes. When possible, stabilization of respiratory status is advisable before surgery. (Muhammed Aslam, Syed Hussain, 2005). Decline in pulmonary function after major abdominal surgery is thought to be identified in daily assessment by observation of breathing and pain intensity. Measurement of pulmonary function is usually not included in the assessment of the patient in postoperative period. The aim of this study was to investigate the relationship between clinical observation of breathing and decline in pulmonary function and pain. Eighty nine patients admitted for elective major, mild and upper abdominal surgery, participated in the study. Clinical observation of breathing covered the following parameters like abdominal expansion, side expansion, high thoracic expansion, paradoxical breathing, symmetry of thorax expansion, ability to huff and signs of mucus retention. Pain intensity was assessed at rest and during breathing exercises and during coughing using a visual analogue scale. Peak expiratory flow rate were performed on the preoperative day and for seven postoperative day. A poor correlation is found between clinical observation of breathing and pulmonary function after abdominal surgery. (Johannes vandeleor et al ., 2003). Fung et al., (2010) compared postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared.  Forty-nine obese children were identified (20:29, female: male). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications (P = 0.000). Ten obese patients and two controls incurred major events (P = 0.012); 36 obese children had minor complications versus 12 controls (P = 0.000). Obese children had significantly more upper airway obstruction (19 vs. 4, P = 0.0003), particularly during the immediate postoperative period. The mean hospital stay was significantly longer for the obese group (18 vs. 8 hours, P = 0.000, mean difference of 10 hours). He concluded that Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Sixty patients were studied to determine the incidence of postoperative pulmonary complications and the value of preoperative spirometry in producing pulmonary complications after upper abdominal surgery. On the day before the operation and for 15 days after the operation, each patients respiratory status was assessed by clinical examinations, chest x-ray, spirometry and blood gas analysis. A chest physician and surgeon monitored patients for pulmonary complications independently. In this study postoperative pulmonary complications developed in 21(35%) patients (pneumonia in 10 patient, bronchitis in 9 patients, atelectasis in 1 patient, pulmonary embolism in 1 patient) of 31 patients with abnormal preoperative spirometry, 14 patients showed normal preoperative spirometry, 7 patients showed complications. It was concluded that postoperative pulmonary complications was still a serious cause of postoperative morbidity. (Kocabas et al.,1996). Study conducted by Ephgrave et al., (1993) revealed that postoperative pneumonia was a major complication that had been linked to micro aspiration of pathogens originating in the gastrointestinal tract. 140 patients who had undergone major surgeries were selected. Postoperative pneumonia is present in 26 (18.6%) of 140 patients. Postoperative pneumonia is a morbid postoperative complications associated with presence of gastric bacteria during operation and transmission of gastric bacteria to the pulmonary tree after surgery. Studies related to chest physiotherapy and incentive spirometry Chest physiotherapy is an important therapy in the treatment of respiratory illness. It is very important to carry out this procedure in children for the purpose of loosening secretions from the lungs. Morran, et al., (1993) has done a randomized controlled trial on physiotherapy for postoperative pulmonary complications. A sample size of 102 patients undergoing cholecystectomy were assigned to control group and study group. The patients in the control group did not receive chest physiotherapy, while patients in the study group received chest physiotherapy. The study proved that without chest physiotherapy 21 patients developed atelectasis and 19 patients developed chest infections whereas with chest physiotherapy 15 patients developed atelectasis and 7 developed chest infection and 40 patients developed no complication. The author concluded that routine prophylactic chest physiotherapy significantly decreased frequency of chest infection (p

