The History of Advertising Essay Example | Topics and Well Written Essays - 3000 words

The History of Advertising - Essay Example This conversation focuses on that there are numerous explanations behind this like, culture, riches, accessibility of credit and obviously item advancement. This paper takes a gander at these propensities based on a significant section throughout the entire existence of publicizing. The promoting business was stirred up by a man called William Bernbach. His most outstanding accomplishments were the advertisements created by his organization for the German automaker Volkswagen, not long after their presentation in the US. The work here will concentrate a portion of the highlights of the module and its connection to the notices of Bernbach for Volkswagen.â From this paper unmistakably William Bernbach and his partner Ned Doyle and Maxwell Dane framed the publicizing organization named Doyle Dane Bernbach (DDB) in 1949. This office made the progressive promotion crusades for the 1950s and 1960s.The Volkswagen battle was viewed as outstanding amongst other battle since it expanded the deals of the Volkswagen vehicle. â€Å"This advertisement crusade built up the Volkswagen brand as a marker for nonconformity.† Bernbach’s promoting system was to trey to keep clients as opposed to pulling in the consideration of the individuals who were not intrigued by the item. Bernbach comprehended that a promotion didn’t sell an item and he defined inventive styles in printing the notices. Their thought was to give straightforwardness in print ads. These commercials were completely unique in relation to the recognizable promotions which offered significance to the American automobile’s ground-breaking motors, and huge size a nd so on. The Volkswagen ads encouraged individuals to purchase a vehicle which they could drive cheaply.â

De Niros Game

De Niro’s Game â€Å"De Niro’s Game† by Rawi Hage is a story about growing up about a kid named Bassam from war torn Lebanon. The principle settings are the headings of the three pieces of the novel; Roma, Beirut and Paris. The settings help to outline character advancement, the novel’s topics and are significant images all through. The main area of the novel is entitled â€Å"Roma,† however the occasions all happen in Beirut. Bassam never goes to Roma, anyway it is constantly present in the novel and a significant image all through. Roma is a spot that Bassam has needed to go his whole life.Roma represents Bassam’s trust in a superior life. He fantasizes that it is an ideal spot, just about a paradise. At the point when a young lady from his local bites the dust he says â€Å"I went to the little girl’s memorial service, the young lady who was headed to Roma. † pg. 25. While visiting his companion George he says that they †Å"whispered connivances, traded cash, drank lager, moved hash in delicate, white paper and I applauded Roma. † pg. 34. In the Roma segment Bassam is more youthful and more honest than in different segments. Bassam is as yet an insignificant criminal.He just carries out little wrongdoings, for example, vandalism and medication use. The way that the primary segment is called Roma, yet it isn't in Roma, is a type of anticipating, proposing this dream may never become reality. The second piece of the novel is called â€Å"Beirut. † This segment is the defining moment of Bassam’s life. In this area Bassam quits dreaming about Roma. Beirut represents Bassam’s loss of guiltlessness. He begins perpetrating significant wrongdoings, for example, killing the minute man ‘Rambo. ’ Bassam begins to find out about the fierceness of the war and the butcher being submitted by the militia.Beirut is an image of the frightfulness on the planet. In Beirut, Bassam acknowledges how brutal reality and the war are. Not long after understanding this he says â€Å"Ten thousand final resting places had slipped underground and the living despite everything moved over the ground with guns in their hands† pg. 88. At a certain point Bassam says â€Å"From the rooftop I could see West Beirut ablaze. The Israelis besieged the occupants for quite a long time, orange light sparkled in the night, automatic weapon projectiles left the ground and shot into the air in red curves. The city consumed and suffocated in alarms, boisterous blood and death† pg. 163.Not just does Bassam find out about the terrible things going on in the war yet he likewise witnesses his closest companion George slaughtering himself, since George can't continue realizing that he has carried out such deplorable wrongdoings against mankind. Due to the war Bassam is double-crossed by his closest companion, tormented by the state army for a wrongdoing he didn't submit and is compelled to understand that the local army and war are bad, but instead ethically off-base and trivial. Part III, of the novel is called Paris. Bassam escapes from Beirut and goes to Paris scanning for George’s father. After Bassam discovers Georges family, they before long deceive him.Paris is an image of Bassam’s complete and articulate sadness. In Paris Bassam thinks â€Å"I had no plans, and understood that I was unable to think about any. Other than Rhea, nobody in Paris knew me, nobody was anticipating me for supper, nor to stroll in a memorial service parade, nor to work, eat, convey the injured, speed around on motorcycles† pg. 215. He has practically no spot in Beirut and even to a lesser degree a spot in Paris. Paris represents that Bassam is demolished by the war in Lebanon. Bassam is an outcast in Paris due to his wound ethics and qualities that were undermined because of the war.He peruses â€Å"The Outsider† by Albert Camus, which discusses the unimportance of presence and acknowledges there are numerous likenesses among him and the character in the book. Regardless of where he goes, Bassam will consistently be an outcast. Paris helps Bassam create as an individual, understanding that things are unpleasant all over the place, and he can't get away from quite a while ago. Close to the finish of the novel, Bassam says â€Å"And so I floated for quite a long time, trying and neglecting to accommodate Paris with the ghost of my childhood, with the books I had perused, with my educators stories† pg. 204. Bassam acknowledges Roma is a fantasy.Setting and spot are indispensable abstract gadgets in â€Å"De Niro’s Game†. The settings are connected to the topics, in that Beirut is a city obliterated by war as Bassam is annihilated by war, and because of his excursion through Paris he understands his fantasies of Roma are out of reach. The adjustments in setting additionally equal and imprint the phases of his transitioning. In Roma Bassam was a kid, in Beirut his change started and in Paris, Bassam turned into a man. While Bassam is not the slightest bit an ideal or even great individual, he has made a change into adulthood. Without the setting his change into masculinity would have been less clear and with

