Illustration Essay With Citations

Illustration Essay With CitationsA sample illustration essay with citations can be a powerful tool to learn a craft. There are many aspects of illustration, but one of the main reasons that illustrators are successful is that they understand how to tell stories through their work. For those that don't have much time to design a full-blown illustration for a magazine or book, but would like to create a resume or portfolio piece, a sample illustration can be your starting point. Here's how to use it effectively.In order to fully appreciate the power of a sample illustration, you need to first look at what you should include in it. It's probably a good idea to place a sample illustration on your website, if you haven't already done so. You want to include your website address as well as contact information.When you are designing your own sample illustration, you need to follow your imagination and never follow a template. Instead, you should be able to draw inspiration from an article, video, or image that reflects your personality. Keep it simple, and try to tell a story through your illustration.If you are working with a graphic designer, hiring one of their assistants can help you make sure your illustration meets all your requirements. When you have everything that you need, it will only take you a few hours to complete your illustration. Since the majority of your work will be displayed, it's important to choose an illustrator that is trustworthy and reliable.When you are designing your own sample illustration, you can usually include multiple sections. This allows you to explain your background, education, art education, or training, or how your ability matches with the job description. You can also include an explanation of the project itself, and why you chose illustration as your specialty. Your illustration may be short, or it may even be long, depending on your needs.When you are designing your own sample illustration, you don't have to include all of t he information needed. However, in order to make sure that you are following your imaginations, it's a good idea to include a brief description of the project. It's also a good idea to include your contact information, since people may be able to call you for more information. The descriptions for these samples will usually vary by illustrator, but you should include as much information as possible, including the name of the company and website address.Remember that when you are creating an illustration, your goal is to reach your audience. The illustration will serve as a statement of who you are, and your audience will get a chance to see what you are like. By explaining your reasons for doing the project, you can create a more personal picture for your audience, and by including a link to your website, it will allow them to learn more about your work.

Is Dyson Product or Market Oriented Essay Example

Is Dyson Product or Market Oriented Essay In 1979, James Dyson bought a vacuum cleaner. However, various faults developed after some time, and so he resolved to one day create a better product. He did exactly this, and opened the company Dyson in 1992. Since then, he has created some of the most advanced technologies the world has seen.Product PortfolioDryerThe Dyson hand dryer is promoted by the company as reducing ones carbon footprint, using only clean air to dry your hands and needing only 10 seconds to do so. This first example contains elements of both product and market-oriented products. One can see that it is product oriented because it focuses more on making a product the best it can possibly be, as one finds with all products made with Dyson. However, it is also market oriented: Dyson looked at what consumers wanted to improve in terms of hand dryers, and found that they wanted something more environmentally friendly. Thus, they considered the environment more not just to make the product the best it can be, but a lso in order to meet consumers needs.Fan and HeaterThe fans and heaters that Dyson produce are also different from their competitors. The fans are bladeless, and the heater contains no visible heating elements, so reduce air buffeting and increase the safety of the product. Instead, they project a stream of smooth air into the room. This product is much more product oriented. One can see that Dyson is focusing more on marketing the product than conducting market research, and have also invested in creating new technology that wasnt previously in demand.Vacuum CleanerThe vacuum cleaner of Dyson is said to contain various advanced technologies. Its motor is smaller and more energy efficient, it is much easier to steer due to Dyson Ball technology and contains no bags.This product is again both market and product oriented. The use of new technologies to improve an existing product is an element of a product-oriented products, but because these technologies are used as a result of feedb ack from customers on cleaners from other companies makes the product also become rather market-oriented.ConclusionOverall, we found that Dyson is a more product-oriented company. We found this because when looking at the various products that they provide, and weighing up the elements of them, there were more elements of product-orientation. We found that Dyson is much more likely to push much-developed existing products into the market than producing products which are then immediately pulled into the market, and so the company is product-oriented.

