Video project Assignment Example | Topics and Well Written Essays - 500 words

Video project - Assignment Example In this context, spectrum health involves itself with the community by creating direct contact and addresses their concerns in the manner that is best suited for them. The company involvement with the affairs of the community enables the community to appreciate its existence while the company can know the needs of the community health wise and address them in future community focused programs. The video illustrates the assigned course very well as it clearly shows the innovative manner a company or organisation can be involved in the community around it especially making the programs community friendly through participation. In this case, it is initially all about the social parties rather than what the organisation derives from it. The company does not engage mainly to rip benefits but it stands to ultimately benefit from its involvements through several avenues. The proceedings in the video provided bear a relation with what was discussed in class. One notable element relates to how corporate social responsibility in modern days functions. It is notable that the organisation Spectrum health stands to gain from its involvement with the community. Through corporate social responsibility, it is building reputation which in line translates to a better image. Demand for its health insurance services are likely to go up because it identifies with people surrounding its basic operations. According to the iron law of responsibility, those organisations that do no appeal to the society through usage of their power loses it. From the video, it is evident that Spectrum Health’s goal is to use their influence and contribute positively to the society. Essentially, their goal with coming up with the project is to make a positive impact which they achieve. The actions of the organisations contain some present forms of corporate social responsibilit y. There is the citizen ship approach- they do it out of obligation and accountability, they are also focused on the

Is Drug Addiction a Disease of the Brain Research Paper

Is Drug Addiction a Disease of the Brain - Research Paper Example As for drugs like marijuana and heroin, their molecules have a similar structure to neurotransmitters, and thus they activate nerve cells in order to form even harmful synaptic connections as well as send abnormal messages. Cocaine and methamphetamine, on the other hand, would cause the overproduction of neutransmitters like dopamine, which eventually â€Å"shuts off† synaptic communication or the signaling between neurons and alters the brain’s reward system (â€Å"Drug Facts,† 2011). As the addiction continues, it is getting harder and harder to bring the dopamine level to normal in order to produce the same rewarding or satisfying feeling, thus more and more amount of drugs is needed to achieve this. Another effect of drug addiction on the brain is altering glutamate, which is actually associated with the brain’s reward system and cognitive function. Long term abuse, therefore, may impair the glutamate and consequently affect judgment, learning, memory, behavior control, and decision-making activities of the drug addict (â€Å"Drug Facts,† 2011). ... tion is not a brain disease because of two reasons: First, â€Å"the changes in the brain which [those who are on the opposite side of the issue] show us are not abnormal at all,† and second, â€Å"there is no evidence that the behavior of addicts is compulsive [or involuntary† (â€Å"Addiction is NOT,† 2012). For the first reason, those who believe that drug addiction is a disease often point out to brain images of neuroadaptations and a totally different prefrontal cortex that both result from a repetitive intake of drugs. According to authors of Clean Slate, this is not abnormal at all because any human being can alter the synaptic pathways of his brain simply through constant practice, and the authors point out Begley and Jeffrey Schwartz, who both authored The Mind and The Brain. Both authors pointed out in their book that the scanned images of both experienced and inexperienced taxi drivers in London are not the same in terms of the prefrontal cortex, but t his does not necessarily mean that drivers who do not know much of the city would have a mental disease. The point is that â€Å"these brain changes don’t need to be brought on by exposure to chemicals,† and since there is no physiologic malfunction and that there are no pathologically affected parts, then the author of Clean Slate contends that drug addiction is not a disease (â€Å"Addiction is NOT,† 2012). In fact, the aforementioned claim is rather supported by Satel and Lilienfeld (2007), who state, â€Å"In the days between binges, cocaine addicts make many [normal everyday] decisions that have nothing to do with drug-seeking.† However, although it makes perfect logical sense that drug addicts do not act like drug addicts all the time, it is basically the same thing with AIDS patients since these people can

The Making of the Korean War and Its End Term Paper

The Making of the Korean War and Its End - Term Paper Example With the help of communists, North Korea was sure of a swift win in South Korea and never thought that the United States would come to the assistance of South Korea in time. However, the South Korean communists had been suppressed harshly with no chance of helping North Korea forces. After successfully defeating the South Korean army and on the brink of winning, a combined United States and United Nations forces attacked North Korean forces successfully pushing North Korean forces past the 38th parallel. Kim had grossly underestimated the United States armed forces capacity in the region and the U.S commitment to Ryee’s government. North Korea invaded South Korea starting the civil war in which Koreans fought each other on their own soil. Had Kim not invaded the south the civil war would not have started but still it could not have been fought if the communist Russians and the United Nations had not divided the country at the 38th parallel splitting the country into an industr ial north and an agricultural south after World War II. North Korea had a superior army and quickly overwhelmed the South Korean Forces. With military support from Stalin and blessings from Mao, South Korea could not hold long, and they did not; they had a weaker army and were not prepared for war. North Korea’s leader had unified his country with swift reforms and nationalistic policies, which increased his popularity in contrast to Ryees government, which had embarked on a campaign to root out communists. It was his unification ambition and his brutal leadership that had prevented the United States from strengthening his military strength. Kim’s army had the support of the Soviet Union and without Stalin’s support; he would have delayed his attempts at unifying Korea through military means. Why Did United States and Russia Interfere In The War? Failing to unify their country due to bad communications and different ideologies, Kim and Ryee had to involve extern al powers to unite Korea. Stalin initially did not support Kim in attacking South Korea, he changed his mind when China’s communist took china’s leadership and the Soviet Union acquired and tested their first atomic bomb. NATO was established when Russia’s relation with the west was very poor. They could not support the war because the country’s sovereignty was threatened by the west and he did not want to aggravate the situation1. The atomic bomb made the Soviets more secure and hence they stopped being concerned with the reaction of the United States if they actively supported the war. The United States could have attacked the Soviet Union from the south but through Acheson statements America weakening involvement in Asia was evident. Russia wrongly interpreted this as a weakening of the United States military capabilities and influence around the region. If Russia did not have the capability to defend itself against the west, Stalin would not have cons ented to the war. The increasing communist successes in the region concerned the United States government. Communist governments spread would weaken their influence in the region. If South Korea had suppressed North Koreas attack, Washington would not have a valid reason to attack. By defending the South Korea nationalistic government, it would empower the people through democracy, but Bruce Cumings disagrees claiming that the United States and South Korea committed sustained atrocities during the war. He claims that many unarmed civilians were shot

Nature-Nurture Debate Essay Example for Free