How Strattera and Adderall Treat ADHD

How Strattera and Adderall Treat ADHD ADHD Treatment Print The Difference Between Strattera and Adderall By Jacqueline Sinfield facebook twitter Jacqueline Sinfield is an ADHD coach, and the author of Untapped Brilliance, How to Reach Your Full Potential As An Adult With ADHD. Learn about our editorial policy Jacqueline Sinfield Medically reviewed by a board-certified physician Updated on June 25, 2019 ADHD Overview Symptoms Causes Diagnosis Treatment Living With In Children istockphoto In This Article Table of Contents Expand How They Work Treatment Choices Forms, Dosages, and Efficacy Side Effects Risk of Abuse Black Box Warning View All Strattera and Adderall are medications prescribed to help treat attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder characterized by difficulty with regulating attention and controlling impulses and hyperactivity. Both drugs improve attention span and decrease hyperactivity and impulsiveness; however, they are very different medications. The most striking difference between the two is that Strattera is a non-stimulant, while Adderall is a psychostimulant medication. How They Work These drugs are from different drug classes and work in distinct ways in the body. Strattera Strattera is a brand name for a drug that contains atomoxetine. It was approved by the U.S. Food and Drug Administration (FDA) in 2002 and became the first non-stimulant medication to receive approval for ADHD.?? It was also the first medication to be approved for treating adults with ADHD. It can be prescribed for people 6  years of age and older. Strattera is a norepinephrine reuptake inhibitor, which means it allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer. It also raises the quantity of the neurotransmitter dopamine in the prefrontal cortex of the brain. Adderall Adderall is a brand name for the combination of drugs dextroamphetamine and amphetamine. It belongs to the amphetamine drug family. The FDA approved this medication in 1996. In addition to ADHD, Adderall is also approved to treat narcolepsy. It can be prescribed to people ages 6 and up. Adderall acts on the central nervous system by boosting the number of neurotransmitters in the brain. This increase in dopamine and norepinephrine boost your ability to focus and pay attention while decreasing hyperactivity and impulsive behavior. Treatment Choices ADHD medication is divided into two categories: first-line medications and second-line medications. Stimulant medications like Adderall are known to be the most effective treatment for ADHD, and as such are considered first-line medication. Non-stimulant medications like Strattera are second-line medications. While not as effective as stimulants, they do still help ADHD symptoms. For example, studies found that Strattera reduced hyperactive, inattentive symptoms in adults compared to a placebo. However, 40% of the participants still reported significant ADHD symptoms. Although stimulants are the most effective medication, they dont work for everyone. In addition, sometimes people experience severe side effects with stimulants or have an underlying medical condition that increases the risks of taking a stimulant,  such as a history of addiction, a psychiatric condition like bipolar disorder, or a heart condition or  sleep disorder. In these cases, a non-stimulant medication like Strattera is an option. Strattera has also been found to sometimes  help with conditions that often co-exist with ADHD like anxiety and oppositional defiant behavior, a pattern of aggression, disobedience, and a lack of respect for authority. Forms, Dosages, and Efficacy Strattera is available in an oral capsule that comes in seven doses ranging from 10 to 100 milligrams (mg). Generic versions of the drug are available in the United States, Canada, and other countries. Adderall IR (immediate-release) is available in tablets from 5 mg to 30 mg. Adderall XR (extended-release) is available in six doses, from 5 mg to 30 mg. There are generic medications available (amphetamine salt combination), but sometimes  people report these arent as effective for them as the brand versions. It can take four to eight weeks before Strattera reaches its maximum therapeutic effect.?? Once therapeutic levels have been reached, the effects of the medication last 24 hours. In contrast, the effects of Adderall IR and Adderall XR can be felt as quickly as 30 minutes to one hour. The effects of Adderall IR begin to wear off after four hours, and after 12 hours for Adderall XR. Taking a break from the medication (a drug holiday) is an option with Adderall. After discussing it with your doctor, you might not take Adderall on the weekend or over holidays. Strattera needs to be taken every day.?? Side Effects For both medications, doctors usually prescribe a low dose, to begin with, and gradually increase it until the right therapeutic dose is found for you and your symptoms. This usually means youll have fewer side effects as your body adjusts to the medication. The side effects of Strattera include dry mouth, dizziness, upset stomach, and reduced appetite, constipation, reduced libido, and sweating. Men may experience some erectile dysfunction. The side effects of Adderall include loss of appetite, diarrhea, dizziness, dry mouth, fever, headache, insomnia, nausea, nervousness, sleep issues, vomiting, weight loss, and erectile dysfunction. More serious, but rare side effects are increased heart rate, high blood pressure, hallucinations, paranoia, shortness of breath, heart attack, and stroke. Cardiac Concerns Research has found that the likelihood of cardiac problems with the use of stimulant medications like Adderall is very low in healthy people.??  For example, one study found that people on stimulant medications for ADHD did not have an increased risk for cardiac events like heart attack, stroke, or sudden cardiac death. In the past, patients had electrocardiography (EKG) screenings if a stimulant medication was going to be prescribed. With new research findings, these screenings are no longer required unless you, or someone in your family, have a history of cardiac problems. If youre taking a stimulant and notice any unusual signs, contact your doctor immediately. ?? For Women Both medications are category-C drugs, which means theyre considered unsafe to take during pregnancy or while breastfeeding. Talk to your doctor if youre pregnant or planning to become pregnant. Risk of Abuse Adderall is a schedule-II controlled substance. This means theres the potential for abuse and that extended use might cause dependence. Because Adderall’s mode of action is to increase the activity of  the dopamine, it could be misused and inhaled or injected to create a high. Surges of dopamine cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again. That said, its reassuring to note that studies show that people taking a prescription stimulant have a lower rate of substance abuse compared to those not taking this type of medication. This could be because when ADHD is being treated safely, people are less likely to self-medicate and use non-prescription methods to manage their condition. When stimulant medications are prescribed at appropriate doses and taken as prescribed, the risk of potential addiction is low. Always store your medication safely away from other people, and dont share your medication. As a non-stimulant medication, Strattera is not a controlled substance and doesnt carry the potential risk for abuse. It works by inhibiting norepinephrine uptake, rather than significantly affecting dopamine. Because it takes several weeks for the medication to take effect, it would be difficult to abuse. Black Box Warning The FDA places a black-box warning on some prescription drug labels to bring attention to possible serious or life-threatening risks that people need to be aware of. Strattera has a black box warning for the possible increased risk of suicidal thoughts or actions in children, teens, and young adults. Parents and caregivers are encouraged to monitor possible changes in their child’s behavior and keep in close contact with the child’s doctor. Adderall has two black box warnings. The first is to highlight the potential for abuse. The second is to warn about cardiac events.

Customer Service Essay - 1845 Words

Customer Service Questionnaire (step 5 of 6) Screening Questions | Instructions This questionnaire has been designed to help us to understand whether the role of customer assistant is right for you, as well as help you to understand more about what it might be like to work for Tesco. Based on actual experiences of Tesco customer assistants, each question describes a situation that you might find yourself in while at work. You should imagine yourself as a customer assistant in each situation and select one of the three options. The one you select is the option you would do in each of the given situations. | | *Question 1 You are refilling a section of shelves in the store which you need to have completed before your break. Your†¦show more content†¦A customer asks you to help them to take their shopping to the checkout. Answer A: Tell the customer that you cannot help them because if the spilt yoghurt is not cleaned up it could cause an accident. Answer B: Ask the customer to wait while you find someone else to finish cleaning up the spilt yoghurt so that you can assist the customer. Answer C: Tell the customer that you would be happy to help them with their shopping once you have finished cleaning up the spilt yoghurt. | | | *Question 8 You have just returned from your break and are about to start refilling the sweets aisle when a customer approaches you to complain that the apples they bought tasted very bitter. Answer A: Listen to the customer’s complaint so that you can decide on the best way to help the customer. Answer B: Suggest that the customer goes to Customer Services as you have been asked to refill the Sweets aisle. Answer C: Ask the customer to wait while you go to find a manager to help them. | | | *Question 9 You have a long queue of customers waiting to be served at the checkout. While you are scanning a customer’s shopping one of the products does not scan properly. You need help to find out the product’s price but your colleagues are serving other customers. Answer A: Apologise to the queue of customers while you alert your team leader and offer to help the customer to pack their shopping. Answer B: Suggest that the customers inShow MoreRelatedCustomer Service2488 Words   |  10 PagesCustomer Service Research Paper Before I get into further analysis of my own personal experience, I am going to explain about different characteristics that are involved in customer service. Most businesses will tell you that quality customer service is the keystone to success. An essential component of outstanding customer service is the possession of a great staff. Larger companies may be weighed down by employee handbooks that specify the customer service guidelines. Independent, smaller businessesRead MoreCustomer Service2541 Words   |  11 Pagesï » ¿Customer Service at Datatronics Datatronics is an organization that serves their customers with Enterprise Resource Planning integrated solutions. Their growth is mainly attributed to acquisitions of smaller competitors. E-Z RP was such a company that despite its inferior size compared to Datatronics was able to succeed and outperform Datatronics on grounds of customer service and customer satisfaction. Datatronics recognized the fact and acquired E-Z RP with the aim to improve in that respectiveRead MoreCustomer Service Services And The Service Sector2162 Words   |  9 PagesSince+ the global economy embraced customer service, issues regarding levels of customer service have become more prominent in service organisations. Even now there are organisational managers with no training or knowledge of how organisations in the service sector require a high level of customer service. This is ignorance of the fact good customer service can create a competitive advantage; increase profit; efficiency; and increase staff a nd customer retention and satisfaction. Based on comprehensiveRead MoreCustomer Service And An Organization1445 Words   |  6 Pagescontinuously fail in customer service satisfaction for many reasons. As service failures are inevitable, it is important for companies, especially small businesses, to capitalize on learning the importance of reducing service failure. Just as the seed is the core of the fruit, customer service is the core of an organization; its meaning is the primary function for organizations to retain business and discover new ventures. Customer service is the primary source of business-to-customer communication andRead MoreCustomer Service Essay641 Words   |  3 Pagesto communicate with customers to identify and agree on product/ service specifications. It is crucial to be aware that customer expectations and needs will change from time to time and will be affected by market trends, fashions and changes in external environments. This means the business plans need to be adapted to changing needs of customers and is important that organisations communicate with its customers. Profiling is a method to understand the needs of the customers. Profiling enables organisationsRead MoreThe Etiquette Of Customer Service1601 Words   |  7 PagesThe Etiquette of Customer Service – Instructional Guide Overview Objective Key points How to say â€Å"I’m sorry† without apologizing in customer service? There are justifiable situations that require customer service representatives to say â€Å"I’m sorry† without apologizing. Situations include: a plan benefit that is not covered, denial of a pre-authorization, or an appeal denial. Session#1 I’m Sorry When this occurs, there are phrasesRead MoreCustomer Service Representatives1622 Words   |  7 PagesZappos. This is followed by a hierarchal ranking of the four major presenting problems for the company, which are: maintaining the â€Å"wow† image without overspending, inventory management/distribution problems, transportation efficiency problems and customer behavior problems. Each of these problems is addressed in more detail in the discussion section and the recommendations section at the end of the analysis. Prior to the conclusion and recommendations section, a list of possible strategic alternativesRead MoreCustomer Service At The Restaurant2103 Words   |  9 Pages†¢ Execute exceptional outstanding customer service by recruiting, leading and developing people and planning, organising, directing, controlling and evaluating all the operations of the restaurant to build sales and control costs to deliver optimum business results for the restaurant †¢ Understand, enforce and train Crew and Managers on all appropriate policies, award minimums, security and safety procedures. †¢ Modifying the operational procedures as per the requirement of the profitability of theRead MoreCustomer Service1186 Words   |  5 Pagessome companies aim to look after their customers well, ensuring that the customer is at the heart of their business and everything they do. In marketing terms this is called being customer focused. It is important to realise that customers can take their business anywhere they want to and if they are not satisfied they will take their business elsewhere. Therefore, it is very important to understand who our customers are, their expectations of the service they experience and how that effects futureRead MoreEssay on Customer Service1144 Words   |  5 PagesSection 1 – Understand the factors that affect an organisation and the customer service role 1. Complete the table below with a description of the products and services for at least two commercial organisations, public organisations and third sector organisations. Please ensure you provide a description for each organisation, rather than a list. Organisation type Name of organisation Description of products and services Commercial organisation Commercial organisation