5 grammar skills you need to master for career success

5 grammar skills you need to master for career success No matter what field you’re in, it’s likely that any given job description calls for good communication skills. At the top of this list is making sure your writing and speaking skills are top-notch. Let’s look at some of the key grammar tips that make your conversation and resume are polished and professional. 1. Use possessives correctly.This is one of the most frequent grammatical errors. Always take a minute to make sure you’re using the they’re and you’re  contractions for they are and you are. Their and your are possessive pronouns. These mistakes are often some of the easiest to spot for a reader, and they are so common from people of all backgrounds and education levels. If this is an issue that makes you nervous, one way to avoid this is to avoid confusion by not using contractions. It’s totally fine to spell out you are.Rule of thumb: If you’re making a contraction, you should always have an apostrophe. Possessive pro nouns never have an apostrophe.2. Don’t speak in the third person.Sometimes we (royal we) like to be extra formal in resumes or job interviews, because we want to present ourselves as highly dignified professionals. Resist that urge. Don’t go too informal (keep it professional, always), but it is absolutely okay to say â€Å"I† or â€Å"me,† and make it personal.Rule of thumb: You’re presenting yourself. You don’t need to hide behind the third person just to be fancy.3. Don’t use jargon or tons of abbreviations.Jargon is extremely popular on resumes, because you want the reader to know that you understand the ins and outs of an industry. You talk the talk, so that must mean  you’re an insider, right? Not really. Instead, you run the risk of turning off readers if they don’t quite get the same terminology, or if that jargon is hyper-specific to, say, your current job. It’s always better to keep things generic. An d if you do use abbreviations to save space, make sure you spell it out on the first use in your resume, cover letter, email, etc.Rule of thumb: Simpler is better. You never know who’s reading.4. Don’t use unnecessary capitals.Like jargon or being overly formal, extra capitals can be a crutch when we want people to Know What We’re Talking About. You may think you’re providing emphasis that draws the reader’s eye and makes your writing easier to read, but it really just complicates things unnecessarily.Rule of thumb: Only legitimate proper nouns (names) should have capitals.5. Proofread everything three times.I can’t emphasize this enough. All of us are prone to little mistakes when we write. This is especially true when you’ve written, rewritten, and edited a resume or cover letter so many times that you stop seeing what’s in it because you know it so well. That’s inevitably where the little mistakes creep in. If at all possible, get a trusted reader to review something official before you turn it in. Having an extra pair of eyes can help you spot blatant spelling or grammar errors, and can also help ensure that you’re making sense to the reader.Rule of thumb: Do it. Then do it again.

Assignment Research Paper Example | Topics and Well Written Essays - 1750 words

Assignment - Research Paper Example One of the most notable empires that used communication technologies effectively to handle information was the Assyrian Empire. In the first millennium BC, the Assyrian Empire expanded to an unprecedented size; the empire stretched from River Nile in Egypt to the Iranian mountains, thereby nearly enveloping the modern Middle East. The empire’s ruling elite managed to control the empire despite its massive size primarily because they used efficient communication technologies that facilitated effective handling of administrative messages and records. Constant innovations in administrative technology facilitated the development of communication systems, which facilitated economic growth. One of Assyrians’ most prominent exports was technologies of social management and control, which entailed the technologies such as coercion, information management and control of the empire’s physical assets. Assyrians typically found effective ways of managing storage, movement an d management of goods, armies, people, information and capital. In order to sustain the empire’s massive population, Assyrian administrators developed an administrative structure