Nature-Nurture Debate Essay Introduction In this report I will examine and explain effective communication by looking at the role of effective communication and interpersonal interaction in health and social care context, theories of communication, methods of communication (verbal, non-verbal and written communication), communication cycle, what is effective communication, formal and informal communication, differences between language and culture. Communication between people enables us to exchange ideas and information, but it involves much more than simply passing on information to others. Communication helps people to feel safe, to form relationships and develop self-esteem. Poor communication can make an individual feel vulnerable, inferior and emotionally threatened. Effective communication helps us understand a person or situation, enables us to resolve differences, build trust and respect and create an warm environment. The effective communication helps us improving communication skills in everyday live, business, relationships, but also in health and social care context. Learning and understanding the effective communication skills the people can better connect with the family members, friends, co-workers (by improving teamwork), people looked after in care homes. What is effective communication Effective communication combines a set of skills including verbal and non-verbal communication, attentive listening, the ability to manage stress, the capacity to recognize and understand your own emotions and those of the person you are communicating with . Effective communication is about more than exchanging information. It requires also understanding the emotion behind the information. It enables us to communicate even negative or difficult messages without creating conflict or destroying trust. Effective communication-Methods of communication Verbal communication The basis of communication is the interaction between people. Verbal communication is the main way for people to communicate face to face. The components of the verbal communication are: sounds, words, speaking and language. Only people can put meaning into words; words alone have no meaning. As meaning is an assigned to words, language develops, which leads to the development of speaking. Over 3000 languages and major dialects are spoken in the world. The huge variety of languages creates difficulties between different languages, but even in one language there can be many problems in understanding. Speaking can be looked in two major areas: interpersonal and public speaking. To communicate effectively we must not simply clean up our language, but learn to relate to people. To be an effective communicator, one must speak in a manner that is not offending to the receiver. Listening Successful listening means not just understanding the words or the information being communicated, but also understanding how the speaker feels about what they are communicating. Effective listening can: -create an environment where everyone feels safe; -save time; -relieve negative emotions; -focus fully on the speaker, make the speaker feel heard and understood; -avoid interrupting; -show you interest. The communication cycle According to Michael Argyle(1972) skilled interpersonal interaction (social skills) involves a cycle in which you have to translate or â€Å"decode† what other people are communicating and constantly adapt you own behaviour in order to communicate effectively. Good communication involves the process of checking understanding, using reflective or active listening. The communication cycle supposes: -an idea occurs: you have an idea that you want to communicate; -message coded: you think through how you are going to say what you are thinking and you put your thoughts in to language or sign language; -message sent: you speak, or sign, or write, or send your message in some other way; -message received: the other person has to sense your message; -message decoded: the other person has to interpret or â€Å"decode† your message; -message understood: your ideas will be understood if all goes well. Non-verbal communication Non-verbal means â€Å"without words†, so non-verbal communication refers to the messages that we send without using words. We send these messages using our eyes, the tone of our voice, our facial expression, our hands and arms, the way we sit or stand. We can enhance effective communication by using open body language (arms uncrossed, standing with an open stance, maintaining eye contact with the person you are talking to). When we speak about non-verbal communication we actually mean: -posture; -the way we move; -facing other people; -gestures; -facial expression; -touch; -silence; -voice tone; -proximity; -reflective listening. As well as remembering what a person says, good listeners will make sure that their non-verbal behaviour shows interest. Skilled listening involves: -looking interested and communicating that you are ready to listen; -hearing what it is said to you; -remembering what was said to you, together with non-verbal messages; -checking your understanding with the person who was speaking to you. Written communication When people remember conversations they have had, they will probably miss out or change some details. Written statements are much more permanent and if they are accurate when they are written, they may be useful later on. Written records are essential for communicating formal information that needs to be reviewed at a future date. For the people who cannot see written scripts or who have limited vision there is a communication system known as Braille which uses raised marks that can be felt with the fingers and it’s based on the sense of touch. This system is now widely used for reading and writing by the people who cannot see written script. Theories of communication The verbal and non-verbal communication is not always straightforward. Effective communication involves a two-way process in which each person tries to understand the view point of the other person. According to Michael Argyle (1972) interpersonal communication is a skill that could be learned and developed. Skilled interpersonal communication, interaction(social skills) involve a cycle in which you have to translate or â€Å"decode† what people are communicating and constantly adapt your own behaviour in order to communicate effectively. The communication cycle involves a kind of code that has to be translated. The stages of communication cycle might be: 1. An idea occurs. 2. Message coded. 3. Message sent. 4. Message received. 5. Message decoded. 6. Message understood. Tuckman ‘s stages of group interaction Bruce Wayne Tuckman(1965) argued that communication in groups can be influenced by the degree to which people feel they belong together. Tuckman suggested that most groups go through a process involving four stages: 1. Forming refers to people meeting for the first time and sharing information. 2. Storming involves tension, struggle and arguments about the way the group may function. 3. Norming sees the group coming together and agreeing on their group values. 4. Performing means that the group will be an effectively performing group, once they have established common expectations and values. Formal and informal communication in health and social care Health and social care work often involves formal communication, which is understood by a wide range of people and shows respect for others. Usually care workers will adjust the way they speak, in order to communicate respect for different communities they address to, as the service users, visitors, colleagues. Formal communication is used in local authority social services and supposes proper English. It also shows respect for others (e.g.: if one went to a local authority social services reception desk, that person will expect to be greeted in a formal way like â€Å"Hello! How can I help you?†, and not informally, like â€Å"Hi! How’s it going?