Arthur Miller s Death Of A Salesman - 1027 Words

An Analysis of Tragic Heroism of Biff Loman in Death of a Salesman by Arthur Miller This literary study will define the tragic heroism of Biff Loman in Arthur Miller’s play The Death of a Salesman. Biff is initially a victim of Willy’s continual harassment to make more money and find a better career. In this family unit, Biff must endure the unrealistic and fantasy-based elusions of his father in his fanatical pursuit of the American Dream. However, Biff soon learns of Willy’s extra-marital betrayal to his mother, which allows him to experience an epiphany against the self-deception of his father’s abusive fantasy world. Biffs’ tragic role in this family is found in the ability to accept reality and overcome the victim role imposed on him by his father. This tragic aspect of Biffs’ heroism defines a single voice of reason in a self-deceiving family unit, which defines his liberation from his father’s tyrannical behavior. In essence, Biffs’ tragic heroism will be examined by analyzing the journey towards self-r ealization in Arthur Miller’s The Death of a Salesman. The beginning of Miller’s play presents Willy Loman, a failed salesman that is continually putting pressure on his children to get better jobs and make more money. Willy’s pursuit of the American Dream exploits Biff and Happy as a type of retirement plan in this materialistic mindset: â€Å"You’ll retire me for life on seventy goddamn dollars a week?† (Miller 28). In this way, Willy views Biff as being weaker thanShow MoreRelatedArthur Miller s Death Of A Salesman1144 Words   |  5 Pages Arthur Miller: Death of a Salesman Life for many in America are missing the same elements that â€Å"Death of a Salesman† exposed. Those element are love and direction. Many people face these struggles at some point in their life, but don’t know what to do to progress. Arthur Miller devised a style whereby he could show how your past can continuously impact on your future. Each character highlights the powerlessness of a dream to give meaning and control to human life. I disagree with someRead MoreArthur Miller s Death Of A Salesman1061 Words   |  5 PagesIn â€Å"Death of A Salesman,† Arthur Miller takes a view about the usually positive value people put on success. By examining Willy’s downfall, we can see Miller is arguing how the fallacy of success crafts the amiss dreams. Miller displays how the constant mania to maintain the image of success destroys the concept of American Dream for ordinary people like Willy. Miller portrays Willy as a hard-working exhausted man, â€Å"I’m tired to the death† (1557). Willy expends enormous amounts of time and energyRead MoreArthur Miller s Death Of A Salesman1039 Words   |  5 Pages The play Arthur Miller, Death of a Salesman, is about an old salesperson who returns early from a business trip. After crashing multiple times, he realizes he should stop driving. The other book, Oedipus the King narrates the story of Oedipus. He was a man who became the king of Thebes, while unwittingly fulfilling a prophecy that he would murder his father, Laius, and marry his mother, Jocasta. The above characteristics of tragedy are well highlighted. In the play Death of a Salesman, one flowRead MoreArthur Miller s Death Of A Salesman And The Crucible2615 Words   |  11 Pagesand conflicts have been a constant. As individual people and as a world, there have never been perfect times. Arthur Miller’s writing style focuses on how his characters deal with external and internal problems and how their reactions to these problems reflect their characterization. Arthur Miller uses external conflict, internal conflict, and indirect characterization, in Death of a Salesman and The Crucible, to show how ideas of society do not always agree with the ideas and beliefs of others whichRead MoreArthur Miller s Death Of A Salesman1159 Words   |  5 Pagesmarriage, or through one’s own self. Willy Loman, a delusional salesman, in Arthur Miller’s Death of a Salesman; Minnie Wright, an unhappy and lonely housewife, in Susan Glaspell’s Trifles; and Oedipus, a king with excessive pride and determination, in Sophoclesâ €™ Oedipus the King illustrate how people lose their identities over the course of time. Society can cause the loss of a person’s identity, as Arthur Miller’s Death of a Salesman depicts the American dream as society’s view of success. The AmericanRead MoreArthur Miller s Death Of A Salesman1373 Words   |  6 PagesAmerican In Arthur Miller’s Death of a Salesman, the main character is Willy Loman a lifelong traveling salesman. Willy is in his early sixties and there is no doubt he has had a long life with the occupation he chose for himself some years ago. It seems as if Willy is doing well for himself as well as his family from any outsider, however, what happens behind the scenes is a completely different story. Constantly borrowing from a fellow friend Willy finds himself in a black hole of debt. Arthur Miller’sRead MoreArthur Miller s Death Of A Salesman1326 Words   |  6 PagesAs though to recreate the connection in life, literature often shows the relationship between past events and a character’s present actions and values. In Arthur Miller’s Death of a Salesman, Willy is haunted by memories of his older brother, father, and salesman Dave Singleman. Willy’s character and values are constantly influenced by the memory of the three men, compounding upon his deli ria throughout the play. Willy considers these men the epitome of success, thus explaining his dependency onRead MoreArthur Miller s Death Of A Salesman2019 Words   |  9 Pagespersonal growth and forming realistic, healthy relationships. Both Judith Guest and Arthur Miller use their respective literary works ‘Ordinary People’ and ‘Death of a Salesman’ to illustrate that not addressing who we are as individuals and remaining unaware of reality will only lead to unhappiness, dysfunction, and eventual tragedy. The main character and the driving force behind the action of ‘Death of a Salesman’ Willy Loman is both unaware of reality and ignorant to his own need to find himselfRead MoreArthur Miller s Death Of A Salesman910 Words   |  4 PagesGuilty Conscience â€Å"Death of a Salesman† by American playwright Arthur Miller is a drama that resonates with the majority of viewers and readers of the play. Miller eloquently illustrates the drama and complex dynamics of the Loman family. The Loman’s consist of Willy and Linda Loman as well as their two sons Biff and Happy. Specifically, â€Å"Death of a Salesman† focusses on Willy and his oldest son Biff. Willy, now an old man has deteriorated into a miserable and senile man. Willy Loman’s characterRead MoreArthur Miller s Death Of A Salesman Essay1567 Words   |  7 Pagescharacter with a tragic flaw leading to his downfall. In addition, in traditional tragedy, the main character falls from high authority and often it is predetermined by fate, while the audience experiences catharsis (Irving 247). Arthur Miller’s play Death of a Salesman is considered to be a tragedy because this literary work has some of the main characteristics of the tragedy genre. In this play, the main character Willy Loman possesses such traits and behaviors that lead to his downfall, and the