consisting of four intertwining components that enabled effective communication throughout the empire. These components were the temple administration, the palace, the city or town administration and the provincial administration (Black, 2001). While all components had their individual hierarchies, as well as power bases, the ultimate power typically trickled down from the king. The four structures served to create a balance in power, allowing information and decrees to flow from the king to the common folk. These structures allowed Assyrians to construct a streamlined economic and administrative system that saved on administrative costs, while also controlling a vast majority of the empire’s internal production means. Administrators at the lowest structure (the town/city administration) were primarily tasked with collection of taxes and management of tax records, labor conscriptions, as well as military call-ups. As a result of the effective hierarchical system of communication, the king continually settled deportees from other regions of the empire and parceled out such land as favors in exchange for loyalty. This developed an extremely stratified society with minimally sized aristocratic elite, thereby keeping public expenditure at a minimal. Assyrian military innovation also enabled the empire to maintain a well-organized system of material and food distribution and storage for soldiers and the entire population. Communication problems were resolved through an effective chain of posts, which facilitated speedy communication between distant and capital province. They perfected the communication technology by using horses for military purposes and typical communication aims. One of the reasons why the Roman Empire was quite strong was because of its capacity to communi cate with the masses. Communication held the society together through beliefs in similar laws and myths, which demonstrated a common bond passed down from one generation to another (Black, 2001). Emperors in the Roman Empire used inexpensive means to communicate with the masses, for instance, emperors communicated by displaying gestures,

Magnetic Resonance Imaging Technique Essay Example | Topics and Well Written Essays - 2000 words

Magnetic Resonance Imaging Technique - Essay Example The essay "Magnetic Resonance Imaging Technique" talks about an advanced imaging technique used in the field of medicine under radiology particularly how it works. All bodies expose themselves to water molecules. The water molecule has two protons and hydrogen nuclei. When one is using a powerful magnetic field of a scanner, the overall magnetic moment of different protons aligns themselves in the direction of the field. Turning on of the radio frequency transmitter follows, thus, producing different electromagnetic fields. The electromagnetic field has the appropriate frequency termed as resonance frequency; the protons in the magnetic field absorb and flip the spin. After a while, when the electromagnetic field is in off status, the protons’ spins get to thermal dynamic equilibrium. The bulk magnetizations get aligned by the static field. As a result, this relaxation, radio frequency signals arise; these can be measured using receiver coils. Additional magnetic fields can facilitate learning about the information regarding the origin of the 3D space during the scan. Fields generated by passing electrical current via gradient coils results to varying magnetic fields in reference to the position of the magnet. This also alters the frequency of the signal, as it depends on the origin of the signal. Mathematically, the distribution of the signal can also be recovered from the body; however, this uses the inverse frontier transformation. After the relaxation rates, protons in various tissues return to the equilibrium.

Using gentamicin in the management of sepsis