† In many situations such informal language could make people feel not being respected; so it is often risky to use informal language unless you are sure that people expect you to do so. The formal communication is also used in social care services with the manager and even between colleagues if they don’t know very well each other. Otherwise, when they know each other better, they will use informal language. Communication with people at work (between colleagues) is different, because care workers must communicate respect for each other. Colleagues, who do not show respect for each other, may fail to show respect for people who use care services. Colleagues have to develop trust in each other. It is important to demonstrate respect for confidentiality of conversation with colleagues. Care settings may have their own social expectations about the correct way to communicate thoughts and feelings. Communication between professional people and people using services involves the professionals being well aware of the need to translate technical language in to everyday language, when they work with people from other professions or people who use services. Professional people such as doctors or nurses often use their own specialised language, called jargon. It is important that people check that they are being understood correctly. Differences between language and culture Language There are many minority languages in the world. Some people grow up in multilingual communities, where they learn several languages from birth. Many people have grown up using only one language to think and communicate. People who learn a second language later in life find more difficult to express their thoughts and feelings in that language, and prefer to use their first language. Working with later languages can be difficult, as mental translation may be required. Different localities, ethnic groups, professions and work cultures have their own special words or phrases known as speech communities. Some people might feel threatened or excluded by that kind of language they encounter in these speech communities. The technical terminology used by care workers (called jargon) can also create barriers for people who are not a part of that speech community. When people who use services communicate with professionals there is always a risk of misunderstanding between people from different language communities, therefore the health and social care staff needs to check their understanding with the people communicating with them. Culture means the history, customs and ways of behaving that people learn as they grow up. People from different regions use different expressions. Also non-verbal signs may vary from culture to culture. In Europe and North America people often expect other people to look them in the eyes when talking. If a person looks down or away they think it is a sign of dishonesty, sadness or depression. On the other hand, in some other cultures (some black communities or Muslim communities) looking down or away when talking is a sign of respect. (E.g.: in social care settings a Hindu or Muslim person will not accept to be looked after by a person of the opposite sex). People from different geographical areas who use different words and pronounce words differently, they are often using a different dialect. Some social groups use slang (non standard words that are understood by other members of a social group or community, but which cannot be usually found in a dictionary). BTEC Level 3-Health and Social Care-Book 1-Beryl Stretch/Mary Whitehouse www.helpguide.org/effectivecommunication http://louisville.edu

Us Involvement in the Vietnam War

Us Involvement in the Vietnam War The Vietnam War (1965-1973) was a conflict fought in South Vietnam between the government forces, aided by the United States, and the guerrilla forces, backed by the predominantly communist North Vietnam. The conflict escalated from a Vietnamese civil war into an international conflict in which the United States played a dominant role. Despite peace agreements of 1973 between the two factions, the conflict did not end! In fact, peace only emerged when North Vietnams successful offensive in 1975 resulted in South Vietnams collapse and the subsequent unification of Vietnam under the Communist government in the North. (Columbia Encyclopedia,6th Ed) The Vietnam War (1965-1973) was one of the longest wars the United States was ever engaged in. It is distinctive as it gave rise to the largest and the most successful antiwar movement in the United States history. In fact, the war in Vietnam can be described as a war that was fought on two fronts: a war in Vietnam: being waged with tanks, guns and bullets, and a war in the United States: fought through demonstrations on the streets and college campuses across the US. (Columbia Encyclopedia, 6th Ed) Along with the Civil Rights campaigns of the 1960s, the antiwar movement was one of the most divisive forces in twentieth-century U.S. history. It attracted members from college campuses, middle-class suburbs, labour unions and government institutions. The movement gained national prominence in 1965, peaked in 1968, and remained potent through the conflict. (Columbia Encyclopedia,6th Ed) The American movement against the Vietnam War was the most triumphant antiwar movement in U.S. history. During the Johnson administration, it helped constrain the war and was a major factor in the administrations policy reversal in 1968. During the Nixon years, it hastened U.S. troop withdrawals, fed the deterioration in U.S. troop morale and discipline, and promoted legislation that severed U.S. funding for the war. (Columbia Encyclopedia,6th Ed) The discussion of the Vietnamese antiwar movement is extremely relevant today. This was the first time in history that the military might of the United States was successfully blocked, that too by the guerrilla movement of a virtually unarmed section of the Vietnamese people. (Columbia Encyclopedia,6th Ed) This triumph of the human spirit is a significant chapter in history. It made the American people question the almost dogmatic anti-communist focus of the American government. This movement went beyond ideology, encompassing nationalist fervour and ingraining in the American people a national fear of whether every war they participated in would spiral into another Vietnam. (Columbia Encyclopedia,6th Ed) CHAPTER ONE A ZEALOUS FORCE TO RECKON WITH : THE IRATE AMERICAN PUBLIC In 1965, a majority of Americans supported U.S. policies in Vietnam; by the fall of 1967, only 35 percent did so. For the first time, more people thought U.S. intervention in Vietnam had been a mistake than did not. They questioned how the U.S. could be fighting for the freedom of the Vietnamese people if it had to indiscriminately bomb, burn, and imprison the Vietnamese people themselves for fear that any one of them could be an enemy? The Vietnam war protests, or Anti-war movement, initiated by the American college students, was instrumental in questioning the policies surrounding Americas involvement in Vietnams bloody affairs. The countrys youth, the ones dying in the line fire, began demanding answers to Americas high profile presence in Vietnam. They wanted to know what they were fighting for. Through it all, the bombings continued and more and more of Americas young GIs came home in body bags. Aspects Leading to Anti War Protests Why did the Americans react adversely to the senseless War? During the four years following passage of the Tonkin Gulf resolution (Aug., 1964), which authorized U.S. military action in Southeast Asia, the American air war intensified and troop levels climbed to over 500,000. Opposition to the war grew as television and press coverage graphically showed the suffering of both civilians and conscripts. (Columbia Encyclopedia,6th Ed) Extensive media coverage brought the violent and bloody guerrilla war home each night to every American living room. People realised that the glowing reviews of the war effort their government had been releasing were sanitised and far from the truth. (Columbia Encyclopedia,6th Ed) Americans wanted to know why peace talks were organized and continually failed. Alongwith, they objected to the military draft policy. North Vietnams bloody TET Offensive of 1968 and the resultant horrendous casualties the Americans suffered eroded the situation in America even further. The assassinations of Martin Luther King and Robert Kennedy also sparked racial tension and unrest. (Columbia Encyclopedia,6th Ed) The length of the war, the high number of U.S. casualties, and the exposure of U.S. involvement in war crimes such as the massacre at My Lai helped to turn many in the United States against the war. (Columbia Encyclopedia,6th Ed) One of the most controversial aspects of the of the U.S. military effort in South East Asia was the wide-spread use of herbicides between 1961 and 1971. They were used to defoliate large parts of the countryside. These chemicals continue to change the landscape, cause diseases and birth defects, and poison the food chain. (Columbia Encyclopedia,6th Ed) Early in the American military effort it was decided that, since PAVN/NLF were hiding their activities under triple-canopy jungle, a useful first step might be to defoliate certain areas. This was known as Operation Ranch Hand. Corporations like Dow Chemical and Monsanto were given the task of developing herbicides for this purpose. When the Americans realized this, they were disgusted. (Columbia Encyclopedia,6th Ed) Richard Nixons number one campaign promise to Americans was that hed end the war with Vietnamization, or systematic troop withdrawals. Yet the American presence in Vietnam remained high and casualties mounted, as did the cost of running the war