True Tragic Hero in Sophocles Antigone :: Antigone essays

The True Tragic Hero in Sophocles' Antigone    In Master Sophocles' Antigone, the question of who the tragic hero really is has been a subject of debate for a great number years. Creon does possess some of the qualities that constitute a tragic hero but unfortunately does not completely fit into the role. Antigone, however, possesses all the aspects of a tragic hero. These are, in no particular order, having a high social position, not being overly good or bad, being tenacious in their actions, arousing pity in the audience, a revelatory manifestation, and having a single flaw that brings about their own demise and the demise of others around them. Antigone possesses all of these traits therefore qualifying as the tragic hero.    The first qualifying aspect is that Antigone is of a high social standing in Thebes. Creon himself refers to her as a princess though she is technically no longer one. Because of her high standing she is capable of great suffering, in that she has a lot of fame and regard to lose. Those who say Creon is the tragic hero state say that Antigone is no longer in a high position in the society, therefore does not qualify on that account. If the character had needed to be in a high political position this would be true, but they need only have a great deal to lose in their downfall. Although she may no longer hold political power Antigone is still a powerful figure in Thebes, since she was to be married to Creon's son Haemon and the whole city seemed to know how tragic her life had become.    Antigone and Creon would qualify as the tragic hero if the only requirement was not being overly good or bad. Creon shows his negative side when he refuses to bury Polyneices and when he speaks to the sentry. His positive side is shown in his obvious affection for Antigone and Ismene, whom he has attempted to raise since their fathers death. Antigone's ungodly side is shown by her incestuous behavior with her brother Polyneices. Her positive side is shown by the way the she insists on respecting his right to be buried in the religious tradition of Greece so that his soul may live on in the afterlife.    Another aspect of a tragic hero is an unwavering course of action, most likely caused by their flaw, that brings about their demise and the demise of those around them.

Financial Statement Essay: Internal & External Users Essay

Abstract Whether or not myself or anybody else who may or may not be going to school to be an accountant, it’s still important to know the basic fundamentals of more than just a business and/ or company but the numbers as well. Any success comes from the time, patience, passion, potential, and MONEY. Money is most important because without it, how can anything become an investment. We have to learn the four basic financial statements to set ourselves for a future. Even if there are ones who are going to be internal users- such as managers or external users- ones who are creditors and investors that may use financial statements to use as a tool of decision making. In this essay, I have discussed the importance of financial statements and the usefulness that it is to both internal and external users. Identifying & describing the four basic financial statements. The backbone of financial accounting is arranged in four different financial statements. The first would be a balance sheet, in which the purpose of this financial statement is presenting a picture at a point in time of what the business owns (assets) and what it owes its (liabilities). The second, an income statement, which shows how successful your business is performed during a period of time and this is where you report all the revenues and expenses. Third, the retained earnings statement, which indicates how much of previous income was distributed to you and the other owners of your business in the form of dividends- shares, and how much was retained in the business to allow for further growth and increase. Lastly, a statement of cash flows, which shows where your business obtained cash during a period of time and how much cash was used. How financial statements can be useful to internal users. Financial statements would be useful to internal users because managers are those who plan, organize, and run an entire business; they have to be able to present summarized financial information, which is a financial statement. It is important for them to know because numbers matters when it comes down to any type of business. They have so many important questions that needs to be asked and answered; for an example, â€Å"Is cash sufficient to pay dividends to Microsoft stockholders,† which is a Finance question. All the information has to be detailed on a timely basis. Also, for internal users, accounting provides internal reports, such as forecasts of cash needs for the next year. How financial statements can be useful to external users. External users are investors- owners, creditors, and investors. Financial statements are very important when it comes down to external users. Investors buy and sell stocks based upon their own belief of a company’s performance in the future; they are always interested in a company’s past net income because it does provide information for predicting how well the company’s will do. For an example, The United Airlines, creditors will ask â€Å"Will United Airlines be able to pay its debts as they come due?† Concerns all depends on the past, present, and future of a company’s success of its net income because if investors and creditors didn’t have assurance in different types of businesses then the economy would suffer. Many prospective company’s look to receive loans and borrow money so they can invest into something they have been planning over a period of time but, doesn’t have the funds to cover it so they are in need of sources to finance their vision. It takes money to make money. References Kimmel, P. D., Weygandt, J. J., & Kieso, D. E. (2011). Financial accounting: Tools for business making (6th ed.). Hoboken, NJ: John Wiley & Sons.