Using gentamicin in the management of sepsis Sepsis is defined as the inflammatory response toward an infection (1). It is either simple or severe sepsis depending on the organ dysfunction involved as a result of the infection and other factors (2). In terms of the pathophysiology of severe sepsis, a cascade of inflammation and activation of the coagulation system associated with impaired fibrinolysis causes changes in microvascular circulation associated with organ dysfunction, severe sepsis, multiple organ dysfunction syndrome, and death (3). In terms of definitions of other sepsis-associated symptoms, it was generally agreed at the International Sepsis Definitions Conference which was convened in 2001 and the following definitions of sepsis syndromes were published in order to clarify the terminology used to describe the spectrum of disease that results from severe infection. Sepsis is the presence of infection in association with meeting the Systemic inflammatory response syndrome (SIRS) criteria (Box 1 (2)). The clinical significance of meeting SIRS criteria in the absence of organ dysfunction or shock is still unclear. Severe sepsis is defined as evidence of end-organ dysfunction such as altered mental status, episode of hypotension, elevated creatinine, or evidence of disseminated intravascular coagulopathy. Septic shock is defined as persistent hypotension despite adequate fluid resuscitation or tissue hypoperfusion manifested by a lactate greater than 4 mg/dL. Bacteremia is defined as the presence of viable bacteri a within the liquid component of blood (1). Acute pyelonephritis is defined as an acute infection of one or both kidneys; usually, the lower urinary tract is also involved (4). Antibiotic regimen of choice for Sepsis that is associated with urinary tract infection is Co-amoxiclav 1.2g 8 hourly intravenously together with Gentamicin IV dose of 5mg/kg once daily (5). Although that is controversial whether to use the ideal body weight (IBW) or to obtain blood samples indicating Gentamicin level to get the optimal dosing regimen for Gentamicin in obese patient due to risk of accumulation with Aminoglycoside and the fear of oto- and nephrotoxicity (6). Other supportive measures depend on the patients status; table 1 (1) contains helpful measures that indicate markers of organ dysfunction. Case Summary Our patient, C.M., is a 56 years old female who was admitted to the Accident and Emergency department (AE) due to an increased urinary frequency and a high temperature of 40.5 °C. Other complaints were back pain and shortness of breath (SOB). Also, the patient had reported a fall the night before admission. Moreover, the patient had vomited the night before and in the morning of admission. C.M. is a previous smoker who had stopped smoking several years ago and she lives with a partner. She is clinically obese weighing 100kg and her height is 152.4cm. Giving this, her ideal body weight (IBW) comes to 49kg. The only known allergy for this patient is microspores tapes. The patients past medical history (PMH) included asthma, non-insulin dependent diabetes mellitus (NIDDM) and fibromyalgia. She was on one puff daily of each Symbicort Turbohaler 200/6  µg and Ventolin Accuhaler for the management of her stage 3 asthma. Metformin 1g daily was prescribed for her diabetes control; however, its formulation was not mentioned (whether it is a sustained release tablet or a normal release one!). For her fibromyalgia, she was taking 300mg of Quinine sulphate daily together with 150mg of Amitriptyline daily (which is a very high dose; low dose of tricyclic antidepressant (T CA) is recommended i.e. 20-30mg of Amitriptyline). For her pain, the patient was on Co-codamol tablet as required (strength, dose and frequency were not mentioned). Having that she is a diabetic patient over 40 years old, a dose of Simvastatin 40mg daily was prescribed as a primary cardiovascular disease (CVD) protection measure. In addition, Omeprazole 20mg daily was one of her regular m edications with unclear indication. Investigations On admission, an Electrocardiography (ECG) was performed and indicated sinus tachycardia; which could be related to the high temperature, pain or sepsis. The patients vital signs were abnormal having a respiratory rate (RR) of 22 breaths per minute (normal is ~ 12bpm), a heart rate (HR) of 117 beat per minute (normal is ~ 70bpm) and a blood pressure (BP) of 142/65 mmHg (target for diabetic patients is Her laboratory investigations were almost normal except for some parameters. The Sodium level was a bit low which could be a result of the frequent urination or an Amitriptyline hyponatremic effect. Glucose and C-reactive protein (CRP) levels were high which might indicate the presence of infection. Thrombocytopenia may be caused by Quinine or Simvastatin administration! Impression and related Management Plan The patient was diagnosed as a pyelonephritis and sepsis case; so empirical antibiotic regimen was initiated with 