effort. Taxpayers were paying 25 billion dollars per year to finance a conflict no one believed in anymore. (Columbia Encyclopedia,6th Ed) Nixons plan to attack communist supply locations in Cambodia in 1970 failed and set off another round of protests. The Kent State student protest in May of 1970 turned deadly when National Guardsman fired into crowds, killing 4 students and injuring dozens more. Students all across the country became enraged and over the next few days campuses all over the US came to a virtual standstill. (Columbia Encyclopedia,6th Ed) As the year drew to a close Nixons plans to end the Vietnam war had not been realized. American citizens were not impressed. However, after Kent State Anti-war activism seemed to wane. Yet the people still demanded to know why their country was involved in a war where a resolution seemed impossible. (Columbia Encyclopedia,6th Ed) 1971 also saw the Mylai massacre come to light, an atrocity committed by American soldiers that shocked the world and gained huge media attention. Another round of peace talks were organized on the heels of this controversy but again all attempts to end the fighting in Vietnam failed. (Columbia Encyclopedia,6th Ed) When the New York Times published the first installment of the Pentagon Papers on 13 June 1971, Americans became aware of the true nature of the war. Stories of drug trafficking, political assassinations, and indiscriminate bombings led many to believe that military and intelligence services had lost all accountability. The top-secret history of U.S. involvement in Vietnam, commissioned by the Department of Defense, detailed a long series of public deceptions. The Supreme Court ruled that its publication was legal. (Columbia Encyclopedia,6th Ed) Bombings raids on North Vietnam were re-escalated in the spring of 1972, after peace talks headed by Henry Kissinger once again collapsed. The cities of Hanoi and Haiphong were subjected to night raids by American B-52 bombers that was unprecedented and that left the world in shock. (Columbia Encyclopedia,6th Ed) Antiwar sentiment, previously tainted with an air of anti-Americanism, became instead a normal reaction against zealous excess. Dissent dominated America; the antiwar cause had become institutionalized. By January 1973, when Nixon announced the effective end of U.S. involvement, he did so in response to a mandate unequaled in modern times. (Columbia Encyclopedia,6th Ed) Peace talks resumed in Paris and by the end of January, 1973, a pact had been signed by the United States, South and North Vietnam and the Viet Cong. By March, all American troops were pulled out of the country and systematic release of prisoners of war on both sides was initiated. Yet by the time the Watergate scandal came to light, and ruined Nixons presidency at the close of 1974, Communist forces had overrun Saigon. Within a few short months most of Indochina fell into Communist hands. The Anti-war movements mantra of what are we fighting for seemed eerily prophetic. (Columbia Encyclopedia,6th Ed) U.S. casualties in Vietnam during the era of direct U.S. involvement (1961-72) were more than 50,000 dead; South Vietnamese dead were estimated at more than 400,000, and Viet Cong and North Vietnamese at over 900,000. (Columbia Encyclopedia,6th Ed) The U.S. war against Vietnam was over, although the destruction continued. Large parts of Cambodia were devastated, populations were dislocated, and famine and war brought on by the U.S. war against Vietnam led to the deaths of hundreds of thousands there, and the Vietnamese had to cope with thousands of injured, with destroyed industrial facilities, and with burned and poisoned land. But the war was over, and the anti-war movement was over(Columbia Encyclopedia,6th Ed) A Series of Protests: The Anti War Movement Once the draft was introduced, young people on college and university campuses all around America began to organise protests against the war. Teach-ins and student organizations like the SDS (Students for a Democratic Society) held rallies and marches, the first of which happened in Washington in April of 1965. Over the next 2 years the anti-war movement snow balled. Activists, celebrities and musicians like Abbie Hoffmann, Timothy Leary, Allen Ginsberg, Jane Fonda, Jefferson Airplane, and countless others took up the Anti-war cause and waved Anti-war banners. Their speeches and their music reflected the anger and hopelessness that Americans felt over the Vietnam war. Even the GIs stationed overseas began supporting the Anti-war movement in whatever capacity they could, from wearing peace symbols to refusing to obey orders. As the American public realized the intensity of its involvement in the Vietnam War, civil unrest fomented. 100,000 Anti-war protesters gathered in New York and thousands more in San Francisco. There were urban riots in Detroit. Johnsons support fell drastically on all fronts. Anti-war rallies, speeches, demonstrations and concerts continued being organized all over the country. There was a backlash against all that was military. Soldiers returning home from the war were no longer regarded as heroes but as baby killers. Young men sought to evade the draft by being conscientous objectors or leaving for Canada. The Woodstock concert brought 500,000 together from across North America in a non-violent protest against the war. The most famous campus protest of the early 1960s was the Free Speech Movement (FSM) at University of California, Berkeley. In 1965, demonstrations in New York City attracted 25,000 marchers; within two years similar demonstrations drew several hundred thousand participants in Washington, D.C., London, and other European capitals. Most of the demonstrations were peaceful, though acts of civil disobedience-intended to provoke arrest-were common. Much of the impetus for the antiwar protests came from college students. Objections to the military draft led some protesters to burn their draft cards and to refuse to obey induction notices. (Columbia Encyclopedia,6th Ed) In October, 1967, a large anti-war demonstration was held on the steps of the Pentagon. Some protesters were heard to chant, Hey, hey, LBJ (Lyndon Baines Johnson)! How many kids did you kill today? One reason for the increase in the opposition to the Vietnam War was larger draft. By 1967 the Students for a Democratic Society (SDS) invoked the language of revolution in its denunciations of the war in Vietnam as an inevitable consequence of American imperialism. There was also a more moderate opposition to the war from clergy, elected politicians, and people such as Dr. Benjamin Spock. (Columbia Encyclopedia,6th Ed) Perhaps the most significant development of the period between 1965 and 1968 was the emergence of Civil Rights leaders as active proponents of peace in Vietnam. In a January 1967 article written for the Chicago Defender, Martin Luther King, Jr. openly expressed support for the antiwar movement on moral grounds. Reverend King expanded on his views in April at the Riverside Church in New York, asserting that the war was draining much-needed resources from domestic programs. He also voiced concern about the percentage of African American casualties in relation to the total population. Kings statements rallied African American activists to the antiwar cause and established a new dimension to the moral objections of the movement. The peaceful phase of the antiwar movement had reached maturity as the entire nation was now aware that the foundations of administration foreign policy were being widely questioned. (Columbia Encyclopedia,6th Ed) The antiwar movement became both more powerful and, at the same time, less cohesive between 1969 and 1973. Most Americans pragmatically opposed escalating the U.S. role in Vietnam, believing the economic cost too high; in November of 1969 a second march on Washington drew an estimated 500,000 participants. The invasion of Cambodia sparked nationwide U.S. protests. On 4th May, 1970, four students were killed by the National Guard at Kent State University during a protest in Ohio, which provoked public outrage in the United States. The reaction to the incident by the Nixon administration was seen as callous and indifferent, providing additional impetus for the anti-war movement. Nixon was taken to Camp David for his own safety. (Columbia Encyclopedia,6th Ed) Waning Support From Within the Government As the Anti War movements ideals spread beyond college campuses, doubts about the wisdom of war escalation also began to appear within the Johnson administration itself. As early as the summer of 1965, Undersecretary of State George Ball counseled President Johnson against further military involvement in Vietnam. In 1967, Johnson fired Defense Secretary McNamara after the secretary expressed concern about the moral