Annoying Shoppers Free Essays

Johnny Bullock English 104 Bowman December 5, 2012 Annoying Shoppers Grocery shopping can be a very interesting experience. It seems like nothing more than a quick and easy chore at first. You go in, throw whatever you want into your cart, pay and then get out. We will write a custom essay sample on Annoying Shoppers or any similar topic only for you Order Now Its almost relaxing, that is if the grocery store is completely empty. Unfortunately, there are always those other shoppers. The ones who think they own the place or something. They’re in just about every grocery store in America. You know who I’m talking about, that one parent- usually a mom- with a kid who just so happens to be screaming bloody murder. Also, everyone knows a bad cart driver when they see one, not to mention the label readers. And finally, probably the worst of them all, the Couponers. If you’re like me and you like to get your grocery shopping done as fast and productive as possible, these four shoppers are your worst enemies. Imagine yourself going to the grocery store. You drive into the parking lot, circle around for a minute or so just to find that perfect spot as close to the front door as possible. You gather the things you need: grocery list, phone, money, credit cards etc, and exit your car. As you walk by the automatic doors to go get a cart, the doors open and that’s when you hear it. That ear piercing, glass breaking, nails-on-a-chalkboard howl that comes from a small child no taller than your knee. As the screaming stops- only for an instant as the heathen catches its breath- and starts back up again, you find yourself blankly staring at the mother of this child as you pass by each other. You can’t help but think, â€Å"can you please take some control of your kid? This is a public place not your home! † but decide its better to just keep walking. Until you realize that you have completely forgotten what you were shopping for thanks to that bellowing kid. Good thing you brought a list right? The doors close behind you and the screaming fades. You have but a moment of peace before you look up and ZOOM!! Some guy decides its a good idea to use his cart as a scooter, almost hitting you as he whizzes over to the produce section. Now, what in the world would make him think that’s a good idea? The grocery store is not a skatepark, and I’m certain that its small enough to easily get from point A, to point B just by walking. Is it possible that he’s just looking for a little more excitement in his life? Maybe, he’s the same as you or me and wants to get his shopping done as fast as he can. Whatever the reason, people like him need to learn some courtesy and realize that there are other people in the world. You are now able to get started and pick up all the things on your list, you decide to turn down the â€Å"organics† aisle figuring it would be a shorter path to the front of the store. Little did you know this would be your worst mistake of the whole trip. Walking down the row of healthy foods are some of the worst grocery shoppers there are, the label-readers. These are the health-nuts who will literally stand in the middle of the aisle and read every nutrition fact, ingredient, percentage and amount of grams per serving there are in a caesar salad. Then, as if it wasn’t already bad enough, they will continue to put that salad down and grab another salad made by a different company in order to compare the labels. Now, this wouldn’t be such a problem if they didn’t decide to park their cart on one side of the aisle and stand on the other side reading the labels, stopping you dead in your tracks. Obviously label-readers must think its their world and the rest of us are just living in it. In which case, they need a wake up call. But regardless of the fact, you don’t want to be rude so you politely say â€Å"excuse me† and proceed to the check out counter. The check out counter, the final stretch of your shopping experience. All there is left to do now is pay for your items and go. It seems like this should be the easiest part right? Wrong. Unfortunately, you have two items too many to use the â€Å"express lane,† and all but one of the â€Å"self checkout† machines are out-of-order. So, after carefully scanning each regular check-out line, you finally spot the one with what seems like the shortest line and casually stroll over there to wait your turn. What you didn’t see, was that the lady you decided to stand behind had the entire store in her cart! Little did you know that she was the worst shopper of them all- the Couponer. This is the bargain-shopper who’s annoying actions are broken down into three steps. First, this shopper will decide to pack her cart so full that the pile of groceries in her cart is taller than she is! Inevitably, creating a longer waiting time for you. Next, she will stand there, stare at the clerk’s computer screen and argue about the 2-for-1 price for every item that doesn’t match up exactly the way she wants. Finally, after all her groceries are scanned, bagged and carted, the couponer will then proceed to dig through her entire purse searching for every coupon she has ever saved over the past year for that one shopping trip. As if she hasn’t already wasted enough of everyone’s time. It is at this point of your experience when you realize that any hope of an efficient and speedy shopping trip was just tossed out the window. With all of the annoying people that decide to go to the grocery store, shopping can easily turn from a quick and easy chore into one of the most tedious experiences of your life. I encourage you, as a shopper, to watch out for people like this the next time you go shopping. Unless you just so happen to be one of these people, in which case I will be watching out for you next time I take a trip to the grocery store. How to cite Annoying Shoppers, Papers

Renewable Energy free essay sample

Renewable Energy BY frappe04927 Non renewable energy sources are becoming harder to find and with that being said, these resources are more expensive. So what will we do when these resources are no longer here on earth for use to use? Many people are looking for and testing new forms of materials that we can use for energy. These sources are called renewable energy sources. Throughout the paper you will read about non renewable energy sources and the small supply that we have left, humans influences on theses non renewable resources and what some are trying to do to make new forms of energy. Energy Conservation Plan Energy conservation is becoming a great issue. We are using up the forms of non renewable energy sources that we have depended on for so long. Some types of non renewable energy resources are oil, coal, natural gas and nuclear. These forms of energy come from the ground. We will write a custom essay sample on Renewable Energy or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Many people take these forms of energy for granted, maybe thinking that these forms of energy would always be here for us to use. But since we are finding out that non renewable energy resources are becoming harder to find, we are now taking action to find or make new forms of energy. Many people take energy for granted. They do not think about running out of energy. But this is a very real problem, and running out of non renewable energy could happen. Humans are the reason that there are damages to our planet and also for the non renewable resources drying up. Over population of the human race is one of the biggest factors that are causing the disappearance of reserves and resources. James Leape, director general of WWF international stated that Reckless consumption is endangering our future prosperity. He also states that by the year 030 we will need the equivalent of two planets in order to continue to live the way we are living now. You can tell by this that energy conservation is a real issue that we need to face now. Humans are affected by this problem and things are only going to get worse. So why is it that with humans being affected by this we do not do something to make a difference? I believe it to be that most humans do not really understand what we ar e doing and the damages of what we are doing. By 2025 people will be experiencing physical scarcity and will not have enough water to live, says Morne du Plessis, CEO of WWF-SA. There are many non living things that contribute to the use of energy consumption. Many of these things are found in our households, starting with space conditioning at 44%, water heating at 13%, Lighting at 12%, Refridgeration at 8%, Home electronics at 6%, Laundry Appliances at 5%, Kitchen Appliances at 4% and other uses at 8%. These are all things that people have made to live better. But what many people do not think about is that these items that we are using are greatly affecting the conservation of energy. So, yes man made products do play a big role in the use of energy. The percents above are based on an average household usage. Now add up all ot the household usage in America, and that would snow a shocking and devastating number. Most of the humans actions that are done to this world are negative. People take too much for granted out of life. Energy conservation is one of those things. People are in the mind set that we will always have everything that we will always need. There are not enough people that fully understand the problems that we are facing or even what we can do to help with this problem. Therefore not to many people put in the ffort to make the changes needed to do this. But on the other hand, there are people that do understand the energy crisis and are working hard to find and use new means that we can use for energy. This is the positive part of the energy situation, people with the knowledge of the energy problem that are trying to make small changes, in which individuals can do and the larger corporations that are trying to find and use new renewable resources to help with the energy problem. Recycling is one of the biggest ways to help with trying to better our planet. This ives people a chance to reuse materials that otherwise would be sitting in landfills. Also there are people that are trying to use waste as a form of energy. There are also products such as bio fuel that is taken from animal oils and vegetable oils that we are now being able to use as fuel in vehicles. Tom Capehart stated in November 2008 that there are increased benefits to using biodiesel because it is made from low cost, diverse, non food feed stocks. Who knows, maybe in the future we might be able to use this form of fuel for another type of energy. I feel that by making people more ware of the problem then more people will get involved. Another way to help with sustainability is to reduce the consumption of natural resources and materials. As with anything we can maybe end up using all of the renewable materials that can make up a new form of energy. One other way would be to maximize energy efficiency. This might be a great way to help with the energy situation, as said by Rick Parks and Kip Grubb, September 2005. As for my sustainability plan, one of the first things that would need to be addressed would be that we are in an energy crisis. I would want to maybe travel the country preading the word of the damages that we are doing to our world and get people informed on the topic. I would want to try to get as many people involved in the support to conserve energy. To get this plan started, I would first start telling people and groups that I would be traveling to spread the information on energy conservation and what the future could hold for use if we do not make the much needed changes. I would want the word to get out about this issue. Second of all I would do some time of fund raiser at each stop I made to raise money for research for other forms of energy. Lastly I would travel the country talking to audiences about the damages that we have done to our planet and what we can do to help fix some of the mess that we have made. I would also offer information that people could take with them after the meetings so that they could read up on more information on the energy crisis. I would ask tor sponsors or ditterent groups to help suppo t rt ne cause and some ot the funding for materials and the traveling to get the word out on this issue. As far as when I would do these meetings, well I would contact schools and energy sellers and ny other type of large group that I could schedule a meeting with. I would try and set the meetings up two weeks apart so that I could allow time for travel and depending where the location was. I would set out at first on a six month tour and try to reach as many people as I could my state. If all went well with that, I would continue on to another state and another after that. Time would vary from place to place, but dedication plays a big part in getting something done about a very real problem. I believe that the benefits of my plan would be getting the information out to people hat do not know much about this problem or that are not aware of it at all. I think that by doing this, this might give people the push that they might need to start to help make a difference in their everyday lives. Some of the challenges that I may face could be the disregard of the information by some. People are used to living the way they have always lived. Sometimes it is hard for some people to make changes. People may also feel that this is not as bid of a problem or that it is not affecting them right now, so why worry about it. Another roblem that I could face is that maybe I might not get much funding or not enough places that would like for me to speak at. This would be hard to get information out to people and to get more people to help with energy conservation. I think that if the government, society and with global support we would start to see some big changes. The government alone has a lot of pull and influences on what people in society do. If the government did more to get information out to people about the energy crisis that we are facing and gave people ways to help with this roblem, I think that would influence many people to change the way the live to help with the energy problem. If society was more informed on the issue, then I also believe that many would try and do their part to help as well. As for globally, if the whole world were to pitch in and help get the word out about energy conservation, then I strongly feel that we would see some very good changes. Conclusion We are in an energy crisis, which is a very big problem. People need to become more aware of this problem and try to do their part to help preserve the non renewable esources that we still have left and to also help the environment by recycling and watching the energy use at home and in the car. One person can only do so much, and we may never see a difference from one person making that change. But if several people started making changes to their life styles, then there is a big possibility that we could start to see a big difference. This is an issue that everyone needs to know about and take seriously. If we do nothing, what will happen to mankind as we know it? What will we allow are childrens tutures to not take action now? ke it we do