1g Amoxicillin intravenously six hourly and 500mg ciprofloxacin orally once daily. Also, 1g Paracetamol intravenously six hourly and one liter Normal Saline intravenously over 24hours was started. Urinalysis on the first day indicated the presence of leucocytes, nitrites, glucose, ketones and blood which means a presence of infection. On the second day, blood culture showed a growth of E. coli which is sensitive to Gentamicin, therefore, 400mg Gentamicin intravenously every 24 hour was prescribed and ciprofloxacin was discontinued. Gentamicin plasma level was requested 6-14 hours after administration of the first dose. In addition to the patients regular medications, 50 mg of Cyclizine eight hourly and 20mg of Citalopram once daily were added, paracetamol IV was switched to orally in the second day and 30mg of oral codeine as required was prescribed ; but the patients Salbutamol Inhaler had been stopped for unclear reason. Discussion Revising the management plan for this patient and in comparison to the local guidelines for the management of pyelonephritis and sepsis patients, we would notice that 1.2g intravenous Co-Amoxiclav is the first-line choice of Penicillins, not Amoxicillin, together with Gentamicin. However, if the ideal body weight is required to obtain the appropriate dosing of Gentamicin for obese patients, so in this case, 245mg of Gentamicin supposed to be prescribed instead of 400mg which is the maximum daily dose (Although that some infectious diseases specialist would recommend going to the maximum dose to make sure that we get the maximum benefit; but we must consider patient status and severity of infection!). Also, it is essential to check the optimal timing for monitoring each drug plasma level, in our case, Gentamicin therapeutic drug monitoring (TDM) has not deviated from the local guidelines recommendation for the once daily dosing of Gentamicin i.e 6-14 hours after giving first dose. Having a patient with increased urination and vomiting, we must consider fluid replacement. Replacing with one liter Normal Saline (NS) might have not met the patients requirement! So it is recommended to check patients need to ensure appropriate replacement i.e. at least 2.5-3 liter daily. We could have recommended giving 2 liter NS each over 8 hours plus the addition of 500ml 5% Dextrose to ensure calories intake if the patient cannot tolerate oral intake. Considering the patients asthma control, we must confirm that Salbutamol inhaler was not mistakenly missed after admission. Since that SOB was one of the patients complaints, we must ensure that it was relieved, if not, consider 5mg of Salbutamol nebulizer four times daily to be added to the regimen and if nebulizer is not necessary, ask for Salbutamol inhaler to be charted as if required basis (6). Also, blood gases were not mentioned so it is probably safer to ask for the oxygen and carbon dioxide saturations to consider if oxygen therapy is needed! Confirm that the patient and nursing staff are aware of inhalers techniques. The patient is on Amitriptyline 150mg orally daily which is considered an old practice for the treatment of fibromyalgia (high dose TCA) and the current recommendation states 20-30mg of Amitriptyline daily for 8 weeks (6) so it is better to re-consider dosing or to change regimen. Low dose Sertraline or high dose Venlafaxine therapy may be effective (6) so consider changing if no further benefit of the use of Amitriptyline. For the associated pain, Paracetamol with Tramadol has better efficacy than Co-codamol. Pregabalin (150-300mg every 12 hours) may improve pain especially if combined with Tramadol; it also improves sleep and morning stiffness (6). So, knowing the patients control with the current medication would be helpful to consider treatment change or modeling to get the most of pharmacologic treatment. Suggesting alternative ways to manage symptoms is also recommended, e.g. spa therapy, physiotherapy, stress management, acupuncture or diet (6). NICE guidelines for the management of type II diabetes mellitus state that Metformin is the first line choice for obese patients. Choosing appropriate formulation that suits the patients lifestyle is essential to ensure patients compliance. Once daily dosing of sustained release formula could provide 24 hour control over glucose, but in this case the present of infection interfered with having accurate reading so it is logical to check the HbA1c to check the glycemic control over the last 8 weeks to consider any therapy modification. Also, pre- and post-prandial glucose level monitoring is required to avoid both hyper- and hypoglycemia using the current regimen. Statins must be prescribed for all diabetic patients who are over 40 years old (6) and having any risk factor of Coronary Vascular Diseases (CVD). The patient was on Simvastatin 40mg daily but no Cholesterol level obtained (consider Ezetimibe if high Cholesterol). Monitoring liver function tests (LFTs) and any muscular side effect is important. Also, having a high BP on admission, checking that BP is normal after sepsis reveals is vital. If persistent high BP, consider adding ACE inhibitors, having the benefit of BP control and protecting the heart in patients susceptible to Vascular Diseases. Weight loss in this patient is advisable so consider dietitian and physiotherapist review to consider going on diet and exercise. Also, annual eye check is recommended to control retinopathy due to DM. Cyclizine was prescribed on regular basis, so we better check if the patient is really on need of a regular anti-emetic, otherwise, consider changing it to as required basis. Regarding Paracetamol, it was prescribed on as needed basis but it was not put clear not to exceed the maximum daily dose, so it is recommended to clarify that to not give the patient more than 4g per day. It is safer to contact the patients GP to confirm the indication of Omeprazole and to consider discontinuation if no clear indication was obtained. Additionally, the patient was thrombocytopenic, which could be a side effect of administration either Quinine or Simvastatin, so monitoring the platelets count is highly recommended to prevent any complication, although DVT prophylaxis is not needed as long as the patient is mobile. Conclusion In conclusion, the overall patient management had no much deviation from the current guidelines recommendation except for some practice that need to be reviewed considering the current patients status. Therapeutic monitoring should be carried on because the patient is under risk of many complications or side effects. Lastly, patients awareness of her clinical condition and treatment requirement for each problem is helpful to prevent or reduce future health problems. Appendix 1: PATIENT MEDICATION PROFILE Patient details Name C.M. Consultant General Practitioner Address Gender Female Weight 100 kg Height 152.4 cm Community Pharmacist Date of Birth (Age) 56 y.o. Known Sensitivities Micropores tapes Social History Previous smoker, lives with partner Patient hospital stay Presenting complaint in primary care / reason for admission Admission date 2008 Increased urinary frequency Back pain Shortness of breath Vomiting Fall (the night before) Fever (40.5 °C) Discharge Date Discharged to Relevant medical history Relevant drug history Date Problem Description Date Medication Comments Asthma Symbicort 200/6 Turbohaler 1 puff daily Ventolin Accuhaler 1 puff daily Non-insulin dependent diabetes mellitus Metformin 1g daily Formulation? Fibromyalgia Co-codamol PRN Strength? Amitriptyline 150mg daily Too high! Quinine sulphate 300mg daily Duration? Simvastatin 40mg daily 1ry CVD prevention Omeprazole 20mg daily Indication? Relevant non drug treatment Prescribed Medication Start Stop Clinical/Laboratory Tests Result 1 Paracetamol 1g IV 6 hourly Day 1 Day 2 ECG Sinus tachycardia 2 0.9% sodium chloride 1000ml IV over 24 hours Day 1 HR 117 bpm 3 Amoxicillin 1g IV 6 hourly Day 1 BP 142/65 4 Ciprofloxacin 500mg PO OD Day 1 Day 2 RR 22 bpm 5 Metformin 1g PO OD Day 1 Urine analysis Leucocytes, nitrites. Glucose, ketones, blood +ve 6 Omeprazole 20mg PO OD Day 1 Blood culture E. coli 7 Quinine sulphate 300mg PO OD Day 1 Na 134 (135-145) 8 Simvastatin 40mg PO OD Day 1 CrCl 145.3 (78-120) 9 Amitriptyline 150mg PO OD Day 1 Glucose 8.9 (3.9-5) 10 Symbicort 200/6 inhaler 1 puff daily Day 1 CRP 180 ( 11 Codeine phosphate 30mg PO PRN Day 1 Bilirubin 35 (3-16) 12 Citalopram 20mg PO OD Day 1 PT 17 (12-15) 13 Cyclizine 50mg PO 8 hourly Day 1 APTT 39 (20-30) 14 Gentamicin 400mg IV 24 hourly Day 2 Platelets 70 (150-400) 15 Paracetamol 1g PO PRN Day 2 Clinical management Diagnosis Pharmaceutical Need Pyelonephritis Evidence-based treatment Sepsis Treatment according to guidelines Care Issue/Desired Output Action Output Confirm drug history + reconcile drug history Ask patient how