justifications for war. (Columbia Encyclopedia,6th Ed) After the news of My Lai massacre became public in February 1970, new groups-Nobel science laureates, State Department officers, the American Civil Liberties Union-all openly called for withdrawal. Congress began threatening the Nixon administration with challenges to presidential authority. (Columbia Encyclopedia,6th Ed) As the number of troops in Vietnam increased, the financial burden of the war grew. One of the rarely mentioned consequences of the war were the budget cuts to President Johnsons Great Society programs. As defense spending and inflation grew, Johnson was forced to raise taxes. The Republicans, however, refused to vote for the increases, unless a $6 billion cut was made to the administrations social programs. The Vietnam War claimed more than just victims overseas at home it claimed reforms aimed at lifting millions of people out of poverty. (Columbia Encyclopedia,6th Ed) The Americans were no longer going to accept the ongoing nature of American involvement in the Vietnam War. The entire nation was questioning the administrations foundation of foreign policy. The Anti-War Counter Culture Alongside the antiwar protest movement, a counter culture arose that most Americans disapproved of. The clean-cut, well-dressed SDS members were being subordinated as movement leaders. Their replacements deservedly gained less public respect, were tagged with the label hippie, and faced much mainstream opposition from middle-class Americans uncomfortable with the youth culture of the period-long hair, casual drug use, promiscuity. Words like counter culture, establishment, non-violence, pacification, draft-dodger, free love, Kent State, and Woodstock were added to the American vocabulary. It was the beginning of the hippie generation, the sexual revolution and the drug culture. Protest music, typified by Joan Baez and Bob Dylan, contributed to the gulf between young and old. A Cultural and political protest had become inextricably intertwined within the movements vanguard. The new leaders became increasingly strident, greeting returning soldiers with jeers and taunts, spitting on tro ops in airports and on public streets. unique situation arose in which most Americans supported the cause but opposed the leaders, methods, and culture of protest. CHAPTER TWO CONTAINING THE COMMUNIST EXPANSION:THE AMERICAN POLICY OBSESSION The Domino theory is the notion that if one country embraces Communism, other nations in the region will probably follow. This can be likened to dominoes falling in a line. This absurd argument simply assumed nations to be dominos in a row, to be knocked down or picked up by the worlds two largest powers: US and the Soviet Union. (Columbia Encyclopedia, 2007) The Domino Theory The cornerstone of U.S. policy was the Domino Theory. The theory argued that if South Vietnam fell to communist forces, then all of South East Asia would follow suit. This theory was popularized by President Dwight Eisenhowers administration. A section of individuals believed that if communism spread unchecked, it would follow them home by first reaching Hawaii and then emerging in the West Coast of the United States. They were thus of the opinion that it was prudent to contain communism in Asia itself. Thus, the Domino Theory provided a powerful impetus for the American involvement in southern Vietnam. (Columbia Encyclopedia, 2007) Policy of Containment In a bid to stop this communist expansion, the United States pursued a policy of containment.  [1]  This policy of containment was first suggested by George F. Kennan in the 1947 X article, published anonymously in Foreign Affairs. It remained the U.S. policy for the next quarter of a century. (Columbia Encyclopedia,2007) The policy of Containment adopted the approach of not fighting an all out war with the communist Soviet Union. Rather, it propounded confining communism and the Soviet Union to their existing boundaries. This doctrine led directly to the Vietnam war. Containment was based on several arguments: (Chomsky,2003) That the Soviet Union was always expansionistthe Soviet Union, driven by its dogmatic faith in communism was determined to impose its absolute authority on the worlds nations. Containment was necessary for maintaining the worldwide balance of power between the US and the Soviet Union. (Chomsky, 2003)   2. That any newly established communist governments would inevitably be part of Soviet empire. The Doctrine of Containment believed that there could be no such thing as a nonaligned nation. No nation could be neutral: it must either align itself with the Soviet block or the democratic American block. (Chomsky,2003) 3. That communist and Soviet expansion must be limited. The Doctrine of Containment advocated that a conventional war should be avoided. However, the US should pledge itself to stopping the formation of any new communist governments and preventing existing communist governments from growing. (Chomsky, 2003)   4. Most importantly, it was based on a belief in the special mission and destiny of America. Kennedys advisor McGeorge Bundy believed that the United States was the locomotive at the helm of mankind, and the remaining world was dependent on this mighty nation. They seemed to believe that it was their destiny to protect the world from the evils of communism. (Chomsky,2003) Thus, we can conclude that the American policy makers believed in a simplistic American vs. Communism stand. The general premise of Containment was that every communist government, the world over, was an implement of Moscow and it was the duty of the American government to safeguard the nations of the world from communism. (Chomsky,2003) Was the Soviet Threat A Realistic Assessment? The threat of an expanding communism was indeed a realistic assessment. The Soviet Union had certainly acted in an expansionist way in the recent past. More worryingly, the Soviet Union was officially committed to the worldwide spread of communism. A newly acquired nuclear capability and a vast army positioned the Soviet Union as a perilous potential enemy of the United States. In fact, in 1959, Soviet Premier Nikita Krushchev, while debating with Richard Nixon in Moscow, threatened we will bury you!. It would indeed have been wrong, as also foolish, to underestimate the force of the Soviet Union as an enemy. (Chomsky,2003) Subsequently, however, the Domino theory was disprovedcommunist governments in Laos, Cambodia, Vietnam and China do not act collectively. After a period of great turmoil, most have abandoned communism. Vietnam, surprisingly, is now enthusiastically pro-capitalist, and an inviting place of investment for the United States of America. (Chomsky,2003)   Americans will, sometimes citing a dozen reasons, argue that we could have won if. Example: Ronald Reagan frequently asserted that the US would have won if the government had made a wholesale commitment instead of a limited war.  (Chomsky,2003) However, one could argue, won what? Can a victory be defined as one that leaves the nation with a devastated landscape, millions of dead civilians and a crippled economy? A victory, by means of which, the US would have ruled repressively over a country whose citizens despised it? It would certainly have been a hollow victory. (Chomsky, 2003) A Misguided Attempt The Vietnam War was misguided from its inception. A large number of major architects of the Containment policy George Kennan, McGeorge Bundy, Robert MacNamara have unequivocally acknowledged they were mistaken about the Vietnam War. They admit that Containment was a flawed policy. It was flawed due to its indifference to the history of Southeast Asia. The American obsession with Communism led them deeper and deeper into a tragedy. They believed in Americas mission, and in the undisputable superiority of Americas endeavours. They were erroneous, and consequently, so was the war! (Chomsky,2003) CHAPTER THREE PARALLELS OF IRAQ WITH THE VIETNAM WAR The Iraq war has evoked memories of the Vietnam war, the most significant political experience of an entire American generation. American involvement in both the wars was inspired to contain the expansion of a principle that it rejected: one was expansion of communism and the other is expansion of Islam radicalism. Vietnam was an event that emerged in the backdrop of the Cold War, a combination of geopolitical and ideological conflict with the expansion of communism. Iraq is part of an ideological struggle between radical Islam and the rest of the world in which the jihadists reject the established order, challenge the structure of the international system based on the nation state. (Kissinger,2007) 1. Was the US unilateral withdrawal from Vietnam an option in 1969 when Nixon took office? In Vietnam, unilateral