Free Essays on Loan Officer

Subject: Loan Officer A loan officer performs many tasks in preparing a loan. A loan officer not only helps an individual or business structure the type of loan they need, but a loan officer will analyze an applicant to decide if they are financially able to repay the loan. In this memo, I will explain some of the job duties and responsibilities, education, technology, and current events that surround my career choice. Duties and Responsibilities There are usually three types of loans 1) commercial, 2) consumer or personal, and 3) mortgage loans. Loan officers are usually specialized in only one of these. Depending on the size of the bank, a loan officer might be specialized in more than one loan category. Meaning, if you work at a small bank branch, you will be more likely to handle all three types. In a larger bank they have departments for each type of loan. There are many steps that a loan officer must take when to approve a business or a person for a loan. First, the officer must take a salesman type role and get the customer into the bank. This step can also be completed over the telephone. The next step is to help the costumer determine the right type of loan that meets their specific needs. Today, financial institutions are finding more and more ways to better serve their customers. As banks and other financial institutions begin to offer new types of loans and a growing variety of financial services, loan officers will have to keep abreast of these new product lines so that they can meet their customers’ needs (1:2). After the loan officer helps determine the correct type of loan, the application process begins. This first step is the gathering of information and it is the loan officer’s job to help the client complete the application and answer any questions. Once the application process is done, the officer w ill take all the information and compute it into a number, or â€Å"credit score†. ... Free Essays on Loan Officer Free Essays on Loan Officer Subject: Loan Officer A loan officer performs many tasks in preparing a loan. A loan officer not only helps an individual or business structure the type of loan they need, but a loan officer will analyze an applicant to decide if they are financially able to repay the loan. In this memo, I will explain some of the job duties and responsibilities, education, technology, and current events that surround my career choice. Duties and Responsibilities There are usually three types of loans 1) commercial, 2) consumer or personal, and 3) mortgage loans. Loan officers are usually specialized in only one of these. Depending on the size of the bank, a loan officer might be specialized in more than one loan category. Meaning, if you work at a small bank branch, you will be more likely to handle all three types. In a larger bank they have departments for each type of loan. There are many steps that a loan officer must take when to approve a business or a person for a loan. First, the officer must take a salesman type role and get the customer into the bank. This step can also be completed over the telephone. The next step is to help the costumer determine the right type of loan that meets their specific needs. Today, financial institutions are finding more and more ways to better serve their customers. As banks and other financial institutions begin to offer new types of loans and a growing variety of financial services, loan officers will have to keep abreast of these new product lines so that they can meet their customers’ needs (1:2). After the loan officer helps determine the correct type of loan, the application process begins. This first step is the gathering of information and it is the loan officer’s job to help the client complete the application and answer any questions. Once the application process is done, the officer w ill take all the information and compute it into a number, or â€Å"credit score†. ...

French Expressions Using Trouver

French Expressions Using Trouver The French verb trouver literally means to find and is also used in many idiomatic expressions. Learn how to meet ones match, find ones way, be lost for words, and more with this list of expressions with trouver. Possible Meanings of Trouver to findto come acrossto come up withto imagine Expressions with Trouver trouver boireto find something to drinktrouver se distraireto find a way to amuse oneselftrouver faireto find something to do, to manage to do somethingtrouver mangerto find something to eattrouver soccuperto find a way to keep busytrouver qui parlerto meet ones match, get more than one bargained fortrouver redire quelque choseto find fault with, criticize, have a complaint about somethingtrouver bien faireto be bound to do somethingtrouver bon de faireto see fit to do somethingtrouver le bonheurto find happinesstrouver bonne mine quelquunto think someone looks welltrouver le cheminto find ones waytrouver une consolation dans quelque choseto find consolation in somethingtrouver le courageto find the couragetrouver des difficultà ©sto come up against difficultiestrouver là ©nergieto find the energytrouver grà ¢ce auprà ¨s de quelquunto find favor with someonetrouver grà ¢ce aux yeux de quelquunto find favor with someonetrouver une idà ©eto hit on an ideatrouver la mort to meet ones deathtrouver le moyen de faireto find some way of doing, to manage to dotrouver plaisir faire quelque choseto take pleasure in doing somethingtrouver plaisir quelque choseto take pleasure in somethingtrouver un planto hit on a plantrouver preneurto find a buyer, takertrouver queto think, believe thattrouver quelque chose son goà »tto find something to ones likingtrouver quelque chose en quelquunto find something in someonetrouver quelque chose mauvais (informal)to not like something at alltrouver quelque chose trop adjto find something too adjtrouver quelquun adjto find someone adj, to think someone looks adjtrouver sa voieto find oneself, find ones life pathtrouver le sommeilto get to sleeptrouver son bonheurto find what one is looking fortrouver son maà ®treto find ones mastertrouver le tempsto find the timetrouver le temps longto find that time passes slowlyaller trouver quelquunto go see someonene pas trouver ses motsto be at a loss for wordsvenir trouver quelquunto come and see someoney trouver son compteto get something out of itComment las-tu trouvà ©(e)  ? What do you think of him (her)?Jai trouvà ©Ã‚  !Ive got it!Oà ¹ est-il allà © trouver à §a  ?Where did he get that idea from? Whatever gave him that idea?Quest-ce que tu lui trouves  ?What do you seen in him?Tu le (la) trouves sympa  ?Do you like him (her)? Do you think (s)hes nice?Tu trouves  ?Do you think so?Tu trouves à §a normal  ?Do you think thats right?bien trouvà ©well-spoken, cleverune formule bien trouvà ©eclever phrasetout trouvà ©ready-made, obviousune excuse toute trouvà ©eready-made excuseune explication toute trouvà ©eobvious explanationune solution toute trouvà ©eready-made solutionun sujet tout trouvà ©obvious topic Possible Meanings of Se Trouver to beto be foundto be situatedto feelto find oneselfto think/consider oneself adj Expressions with Se Trouver se trouver avoirto happen to havese trouver biento feel well, comfortable, happyse trouver bien davoir fait quelque choseto be glad to have done somethingse trouver daccordto happen to agreese trouver dans limpossibilità © de faireto find oneself unable to do, to not be in a position to dose trouver dans lobligation de faireto find oneself compelled to do, to have to dose trouver dans une situation dà ©licateto find oneself in a delicate situationse trouver à ªtreto happen to bese trouver malto pass out, faintse trouver mal davoir fait quelque choseto regret having done somethingse trouver mieuxto feel betterÇa ne se trouve pas sous le pas/sabot dun cheval. Thats not easy to find, not easy to come by.Ça se trouve facilement.You can find that anywhere.Il sen est mal trouvà ©.He lived to regret it.Je me suis trouvà © fin  !I looked like an idiot!Oà ¹ se trouve ...  ?Where is ...  ?Il se trouve... (impersonal)There is/are...Il se trouve que...It happens to be..., As it happens...si à §a se trouve (informal)maybe, its possibleTrouver conjugations

Psychology Essay Example | Topics and Well Written Essays - 250 words - 4

Psychology - Essay Example Piaget divided development into a Sensiormotor Stage (birth to age 2), a Preoperational Stage (ages 2-7), a Concrete Operational Stage (ages 7-11), and a Formal Operational Stage (ages 11- adult). Each stage is marked by certain abilities, such as the ability to understand conservation of mater or the ability for hypothetical thinking. Erikson’s work closely resembles Piaget’s, but it is showing the development of a person’s social intelligence and self-awareness, not cognitive ability. Erikson believed that we went through eight different levels of psychosocial development, each one possessing a unique crisis for the individual’s understanding of who they are and where they fit into society. Stage 1 is Trust v. Mistrust, Stage 2 is Autonomy v. Doubt, Stage 3 is Initiative v. Guilt, Stage 4 is Industry v. Inferiority, Stage 5 is Identity v. Role Confusion, Stage 6 is Intimacy v. Isolation, Stage 7 is Generativity v. Self-absorption and Stage 8 is Integrity v. Despair. Erikson suggests that if the conflict of each stage is not successfully resolved, the final adult will be a person that has emotional baggage. They will have a difficult time reconciling conflicting feelings that should have been resolved at an earlier stage. Both of these theories are as relevant today as they have ever been. Students may use different technology and have a different social environment than they once did, but they still must follow these stages of development in order to be fully functional human