and when she takes her medication and the indication for each medicine. Compare with GPs DHx + Phone GP for indications for amitrip., omep. and quinine, and when they were initiated. All regular meds have been charted except prn salbutamol. Patient is SOB; advise Dr to chart it prn. Confirm antibiotic regimen for pyelonephritis/sepsis in addition to TDM Check the local guidelines that amoxicillin is first-line for the indication (culture sens. to gent.).Calc. her ideal body weight and CrCl.Calc. gent. dose based on ideal body weight and compare to 400mg iv od (max dose).Check local guidelines whether 6-14 post dose gent. level is correct procedure. Chase level. Monitor BP, Temp, Pulse, RR for signs of resolving sepsis whilst on current regimen. Co-amox 1.2g iv tds is first-line with gent 5mg/kg (max 400mg, ideal body wt 49kg, CrCl 71ml/min). Recommend switch to co-amox because she needs 7/7 iv + oral. Recommend 245mg gent iv od Obtain level before 2nd dose is given+TDM for gent is correct. Review need for gent in 48h Fluid requirements possibly not being met by 1L N. saline in 24hours Request a running fluid balance chart due to vomiting + increased urinary frequency. Ask patient if she can tolerate oral liq. or if feels thirsty. Assess if iv is necessary (2.5L daily + replace losses) Advise doctor to amend first bag to 8 hours and chart 1L N.saline over 8hours + 500ml glucose 5% over 8 hours if patient cant tolerate oral liq. Is her current SOB being treated appropriately? If patient is still wheezy, ask for PaCO2 + PaO2. Request salbutamol nebs 5mg qds + O2 60% to be charted. If not currently SOB, ask for accuhaler to be charted prn. Assess inhaler technique for both inhalers when breathing ok Is her fibromyalgia regimen in-line with current evidence? Check Brit. Soc. Rheum for current guidance on fibromyalgia. Check that citalopram is the SSRI of choice in fibromyalgia since it has been started on admin. Review quinine; if has been in use for 3 months with no benefit consider stopping it High dose TCA is an old practice; current evidence states 25mg/day for 8 weeks. Advise a review of Amitrip. Low dose sertraline has better evidence for use in Fibro. Advise switch + show evidence to prescriber. Tramadol with paracetamol has better efficacy than co-codamol. Suggest trial switch and monitor for dizziness due to recent unexplained fall. Consider pregabalin. Lifestyle advice: stress management, diet, physiotherapy/massage, etc. Is her type II diabetes under control? Check SIGN guidelines on diabetes for current management. Request HbA1c test to determine control over last 2-3/12 Monitor glucose pre/post-prandial and random. Ask patient how she takes the metformin and how regularly Metformin is first-line in obese type II. From lab results, assist endocrinologist in determining whether metformin dose should be increased + which preparation suits patients lifestyle. Is her CVD primary prevention needs being met? Check SIGN guidelines on CVD primary prevention. Check BP + Cholesterol. Next UEs ask for urine albumin + protein levels. Ask patient about current diet and exercise plan (obese) + last eye test. Simvastatin 40mg charted. Check cholesterol. If it is high, may need ezetimibe 10mg od. LFTs ok BP 142/65, upon resolving sepsis recheck BP and initiate ACEi if appropriate. Advise dietician review (obese) + physiotherapy review (or GP) for plan (30mins exercise 5/7). Advise eye test once a year Regular cyclizine may be unnecessary Endorse chart for paracetamols maximum daily dose Reassess patients need for a regular anti-emetic and re-chart cyclizine as prn instead of regular if required Max 4g in 24 hours (e.g. 1g QDS) Highlight patients thrombocytopenia No need for DVT prophylaxis if patient is mobile. Mention that quinine or simvastatin could be the cause of low platelets. Suggest trial withdrawal of quinine if not planning on stopping anyway. Monitor Platelets level if continued. Indication for omeprazole Determine indication from GP and patient. Consider trial withdrawal if indication unknown. Appendix 2: Box 1. Consensus Conference of the American College of Chest Physicians and Society of Critical Care Medicine definitions for the various manifestations of infection.   Ãƒ ¢Ã¢â€š ¬Ã‚ ¢ Systemic Inflammatory Response Syndrome (SIRS): Manifest by two or more of the following conditions: 1. A temperature >38oC or 2. A heart rate >90 beats per minute 3. A respiratory rate >20 breaths per minute or a PaCO2 4. A white blood cell count >12,000/mm3 or 10% immature forms. à ¢Ã¢â€š ¬Ã‚ ¢ Infection:Microbial phenomenon characterised by an inflammatory response to the presence of microorganisms or the invasion of normally sterile host tissue by these organisms. à ¢Ã¢â€š ¬Ã‚ ¢ Bacteraemia: The presence of viable bacteria in the blood. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis (Simple): The systemic response to infection, manifested by two or more of the SIRS criteria pus an infection. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis (Severe): Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities that may include, but are not limited to lactic acidosis, oliguria or an acute alteration in mental status. à ¢Ã¢â€š ¬Ã‚ ¢ Septic shock: Sepsis-induced hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include, but are not limited to lactic acidosis, oliguria or an acute alteration in mental status. Patients who are receiving inotropic or vasopressor agents may not be hypotensive at the time that the perfusion abnormalities are measured. This is a subset of severe sepsis. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis-induced hypotension: A systolic blood pressure 40 mmHg from baseline in the absence of other causes for hypotension. Adapted from Bone RC et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101: 1644-1655. Appendix 3: Table 1. Clinical and laboratory markers of organ dysfunction. Organ System Clinical Laboratory Cardiovascular Tachycardia Hypotension Cardiac arrest Arrhythmias Haemodynamic support Altered CVP, PCWP Reduced cardiac output Endocrine Weight loss Hyperglycaemia Hypoalbuminaemia Haematological Bleeding Thrombocytopenia Increased D-dimers Abnormal white cell count Abnormal clotting profile Gastrointestinal Ileus GI bleeding Acute pancreatitis Acalculous cholecystitis Decreased intestinal pH Elevated amylase Hepatic Jaundice Hyperbilirubinaemia Increased PT Elevated LFTs Hypoalbuminaemia Neurological Delirium Confusion Altered consciousness Altered EEG Renal Oliguria Anuria Renal replacement therapy Elevated creatinine Elevated urea Respiratory Tachypnoea Cyanosis Mechanical ventilation PaO2 SaO2 PaO2/FiO2 Immune Pyrexia Nosocomial infection Altered white cell count Impaired white cell function Adapted from Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin 2000; 16: 337-352.

Deontological ethics Essay

Attempting to explain the differences and similarities of virtue theory, utilitarianism and deontological is basically from my own understanding of each. I am having much difficulty reading the materials as well as sitting at this computer for any length of time. I believe my reading visual is deteriorating at a rapid pace because of the straining to my eyes. Virtue ethics focuses on a person’s character and morals. This person will always try to do what is right because he was taught at an early age and by someone he loves and wants to always please by doing the right thing, regardless of the consequences. Utilitarianism focuses on the consequences of your actions. What I mean by that is that if you steal something and not get caught, there are no consequences. No one knows that you stole and therefore you do not have to answer to anyone but yourself. Deontology focuses on the outcome of the act whether right or wrong. The person steals food from a grocery store because his children are hungry and he does not have the money to buy food. Although it is his responsibility to feed his children, stealing is clearly wrong. The consequences did not matter at that particular time; he did what he felt he had to do. Recently there was an incident on my route where a woman called in to my job and conveyed to my superior that I was talking about Jesus on the bus and she was offended. I was called in and reprimanded and told not to speak about religion on the bus. My response to her was, is that right? Quite a few of my regular passengers know that I am a minister and talk to me regularly about the Bible, Jesus and the Christian faith. Based on the virtue ethics, I was taught to speak the word of God in season and out of season, when it is time or easy and when it is not a good time or hard. This is my first and most important job and regardless of the consequences, I will continue to preach the word and pray for anyone who desires to hear it. I will always try to please Jesus in whatever I do.