withdrawal was not practically feasible. To dispatch over half a million troops, from Vietnam to the US, would have been a logistical nightmare, even under peacetime conditions. But in Vietnam, the US troops were countering over 600,000 armed North Vietnamese Communist forces on the ground, who were being bolstered by guerrilla forces. If the US troops even hinted at withdrawal, these troops may well have been joined by a large section of the 700,000 strong South Vietnamese army as they may have felt betrayed by their allies and tried to work their way back into the good graces of the Communists. The U.S. forces tried to withdraw, they would have become hostages and the ordinary Vietnamese people victims. (Kissinger,2007) A diplomatic alternative did not exist. Nixon correctly summed up the choices before him when he rejected unilateral withdrawal: Shall we leave Vietnam in a way that by our own actions consciously turns the country over to the Communists? Or shall we leave in a way that gives the South Vietnamese a reasonable choice to survive as a free people? When negotiations stalemated, the Nixon administration moved to implement what could be done unilaterally without undermining the political structure of South Vietnam. Between 1969 and 1972, it withdrew 515,000 American troops, ended American ground combat in 1971 and reduced American casualties by nearly 90 percent. (Kissinger,2007) In the same vein, unilateral withdrawal is not practically feasible even in Iraq. Whenever gradual withdrawal from Iraq is implemented, it should be done in a way that it prevents a takeover by radical Islam in Iraq. Given that a democratic government has been installed, after much struggle, the US should try to do everything possible to ensure its continuance. The following issues should be kept in mind before implementing a graduated withdrawal: In Iraq, the military forces of the adversary are less powerful than they were in Vietnam, but the international political framework is more complex. This fragile situation should be handled with caution. Before withdrawal, a political settlement has to be distilled from the partially conflicting, partially overlapping views of the Iraqi parties, Iraqs neighbors and other affected states. It should be based on a shared conviction that the cauldron of Iraq would otherwise overflow and engulf all surrounding countries and then spread internationally. 2. Did the American domestic debate and American publics protest movement doom the effort in Vietnam? During the Vietnam war, a point was reached when the domestic debate over American involvement in the War, became so bitter as to preclude rational discussion of hard choices. For a decade and a half, successive administrations of both political parties perceived the survival of South Vietnam as a significant national interest. Starting with the Johnson administration, they were opposed by a protest movement. This impasse doomed the American effort in Vietnam! The American public should learn to contain their outrage so that it does not lead to an impasse or due consideration to available choices as and when the time is right. The American public must not repeat the massive show of angst over Iraq.(Kissenger,2007). It is creditable that American officials have gone to great lengths to make sure the American people understand that the American military cannot possibly be defeated in Iraq (PINR,2003). The strategy of Vietnamese and Iraqi guerrillas was/is to sap the political will of the U.S. public. Is their political will being sapped? The attacks launched against U.S. forces in Iraq are not the type required or intended to defeat the United States militarily. But the fact is that Washington is not operating in a military vacuum. The strength of the U.S. military means little when faced with an increasingly skeptical U.S. public who has the potential to force Washington to pull U.S. troops out of Iraq. In addition, while Washington cannot be overwhelmed by sheer force, there is no evidence that the guerrilla fighters in Iraq can be defeated that way either. In Vietnam, Washington faced a similar predicament. There was an increasingly organized and brash guerrilla force preventing the U.S. from bringing stability to South Vietnam. Due to the massive technology gap, Vietnamese guerrillas and the North Vietnamese Army stood little chance of defeating the U.S. militarily. Just the same, however, Washington stood little chance of defeating the Vietnamese guerrilla movement militarily. The effective guerrilla tactics of the North Vietnamese Army were a military strategy aimed at sapping the political will from the U.S. public. This was well known at the time and was often articulated in the speeches of U.S. President John F. Kennedy. Always aware of U.S. public opinion, North and South Vietnamese military and guerrilla leaders worked to undermine Washington. When they launched the massive Tet Offensive in over 100 different cities of South Vietnam on January 31, 1968 successfully storming and occupying the U.S. Embassy in Saigon the attack was orchestrated shortly after U.S. military leaders and politicians claimed that the war in Vietnam was almost over. The strategy of Vietnamese resistance fighters was successful, and it looks as if resistance fighters in Iraq are following a similar one; Iraqi guerrillas are most likely aware that they will not be able to crush the U.S. military occupation in Iraq. They do know, however, that if they continue to kill and maim U.S. soldiers, it will only be a matter of time until the American public demands a return of U.S. troops and applies political pressure to the Bush administration. General Abizaid admitted as much, recently warning, The goal of the enemy is not to defeat us militarily. The goal of the enemy is to break the will of the United States of America, to make us leave. It is evident that the Iraqi guerrillas have been somewhat successful in this goal. According to a CBS News poll released on November 13, 2006 only 50 percent of the American public now believe that removing Saddam Hussein was worth the loss of American lives and other costs of attacking Iraq. If the losses of U.S. troops continue to mount, this number can be expected to drop further. Therefore, the strategy of anti-U.S. guerrillas in Iraq will be to launch high profile attacks on U.S. and also coalition troops. Yet, at the same time, the Central Intelligence Agency (CIA) released a report, titled appraisal of situation, written by the CIA station chief in Baghdad, which contradicted Abizaids Whether or not Washington is able to bring stability to Iraq before the U.S. public becomes disenchanted with U.S. objectives there, largely depends on the size and capacity of the guerrilla movement. (Kissinger,2007) Furthermore, the CIA report concluded that more and more ordinary Iraqis were siding with the insurgency due to their disillusionment with the U.S. occupation and because of the instability plaguing the country since the fall of Saddam Husseins hold on power. These assessments indicate that the U.S. occupation in Iraq is becoming increasingly precarious, and it is not yet clear how the U.S. public will respond to deadlier and bolder attacks launched on U.S. forces. (Kissinger,2007) Lessons for the Americans to Apply to the Conflict in Iraq Two lessons emerge from the American experience in Vietnam. A strategic design cannot be achieved on a fixed, arbitrary deadline; it must reflect conditions on the ground. But, at the same time, it must also not test the endura

Risk Factors of Cardiovascular Drugs