Nutrition and Obesity Researchers Essay Example

Nutrition and Obesity Researchers Essay Example Nutrition and Obesity Researchers Essay Nutrition and Obesity Researchers Essay Nutrition and Obesity Researchers BY kellygur13636 Obesity and Ways to Overcome It 1 Obesity A. )What is Obesity? 1 . ) Too much body fat 2. ) BMI calculates this B. )What are the causes? 1 . ) Overeating/Fast food 2. ) Not enough exercise 3. ) Television advertisements 4. ) Genes C. )Physical effects 1 . ) Not attractive 2. ) Health problems a. ) Diabetes b. ) High blood pressure D. )Mental Effects 1 . ) Social discrimination 2. ) Bias due to media 3. ) Low self-esteem 4. ) Depression 5. ) Eating Disorders 6. ) Limitations E. )Prevention 1 . ) Limiting fast food and calorie intake 2. ) Read nutrition facts . Exercise F. )Conclusion 1 . ) Eating right and exercise is the key to being healthy 2. ) Websites that can help obesity Obesity is becoming a major issue in America today. More than one-third of the population is obese according to the Centers for Disease Control and Prevention, and nearly 112,000 people die each year from obesity-related illnesses (Adult Obesity Facts). Obesity is still on the rise and has been for years. Obesity can affect anyone regardless of age, race, or gender. THERE ARE MANY FACTORS THAT CONTRIBUTE TO OBESITY AND THESE CAN HAVE MANY NEGATIVE EFFECTS BUT REASEARCH HAS SHOWN THAT HEALTHLY EATING HABITS AND EXERCISE CAN HELP AN INDIVIDUAL LIMIT THESE EFFECTS. Obesity simply means having too much body fat. This usually happens when one takes in more calories than he can burn off. This causes extra body fat and over time measured with BMI: Body Mass Index (BMI) can be used to measure both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and other health professionals. BMI is a direct calculation based on height and weight, and it is not gender-specific. Most health organizations and published information on verweight and its associated risk factors use BMI to measure and define overweight and obesity. BMI does not directly measure percent of body fat, but it provides a more accurate measure of overweight and obesity than relying on weight alone (How Obesity is Measured). A BMI of 18. 5 to 24. 9 is considered healthy for adults. A BMI of 25 to 29. 9 is considered overweight, while a BMI of 30 and above is considered obese. People with BMIs of 18. 5 or less are considered underweight (Weight Loss Diet Plans). Obesity can be caused by several things. Eating too many fatty foods and not xercising is one cause. Some people think that fast food is to blame for obesity. Fast food is so tasty, convenient, and inexpensive. The portion sizes are bigger than they should be with supersize and extra-large. According to McDonalds USA nutrition facts a big mac contains 550 calories, a large French fry contains 500 calories, and a large coke contains 310 calories. Thats a total of 1,360 calories for one meal which is more than half of the daily recommended amount of 2,000 calories (McDonalds USA Nutrition Facts for Popular Menu Items). Fast food advertisements are constantly shown on television. Advertisers spend so much money advertising messages for children and teens. In the book Obesity and the Media, Oconner states: According to a Kaiser Family Foundation study, the average American child watches more than forty thousand television commercials per year Most of these forty thousand ads are for candy, cereal, soda, and fast food ( Oconner 21). Its no wonder people choose fast food over healthy, home cooked meals. Genes can also cause obesity. The genes that could influence obesity are still being investigated. Freedman states: According to the U. S. Centers for Disease Control and prevention, several independent studies have reported that a gene referred to as an FTO(fat mass- and obesity-associated) gene might be responsible for up to 22 percent of all cases of common obesity in general population(Freedman 14). If a persons parents are obese, he is at risk of becoming obese. If both of a persons parents are obese, this risk doubles. Children tend to follow the eating habits of their parents. So if the parent is always eating fatty foods, the child follows because they think it is okay (How Parents Are Influencing Their Childrens Bad Eating Habits). In todays society Obesity is not attractive. Rarely do you see someone who is obese in movies or magazines because she is not physically attractive to most people. Not only does obesity affect someone on the outside, obesity can also cause many physical effects to ones health. Being overweight or obese can increase the likelihood of developing serious health problems including the following: type 2 diabetes, high blood pressure, coronary heart disease, stroke, some types of cancer, gall bladder disease, osteoarthritis, respiratory problems, and sleep apnea (Overview of Obesity). the book The Mental and Physical Effects of Obesity, Jeri Freedman states: Ninety percent of people with diabetes have type 2 diabetes. Studies have shown a close relationship between obesity and type 2 diabetes. In the past, most cases of type 2 diabetes were diagnosed in middle-aged and elderly people. However, in numbers of preteens and teens have been diagnosed recent years, increasing with type 2 diabetes (22). This can make the lives of these people very difficult. A person with diabetes is supposed to follow a special diet, take medication, and constantly monitor the level of sugar in his blood. If this is not followed, it could cause other problems and could be fatal (22). High blood pressure, which can also be linked to obesity, is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems. In an online article titled High Blood Pressure and Obesity it says: Many medical studies have shown a relation between obesity and high blood pressure. In fact, obese people have a higher blood pressure than people with a normal blood pressure. The cardiovascular risk is increased with obesity (High Blood Pressure and Obesity). Its alarming to know that obesity can cause this many health problems. There are also many mental issues that are linked to obesity. Social discrimination is common among people who are obese. Obesity is looked down upon. People can learn to be biased from messages in the media. In the book Obesity Discrimination by Dale-Marie Bryan, he states: A 2002 study published in Research and Practice by Greenberg, Eastin ,Hofschire, Brownell and Lachlian, showed that in real life, one in four women is obese, but on television only three out of every one hundred women are portrayed as heavier. It also showed that men in real life are three times more likely to be large-sized than he men on television (27). With that said, people think that the world should be skinny, and try to live up to those standards. Discrimination can happen at school, work, and even within families. Sometimes children who are obese are ignored and made fun of by other children. This can cause low self-esteem. Low self-esteem can lead to depression. Freedman states: Depressed people often have low energy, which makes them less likely to get exercise and more likely to stay home and eat (33). Obesity can also lead to eating disorders because of the emphasis of being overweight. In an online article it states: High numbers of adolescent girls are reporting that they are dissatisfied with their bodies and are trying to lose weight in unhealthy ways, including skipping meals, fasting, and using tobacco. A smaller number of girls are even resorting to more extreme methods such as self-induced vomiting, diet pills, and laxative use. (Eating Disorders and Obesity). People who are obese cannot do some of things that people who arent obese can do. One example is, when going to an amusement park, there are weight limits on the rides, and the seats are made for smaller people. Someone who is obese cannot get n. Movie theaters, bathrooms, and restaurant booths are all made for smaller frames so being obese makes it hard to use these. A friend of mine, is considered obese. She is 25 years old, weighs 300 pounds and is 58. She has been obese since elementary school. I conducted a phone interview Being obese has affected me physically because its hard for me to do physical activities and I become out of breath and tire easily. Mentally, I often feel depressed because of my weight. Sometimes I feel that people look at me differently because of my weight and criticize me. I have been called fat and a whale numerous times by my peers. It is something that I struggle with every day. I havent had a serious relationship with a male and I believe that it is because of my weight. Guys Just dont seem to find me attractive. Both of my parents have passed away at a young age due to being obese. They both suffered from diabetes and high blood pressure. My mother was 45 when she died and my father was 47. This has opened my eyes and I have been trying to change my eating habits and exercise more. It is not easy though since I have been this way all my life. Being obese affects Katie in many ways. It is sad to hear how people treat her because of her weight. In my eyes, she is a great person, and I dont Judge her by her weight. I do try to encourage her to change her eating habits and exercise more frequently because I dont want her to lose her life because of her obesity. There are several ways that obesity can be prevented and treated. Limiting the amount of food, especially fast food, is a good way. Because fast food is so high in cholesterol and fat, limiting the amount eaten to no more than once per week can prevent someone from becoming overweight or obese. Reading the nutrition labels on foods being eaten is a good way to recognize how much fat and calories is in it. The FDA recommends that someone should choose foods that have fewer calories per serving and that are lower in saturated fat, cholesterol and sodium . The majority of calories someone eats should come from vegetables, milk, whole grains, fruit, and smaller amounts of meat. Portion control should be practiced (Using Nutrition Labels). Here are some suggestions from the FDA: Dont think of certain foods as off-limit, instead start by reducing the portion size of the unhealthy foods that you crave and add something healthy on to your plate. Use smaller plates, drink more water, and start implementing the plate model MyPlate enforced by the U. S. Department of Agriculture. When eating out, its a good idea to choose a starter like a delicious salad and then skip the supersized meal and order a normal sized meal instead. Healthy eating also means to eat slowly and make sure to chew your food properly for a better digestion. If you have a habit of eating in front of the TV or computer, its easy that you overeat. Make time to eat and dont rush it and enjoy your food without distractions (Eating Health can be easy). Exercising on a regular basis can help someone to stay fit and in shape by burning off excess calories. Bill Hendrick, a writer for WebMD Health News says, While frequent exercise is known to fght obesity and improve mental health, as little as 30 minutes of physical activity one or two days a week can have benefits. Exercise can improve someones mood because it causes the brain to release chemicals that can make someone more relaxed and less stressed out. It helps weight management and can even help someone to sleep better. (Hendrick). In the article Exercise and Physical Fitness it states that, Regular exercise is a critical part of staying healthy. People who are active live longer and feel better. Exercise can help you maintain a healthy weight. It can delay or prevent diabetes, physical activity at least five days per week. Examples include walking briskly, mowing the lawn, dancing, swimming for recreation or bicycling. Stretching and weight training can also strengthen your body and improve your fitness level (Exercise and Physical Fitness). Obesity is something that has been growing in America. With the harmful effects that come with it, many measures are taken to address it and treat it. It can be hard to lose weight and it doesnt happen overnight some people are taking steps to help it. Eating right and exercising is the key to being healthy and fit. A good way to measure BMI and determine if someone is overweight or obese is to visit cdc. gov and use the BMI tracker. There is a website available (www. myfitnesspal. com) that can track calorie intake and exercise. Many other websites are available to help overcome obesity. There are also groups someone can attend to get help, one example is weight watchers. Although obesity is still a major issue today people can get the help and take the steps needed to overcome it. BMI Calculator Plus: Personalized BMI for Your Body Type and Metabolism. WebMD. WebMD, n. d. web. 28 NOV. 2012. Bryan, Dale-Marie. Obesity Discrimination. First ed. New York: Rosen Central, 2009. Print. Eating Healthy Can Be Easy. Food Pyramid. N. p. , n. d. Web. 28 Nov. 2012. Exercise and Physical Fitness. U. S National Library of Medicine. U. S. National Library of Medicine, n. d. Web. 28 Nov. 2012. Freedman, Jeri. The Mental and Physical Effects of Obesity. First ed. New York: Rosen pub. , 2009. print. Hendrick, Bill. Even a Little Exercise Fights Obesity. WebMD. WebMD, n. d. Web. 08 NOV. 2012. High Blood Pressure and Obesity. Blood-pressure-hypertension. com. N. p. , n. d. web. NOV. 2012. How Is Obesity Measured? Annecollins. com. N. p. , n. d. Web. 08 Nov. 2012. McAlpine, Katie. How Does Obesity Affect Your Life. Telephone interview. 08 Nov. 2012. McDonalds USA Nutrition Facts for Popular Menu Items. Nutrition. mcdonalds. com. N. p. , n. d. web. 28 NOV. 2012. Overview of Obesity. Summa Health System. N. p. , n. d. Web. 28 Nov. 2012. Using the Nutrition Facts Label. Fda. gov. N. p. , n. d. Web. 28 Nov. 2012. Wilkinson, Michelle. How Parents Are Influencing Their Childrens Bad Eating Habits. Dr Akilah El Celestial Healing Wellness Center. N. p. , n. d. Web. 28 Nov. 2012.