EC3--Movie, book, TV show, or song Essay Example | Topics and Well Written Essays - 250 words

EC3--Movie, book, TV show, or song - Essay Example Hunt Stevenson, the plants now former foreman, travels all the way to Tokyo in an attempt to convince the corporation to restart operations on the Hadleyville Plant. Owing to the desperate nature of the laborers, the corporation agrees to reopen the plant, but institutes changes that drastically affect the workers. The new contracts that the workers are issued clearly contradict the law. This movie is relevant to the topic, contract law, by virtue of highlighting the various issues that are associated with contract law. In the movie, the corporation’s management decided to change elements of their contracts with their workers, making the working conditions literally unbearable. The workers are denied the right to a union, receive lower pay rates than before, each have to learn all the jobs within the factory and are supposed to meet quality standards that are virtually impossible. The management later on decides to loosen up on the standards and harsh regulations that govern the workers on a day-to-day

Chronic Opiod Use after Hysterectomy

Chronic Opiod Use after Hysterectomy Specific Aims The rapid increase in the incidence of opioid-related overdoses and deaths has become a big public health threat in the United States. This opioid epidemic affects more women than men due to higher opioid prescribing and dose, longer period use, and more opioid dependence in women.1 From 1999 to 2010, the rate of opioid overdose caused death increased 5-fold among women.2 Besides the illicit purchase for some women, the initial exposure to opioids for many others may likewise come from the regular medical treatment as prescription opioids are widely used for pain management after surgery.3 As such, the critical research gap on opioids use is that the evidence is insufficient to draw conclusions about optimal strategies for initiation and titration of opioid therapy.4 Several observational studies have investigated the patterns of opioid use for noncancer pain in patients pre and post-surgery, and identified the risk factors of chronic opioid use post-surgery.5-11 Most of these studie s examined the prediction of baseline demographic and clinical characteristics of patients for prolonged opioid postoperative use and suggested that surgery is a risk factor for chronic opioid postoperative use.5-9 Only two studies examined the initial opioid exposure within 6 or 7 days of the surgery date and results are controversial.10,11 One study reported that initial exposure of opioid poses 44% increase risk of chronic postoperative opioid use and another one suggested that this risk would be low and statistically insignificant.10,11 Similar investigation has not been done specifically for hysterectomy, the most frequently performed non-obstetric surgeries in the United States for women of reproductive age.3,12 Pain has been demonstrated as a common symptom before and after hysterectomy.13,14 A small cross-sectional study has examined the predictors for opioid prescription in women of productive age and identified that opioid use was significantly associated with hysterectomy status and pain-related dysfunction.15 Another cross-sectional survey study reported that 32% patients had chronic pain after hysterectomy.14 Neither chronic opioid postoperative use nor initial opioid exposure for acute surgery pain was examined in these two studies.14,15 Filling this gap in knowledge is critical since identifying the risk factors of chronic opioid postoperative use could lead to optimized initial opioid prescribing for acute pain management and reduced chronic opioid postoperative use and improved women health. Our long-term goal is to help reduce chronic use of opioids and optimize the pain management in women after obstetric and gynecologic surgery through identification and dissemination the safer initial opioid prescribing for acute post-operative pain. Our objective here, which is the next step in our long-term goal, is to compare the patters of opioid use pre and post hysterectomy and determine the important risk factors that associate with chronic use of opioids in women post hysterectomy. The national OptumInsight Clinformatics data offers an essential resource to investigate these aims. The availability of clinical diagnoses and pharmacy medical dispensing offers a significant advantage for investigating drug utilization with corresponding clinical conditions in large population. Our team is well suited to conduct this research given extensive expertise in contemporary pharmacoepidemiology, many years of experience on opioid abuse research, prior drug utilization studies using large claims data, and clinical expertise from obstetric and gynecologic physicians. Our specific aims are to investigate patterns and predictors of chronic opioid use in women pre and post hysterectomy with the following analyses: Aim 1: To characterize the patterns of chronic opioid use in women after hysterectomy. Aim 2: To determine the significant risk factors for chronic use of opioids in women after hysterectomy. The first specific aim for this study is to identify patients who chronically take opioids during six months post hysterectomy, and investigate the time and geographical patterns of chronic opioid use in women after hysterectomy. The pattern of chronic opioid use pre- and post-surgery will also be compared in women with varied age, comorbidities, co-medications, as well as types and doses of initial opioid prescribing. The second specific aim is to determine the risk factors that significantly relate to chronic opioid use, and determine if characteristics of initial filled opioid prescriptions significantly associate with the chronic use of opioids after adjusting for other potential risk factors. Many pain related studies have demonstrated that long term opioid prescribing was significantly predicted by patients clinical characteristics and psychosocial factors, including pain conditions, psychiatric disorders, frequency of medical visits, smoking, and pain-related dysfunction.16-18 Therefore, the adjusted covariates in this study would include both demographic and clinical characteristics. B. Significance and Innovation Currently the United States is experiencing an unprecedented opioid epidemic. According to the Centers for Disease Control and Prevention (CDC), opioid-related deaths increased 200% overall from 2000 to 2014.19 During 2014, about 1.9 million people had an addiction of opioids, with overall 47,055 overdose deaths, 18,243 overdose deaths in women, and 18,893 overdose deaths related to prescription pain relievers.20,21 Based on the data reported by the CDC, women are more likely to have chronic pain, be prescribed opioids with higher dose and longer period, and hence progress to dependence.22 Although opioid abuse is a public health crisis, opioid analgesics are still the mainstay for treatment for acute pain after major surgery. In 2014, total 245 million prescriptions for opioids were dispensed from U.S. retail pharmacies.23,24 During 1998-2010, approximately 7.4 million hysterectomies were performed, making hysterectomy one of the most frequently performed surgeries for women in the United States.25 With over 60% of hysterectomies performed abdominally and up to 85% of patients experiencing moderate-to-severe pain after hysterectomy, postoperative pain management becomes very important.26,27 Evidence suggests that intense and long-lasting postsurgical pain can increase postsurgical morbidity, delay recovery, and lead to chronic pain.28 Opioids such as morphine, meperidine, and oxycodone are widely used postoperatively to reduce and manage pain in patients after hysterectomy.29 Women with hysterectomy and high levels of pain-related dysfunction were almost twice as likely to have opioid prescription. More than 85% of women with hysterectomy and a high level of pain-related dysfunction were found to use opioid.15 Hormonal disturbance, hyperalgesia, and iatrogenic effects are potential adverse effects from op ioid use in women after hysterectomy.14,15 The interaction of opioid-induced adverse effects and post-hysterectomy hormonal dysregulation may intensify pain and promote continued use of opioids.15 There are no known studies that evaluate the connection between acute and chronic postsurgical opiate prescription in women experienced hysterectomy. In consideration of the current opioid epidemic it is important to understand how post-surgical pain is managed, and if this setting presents increased risk of opioid addiction among certain groups, or related to particular prescribing practices. The goal of this proposed study is to examine whether opioids prescribed in women following hysterectomy is associated with chronic use of opioids, and to evaluate which factors may predict patterns of opioid use that indicate overuse or addiction. Accordingly, this study first aims to describe the incidence pattern of chronic opioid use in women post hysterectomy. The second aim is to explore the significant risk factors and determine if the characteristics of initial opioid prescribing significantly associate with chronic opioid use after adjusting for other potential risk factors. This study will reveal important insights regarding post-surgical pain management for a common procedure, and determine if certain patient or treatment characteristics increase the risk of chronic opioid use in this setting. We expect that this research will provide evidence for the need to improve clinical practice towards optimized pain management and reduced chronic opioid use in women after hysterectomy through identification the specific opioid, drug type (short-acting or long-acting), and doses that significantly associate with chronic opioid use in women after hysterectomy. Our study will provide sufficient evidence to draw conclusion about optimal strategies for initiation and titration of post-surgery opioid therapy, and enhance evidence-based medicine for opioid use in Rhode Island, and also the United State. This award would enhance my capabilities on handling interdisciplinary studies and further help me to develop my own research projects and seek for external funding. Innovation Our proposed observational studies based on the administrative claims data will allow for investigation of time trends and geographic variation of drug use in large population and address for well-characterized clinical conditions. Our approach will employ state of the art, innovative pharmacoepidemiologic study designs and statistical models, to improve the precision of outcome definition and minimize measured and unmeasured confounding and bias in our estimation of significant predictors for chronic opioid use after hysterectomy. The unintended outcomes from adverse drug effects make the prospective trials unethical. In this circumstance, a well-designed, retrospective observational study with sufficient sample size offers an efficient design to determine if there is an adequate signal for impropriate opioid prescribing to women post obstetrics and Gynecology surgery. The generalizability of study results are guaranteed due to the nationwide large health plan data that the analyses are based upon. C. Approach Data Sources Study data will be derived from the national OptumInsight Clinformatics Data MartTM, a research database spanning January 01, 2010 through December 31, 2013. The Optum Research Database includes about 23 million beneficiaries from the nationwide commercial health insurer, United Healthcare. The data contains health care utilization with transactional reimbursement data from outpatient pharmacy dispensing, inpatient and outpatient services.30 It links administrative enrollment data with the important medical codes including the national drug code (NDC) for pharmacy dispensing, the Current Procedural Terminology (CPT) code for medical procedure, and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for diagnosis. The claims data in this database have been adjudicated, ascertained, and deidentified for research purpose. The University of Rhode Island (URI) and OptumInsight Inc have approved utilization of these data. URI already licenses thi s database that it is freely available for faculties to use. Study Population This study will include adult women who receive the hysterectomy surgery between July 01 2010 and June 31 2013 and have at least 6 months of continuous prior coverage under this health insurance plan. This continuous 6-month coverage provides a baseline for defining new drug users, as well as baseline clinical characteristics, such as comorbidities and co-medications. The hysterectomy procedures will be derived from the ICD-9-CM diagnostic codes 68.3x-68.7x, and 