Risk Factors of Cardiovascular Drugs Characteristics and risk factors of Cardiovascular Drugs induced Adverse Drug Reactions: Hospital based Active Surveillance Study. Abstract: Background: Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. Several studies report the incidence various from 10 50% of all hospital admissions due to ADRs and no recent data available on the safety of cardiovascular drug from India. Aim: This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs. Methods: A prospective active surveillance study was carried out in the cardiology department of a south Indian tertiary care teaching hospital for eight months. Population averaged Poisson regression [Generalized Estimating Equation (GEE)] models was used to estimate the adjusted relative risk associated with ADR. Results: The overall incidence of cardiovascular drug induced ADRs was 31.8%. A total of 757 patients treated cardiovascular medications. Of which 241 patients (31.8%) including 122 (16.1%) females and 119 (15.7%) males reported at least one ADR. Aspirin produced the highest number of ADRs (150; 38.7%) followed by Heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%). The causality assessment reveals that 85.3% of ADRs were probable in nature. GEE was used to estimate the adjusted relative risk of each covariate associated with ADRs. The predictors of ADRs identified were: female gender, age > 60 years, multiple drug therapy (p= 0.0231) and concurrent diseases like diabetes, drugs like Heparin (RR-2.90, 95% CI 2.22-3.8) and Enalapril (RR-1.95, 95% CI 1.34-2.83). Conclusion: The incidence of cardiovascular ADRs was 31.8%. The most common drugs causing ADRs were the anti- platelet and anticoagulant class of drugs. Female gender, age > 60 years, multiple drug therapy, concurrent illness and certain drugs like heparin were identified as potential predictors for adverse reactions. Keywords: adverse drug reactions, hospitalized patients, cardiovascular drugs, pharmacovigilance, Risk factors Key Messages: This study reports the risk factors for adverse reactions to cardiovascular drugs from an Indian clinical setting. The incidence of cardiovascular drugs induced ADRs was 31.8%, which is higher than many reported studies. Anti-platelet and anticoagulant drugs were commonly associated with ADRs in the study population. Introduction: Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. ADRs are one of the major drug-related problems, resulting in increased morbidity and mortality and healthcare costs.[1-3]The WHO defines an ADR as a response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function.[4] The prevalence of cardiovascular diseases (CVDs) has increased in recent years and it has been estimated that CVDs are the most common cause of death.[5] Reports on drug related problems including adverse drug reactions associated with cardiovascular pharmacotherapy are available.[6-10]Studies report that cardiovascular drugs may account for 10 to 50% of all hospital admissions due to ADRs.[11-13] There are reports of serious adverse drug events with cardiovascular drugs.[14]Continuous monitoring of ADRs are important in patients treated with cardiovascular drugs since, these patients who need multiple drug therapies to treat their comorbid conditions and other related risks[15] Various methods are used to detect ADRs in hospitalized patients.[16] Analyzing the adverse reaction data in relation to the presence of risk factors provide the link between the ADRs and the associated factors. Such analysis might help to identify patients who are at increased risk for the adverse reaction and therefore employing suitable monitoring and the preventive procedure is possible.[17] Reports are available on the risk factors for adverse reactions.[18-20] Studies have shown that the cardiovascular drugs are most common cause of ADRs.[6,21]A university hospital-based studies report 49 % ADRs are due to commonly used cardiovascular drugs (nitrates, digoxin, propranolol, heparin, warfarin, anti-hypertensive and anti-arrhythmic drugs)[22] A number of studies are available on the adverse effects of cardiovascular drugs. In the Indian context data on adverse effects of the cardiovascular drugs is not available. Therefore, the current study was planned to evaluate ADRs due to cardiovascular drugs in hospitalized patients. This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs. Subjects and Methods: A prospective active surveillance study was carried out in the department of cardiology of a tertiary care teaching hospital for eight months (Feb to Sep 2009). The study protocol was reviewed and approved by the institutional ethical committee. All patients admitted to the cardiovascular units were monitored and evaluated for cardiovascular drugs induced adverse reactions. Patients who were previously treated or newly prescribed with cardiovascular drugs were monitored and followed for detecting and recording of ADRs. Adverse drug reactions were identified by conducting a daily patient charts review, patient interview, and consultations with treating physicians. In the suspected cases, past medical/medication history of patients were collected. In addition to patients medication history, information on co-morbidities was also collected. We used the WHO criteria for defining ADRs.[4] For every identified patient with ADR, two patients without ADRs were enrolled as matched controls. The information pertaining to the suspected ADRs was collected and documented in a specially designed ADR computerized documentation database for further assessment.[23] An ADR alert card was distributed to those patients who experienced severe adverse reactions to prevent further re-exposure of the suspected drug. All ADRs were reviewed and assessed by the research team. The documented ADRs were evaluated and characterized respect to patient demographics, nature of the reactions, drugs and organ system involved and outcome of the reactions. Using standard approach, the Causality, severity, preventability and the presences of predisposing factors of the reactions were assessed and reported. Patients age and sex were considered for the analysis. ADRs were classified as either Type A or Type B according to the system introduced by Rawlins and Thompson.[24] The suspected drugs were classified according to Anatomical Therapeutic Chemical (ATC) classification based on WHO-ATC Index 2009.[25]Using WHO Adverse Reaction Terminology documented ADRs were further classified into various organ system classes.[26] Management strategies employed for the ADRs were categorized as drug withdrawal, dose reduction, additional treatment for ADR and no change in a regimen without any additional treatment. Patient outcomes were reported as fatal, fully recovered, recovering and unknown. The causality of suspected ADRs was assessed using Naranjos ADR probability scale and classified into certain, probable, possible and unlikely to be drug induced depending upon the level of association.[27] The preventability of ADRs was analyzed and categorized into definitely preventable, probably preventable and not preventable using the modified criteria of Schumock and Thornton by Lau et al.[28]Using the criterion developed by Hartwig et al., for severity assessment, we assessed the suspected ADRs and classified into mild, moderate and severe reactions.[29] The onset of ADRs was assessed and classified into sub-acute, latent and acute groups.[4] Predisposing/risk factors Many patient-related factors predispose the occurrence of ADRs. The patient related factors like age, gender, multiple and inter-current disease states, and polypharmacy are considered as significant risk factor for developing ADR.[30] Patients age was categorized into 6 groups (less than 20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, more than 60 years). Polypharmacy was categorized as minor (2-3 drugs), moderate (4-5 drugs) or major (5 drugs) based on the classification by Veehof et al.[31] Gender of the patient was also considered as a one of the predispose factor for the development of ADRs. Multiple disease state ( > 2 coded diseases) of the patient at the time of reaction also include in the analysis. The overall incidence of ADRs was calculated using the total number of in-patient episodes which resulted in ADRs in relation to the total number of in-patients followed during the study period. The length of hospital stay for each patient was collected from Hospital Patient Administrative System (HPAS) and used to compare the Length of Stay (LOS) between patients with and without ADRs. Additional hospital stay due to ADRs was assessed using the nature and clinical features of ADRs, discussion with treating medical staffs and assessment of patients medical records. Statistical analysis Descriptive statistics was used summarize the patient demographic and clinical characteristics like gender, diagnosis, a number of drug dispensed, the frequency of ADR, drugs involved, organ system involved and severity of ADRs. Mean with 95% confidence interval was used to summarize age and LOS. Chi-square test was used to find the association between age group, gender, the LOS with and without ADRs. Relative risk was used to measure the strength of association. The data were hierarchically arranged, to count the multiple ADR episodes which can occur with multiple admissions. Population averaged Poisson regression (GEE) was used to estimate the adjusted relative risk of each covariate associated with ADR.