American Romanticism Literature quiz Essays

American Romanticism Literature quiz Essays American Romanticism Literature quiz Paper American Romanticism Literature quiz Paper Essay Topic: Literature American Renaissance Five year burst of creative energy from 1850-1855 America gained literary independence from Great Britain What happened in American Literature between 1820-1865 1820-1865 What years did the Era of Optimism last? Confidence in the economy, political system, and citizenry of the nation; population of European immigrants rapidly expanded; technological advances such as the Erie Canal, railroad, farming equipment, the revolver, the telegraph, and oil drilling What conditions fueled national optimism? Sectionalism and cultural provincialism What are 2 issues that undermined national optimism? National division between the North and the South; compromises proved to be only temporary solutions; political independence (States Rights) and slavery; civil war What are some causes of sectionalism? Absence of international copyright law; limited perspective and expectation of many American readers; two schools of thought on the issue of a national literature (strikingly American and universality in theme and form) What are some reasons for cultural provincialism? Revolt against the literary values of the previous age; individualism; imagination; emotion displaced reason; nature; the distant What were some romantic emphases in literary romanticism? Individualism What means man as an individual is superior to man in the mass; all men possess the necessary credentials for public office; man is not a fallen creature, just corrupted by corrupting influences in society?

Information management Essay Example | Topics and Well Written Essays - 1000 words

Information management - Essay Example This paper will equally explain why information and knowledge have become more important in contemporary societies, differentiating industrial from knowledge economies. The paper will relevantly apply the framework Knowledge Management Value Chain to explain how Knowledge Management Systems can improve knowledge management in organisations, and the limitations of such systems. Explaining the three conceptual frameworks by Michel Porter The three generic strategies for building a competitive advantage include cost leadership, differentiation, and focus. The focus strategy has two variables that include cost focus and differentiation focus. In cost leadership, a company seeks to become a low cost producer in its area of specialization where it must find and exploit available sources of cost advantage. This is possible only where the company is able to command prices in the neighborhood of the average price. In this case, cost advantage is dependent on the structure of the industry and its sources are not exclusive and may include proprietary technology, the pursuit of economies of scale, and preferential access to raw materials. A firm that manifests cost leadership guarantees competitive advantage. Dell Computer Company falls in this strategy. ... In cost focus strategy, the company seeks a lower-cost advantage in the minor market segments. It focuses on a basic product that is dominant and high priced but acceptable to sufficient consumers. A small retailer featuring its own-label is a good example in this strategy. In the differentiation focus strategy, a company seeks differentiation between needs and wants that an existing competitor is not providing within just one or a small number of target market segments. A perfume shop is a good example (Porter, 1998, p. 11-15). The five forces model addresses the operating environment of a company and includes the threat of entry, the power of buyers, the power of suppliers, the threat of substitutes, and competitive rivalry. The force of threat of entry notes that the ease of easier of new companies to enter the industry generates stiff competition. As such, the numerous conditions that limit the threat of new entrants to the market are the barriers to entry. On the other hand, the force of threat of substitutes is the probability of a consumer to change to a competitive product or service. This arises from the similarity of substitutes. The lower the changing cost the greater the threat. The force of power of suppliers relates to the amount of pressure that suppliers can place on a business. The larger the suppliers pressure power, the greater the competitive advantage. The force of pressure customers relate to the pressure that a customer can place on a business. The greater the customers pressure power, the less the competitive advantage of the company. The force of competition rivalry describes the intensity of competition between existing firms in an industry. Competitive advantage falls with an increase in competition. The

The Rhetorical Presidency Essay Example | Topics and Well Written Essays - 1500 words

The Rhetorical Presidency - Essay Example He managed not only to rescue his presidency but also instill national moral revival which had been diminishing. Now it has become a common phenomenon in contemporary leadership. The Genesis of Rhetoric Presidency Throughout the 19th Century, rhetoric presidency was received with a lot of suspicion and presidents rarely attempted to directly communicate to the people. Even the few speeches delivered by presidents were totally different from the ones delivered today. They were mostly concerned with constitutional matters, patriotism or conduct of war as opposed to today’s domestic policy speeches aimed at moving the nations’ conscience. In the modern times however, presidents have come to believe that they are not effective presidents if they cannot be able to exhort the public. It is now common for presidents to make press conferences, radio or TV coverage speeches, news releases or congressional address every so often. These speeches have a common tone to them, i.e. â €Å"Speaking is governing,† (Ceaser, 159), and are aimed at exhibiting the public’s reaction as if to a real situation. ... President Nixon was aware of the public’s reaction to a lot of rhetoric and came up with his own anti-rhetoric promising to stop it, but the president could not even control himself from ‘shouting back’ at his detractors. And of course there was President Carter who at first was all calm promising to bring sanity back to government but by the mid of his term his speeches were all full of rhetorical forcefulness talking of the decline and revitalization of the country. But what are the implications of these rhetoric speeches that almost all the contemporary presidents find themselves caught into? The Rhetoric Presidency: ‘Pulpit Bully’ or Mere Baloney? Many people term these speeches as mere rhetoric and they know that it’s all talk. But despite the knowledge of this fact, the excess speeches have continued to inflate people’s expectations to the detriment of these leaders. This has developed into an institutional dilemma for all the mode rn governments. These presidents are expected to match their actions with the ideals they created in the public’s mind through their rhetoric speeches. In the end, it is their government that is weakened by this kind of leadership since it is hard to measure up to the peoples’ puffed up expectations. With failure comes criticism and cynicism from the same people they sought to impress. When George Bush was asked about his most disappointing experience in leadership, he admitted that he was not a good communicator. Clinton too wished he had done a good job in communicating to the public according to what he could achieve, (Edwards, 20). So is the president’s office exactly a ‘bully pulpit’ as Roosevelt described it? Most modern