68.9x, where 68.3x indicates a subtotal abdominal hysterectomy, 68.4x indicates a total abdominal hysterectomy, 68.5x indicates a vaginal hysterectomy, 68.6x indicates a radical abdominal hysterectomy, 68.7x indicates a radical vaginal hysterectomy, and 68.9x indicates other and unspecified hysterectomy.13,31 Patients with pelvic evisceration (ICD-9-CM: 68.8x) will be excluded. We also will exclude patients with any cancer diagnoses, including malignant neoplasm of the female genitourinary organs-cancer (ICD-9-CM: 179-184), a nd carcinoma in situ of female genitourinary system (ICD-9-CM: 233). Exposure Assessment Opioids in this study include the following medications: codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone. Tramadol and propoxyphene, considered as weak opioids or already off market, will not be included.11,15 The exposure group involves adult women who receive the hysterectomy surgery and fill more than one prescription for opioids on the day of hospital discharge or within 7 days after hysterectomy surgery, provided that they have no exposure to opioids for at least 6 months prior to hysterectomy.11 The 7 days of window is based on the assumption that a filled prescription during this period would likely to treat acute postoperative pain caused by hysterectomy. A comparison group, defined as the patients with no opioids use on the day of hospital discharge or within 7 days after hysterectomy surgery, will serve as a control to make a comparison of risks for chronic use of opioids. The control patients also have no exposure to opioids for at least 6 months prior to hysterectomy. The exposure of opioids will be identified using NDC codes from pharmacy claims data. In this study, exposure assessment includes all characteristics of the initial filled opioid prescription at the day of hospital discharge from hysterectomy or during 7 days post-hysterectomy. The different type of opioids (classified as long or short acting), number of supply days, and oral morphine equivalent daily dose (milligrams) will be assessed and analyzed. Outcome Assessment Since the study focuses on the risk of chronic opioid use after initial exposure to opioids following hysterectomy, patients were followed from the 8th day after hysterectomy to the first day of outcome occurrence. The outcome, chronic use of opioids after hysterectomy, will be defined using trajectory models.11 in which patients with similar patterns of medication filling during follow-up will be grouped together. The trajectory model was initially generated for the purpose of the assessment of medication adherence.32,33 In order to classify the trajectory groups for opioid use during the defined follow-up window, we first generate 6 dichotomous variables to indicate if a study participant fills a prescription of an opioid medication during each of 6 consecutive 30 day follow-up periods.11 we then model these 6 binary indicators of using opioids in each 30 day follow-up period as a longitudinal response in a logistic group-based trajectory.34,35 With a trajectory model, we will estimate the probability of membership of patients in each group, and the probability of the certain opioid exposure over time as a smooth function of time. We will fit the model using 2 to 4 opioid exposure groups with comparison of the Bayesian Information Criterion.36 The number of groups will be chosen based on the value of the Bayesian Information Criterion. In each group, a third-order polynomial (including linear, squared, and cubic terms) of time will be used to model the probability of being exposed to opioids. Patien ts will be assigned to different trajectory groups, which are generated from these models and have highest probability of the membership. Based on the model results, the group of patients with the highest probability of filling opioids over time will be defined as the chronic use. Other trajectory groups were classified as nonchronic users. The trajectory models provide new advanced approaches to utilize the observed data to determine distinct filling patterns of opioids in our study population during the year after hysterectomy surgery. It classifies patients into groups with similar opioid exposure patterns without relying on a priori and subjective cutoff line for the definition of chronic opioid use. The trajectory models will be conducted using SAS Proc Traj (SAS, version 9.4, SAS Institute Inc., Cary, NC, USA). Patterns of Chronic Opioid Use After chronic opioid use is defined using trajectory models, we will compare the frequency of the incidence of chronic opioid use over time from 2010 to 2013. The secular trend will be analyzed using Joinpoint regression program (National Cancer Institute, Calverton, MD) to identify the joint points and slopes. The rates of chronic opioid use in women post hysterectomy will also be compared with varied age, comorbidities, co-medications, as well as characteristics of initial opioids exposure, including opioid types and doses. The geographic variation of chronic opioid use will be mapped and analyzed using ArcGIS 10.5 geographic information systems software (ESRI, Redlands, CA). The opioid prescription policies and socioeconomic status in different states will be compared with the geographic variation of chronic opioid use. Predictors of Chronic Opioid Use We will identify the predictors of chronic opioid use at baseline or the time of the initial opioid prescription. A previous study demonstrated that hysterectomy, older age, and higher levels of pain-related dysfunction were associated with opioid prescription.15 Potential predictors in this study would include age, year of surgery, smoking, illicit substance abuse, alcohol abuse, hysterectomy type, psychotropic medication use, pre-operative depression, pre-operative pain condition, primary indication for hysterectomy, co-medications, and characteristics of the initial opioid exposure. Although the benefits of minimally invasive surgical procedures have been documented,37 hysterectomies performed for benign indications in 2010 in the US still consisted of 40.1% total or subtotal abdominal hysterectomies, 30.5% laparoscopic hysterectomy, 19.9% vaginal hysterectomy, and 9.5% robotic-assisted hysterectomy.21,25 Hysterectomy type has been related to the initial opioid prescription,15 how ever, the results from randomized clinical trials showed that abdominal hysterectomies didnt increase postoperative chronic pain.38,39 The primary indication for hysterectomy is defined based on the following algorithm: (i) precancerous conditions will be assigned the primary indication if endometrial cystic hyperplasia or carcinoma in situ of female genitourinary system is listed as an indication associated with hysterectomy surgery; (ii) whichever is listed first of endometriosis, uterine prolapse, or uterine leiomyoma will be assigned the primary diagnosis associated with hysterectomy if cancer or a precancerous condition is not listed; (iii) endometrial cystic hyperplasia is combined with in situ under precancerous and that pain and bleeding were included as reported reasons for hysterectomy, and (iv) other was assigned the leading for the remaining diagnoses.19 Over 60% of patients have reported pain as pre-operative symptoms for hysterectomy.39 After hysterectomy, the prevalent pain was reduced to 4.7% to 31.9% during 1-2 years after surgery, while new onset pain at follow-up was reported in 1-14.9% patients and increased pain was in 2.9-5% of patients with pre-operative pelvic pain.39 Therefore, in our study, we plan to assess pre- and post-operative pain, as well as the pain conditions, including pelvic pain, back pain, fibromyalgia, and migraine or other headache syndromes using ICD-9-CM codes. Patients with pharmacy claims for opioids or diagnoses for opioid abuse (ICD-9-CM: 304.xx) during the 6-month baseline period will be identified as opioid users prior to hysterectomy. Preoperative depression that has been found significantly associated with postoperative chronic pain,40 will be identified using diagnoses, as well as medication use at baseline. Antipsychotropic medication use will be obtained using prescription information. The psychiatric comorbidity, will be assessed using prescription information instead of ICD-9-CM codes for greater specificity.11 Co-medications refer to the use of other medications on postoperative pain management. The postoperative use of Nonsteroidal anti-inflammatory drugs (NSAIDs) or Acetaminophen with opioids has been found safe and effective on pain relieve with reduced opioid dose.41 All potential predictors, including characteristics of initial opioid use, will be adjusted in multivariate analyses to identify the significant predictors for chronic use of opioids in patients post hysterectomy. Statistical Analysis Statistical tests and modeling will be conducted to identify potential significant risk factors for chronic use of prescribed opioids in women post-hysterectomy. Categorical variables will be examined and compared using Chi square or the Fisher exact test. Continuous variables will be compared using the student t test. The covariates will be selected from all demographic and clinical variables using statistical modeling. A univariate analysis will be performed with the initial opioid exposure variable and then with each covariate added one at a time to monitor the change of the estimate of the major exposure variable. The covariates that modify the estimate of opioid exposure (variable >5%) or significantly predict the chronic use of opioids will be selected for further multivariate analysis. To account for many confounding factors, we will also utilize propensity score matching method to combine all confounding factors into a propensity score. The patients with initial opioid exposu re will be 1:5 matched with the patients without initial opioid exposure using the propensity score with a caliper of 0.01. A multivariate conditional logistic regression model will be utilized to measure the adjusted odds ratio of initial opioid exposure on chronic opioid use in two matched groups. A probability of type 1 error (alpha) = 0.05 will be considered to be the threshold of statistical significance. Tukey-Kramer method will be applied to correct the inflated p value due to multiple comparisons. Statistical analysis will be performed using SAS software (version 9.4, Cary, NC). Sensitivity Studies In order to address unmeasured confounding factors, sensitivity analyses will be conducted in two sections: subgroup analyses and instrumental variables. Subgroup analysis In order to investigate the effects of initial opioid exposure in women post hysterectomy, multivariate analysis will be conducted in the following subgroups: women with postoperative chronic pain, women without postoperative chronic pain, women with postoperative NSAIDs use, women without postoperative NSAIDs use, women with postoperative Acetaminophen use, and women without postoperative Acetaminophen use. Interactions between the drug exposure and the important factors will be examined in the multivariate analyses. Subgroup analyses will likewise be conducted if the interaction is statistically significant. Instrumental Variable We plan to use propensity score matching to address all measurable confounding factors and generate two balanced comparison groups. However, the unmeasurable confounding factors, like confounding by indication, may still impact the study validity. Instrumental variable is an advanced methodology that has been utilized in pharmocoepidemiological studies to control for the unmeasurable confounding factors, such as confounding by indication. In the sensitivity study, we will use the physicians preference as an instrumental variable and reexamine the initial opioid exposure on chronic use of opioids post hysterectomy. D. Timeline Table. Study Timeline of the Study. Time Period Study Progress Before 07/01/2017 Obtain IRB approval and Optum data use permission 07/01/2017 08/01/2017 Complete data cleaning, manipulating, and variable editing. 08/01/2017 10/01/2017 Complete analyses for demographic and clinical characteristics 10/01/2017 01/31/2018 Complete trajectory modeling to determine chronic opioid use. Analyze the time and geographic trends. 02/01/2018 02/28/2018 Submit an abstract to the annual meeting of International Society of Pharmacoepidemiology (ISPE) 03/01/2018 06/30/2018 Complete analyses for specific aim 1 07/01/2018 01/31/2019 Complete predictive modeling as described in specific aim 2 02/01/2019 02/28/2019 Submit an R21 to NIH, and an abstract to the annual meeting of ISPE 03/01/2019 06/30/2019 Compete analyses for specific aim 2, including all sensitivity studies. Submit a final paper to a high impact journal 09/01/2017 12/15/2017 Complete course PHP 2090 01/01/2018 05/15/2018 Complete course PHP 2470

Military Commander & the Law Essay

Both in the civilian and the military population, the issue of legal drinking age has been a contentious issue. The proposal to lower the minimum drinking age among members of the military in different states has attracted a lot of debate all over the United States. The basic argument has been individuals who are able to defend the country and participate in combat missions in Afghanistan and Iraq among other areas are responsible enough to be allowed to legally buy and consume alcoholic drinks irrespective of the age. However, any debate that deals with changes in the law is always a controversial issue. There are a large number of people in support of the lowering of the drinking age in the military to 18 years irrespective of the laws in the state in which the military base is located. On the other hand, it has been opposed by a large number of individuals and groups (Bray & Hourani, 2007). However, it is important to note that if an individual is mature enough to take part in military duties, he is mature enough to drinking and therefore the drinking age in the military should be lowered to 18 years. Surveys carried out in the United States have always indicated that majority of Americans support the abolishment of legal drinking age limits in the military. The Americans are generally for the argument that all individuals in active duties in the armed forces should not be limited by the law to consume beer. Being a democratic country, the policy makers have no option but act according to the will of the majority. In the past, all military officials in active duty were allowed to consume alcohol in their military bases irrespective of the laws limiting the drinking age in the state. This changed in the 1980s when the congress enacted laws that required the states and federal laws on legal drinking age be enforced in the military bases (Powers, 2009). Since then, there have been suggestions to abolish this law in different states. The basic argument has always been if the individual is man enough to be in a battlefield, he should be able to handle beer responsibly. Common sense indicates that an individual is recruited and allowed to work in the military because they are adults and therefore should not be limited by the law (Hoellwarth, 2007). An 18 years individual in the United States has attained the majority age and is considered to have the ability to make informed decisions such as participating in general elections. The person can also take a weapon to defend his country. Does it make sense really for such a person to be denied the right to consume alcohol? I don’t think so. The common believe that tolerance to alcohol increases with age is not necessarily true. There are cases where younger people have been found to be more tolerant. Moreover, tolerance to alcohol is an issue of responsibility and discipline rather than age. Many young people serving in the US military are more responsible that some senior members of the society (Jacobson, et al, 2008). In conclusion, it does not make sense the limit the military personnel from consuming alcohol based on their age. The fact that they are mature enough to take part in combat missions and defend their country suggests that they are mature enough to control their drinking. Moreover, majority of the Americans are in support of abolishing legal drinking age in the military. Reference Bray R. M & Hourani L. L. (2007). â€Å"Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys,† 1980-2005. Addiction; 102(7):1092-101 Gittins, R. A. (1996). The Military Commander & the Law, ISBN 0788172603, DIANE Publishing Hoellwarth, J. (2007). Corps lowers drinking age to 18 in some cases, Retrieved on July 22, 2010 from: http://www. marinecorpstimes. com/news/2007/05/marine_alcohol_070511/ Jacobson I. G, Ryan MAK, Hooper TI, Smith TC, et al. (2008). â€Å"Alcohol use and alcohol-related problems before and after military combat deployment. † JAMA; 300:663–675. Powers, R. (2009). U. S. Military: Military Drinking Age. Retrieved on July 22, 2010 from: http://usmilitary. about. com/library/polls/blmildrinkingage. htm

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A Comprehensive Treatment Plan Based Off Diagnosis Of The...

Upon discussions and consultations with general dentistry, periodontics, prosthodontics, and endodontic professors, we have drawn a comprehensive treatment plan based off diagnosis of the problems at hand. Periodontitis, loss of tooth structure due to bruxism, fistula, and periapical abscess were the findings. Based from the presentation of patient, it is apparent patient is at high risk of periodontal issues and of caries. Included in appendix, are the clinical photos, radiographs, periodontal charts, study casts, and treatment plans. Scaling and Root Planning (SRP), prophylaxis, root canal therapy (RCT), post and core, porcelain fused metal crown, and night guard were the major treatments. While broken teeth and possible caries†¦show more content†¦2), Autologous platelet concentrates (APC) for bisphosphonate-related osteonecrosis of the jaw treatment and prevention. A systematic review of the literature is a quality paper. Massimo et al. focused on finding out the differe nce between the group exposed to APC vs. the group Not exposed to APC, in regard to surgical dental treatments, in terms of a) improving success of surgical treatment of BRONJ, b) reducing the incidence of BRONJC after oral surgery procedures, furthermore, 1) improving healing of bone and soft tissue at the surgical site, 2) reducing incidence of any other post-surgical complication and side-effect, 3) improving patient’s quality of life by reducing pain, swelling, and other common symptoms, in the post-surgical period, increasing treatment acceptance by patient, in patient under bisphosphonate treatment world-wide. This paper analyzed original clinical studies including prospective and retrospective, on surgical treatment and prevention. The meta-analysis combined 2 case series and 1 case control but excludes case report and non-outcome study. The studies included address the review question, have appropriate study design, with clear search strategy, The article utilized Cochrane Central Register of Controlled Trials, MEDLINE, and Scopus bibliographic databases that were not limited to just English studies. Also, Del Fabbro et al.Show MoreRelatedAlcohol Use Disorder Identification Test1569 Words   |  6 Pagespropelled by unique problems and conditions. Generally, many people will look for therapy because of sense of dissatisfaction with emotional pain or life. Sometimes it can be from immediate distress that is related to a definite crisis like addiction, separation or a loss, maybe on ongoing difficulty in part of their lives like work or relationship. For some people it might be due to suffering strong sadness, worry or fear. 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