[32,33] Further compound symmetry was used to account for the within-subject correlation. All analysis was performed using SPSS for window 15 (SPSS Inc., South Asia, Bangalore). The significance level was set at P Results: A total of 757 patients (431 men and 326 women) using cardiovascular medications were intensively monitored. The mean age of the study population was 57.21  ± 14.22 years (18 -92 years). The average length of hospital stay was 10.6  ± 5.8 days. Overall, the incidence of ADRs was 31.84%. Two hundred and fourteen patients including 122 females and 119 males reported at least one ADR. Maximum of six ADRs were reported from one patient. Compared to males, females developed more of ADRs was observed more in females when (p 0.0001). The length of stay was increased due to ADR for a minimum of 3 days and a maximum of 28 days. The frequency of different age groups in patients with and without ADRs is presented in table-1. The main diagnosis of the study population is listed in table-1. Age group of less than 20 years is excluded because of lower sample size. Age group of more than 60 years had more ADRs compared to other age groups. Cardiovascular risk factors of a patient with and without ADR are shown in table-2. The most frequent system-organ class affected by ADRs was Platelet, bleeding clotting disorders (188, 48.89%), followed by metabolic and nutritional disorders (53, 13.66%) and gastrointestinal system disorders (50, 12.89%) (Table-3). The most common strategy for management of ADRs was drug withdrawal (94.3%) and dose alteration (5.4%) (Table-4). The mean length of hospital stay was 13.3 and 6.5 days for patients with and without ADR respectively. The length of stay was found to be longer in patients with ADR. Aspirin produced the highest number of reactions (150; 38.7%) followed by heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%) (Table -3) with Platelet, bleeding clotting disorders (188, 48.89%). The most frequently reported reaction was bleeding (186; 47.9%) followed by gastric ulcer (52, 13.4%) (Table-3). The causality assessment of ADRs revealed that 85.31% of ADRs were classified as probable, followed by 7.99% as definite and 6.7% as possible. 64.4 % patients recovered from the ADRs and 35.6 % were recovering at the time of discharge (Table-4). The GEE analysis shows that the female, alcoholics, smokers and patients those taking more than 7 drugs had a higher risk for developing an ADR. (Table-2). Statistical analyses also revealed that patient taking Heparin (RR 2.90, 95% CI 2.22-3.80, Enalapril (RR 1.95, 95% CI 1.34-2.83), warfarin (RR 1.69, 95% CI 1.33-2.54) had a significantly increased probability of developing of ADRs (Table-5). Discussion: ADRs can significantly increase patients mortality or morbidity and consequently higher healthcare expenditure.[34] The study findings reveal that developing an ADRs in hospitalized patients substantially contribute to patients morbidity, further increasing the disease burden and cost of managing ADRs. The incidence of ADRs (31.8%) found in this study was twice higher than a previously reported systematic review of international studies (15.1%).[2] The present study showed that females experienced a higher incidence of ADRs (9.87%) when compared to males (7.23%) which are similar to the findings of previously published studies.[1,35-37]Several reasons have been put forth for this observed difference. Men and women have a different pharmacodynamic response to various drugs; which may consider as one of the factors for women to develop more number of ADRs. But in a study reported by Jose., on comparable Indian population male patients were found to have more ADRs than female population .[38] The incidence of ADRs was higher in the elderly patients (31.19%; age > 60 Years) compare to other age groups. (à Ã¢â‚¬ ¡2= 23.03, df-5, p 0.0001); this finding is similar to the results of Mohebbi et al.[19] Studies have shown that the incidence of ADRs may increase with increasing age. Again, due to multiple comorbid conditions and receive multiple drug therapy the elderly patients tend to have a higher risk for developing an ADR. In addition, older individuals undergo changes in drug responsiveness and disposition.[39] It appears that elderly patients need more attention to prevent the occurrence of ADRs. In this study, the incidence of Aspirin-induced ADRs was 38.7% (n=150); which was the highest rate compared to other cardiovascular drugs in this study. However, High rates of ADRs with streptokinase have been reported previously.[40]Studies reported a rate of amiodarone-induced ADRs as 16%, whereas in the current study it was too low at 0.5%.[41] This might be due to the lower use of amiodarone in the current study subjects. In a study conducted by Wiffen et al., investigating ADRs induced by all groups of drugs, warfarin was among the top three drugs causing ADRs.[42] In our study, the rate of ADRs attributed to warfarin was just 3.6%, whereas heparin-induced bleeding was the second highest ADR in this study population (45, 11.6%). In this study, we found central nervous and gastrointestinal systems are the most frequently affected organ system classes by ADRs. These findings were similar to the findings of a study conducted in Iran.[13]The incidence of preventable ADRs in this study (6.9%) is comparably lower than those detected in other studies.[34]This might be probably due to intensive monitoring of CCU patients in our study. The rate of serious ADRs (22.2%) detected in this study tend to be higher than other studies.[14] Population averaged Poisson regression (GEE) model showed that factors like gender and age of more than 60 years, multiple drug therapy and the presence of co-morbidity were risk factors for experiencing ADRs. The average duration of drug usage was found to be longer in patients without ADR. It appears that most of the ADRs have been noted shortly after initiating cardiovascular drugs and the incidence of ADRs in this study population was not related to the duration of usage. Similar to findings of many other studies, increasing the number of drugs led to increased frequency of ADRs. Conclusion The finding of this study indicates that cardiovascular drugs cause serious and frequent adverse reactions. The incidence of cardiovascular ADRs was 31.84%. The most common drugs causing ADRs were the anti-platelet and anticoagulant class of drugs. Female gender, age more than 60 years and use of more than 7 drugs was found to be the risk factors for developing ADRs. The identified incidence was higher than many reported studies. The current study identified the common ADRs and their predictors. Patients with identified predictors for adverse drug reactions can be intensively monitored and necessary preventive measures can be initiated if signs of reactions are observed.

Analysis of Shakespeares The Tempest - The True Villain :: Shakespeare The Tempest

The True Villain of The Tempest On June 2, 1609, five hundred colonists set out in nine ships from Plymouth in association with the imperial Virginia Company. It was the aim of this expedition to fortify John Smith's colony in Virginia. While eight of the party's vessels securely arrived at Jamestown, the flagship, called the â€Å"Sea Adventure† , was conspicuously absent. This ship --which carried the fleet's most valuable cargo, the admiral Sir John Somers and the future governor of Virginia Sir George Somers --was separated from the other eight during a fierce storm off the coast of Bermuda, the legendary Isle of Devils, dreaded by superstitious sixteenth-century sailors. William Strachey describes the tempest which precipitated the ship's "wracke" in a letter dated July 15, 1610: "a dreadfull storme and hideous began to blow from out the North-east, which swelling, and roaring as it were by fits, some houres with more violence than others, at length did beate all light from heaven; which like an hell of darkenesse turned blacke upon us, so much the more fuller of horror." The â€Å"Sea Adventure† was rebuilt on the island, which was not as menacing as the storm itself, and nearly a year later the ship rejoined the fleet in Virginia. By many, this was deemed a miracle. Some believe it was this shipwreck that prompted Shakespeare to write this political, yet comic play which involves usurpation, mockery, love, reconciliation and forgiveness. It all starts with Prospero, the rightful Duke of Milan, being banished by his brother, Antonio, who illegally usurps the throne. Basically, the first thing Antonio does in scene I is curse the boatswain: â€Å"Hang, cur, hang, you whoreson, insolent noisemaker, we are less afraid to be drowned than thou art.† This already suggests that Antonio is not the nicest of dukes. He is a very authoritative man, he need not do anything, he lets people do it for him. As the ship splits, he still curses the boatswain and does not get involved with the desperate attempts of the mariners to steady the ship. When they find themselves stranded on the remote island, all except Antonio and Sebastian see that which is good around them, Gonzalo remarks how their clothes are surprisingly clean. Antonio and Sebastian mock Gonzalo and the others for seeing good where they only sees rottenness and corruption. Their cynicism clearly show they do not agree, they mock them with witty word-play: