The Assassination Of President Ronald Reagan - 1629 Words

The attempted assassination of former President Ronald Reagan was a horrifying day for many people that were attending his speech; sadly James Brady was at the wrong place on the wrong day. Reagan was not severely injured but Brady certainly was, Brady ended up in critical condition! After recovering from the gunshot, Brady became a serious advocate for an anti-weapon organization, which is why there is currently an organization named after him. The lack of gun control is the main leading effects from gun violence, whether you are at school or sleeping at night, there is someone getting killed or hurt from some type of firearm. Guns tend to be used mainly for harming someone, whether it is self-defense or purposely. Plus gun trafficking has been increasing due to the lack of gun control. Gun violence is pretty much everywhere, and the Brady Campaign statistics show that â€Å"On average 31 Americans are murdered with guns every day and 151 are treated for a gun assault in an emergen cy room† (1). Although the statistics are made from an anti-weapons group, which might be a little bias, the statistics are still accurate enough to get the point across. The only way any of this happened was due to amount of weapons that are in America, it would be less likely for someone to cause a shooting if there were not as many weapons being produced. More and more weapons are being made by the second, due to the continuation of this, people will continue to be hurt because the common saying isShow MoreRelatedJimmy Carter and Ronald Reagan Analysis1118 Words   |  5 PagesRonald Reagan Analysis Paper HIS/145 January / 2014 â€Æ' Ronald Reagan was born in 1911 and died in 2004 the former president of the United States from 1981 to 1989 was also the governor of California from 1967 to 1975. Many people have mixed feelings of Ronald Reagan. Some did not like that Reagan was an actor before he became president of the United States. Attempted assassination In 1981 President Ronald Reagan survived an assassination attempt. The time was estimated around 2:25 p.mRead MoreRonald Wilson Reagan And The President Of The United States Of America1717 Words   |  7 PagesRonald Wilson Reagan was the fortieth president of the United States of America. He was a member of the Republican party. He served two terms as the president. He was shot in attempted assassination attempt by John Hinckley Jr. These are the simple facts that most everybody knows. But what was his personal life like? Did he ever have a family? Was he always a politician, or more specifically was he always a member of the Republican party? These are the questions that not everybody knows the answersRead MoreKilling Reagan By Bill O Reilly And Martin Dugard1601 Words   |  7 PagesKilling Reagan was wrote by Bill O’Reilly and Martin Dugard as a part of their series to talk about the deaths, assassination, and near deaths of certain historical people. O’Reilly an d Dugard write about the events leading up to the attempted assassination of Ronald Reagan including discussing the attempted assassin, John Hinckley, and the events after up until his death. The authors present the viewpoint as if one were there to witness the lives of the people in the book. Killing Reagan talks aboutRead MoreIs Ronald Reagan Under or Overrated as a President? Essay675 Words   |  3 Pages Is Ronald Reagan overrated or underrated as a president? Born Ronald Wilson Reagan on February 6, 1911 in Tampico, Illinois. He was an actor for 30 years before he became involved in politics. He starred in more than 50 movies. Along with acting, he was also a radio sportscaster. He served as the 33rd Governor of California. He was married to Jane Wyman from 1940 to 1949. He married Nancy Davis in 1952. President Ronald Reagan was our 40th president of the United States. He came intoRead MoreRonald Reagan Essay894 Words   |  4 Pages Ronald Reagan was a very popular person before, during, and after his time of presidency. He went from a mere radio announcer, to the head of the United States of America. Ronald had defeated most of the world’s problems with Communism, improved the economy, and handled terrorist threats like a pro. Ronald quickly took America’s heart with his honorable deeds and doings. He was very famous by the time he became deceased. (Ronald Reagan Facts.) Ronald Reagan was born on the 6th of February, inRead MoreBill O Reilly And Martin Dugard Essay1191 Words   |  5 PagesBill O’Reilly, Martin Dugard, â€Å"Killing Reagan: The Violent Assault That Changed a Presidency†, New York, Henry Holt and Company, 2015, pp336, $30.00 Bill O’Reilly and Martin Dugard attempt to bring the reader to the events, through a thrilling story-like account of the assassination attempt on President Ronald Reagan and its impact on the rest of his presidency. The main points examined in this book, include, of course the assassination attempt on Reagan’s life, but it goes deeper to look atRead MoreRonald Reag The Good, The Bad, And The Ugly1699 Words   |  7 PagesRonald Reagan: The Good, the Bad, and the Ugly Born on February 6, 1911, Ronald Reagan lived an eventful life, but he did not become President of the United States until the age of 65. He picked George H. W. Bush as his running mate in the 1980 republican ticket. The incumbent, Jimmy Carter had no chance of retaining the presidency, the economy was stagnant, and America’s influence in the world was on the decline. Just two months into Reagan’s Presidency, it almost came to an abrupt end with theRead MoreNancy Reagan1195 Words   |  5 PagesNancy Reagan made an impact on our society, so large that the impact is still lasting today. She is a very special person because of her determination not to give up however hard life may get. She is an example of a hard worker and a very caring person. Nancy was born July 6, 1921. Born as Anne Frances â€Å"Nancy† Robbins Davis Reagan, at Sloane Hospital Flushing Queens, New York. Nancy was born to Kenneth Seymour Robbins and Edith P. Luckett. Her parents got divorced shortly after marriage. HerRead MoreAll about Ronald Raegan932 Words   |  4 Pageswhatever God intends he should become.†- Ronald Raegan (Hawkins, 2012). This is just one of the amazing quotes that lead Ronald Raegan to be known as the â€Å"Great Communicator.† Marilyn Brayton stated, â€Å"Ronald Raegan was known as one of the most popular, and best presidents we have ever had in our country!† He was known for being very strong willed, and fought to achieve â€Å"peace through strength† (The White House, â€Å"Ronald Raegan†), and he did just that! Ronald Raegan was born on February 6, 1911 inRead MoreThe Legacy of Ronald Reagan: The Fortieth President of the United States716 Words   |  3 PagesThe fortieth elected president of the United States is none other than the great Ronald Reagan. Reagan left a legacy behind him and still to this day is considered one of the best presidents to serve our nation . Throughout Reagans life he accomplished many great feats such as being a two-term president, film and television actor, radio announcer, and the governor of California Ronald Reagan was born in Tampico, Illinois to Jack and Nelle Reagan on February 6, 1911. Reagan’s father was a salesman

The Whale By John Phillips - 1802 Words

John Phillips Plot Ishmael meets Queequeg and they get hired together and board the whaling ship Pequod, whose captain searches for the whale that bit his leg off. Ahab offers a gold doubloon as a reward to motivate his crew to search for the whale with as much passion as he does. During the hunt, they try to kill any other whales they see, Ishmael gives a run down on whaling, the crew come across bad omens, and they meet ships devastated by Moby Dick in their search for the whale. After a three day chase of the whale, Moby Dick destroys the Pequod and kills every crew member, except for Ishmael, who survives by clinging to Queequeeq’s coffin, and is then rescued by a ship that lost some of its crew to Moby Dick. Characters Ishmael- A cautious sailor aboard the Pequod, that worries too much about his own safety and tends to make things seem worse than they actually are. He is not afraid to speak his mind and he will rebuke anyone that tries to get a laugh out of messing with him. When it comes to spending what little money he has, he is frugal, but will accept whatever he can get. Ahab- Captain aboard the Pequod, who is consumed by his hate for Moby Dick, has an ivory leg. He is intimidating, a natural leader, and on a neverending quest for vengeance against the whale that bit his leg off. As the story progresses, he dives deeper and deeper into the insanity of his obsession over Moby Dick. Moby Dick- An albino whale simply defending himself against the whalersShow MoreRelatedJohn Luther Adams Essay833 Words   |  4 Pages†¢ John Luther Adams was greatly influenced by his surroundings and he had a great love for nature. He moved to Alaska and many of his pieces reflected the Alaskan landscape. Throughout his career, he has taken many different approaches when composing his music. For Adams, the deep listening shaped his musical language. Deep listening is a way of listening completely in the moment. There are no judgements or ability to control because it is the first time the individual is hearing these sounds. AnRead MoreAnalysis Of Frank Zappa, John Cage, And Pamela Z2039 Words   |  9 PagesThroughout this course, the composers we studied all had different approached to creating music, and that is why many of them are well known today. The three most notable composers who combine unusual elements in their music were Frank Zappa, John Cage, and Pamela Z. Frank Zappa was an American artist who had no desire to fit into a single style of music, and he had no interest in creating music for cultural conventions. He created music in the manners he saw fit. His music has influence from rockRead MoreIdentification And Evaluation Of Sources2372 Words   |  10 Pages1910-1920 is used to narrow the span of time that can be considered. Honduras is examined because it was the second largest banana exporter in the world up to 1915, thereafter it was the largest (Bucheli 11). The first source is â€Å"The Fish That Ate The Whale† by Rich Cohen. This is a non-fiction book that is a secondary source. The value of this source is derived from the fact that as an esteemed journalist Cohen can be expected to have credible sources. Cohen has written several books on various famousRead MoreSocial Carrying Capacity2559 Words   |  11 Pagessocial carrying capacity thresholds, it is important to understand that the types of visitors that visit an area change as the carrying capacity changes. For example, as the number of general visitors participating in whale-watching activities increases, the number of specialized whale-watchers decreases, and if the number of visitors remains low, the number of specialist remains high (Duffus Dearden, 1990). Traditional carry capacity theorists, like Dasmann may claim that social carry capacityRead MoreAccurate Timekeeping At Sea2349 Words   |  10 Pagesequator – by measuring the height of the Sun above the horizon at noon; but this won’t let you calculate longitude – your position east or west. The problem of accurate timekeeping at sea was finally fixed in the middle of the eighteenth century by John Harrison. He invented a marine chronometer which could go on accurately telling the time in spite of the changes in temperature and humidity and the constant movement of a ship. This made it possible for ships anywhere to establish their longitudeRead MoreBelonging Essay4112 Words   |  17 PagesChronicle Dickinson, Emily, Selected Poems of Emily Dicksinson Herrick, Steven, The Simple Gift Baillie, Alan, The China Coin Russell, Willy, Educating Rita Cleven,Vivienne et al (eds), Contemporary Indigenous Plays Pung, Alice, Unpolished Gem Noyce, Phillip, Rabbit-Proof Fence Daldry, Stephen, Billy Elliot Making Multicultural Australia, www.multiculturalaustralia.edu.au It is also suggested you choose 3-4 related texts as you will have more to discuss. You do not have to read a full book; a storyRead MoreExegesis: Jonah4151 Words   |  17 PagesApplication Introduction Jonah and the whale is a very popular children’s story, the classic Sunday school lesson. However, many children grow up with the idea and picture of Geppetto and Pinocchio being swallowing by the whale and sneezed out back onto shore. Though we may not want to tell our children every gruesome detail about Jonah, we can at least get the wording correct and say Jonah and the big or great fish, since there is no evidence that it was a whale in particular. Even though the storyRead MoreThe Metrics Of English Literature4721 Words   |  19 PagesNumber: 84 â€Æ' The Metrics of English Fred: Welcome ladies and gentlemen to this lovely evening in the city of London in the world renowned Globe Theatre. Today we are joined by two guests, Sylvia Miller and Joseph Johnson and I am your host, Fred Phillips. Both our guests having many years of linguistics and literature experience will analyse several texts that belong to different stages of the English language and compare their ideas. Why may you ask? To discuss the points of comparison between linguisticsRead MoreMonsanto: Better Living Through Genetic Engineering96204 Words   |  385 PagesWhitehead, this philosophy ‘rejects the doctrine that students had ï ¬ rst learned passively, and then, having learned should apply knowledge’.3 In contrast to this philosophy, the case analysis method is based on principles that were elaborated upon by John Dewey: Only by wrestling with the conditions of this problem at hand, seeking and ï ¬ nding his own way out, does [the student] think . . . If he cannot devise his own solution (not, of course, in isolation, but in correspondence with the teacher andRead MoreProject Mgmt296381 Words   |  1186 Pagescase, and example in the text is drawn from a real-world project. Special thanks to managers who graciously shared their current project as ideas for exercises, subjects for cases, and examples for the text. Shlomo Cohen, John A. Drexler, Jim Moran, John Sloan, Pat Taylor, and John Wold, whose work is printed, are gratefully acknowledged. Special gratitude is due Robert Breitbarth of Interact Management, who shared invaluable insights on prioritizing projects. University students and managers deserve

Conservation of the environment free essay sample

Protection of the environment is very important as the world moves into a new era. This new era also seems to be presenting us with many major environmental issues. Some of these problems are: pollution, rapid industrialization, over population, deforestation and loss of important animal and plant species. The best way to protect the environment is to conserve and protect it by being more conscious of our impact on the planet. Conservation is the philosophy and policy of managing the environment to assure adequate supplies of natural resources for future as well as present generations. One way to be more environmentally responsible would be to cut down on undesirable C02 emissions and to put good things back into the atmosphere. One of the best ways to do this is by planting trees. Trees play a critical role in keeping our air clean, both by releasing oxygen into the air and by trapping carbon. We will write a custom essay sample on Conservation of the environment or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The more trees we have, the better our air quality, and thats why planting trees is an excellent step to take toward saving the environment. While youre at it, plant a tree in a spot that will give your house shade, as that will help reduce your need to crank up your air conditioning in the summer months and be esthetically leasing. Its also important to take a stand against deforestation. Losing large swaths of forest, such as the rainforest, to development or industry means that were losing millions of trees that would otherwise be purifying the air for us. Protesting deforestation, both through activism and by refusing to buy products that are created at the expense of the worlds forests, can help slow and even halt deforestation. Renewable energy is another great way to heal the environment. It significantly cuts down on greenhouse gases, air pollution and the amount of carbon emitted into the air. In the USA around 71% of electricity is produced by burning fossil fuels. Burning coal or other fuels emits greenhouse gases and pollution in the environment. An average home powered by a coal utility will burn twelve thousand pounds of coal a year and will cause about the same amount of pollution as two cars. By using renewable energy as the primary power source, the reduction of pollution per household would be equivalent to that of planting four hundred trees. We can each play a part in improving the amount of trash we throw away by reducing our waste. Buy fewer items and reduce the overall consumption of goods. If less is onsumed, then less energy is used and less waste is produced. Regardless of how consumption is limited, people are bound to produce some waste. We can buy in bulk to reduce the amount of packaging thrown away, but to make a difference, we also have to focus on recycling and repurposing the items that are consumed. Simple changes can be made, like shopping with reusable bags and keeping food and other items in reusable containers, rather than defaulting to plastic bags and disposable containers. Recycling refers to buying recycled products and sorting waste into the appropriate categories: aluminum cans, glass, plastic, paper and cardboard. However, the definition of recycling can be expanded to encompass donating items you no longer need or want to Goodwill or the Salvation Army so others can reuse them. Many cities have freecycle e-mail lists that fill a similar role. If you cant reduce your consumption or tind a way to reuse a product, recycling is a better choice than simply throwing something into the trash. Gandhi wisely said, You must be the change you wish to see in the world. Thats certainly true when it comes to saving the environment, and each of us has an individual responsibility to make the changes and decisions that will benefit the natural world around us. Even our most concerted efforts will have a minimal impact if were the only ones making them, or even if were part of a small group making such environmental choices. The power in the steps on this list comes from getting everyone to take them together. After doing all the other things mentioned here cutting energy consumption, conserving water, driving less and everything else the most important thing is to be bold and vocal about encouraging others to do the same. The environment wont be saved by a handful of activists or even by a collection of powerful world leaders. It will be saved by the collective action of mankind.

NGChernyshevsky. Selected Works Review Essay Example

NGChernyshevsky. Selected Works Review Paper Essay on NGChernyshevsky. Selected Works I can not deny myself the pleasure to bring a classic example of criticism extravaganza performed by the father of the genre theme is the same. plane of perception - also the first artless echo Valentin Linev (Warsaw) wrote that..: the new book by Boris Cherdyntseva opens six verses that author for some reason calls sonnet (?), and have everybody be pretentiously capricious We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer description of lives Chernyshevsky. Chernyshevsky, says the author, was the son of Good Archpriest (but when and where he was born, does not say), he graduated from the seminary, and when his about ec, lived a holy life that inspired even Nekrasov died, his mother sent a young man to study in St. Petersburg, where he at once, almost at the station, I made friends with the then political thinkers as they are called, Pisarev and Belinsky. The young man went to university, studied engineering inventions, worked hard and had a first romantic adventure with Love Yegorovna Lobachevskaya, infected his love of art. After One clash on romantic soil with an officer in Pavlovsk, He however forced to return to Saratov, where he proposes to his future bride on which soon will marry. He returned to Moscow, studied philosophy, participates in magazines, writes a lot of (novel What do we do), is friends with the outstanding writers of his time. Gradually, it draws the revolutionary work, and after a stormy meetings, where it acts together with Dobrolyubov and well-known Professor Pavlov, while still a young man, Chernyshevsky forced to go abroad. For a while he lived in London, working with Herzen, but then returned to Russia and immediately arrested. Charged plotting the assassination of Alexander II Chernyshevsky was sentenced to death and publicly executed. Here is a brief history of Chernyshevsky life and vsЈd situation was excellent, if the author has not found it necessary to provide the story of her many unnecessary details that obscure the meaning, and all sorts of long digressions on the best a variety of topics. And the worst thing is that, after describing the scene hanging, and ending with his hero, he is this not satisfied, and for many more unreadable pages says that it would be if -., if to Chernyshevsky, for example, has not been executed, and exiled to Siberia, like Dostoevsky The author writes in a language having little in common with the Russian. He loves to invent words. He loves long convoluted sentences, such as: These sorts fate in anticipation of the needs (!!) biographer (?) Or puts into the mouth actors solemn, but not quite literate , maxims, such as The poet elect subjects for their songs, the crowd did not have the right to manage his inspiration. Almost simultaneously with this Entertainer review. .. , etc. Taken from:.. Vladimir Nabokov, The gift NGChernyshevsky. Selected Works Review Essay Example NGChernyshevsky. Selected Works Review Paper Essay on NGChernyshevsky. Selected Works I can not deny myself the pleasure to bring the classic example of a buff-criticism by the father of the genre Subject is approximately the same. plane of perception. - too the first artless echo. Valentin Linev (Warsaw) wrote this: The new book by Boris Cherdyntseva opens six verses that author for some reason calls the sonnet, and have everybody be pretentiously capricious We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on NGChernyshevsky. Selected Works Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer description of life known Chernyshevsky. Chernyshevsky, says the author, was the son of Good Archpriest (but when and where he was born, does not say), he graduated from the seminary and when his father, lived a holy life that inspired even Nekrasov died, his mother sent a young man to study in St. Petersburg, where he at once, almost at the station, friends with the then shnimi political thinkers as they are called, Pisarev and Belinsky. The young man went to university, studied engineering inventions, worked hard and had a first romantic adventure with love Yegorovna Lobachevskaya, infected his love of art. After one clash on romantic soil with an officer in Pavlovsk, he however forced to return to Saratov, where he makes an offer his future bride, which soon will marry. He returned to Moscow, studied philosophy, participates in magazines , writes a lot of (novel What do we do), is friends with the outstanding writers of his time. Gradually, it draws the revolutionary work, and after a stormy meetings, where it acts together with Dobrolyubov and well-known Professor Pavlov, while still a young man, Chernyshevsky forced to go abroad. For a while he lived in London, working with Herzen, but then returned to Russia and immediately arrested. Charged plotting the assassination of Alexander II Chernyshevsky was sentenced to death and publicly executed. Here is a brief history of Chernyshevsky life and vsЈd situation was excellent, if the author has not found it necessary to provide the story of her many unnecessary details that obscure the meaning, and all sorts of long digressions on the best a variety of topics. And the worst thing is that, after describing the scene hanging, and ending with his hero, he is this not satisfied, and for many more unreadable pages says that it would be if -., if to Chernyshevsky, for example, has not been executed, and exiled to Siberia, like Dostoevsky The author writes in a language having little in common with the Russian. He loves to invent words. He loves long convoluted sentences, such as: These sorts fate in anticipation of the needs (!!) biographer (?) Or puts into the mouth actors solemn, but not quite literate , maxims, such as The poet elect subjects for their songs, the crowd did not have the right to manage his inspiration. Almost simultaneously with this Entertainer review. .. , etc. Taken from:.. Vladimir Nabokov, The gift NGChernyshevsky. Selected Works Review Essay Example NGChernyshevsky. Selected Works Review Paper Essay on NGChernyshevsky. Selected Works it is all from the same Nabokov in the same Dare is such a um um right now, yes, Valentin Linev, from room to room bezformenno, zabubenno not quite competently pour their literary experience He was famous for the fact that not only could not understand the accounting book, but apparently never finished reading it to the end. Boyko creating out of the author, carried away by his own retelling, snatching some phrases in support of wrong conclusions, bad knowing the initial page, The following vigorously they fell on the wrong track, he made it to the front the final chapter in a blissful passenger state still does not know (and in his case did not find out), that took the wrong train. Invariably it happened that, dolistav blindly long novel or the brief story (size played no role), it imposed a book own ending -. usually just the opposite to the author in other words, if, say, Gogol comes to his contemporary, and Linev written about him, he would have remained firmly at the innocent belief that Khlestakov Auditor indeed. When, as now, he wrote poems, some innocently used the so-called reception mezhtsitatnyh bridges. His analysis koncheevskoy book boiled down to the fact that it is for the author responded to some implied landscape profile (your favorite flower? Favorite character? What virtue do you value most? And so on. P. In pereviranii PerAleka stories can not reproach, he sets out more or less coherently So if we assume that it infuse soul Valketina Lineva, then since Noah became a bit more sane -.)))))))) We will write a custom essay sample on NGChernyshevsky. 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Bird Imagery In Portrait Of The Artist free essay sample

As A Young Man Essay, Research Paper Bird Imagery in A Portrait of the Artist as a Young Man The plants of twentieth-century Irish author James Joyce resound vividly with a alone humanity and mastermind. His novel, A Portrait of the Artist as a Young Man, published in 1916, is a convincing journey through the interior head and spirit of Stephen Dedalus. Portrayed with unbelievable eloquence and pragmatism, imagination guides the reader through the fleet current of growing touchable in the juvenile hero. Above all heavy imagination in the novel is the repeating bird motive. Joyce uses birds to finally associate Stephen to the Daedelus myth of the? hawklike adult male ; ? nevertheless, these images besides represent Stephen? s day-to-day experiences, and hankering for true freedom ( page169 ) . By utilizing imagination of birds as threatening, images of beauty, and images of flight, the reader can unite the work and better understand Stephen? s disruptive journey through life. We will write a custom essay sample on Bird Imagery In Portrait Of The Artist or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The opening scene of Chapter one portrays a conversation between a really immature Stephen and Dante, Stephen? s nursemaid. She scolds him for an unconventional idea, warning him that? the bird of Joves will come and draw out [ your ] eyes? ( 8 ) . This evidently in writing image suggests to Stephen the endangering presence of bird of Joves that are minding all his ideas. Joyce? s color with such ghastly imagination has a existent consequence on Stephen ; he repetitions Dante? s cautiousness in his childish vocal, intonation: ? Pull out his eyes, Apologize? ( 8 ) . A playful, yet sensitive Stephen must instantly conform Pfeiffer 2 even his guiltless irregular actions in fright of the threatening apparition bird of Joves to salvage the effects they will convey. His ideas are threatened once more by birds when he meets an familiarity named Heron when walking down a dark street. Stephen instantly notes the peculiar image of Heron? s? bird face every bit good as a bird? s name? ( 76 ) . Through descriptive images of Heron? s? nomadic face, beaked like a bird? s? and his ? close set outstanding eyes which were light and inexpressive, ? Joyce enables the reader to non merely visualize his birdlike features but besides adds penetration to Stephen? s ideas toward his unchaste equals ( 76 ) . Heron twits Stephen, sarcastically calling him a? theoretical account young person? who? doesn? T coquette and doesn? T darn anything or curse all? ( 76 ) . This blazing comment by the bird-like male child is an obvious verbal menace to Stephen? s character. Continued as Heron and his friend viscously chide Stephen for his esteem for Byron? s poesy, Joyce? s bird imagination bears in this scene a restraint of Stephen? s singularity by endangering his self-expression. As Stephen mentally develops in the patterned advance of the novel, he begins his hunt for the? free dom and power of his psyche, as the great inventor whose name he bore? would hold done ( 170 ) . Stephen is now at the beach, chew overing his new sense of adulthood as he grows? near to the wild bosom of life? ( 171 ) . Walking down a bouldery incline, he takes notice to a miss? entirely and still, staring out to sea? ( 171 ) . Stephen watches her, and awed by her? similitude of a unusual and beautiful sea-bird, ? he realizes she is the prototype of all that is? the admiration of mortal beauty? ( 171 ) . Painted by Joyce? s beaming imagination of the? darkplumaged dove? he sees before him, this rationalisation is the footing of Stephen? s internal epiphany ; she is, to Pfeiffer 3 Stephen, ? an minister plenipotentiary from the just tribunals of life? ( 171, 172 ) . This wholesome bird-like miss with? long slender bare legs ( that ) were delicate as a Crane? s, ? gives Stephen a perceptual experience of a true virtuous beauty he has neer known before, and a naming to? animate life out of life, ? as is the function of the true creative person he aspires to be ( 171, 172 ) . A few old ages subsequently on the stairss of a library stripling Stephen bases, inquiring? what birds are they? as he watches tonss of birds fly free above him, their? fliting quaking organic structures winging clearly against the sky? ( 224 ) . Now more restless and philosophical, he wonders at their images. Joyce? s genuinely hearable imagination of the birds? ? call ( that ) was shrill and clear and all right and falling like togss of silken visible radiation? is, for Stephen, ? cold clamor [ comforting ] his ears? ( 224 ) . Stephen Dedalus sees consolation in the birds? ? waver of wings ; ? they are the cardinal symbol of the freedom he is ready to hold for his ain ( 224 ) . He wishes to hold their release from the society he knows as he reflects on: ? The correspondence of birds to things of the mind and of how the animals of the air have their cognition and cognize their times and seasons because they, unlike adult male, are in the order of their life and have non perverted that order by ground? ( 224 ) . In order to seek true emancipation, Stephen? must travel away for they were birds of all time traveling and coming # 8230 ; of all time go forthing the places they had built to wander? ( 225 ) . Stephen resolves to go forth his Irish fatherland ; free and wild as his images of the birds. Pfeiffer 4 The properties which mold Stephen Dedalus? turning unity and life determinations stem from the actions which surround him. The reader associates Stephen by the images he encounters and his reaction to them. In James Joyce? s A Portrait of the Artist as a Young Man, Stephen? s connexion with bird imagination helps to specify his hunt for a function in his society, and helps readers define and place with his pursuit. 371

Cascade Volcanoes essays

Cascade Volcanoes essays The Pacific Northwest is home to the Cascade Volcanoes. Between Southern British Columbia and Northern California is where the Cascades thrust out of the earth. All along the range majestic peaks climb towards the sky. The Gorda, Juan de Fuca, and Explorer plates are being pulled down into the Cascadia subduction zone and beneath the North America plate. As a result of this the Cascade range was formed, and is still being changed to this day by the interaction of these plates. Because of this specific type of interaction between the plates the Cascades are volcanic. Within the range there are varying types of volcanoes. Major peaks like Mt. Ranier and Mt. Hood are composite volcanoes. Lassen Volcanic National Park has good examples of many types of volcanoes. The peak we see today is a plug dome volcano. However, there are shield volcanoes, and cinder cones found throughout Lassen Volcanic National Park. Crater Lake is a great example of a caldera. All through the Cascade mountain range one can find all sorts of examples of different types of volcanoes. Volcanoes have no regard for human life, and they will erupt, change, and vent whenever it is necessary. The eruption of Mt. St. Helens in the early 1980s is a very good example of an extremely violent eruption. Surrounding forests were devastated and mudflows brought havoc to the lower laying areas around St. Helens. If St. Helens was near a major metropolitan area, or even a modest sized city, the damage would be almost immeasurable. Many Cascade Volcanoes are still very active. Mt. Ranier is near Seattle, and Mt. Hood is just east of Portland. If either of these volcanoes were to erupt the cities below would be directly in the warpath. ...

Analyzing HR Policies of Tesco Essay Example | Topics and Well Written Essays - 1750 words

Analyzing HR Policies of Tesco - Essay Example All these policies are closely knitted with one another. Human resource management components cannot be separated from each other and they together denote effectiveness of the approach. Tesco employs approximately 310,000 people in its UK branch. The company witnessed certain challenges in terms of declining sales margin and falling share price value. This aspect greatly affected employee base and it was essential to boost up their morale. In this report, drawbacks in HR policies of the company shall be highlighted along with some recommendations to be implemented in the system. HR practices and policies revolve around various theoretical frameworks. These frameworks basically state the need for human resource management strategies. Employees should be motivated in every sphere of workplace simply because they are the most valuable asset of an organization. Recruitment and selection procedure are basic methods through which a pool of talent is structured within an organization. These initial methods are then followed by the training and development approach. Learning plays an important role in organizational success (Torrington, Hall and Taylor, 2014). A learning organization is always more productive in comparison to other firms. Kolb’s learning cycle includes different components that are generally focused on by HR practitioners. Figure1 further elaborates this cycle. As per figure1, the first phase of this learning cycle is to identify probable learning need. On basis of this need, learning opportunities are appropriately designed. This eventually leads to influencing candidates so that they are able to opt for these opportunities. The last phase of this cycle is critical since it denotes effectiveness of entire learning program (Bonnici, 2011). Evaluation phase helps a team leader to analyze overall impact of learning program on employees.

How the Anthropocene is related to my major Business Management Research Paper

How the Anthropocene is related to my major Business Management Explain through McDonalds especially their Beef Hamburgers - Research Paper Example Their production activity requires meat from animals, yet livestock production is one of the human practices that results in adverse changes in the environment. Subsequently, the current sorry state of the environment marked by degradation and depletion of essential resources is attributed to anthropogenic activities. Moreover, scientists believe that there is a new wave of anthropogenic activities that started in a particular period, a concept referred to as anthropocene. Being business management student, understanding the concept of anthropocene and environmental degradation is important, as it helps in finding solutions to the issue. McDonalds is one of the biggest fast food restaurants in the world. The restaurant was established in 1955 in Illinois USA and has more than 30000 outlets located in 120 countries globally that serve more than 54 million customers daily. McDonalds is famous for producing delicious and tasty beef hamburgers that attract many customers every day. As a result, the company is growing day by day, and the customer base is equally rising, which translates to increased consumption of beef hamburgers, and thus production of more of meat by farmers. The primary source of meat is nature. Therefore, increased demand for beef is among the anthropogenic activities that results in adverse effects on the environment and natural resources. The continuous and enormous use of natural resources disturbs the balance in the ecosystem resulting in numerous problems that cause environmental problems. One of the adverse effects of production and consumption of beef hamburgers is the depletion of the natural resources in the environment. The main ingredient of McDonald’s hamburgers is meat from animals. Halden and Schwab states, â€Å"Finally, but growing more urgent every day, industrial agriculture may be a significant contributor to climate change, as the production of greenhouse gases from

Carbon, Phosphorus and Nitrogen Cycles Essay Example for Free

Carbon, Phosphorus and Nitrogen Cycles Essay The carbon cycle starts with the reservoir of the carbon dioxide in the air, the carbon atoms move from carbon dioxide through photosynthesis into atoms of organic molecules that form the plants body. These carbon atoms are then further metabolized and are eaten and turned into tissue that all organisms in the ecosystem use. Half of the atoms are respired by the plants and animals and half are deposited back into the soil in the form of dead animal and plant matter, which are eaten by decomposers and transformed back into carbon dioxide. Humans impact this cycle because we are removing so much of the photosynthetic efforts of the plants in order to support our enterprises, we are â€Å"diverting 40% of the photosynthetic productivity of land plants to support human enterprises,† (pg 67). Two examples of our harmful tendencies are burning fossil fuels which has increased atmospheric carbon dioxide â€Å"35% over preindustrial levels,† (pg. 67) and logging. These both are being used naturally by the ecosystem and the lack of these resources causes stress and strain to keep the balance. At the rate it is going carbon to complete its cycle from the atmosphere through one or more living organism and back to the atmosphere happens about every 6 years. The phosphorus cycle includes the cycle of all the biologically important nutrients found in the natural minerals. These elements include iron, calcium, potassium found in the rock and soil minerals in the lithosphere. Over time a rock breaks down and releases phosphate (PO43-) and other ions which replenish phosphorus that is lost due to runoffs and leaching. The phosphate is absorbed by plants and turned into compounds that are moved through the food chain. Humans impact this cycle because we are using the phosphorus to make fertilizers, animal feeds, detergents or other products and mining these locations. Our water systems are being damaged because â€Å"human applications have tripled the amount of phosphorus making it to the oceans,† (pg 68). This is a problem because it causes over fertilization or eutrophication of the aquatic ecosystem. The waterborne phosphorus cannot be returned to the soils this causes too much bacteria or algae in the water and kills of the fish and other water mammals. The nitrogen cycle is similar to the carbon and phosphorus cycles; because it has a gas phase like carbon and can also be a limiting factor such as phosphorus. The main form of nitrogen is in the air â€Å"which is about 78% nitrogen gas (N2),† (pg 68). The plants change the nitrogen into organic compounds which are necessary like proteins and nucleic acids. Humans impact this cycle because many of our crops are legumes or nonleguminous. Legumes like peas, beans provide the bacteria a place to live and a source of food and receive nitrogen in exchange, where it enters the food web. Nonleguminous crops such as corn, wheat, potatoes and cotton have to be heavily fertilized with nitrogen’s from industrial fixations. The over fertilization of nitrogen into the soils are destroying lakes, ponds and forests. However our actions are more than doubling the rate which nitrogen is moved from the atmosphere to the land, â€Å"nitric acid has destroyed thousands of lakes and ponds and caused extensive damage to forests,† (pg 70). Humans have a great impact on all three cycles. If it continues the way that we are using fossil fuels, and destroying the land as we are currently are. We are depleting our resources at a faster rate than we can sustain naturally which is causing harmful living conditions which we may not necessarily feel the repercussions of immediately.

Effect of Calpain-calpastatin System in Meat Tenderness

Effect of Calpain-calpastatin System in Meat Tenderness 1.0 Introduction Meat quality is the freshness of the meat. This is the most crucial things which supplier always find and think in order to fulfill the high demand from the customer. This shows researcher play an important role in increasing the quality of meat because of the high demand from the wholesalers or consumer. The critical point of appraisal of meat quality occurs when the consumer eats the products and they comment on the colour, nutritional value, and price determines the decision to repurchase (Boleman et al., 1997).In addition, consumer evaluation of eating quality is the most determination of meat quality as tenderness, juiciness and flavor of meat are the most important elements (Tarrant, 1998; Bindon Jones, 2001). The variability in tenderness cause by a lot of factors before post mortem, like the feeding types and the environment (French et al., 2001) and after post-mortem, like temperature, pH, sarcomere length and proteolysis (Charlotte Maltin et al., 2003). In this study it focusing majorly on the role of genetic traits which play an important function in order to get the high quality of meat (Williams, 2008). Interest of this study is to identify the relationship between the microsatellite repetition and the calpastatin type1 promoter region effects in meat tenderness. In mid 1980s (Mullis Faloona, 1987; Saiki et al., 1985) as the advent of Polymerase Chain Reaction(PCR), microsatellites were detected in eukaryotes genome and they are the most promising PCR-based markers. Microsatellites are simple sequence tandem repeats (SSTRs) of variable length that distributed throughout the eukaryotic nuclear genome in both coding and non-coding region (Jarne Lagoda, 1996). This can be amplify and identify by the PCR method (Sunnucks, 2000, Strassmann et., 1996, Shriver et., 1995). Due to the high mutation rate of microsatellites, they are potentially the most informative marker with advantages of easy and low-cost detection. Thus, the microsat ellites repeat in calpastatin can influence the tenderness of meat because of the different types can produce with different role. The aim of this findings is to characterise the expression of microsatellite repeat in calpastatin type I promoter region in bovine, to identify the  regulation of CAST gene inhibitory calpain system in affecting the tenderization of meat and to develop a mechanism that can control the calpastatin gene in maintaining the tenderization of meat. 2.0 Literature review 2.1 Meat Quality and consumer perception Meat quality is a term used to describe a range of attributes of meat. Those factors such as post mortem factors, pH, temperature, proteolysis, sarcomere length, and the most important elements is tenderness and juiciness that affect the consumer to repurchase the meat (Warris, 2000). Besides that, meat quality also determine by color, flavor and texture which influence the consumer to enjoy the meat product (Glitsch, 2000). However, the main cause of failure of consumer complain to repurchase is the variability in eating quality, especially in tenderness. Some of the consumer that has more knowledge will concern on the safety of consuming meat. They will think of the health implication like the composition of the polyunsaturated fat and saturated fat, and the microbial contamination especially during handling the meat products. According to the statistical of meat consumption in Ninth Malaysian Plan, the Malaysian government targets to increase the production of beef in order to reduce the import dependence. As per capita consumption which 0.5 kg in 2003 of mutton is very low, more attention is paid to the beef market which increased from 2.3 kg to 5.8 kg (FAO, 2007). Due to the high demand, the qualities of meat need to be increased in order to make sure consumer will repurchase. Anderson and Ferguson (2001) emphasize that quality as the top priority in making decision to buy and consume more meat. Similarly , factors that effect the consumer to repurchase red meat other than economic one is meat quality (Taljaard et al., 2006). 2.2 Tenderness Tenderness is a primary factor that influencing the consumers reaction (Glitsch, 2000).Tenderness is an integrated textural property made up of mechanical, particulate and chemical components (Paerson and Young, 1989).The appreciation of tenderness when eating is not explained by the force required to cut through a piece of meat, but is affected by the way the muscle fibers breakdown and the release of juices and flavor while chewing. Several independent studies have identified a locus on bovine chromosomes 29 with affect on tenderness. The caplain1 (CAPN 1) gene that codes for a calcium dependent protease involved in meat tenderization post- mortem. According to the research Miller et al., 2001, meat tenderness (texture) is the most important organoleptic characteristics that influence the acceptability for consumer. Tenderness is the consequences of postmortem physicochemical and biochemical changes in muscle of myofibrillar. After slaughtering, muscle is extensible and elastic until the onset of the rigor mortis, when the energy for muscle relaxation is depleted (Alberle et al., 2001). 2.3 Tenderization phase 2.3.1 Pre-rigor phase The duration of pre-rigor phase is dependent on the animal species. After the slaughtering of animal, blood, oxygen and nutrient supply are cut to the muscle and these triggers the pre-rigor phase to start (Lawrie, 1998).For chicken is less than 0.5 to 1.0 h and for beef 4 to 6 h (Aberle et al., 2001). The muscle will becomes gradually stiff and its tension reaches maximum on the completion of rigor. This is due to the formation of an irreversible actomysin complex in muscle which lead to the shorten sarcomere length. This will cause the toughening of muscle at the beginning of the post-mortem process (Koohmaraie et al., 1996). 2.3.2 Rigor phase At this phase, muscles maintain the homeostasis by metabolize muscle glycogen by aerobic glycolysis. Thus, it will continue supply of ATP. During this phase, the depletion of ATP will increase the concentration of calcium ion in sarcoplasma. Sarcoplasma reticulum functioning in removing of calcium ion across the membrane utilizing the calcium ATPase pump and dependent on ATP for this active process (Robbins et al., 2003). In the meat process, anaerobic glycosis is take place in order to maintain the production of ATP. From this the lactic acid will produced and decrease in pH value and lead to the depletion of creatine phosphate because of lack of ATP. Thus, the availability of substrate required to maintain the contractile proteins actin or myosin in relaxation state. The irreversible cross bridge and rigor mortis occur because of actin and myosin and these will made the muscle reaches to the maximum toughness as the consequences of shortening the sarcomere length (Goll et al., 1995 ). 2.3.3 Post-rigor phase In the post-rigor, the proteolytic enzyme system are responsible in continuing the tenderness (Kemp et al., 2010; Koohmaraie et al., 1996). This phase started about 24 hours to 14 days of meat storage. The rate change is variable due to the proteolytic degradation of myofibrillar and cytoskeletal proteins cause the loss of structural integrity of myofibrils which enhancing the meat tenderization (Koohmaraie et al., 1996). The calpain/calpastatin(calcium-dependent), proteosomal and lysosomal systems have been extensively investigated for their involvement in post-rigor proteolytic degradation and meat tenderization (Kemp et al., 2010; Koohmaraie et al., 1996). 2.4 Factors that affect the meat tenderness 2.4.1 Muscle pH After the bovine is being slaughter, they need to maintain their homeostasis. So, the muscle will undergoes anaerobic respiration and regenerate the production of ATP by aerobic respiration. The amount of ATP produced is less than normal. During anaerobic, the glycogen is metabolized into pyruvate and then converts into lactic acid. The lactic acid will gradually decrease the pH value of the muscle tissue (Maltin et al., 2003).This level of of pH will give varies effects on glycogen level, ATP turn over and the metabolic characteristic of muscle tissue (Lawrie, 1998). The high level of pH which is greater than 7.5 , typically dark and easy to bacteria to survive on it. This will shorten the shelf life of the meat and this bring to the variability if the tenderness as the low of glycogen substrate (Watanabe et al., 1996). 2.4.2 Temperature Temperature during the pre-rigor and post-rigor phase will affect on the metabolism of the muscle tissue of meat(Hertzman et al., 1993).Meat toughness will increase during the higher temperature (Bruce and Ball, 1990). The declination of muscle temperature will lead to the shortening of muscle. This is because of the reduced calcium sequestering ability by the sarcoplasmic reticulum as a result of the depletion of energy compounds which cause the muscle to contract and increase the toughness of meat (Huff Lonergan et al., 2010). There are a researched found that, at 15 Celsius is the best temperature for maintaining meat tenderization (Geesink et al., 2000). 2.4.3 Juiciness Juiciness is defined as the feeling in the mouth of moisture from cooking meat and chewing. The juiciness is closely related to the attribute of flavor as this latter attribute is also affected by the level of IMF in the meat. The high the intramuscular fat content (IMF) , the higher the meat quality (Kerry et al., 2002). 2.4.4 Proteolysis Proteolysis is a conversion of muscle to meat entrains changes in tenderness due to changes in the properties of muscle fibre and connective tissue. The steps are toughness increase into rigor, proceed with proteolysis and last the rigor is resolve. Proteolytic system is divided into four which, first, cathepsin-lysomal system second, ATP-dependent ubiquitin –proteasome system, third, calpain-calpastatin system and last is matrix Metalloproteinases (MMP) (Thompson and Palmer, 1998). Tenderization increasing during ageing and it is primarily a result of calpain-mediated degradation of myofibrillar and cytoskeleton proteins. Most of researcher doing the investigation on proteolytic system and the have a A1QWdebate on these. But most of the studies agreed that the calpain system has play the major role in post-mortem tenderization (Boehm et al., 1998; Koohmaraie.1992b; Taylor et al., 1995a). Proteolysis involve calpain occurs between 3-14 d post mortem when activity of  µ-calpain low ,  µ-calpain maybe bound to the myofibril and inactivated during post mortem storage but the m-calpain active when the level of calcium arise. Calpain is calcium-dependent which function in softening the muscle tissue of the meat. In proteolysis it involve the calpain proteases and caplain-specific inhibitor, calpastatin. When the low level of calpastatin produce, the more calpain protease produce .Then, the tenderness of meat will increase. 2.5 Microsatellite Microsatellites are simple sequence tandem repeats (SSTRs).The repeat units are generally di-, tri-, tetra- or pentanucleotides (Powell et al., 1996) .Like repetition in birds is ACn, where it`s means two nucleotides A and C are repeated in bead-like fashion a variable number of times. The n could be range from 8 to 50.This always occur on a non-coding region of DNA. On the each side of the repeat unit are flanking regions which consist of unordered DNA. This flanking region is dangerous because they will allow the development of locus-specific primers to amplify the microsatellites with PCR. By having a forward and reverse primer on each side of microsatellites it will be able to amplify a fairy short (100 to 500bp) locus-specific microsatellite region(Sunnucks, 2000, Strassmann et., 1996, Shriver et., 1995). Microsatellites were designed for generative neurology disease in human but it shows a great applicability in other species. Microsatellites act as markers was classified based on the number of bases like short repeats are microsatellites while longer repeats are minisatellites. Besides that, it also classified by the type of repeated sequence present whether it is perfect, imperfect or composite. Imperfect means the repeated sequence was interrupted by different nucleotides which are not repeated while composites when two or more different motifs in tandem (Selkoe Toonen, 2006).In addition, microsatellites is co-dominant and it is widely distributed throughout the genome and transferable between species. These features provide their successful function in these fields (Chistiakov et al., 2006). 2.5.1 Microsatellites mutation Microsatellites are useful genetics markers because they tend to be polymorphic. Normally, human microsatellites with 20 or more alleles ad heterozygosities. This is because their mutation occurs different from the â€Å"classical† point mutations, where the substitution of one nucleotide to another occurs. The mutation in microsatellites occur through slippage replication where two strands could slip relative position a bit but still manage to get the zipper going down the beads. One strand can be lengthened or shortened by the addition or excision of the nucleotides. So, the repeat unit can be one longer and the other is shorter than the original (Selkoe et., 2006). 2.6 Calpastatin Study of calpastatin gene promoter activity had been done by some of the researcher .Calpastatin is proteinase inhibitor for calpain which family of calcium-activated neutral proteases that regulate the of Ca2+. It is encoded by single gene in mammal which produces proteins isoforms through the alternating splicing, There are four types of CAST which are Type I, Type II, Type III has been characterized in porcine with the study of the three promoters directing expression(Parr et al., 2004) while in bovine calpastatin transcripts including Type IV had been characterized with the studied of four functional promoters in the gene (Raynaud et al., 2005).This four types of CAST can bind to the calpain and inhibit proteolytic activity. A single calpastatin can inhibit several caplain molecules in vitro. Several isoforms of calpastatin exist due to the alternative promoter usage and differential splicing (Parr et al., 2001; Raynaud etal., 2005).Increasing response on calpastatin expression to ß- adrenergic stimulation has been associated with skeletal muscle hypertrophy in livestock (Parr et al., 1992; Killefer and Koohmaraie, 1994) and related inversely with the tenderization rates(Koohmaraie, 1996). ß- adrenergic stimulation act by the cyclic adenosine monophosphate (cAMP) responsive elements in calpastatin promoter regions(Cong et al., 1998a, b).three types of promoters located in the 5 region of gene upstream of exons 1xa, 1xb, and 1u generate calpastatin mRNA transcripts the types I, II, and III respectively (Takano et al., 2000; Parr et al., 2004).In pig, these promoters have putative motifs for another transcription factors that will imply other signaling pathways of calpastatin expression(Parr et al., 2001; Raynaud etal., 2005). 2.6.1 The types of calpastatin genes From the previous studies, there were found calpasatin has four types of repetitive-inhibitor domains which are Type I, Type II, Type III and Type IV. The isolated cDNAs from the various mammalian species have conspicuous differences in the regions encoding the N-terminal sequences. These four different types has different function and from the different sources. The Type I and Type II in mouse and bovine respectively also differ from each other in the uttermost N-terminal sequences, possess longer domain L sequences than those of rabbit, pig and human inhibitors which are Type III.The previous obtained mouse calpastatin cDNA is encoded by as many as 31 exons including the first exon. The other three additional exons specifying the N-terminal sequences of the types were identified in the mouse genomic DNA sequence. The mRNAs for Type I and Type III were expressed in the liver, the Type II high in heart and skeletal muscle .Besides , the Type IV abundance in testis. These findings sho w that the calpastatin isoforms possessing different N-terminal sequences are generated by the alternative transcription initiation from their own promoters and skipping of the mutually exclusive exons (Takano et al., 2000). Cong et al. (1998), reported cAMP-dependent transactivation of the bovine calpastatin gene whose promoter located on the upstream of exon .They identified a sequence GTCA which was important for the cAMP responsiveness and corresponded to the half site of the full CRE(a consensus palindromic cAMP-responsive cis-element; TGACGTCA).They demonstrated that mutation of GTCA at -76 nt to ATCT completely abolished the dibutyryl-cAMP .Comparison of the nucleotide sequences of the mouse and bovine genomic DNAs did not show a high similarity but little similar sequence GTGCGGTGTCAGCCGG (identical residues are underlined) containing GTCA was found. The differential expression patterns of the type I, II, III mRNAs among different animal suggests that the presence of different transcriptional regulatory elements upstream of the respective promoters. Besides that, the differences in N-terminal sequences might affect the intracellular distribution of the action calpain-calpastatin system in stimula tion of meat tenderness (Takano et al., 1999). 2.7 Calpain Calpain were intracellular calcium-dependent cysteine proteinases which present in all mammalian(Goll et al., 2003; Sorimachi et al., 2001).In catalysing the limited proteolysis of cytoskeletal and membrane protein , the calpain were play a big role.This regulation occur with help of specific protein inhibitor calpastatin.In striated muscle, the calpain/calpastatin system has been proved in regulation protein turnover especially in meat texture development (Sensky et al., 2001). 2.8 The effect of calpain-calpastatin system in meat tenderness The calpain and calpastatin proteolytic enzyme system is believed to be the main contributor to the tenderness of meat at post mortem.The present of calpastatin in meat influence the calpain by acting as inhibitor. Calpastatin is a marker in order to determine the tenderness of meat. The researcher found the activity of the calpastatin in meat at 24 hours was highly related to shear force value after 14th day after post mortem. It showed that an early event after the animal being slaughter could be predictive of ultimate shear force because of the low activity of calpastatin (Whipple et al., 1990). The findings was repeated in pork. The higher level of calpastatin after 2 hours of post mortem is increasing the toughness (parr et al., 1999).We can conclude that the activity of calpastatin was responsible in variation of tenderness of meat by the differences in proteolytic rate of the animals. A more complex study is performed by the Shackleford et al.(1994) that correlate between both calpastatin level and meat toughness and the possibility of using these for selection purposed to improve the meat quality.

Nursing Practice

My nursing practice has been characterized by a marked transition from the general wards to the intensive care unit. Nevertheless, my values have remained intact. Initially, I must admit, I believed that patients had no role in determining the medication or intervention they receive. However, since I came to know about it, in a nursing class, the value of decision-making independence has guided my practice. I learnt the value in class, thus, my definition of the term is influenced by Fahrenwald et al., who defined decision-making autonomy as the act of allowing patients to make their own decisions regarding diagnosis and treatments, albeit after receiving all relevant information (2005). The value of decision-making autonomy and working with patients under intensive care have shaped my understanding of person-centered care and its relevance to nursing, as a profession and a practice. In the ICU, it is easy to view the person as just a patient. However, I have deliberately chosen to consider them people who are just momentarily inconvenienced by illness. As a nurse, I am in agreement with Ross, Tod, & Clarke's (2015) observation that the definition and use of person-centered care has been fluid and varies in distinct research, guidance, policy and daily practice. Still, I concur with the definition offered by the American Geriatrics Society; eliciting individuals' preferences and values and, once expressed, letting them guide all healthcare aspects, and supporting their practical life and health goals (2015). However, I find an earlier definition by McCormack, Dewing, & Breslin (2010) quite relevant to practice. They define person-centered care as an approach to nursing practice that is created by forming and fostering therapeutic relationships between patients, care providers and other people who are significant to the patients' lives. Drawing from the two definitions, I believe person-centered care is viewing patients as persons with social networks and accomodating their beliefs and values in the provision of care, while developing relationships that enable the attainment of healthcare as well as life goals. In adherence to the value of decision-making autonomy, I always communicate to patients their diagnosis and suggested interventions. To attain the goals associated with the value, one needs excellent communication and people skills, which is one of my strengths in practice. More specifically, I have demonstrated empathy, which is a person-centered communication skill. In the course of my practice, I try to comprehend and share into the perspectives, current situation and feelings of the persons under my care. That creates a bond of trust, social support and mutual understanding. The informed patients then get to decide whether they agree with the diagnosis, and whether they are willing to receive the suggested interventions. In case of the ICU, I consult with the patients' families and let them make the decisions. Human dignity is another value that has influenced most of my decisions in my professional and personal life. As a nurse, I believe it is important to respect all individuals, including the patients, their families and the entire society. In line with the value of human dignity, I respect patients' belief systems and consider their natural human values during my interactions with them and their families. However, at times, it is difficult to know some patients' beliefs, especially in the ICU. Although it is possible to get information about patient beliefs from their families and close friends, I consider it my duty to ensure that the informants do not pass out their own belief systems as the patients'. Trustworthiness and honesty are important strengths that have enabled me uphold human dignity in my practice. Without being trustworthy, patients and their families would not reveal their secrets to me. Many a times, the secrets are critical to the formulation of interventions. Human dignity also dictates that I protect patients' confidentiality during clinical interactions. For instance, I always ensure that I cover all exposed body parts of patients. What's more, I demonstrate my respect for human dignity through respectful communication with patients' families and keeping their secrets confidential. Respecting human dignity calls for mindfulness, which is another person-centred communication skill I believe I possess. Hafskjold et al., (2015) define mindfulness as the art of drawing unique variations by being present in interactions. By being mindful, I am able to observe the happenings and act according to what I notice. Research shows that mindfulness by nurses leads to more satisfied patients (Ross, Tod, & Clarke, 2015). My practice has also been guided by altruism. My own conceptualization of altruism is in line with the definition of the term offered by Shahriari et al., (2013); focusing on patients as human beings, while striving to promote their health and welfare. In nursing practice, the ICU is ostensibly the most tasking department to work in. It requires working without losing concentration, whether one is on a day shift or night shift. I have often found myself standing next to patients' beds throughout the night just to make sure they are fine. Despite the tough requirements, I believe I have exhibited devotion and selflessness the entire time I have attended to patients in the ICU, and even before. Undeniably, sometimes I have felt exhausted by the demands of the job, but my altruistic tendencies have always reminded me that nursing is not just a job, but a calling that requires me to give my all towards the healthcare and welfare of others. To reflect on my professional practice, I use two different strategies; the Gibbs model and John's reflective framework. The Gibbs (1988) Model has six stages; description of event, feelings, evaluation, analysis, conclusion and action. On its part, John's framework has three important elements; bringing the mind home, experience description and reflection (Palmer, Burns, ; Bulman, 1994).Part 2 Wanda formulated a reflection model that requires students to follow a five-step process during reflective practice, also known as the 5Ds structured reflection model (2016). The 5Ds stand for Doubts/differences, Disclosure, Dissection, Discover and Decision. The learner reflects on whether s/he has any doubts in his/her practice, or whether there are any differences between what s/he did in a clinical setting and what is found in literature. Disclosure entails writing about the experiences or situation on the topic discussed in the doubts section, while the dissection section considers why it happened and the impact. Discover involves finding additional information from relevant literature and the decision part describes a future plan.5Ds model of structured reflection (Wanda, 2016) The Rolfe model enables students to reflect on their experiences based on three questions; what, so what and now what (Rolfe, Freshwater, ; Jasper, 2001). The first question allows students and nurses to describe the situation, while the second question gives students room to discuss what they learnt, while the answers to the last question identify what the person should do to develop learning and improve future outcomes. The 5Ds Structured reflection The two models have various similarities and differences. For starters, the two reflective models allow students to explore their experiences while being guided by something. However, in the Rolfe model, students are guided by the questions, while in Wanda model (2016); students are guided by the 5Ds expressed earlier. A key strength of the 5Ds reflection model is that it focuses on the student as an individual (Wanda, 2016). Consequently, it enables students to decide what they need to learn more about, which makes them more self-directed in their learning. Secondly, it has a positive impact on students' ability to self-evaluate during clinical practice (Wanda, 2016). When used by students, it improves their ability to assess their own performance in clinical practice.Despite the apparent strengths, the model also has some limitations. To begin with, the effectiveness of the model can be restricted by students' characteristics (Wanda, 2016). For instance, the less motivated students are not suited to the reflective model. As a result, the model is not an effective learning tool for all students. What's more, the use of the 5D model requires consistent supervision, which is sometimes not possible because faculty members might have workloads that limit their time (Sicora, 2017).Grant, McKimm, & Murphy (2017) posit that the analysis part of the Rolfe et al. framework considers not just the technical-rational knowledge but also other forms of knowledge that might inform the comprehension of a particular situation. This is one of the strengths of the reflective model since it allows learners explore all knowledge points. However, it runs the risk of leading to superficial reflections (Sicora, 2017). At times, the students might just result to answering the three questions in short answers. That would not help in yielding a comprehensive reflection that would help them learning about their achievements and shortcomings that can help improve their practice. At a personal level, I prefer the 5Ds model. My preference for the model is informed by my desire to identify my doubts in practice as well as the tasks I perform in a way that is different from dictates of literature. That would help me refine my skills and procedures in practice, while making me a more confident practitioner, particularly in the ICU. BibliographyFahrenwald, N., Bassett, S., Tschetter, L., Carson, P., White, L., & Winterboer, V. (2005). Teaching core nursing values. Journal of professional nursing , 46-51.Gibbs, G. (1988).Learning by doing: a guide to teaching and learning methods. Oxford: Oxford Polytechnic.Grant, A., McKimm, J., & Murphy, F. (2017).Developing Reflective Practice: A Guide for Medical Students, Doctors and Teachers. Hoboken, NJ: John Wiley & Sons.Hafskjold, L., Sundler, A. J., Holmstrà ¶m, I. K., Sundling, V., Dulmen, S. v., & Eide, H. (2015).A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol. BMJOpen , 1-10.McCormack, B., Dewing, J., & Breslin, L. (2010).Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing , 93-107.Palmer, A., Burns, S., & Bulman, C. (1994).Reflective practice in nursing. Oxford: Blackwel l Scientific Publications.Rolfe, G., Freshwater, D., & Jasper, M. (2001). Framework for Reflective Practice. London, United Kingdom: Palgrave.Ross, H., Tod, A., & Clarke, A. (2015).Understanding and achieving person-centred care: the nurse perspective. Journal of Clinical Nursing , 9-10.Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013).Nursing ethical values and definitions: A literature review. Iranian journal of nursing and midwifery research , 1-8.Sicora, A. (2017). Reflective Practice. London, United Kingdom: Policy Press.Smith, K. (2016).Reflection and person-centredness in practice development. International Practice Development Journal , 1-6.The American Geriatrics Society . (2015).Person?Centered Care: A Definition and Essential Elements. Journal of the American Geriatrics Society , 15-18.Wanda, D. (2016). The development of a clinical reflective practice model for paediatric nursing specialist students in Indonesia using an action research approach. Open Pu blication of UTS Scholars , 1-288.Wanda, D., Fowler, C., & Wilson, V. (2016).Using flash cards to engage Indonesian nursing students in reflection on their practice. Nurse Education Today , 132-137.

Patient Recording System Essay

The system supplies future data requirements of the Fire Service Emergency Cover (FSEC) project, Fire Control, fundamental research and development. Fire and Rescue Services (FRSs) will also be able to use this better quality data for their own purposes. The IRS will provide FRSs with a fully electronic data capture system for all incidents attended. All UK fire services will be using this system by 1 April 2009. Creation of a general-purpose medical record is one of the more difficult problems in database design. In the USA, most medical institutions have much more electronic information on a patient’s financial and insurance history than on the patient’s medical record. Financial information, like orthodox accounting information, is far easier to computerize and maintain, because the information is fairly standardized. Clinical information, by contrast, is extremely diverse. Signal and image data—X-Rays, ECGs, —requires much storage space, and is more challenging to manage. Mainstream relational database engines developed the ability to handle image data less than a decade ago, and the mainframe-style engines that run many medical database systems have lagged technologically. One well-known system has been written in assembly language for an obsolescent class of mainframes that IBM sells only to hospitals that have elected to purchase this system. CPRSs are designed to review clinical information that has been gathered through a variety of mechanisms, and to capture new information. From the perspective of review, which implies retrieval of captured data, CPRSs can retrieve data in two ways. They can show data on a single patient (specified through a patient ID) or they can be used to identify a set of patients (not known in advance) who happen to match particular demographic, diagnostic or clinical parameters. That is, retrieval can either be patient-centric or parameter-centric. Patient-centric retrieval is important for real time clinical decision support. â€Å"Real time† means that the response should be obtained within seconds (or a few minutes at the most), because the availability of current information may mean the difference between life and death. Parameter-centric retrieval, by contrast, involves processing large volumes of data: response time is not particularly critical, however, because the results are us ed for purposes like long-term planning or for research, as in retrospective studies. In general, on a single machine, it is possible to create a database design that performs either patient-centric retrieval or parameter-centric retrieval, but not both. The challenges are partly logistic and partly architectural. From the logistic viewpoint, in a system meant for real-time patient query, a giant parameter-centric query that processed half the records in the database would not be desirable because it would steal machine cycles from critical patient-centric queries. Many database operations, both business and medical, therefore periodically copy data from a â€Å"transaction† (patient-centric) database, which captures primary data, into a parameter-centric â€Å"query† database on a separate machine in order to get the best of both worlds. Some commercial patient record systems, such as the 3M Clinical Data Repository (CDR)[1] are composed of two subsystems, one that is transaction-oriented and one that is query-oriented. Patient-centric query is considered more critical for day-to-day operation, especially in smaller or non-research-oriented institutions. Many vendors therefore offer parameter-centric query facilities as an additional package separate from their base CPRS offering. We now discuss the architectural challenges, and consider why creating an institution-wide patient database poses significantly greater hurdles than creating one for a single department. During a routine check-up, a clinician goes through a standard checklist in terms of history, physical examination and laboratory investigations. When a patient has one or more symptoms suggesting illness, however, a whole series of questions are asked, and investigations performed (by a specialist if necessary), which would not be asked/performed if the patient did not have these symptoms. These are based on the suspected (or apparent) diagnosis/-es. Proformas (protocols) have been devised that simplify the patient’s workup for a general examination as well as many disease categories. The clinical parameters recorded in a given protocol have been worked out by experience over years or decades, though the types of questions asked, and the order in which they are asked, varies with the institution (or vendor package, if data capture is electronically assisted). The level of detail is often left to individual discretion: clinicians with a research interest in a particular condition will record more detail for that condition than clinicians who do not. A certain minimum set of facts must be gathered for a given condition, however, irrespective of personal or institutional preferences. The objective of a protocol is to maximize the likelihood of detection and recording of all significant findings in the limited time available. One records both positive findings as well as significant negatives (e.g., no history of alcoholism in a patient with cirrhosis). New protocols are continually evolving for emergent disease complexes such as AIDS. While protocols are typically printed out (both for the benefit of possibly inexperienced residents, and to form part of the permanent paper record), experienced clinicians often have them committed to memory. However, the difference between an average clinician and a superb one is that the latter knows when to depart from the protocol: if departure never occurred, new syndromes or disease complexes would never be discovered. In any case, the protocol is the starting point when we consider how to store information in a CPRS. This system, however, focuses on the processes by which data is stored and retrieved, rather than the ancillary functions provided by the system. The obvious approach for storing clinical data is to record each type of finding in a separate column in a table. In the simplest example of this, the so-called â€Å"flat-file† design, there is only a single value per parameter for a given patient encounter. Systems that capture standardised data related to a particular specialty (e.g., an obstetric examination, or a colonoscopy) often do this. This approach is simple for non-computer-experts to understand, and also easiest to analyse by statistics programs (which typically require flat files as input). A system that incorporates problem-specific clinical guidelines is easiest to implement with flat files, as the software engineering for data management is relatively minimal. In certain cases, an entire class of related parameters is placed in a group of columns in a separate table, with multiple sets of values. For example, laboratory information systems, which support labs that perform hundreds of kinds of tests, do not use one column for every test that is offered. Instead, for a given patient at a given instant in time, they store pairs of values consisting of a lab test ID and the value of the result for that test. Similarly for pharmacy orders, the values consist of a drug/medication ID, the preparation strength, the route, the frequency of administration, and so on. When one is likely to encounter repeated sets of values, one must generally use a more sophisticated approach to managing data, such as a relational database management system (RDBMS). Simple spreadsheet programs, by contrast, can manage flat files, though RDBMSs are also more than adequate for that purpose. The one-column-per-parameter approach, unfortunately, does not scale up when considering an institutional database that must manage data across dozens of departments, each with numerous protocols. (By contrast, the groups-of-columns approach scales well, as we shall discuss later.) The reasons for this are discussed below. One obvious problem is the sheer number of tables that must be managed. A given patient may, over time, have any combination of ailments that span specialities: cross-departmental referrals are common even for inpatient admission episodes. In most Western European countries where national-level medical records on patients go back over several decades, using such a database to answer the question, â€Å"tell me everything that has happened to this patient in forward/reverse chronological order† involves searching hundreds of protocol-specific tables, even though most patients may not have had more than a few ailments. Some clinical parameters (e.g., serum enzymes and electrolytes) are relevant to multiple specialities, and, with the one-protocol-per-table approach, they tend to be recorded redundantly in multiple tables. This violates a cardinal rule of database design: a single type of fact should be stored in a single place. If the same fact is stored in multiple places, cross-protocol analysis becomes needlessly difficult because all tables where that fact is recorded must be first tracked down. The number of tables keeps growing as new protocols are devised for emergent conditions, and the table structures must be altered if a protocol is modified in the light of medical advances. In a practical application, it is not enough merely to modify or add a table: one must alter the user interface to the tables– that is, the data-entry/browsing screens that present the protocol data. While some system maintenance is always necessary, endless redesign to keep pace with medical advances is tedious and undesirable. A simple alternative to creating hundreds of tables suggests itself. One might attempt to combine all facts applicable to a patient into a single row. Unfortunately, across all medical specialities, the number of possible types of facts runs into the hundreds of thousands. Today’s database engines permit a maximum of 256 to 1024 columns per table, and one would require hundreds of tables to allow for every possible type of fact. Further, medical data is time-stamped, i.e., the start time (and, in some cases, the end time) of patient events is important to record for the purposes of both diagnosis and management. Several facts about a patient may have a common time-stamp, e.g., serum chemistry or haematology panels, where several tests are done at a time by automated equipment, all results being stamped with the time when the patient’s blood was drawn. Even if databases did allow a potentially infinite number of columns, there would be considerable wastage of disk space, because the vast majority of columns would be inapplicable (null) for a single patient event. (Even null values use up a modest amount of space per null fact.) Some columns would be inapplicable to particular types of patients–e.g., gyn/obs facts would not apply to males. The challenges to representing institutional patient data arise from the fact that clinical data is both highly heterogeneous as well as sparse. The design solution that deals with these problems is called the entity-attribute-value (EAV) model. In this design, the parameters (attribute is a synonym of parameter) are treated as data recorded in an attribute definitions table, so that addition of new types of facts does not require database restructuring by addition of columns. Instead, more rows are added to this table. The patient data table (the EAV table) records an entity (a combination of the patient ID, clinical event, and one or more date/time stamps recording when the events recorded actually occurred), the attribute/parameter, and the associated value of that attribute. Each row of such a table stores a single fact about a patient at a particular instant in time. For example, a patient’s laboratory value may be stored as: (, 12/2/96>, serum_potassium, 4.1). Only positive or significant negative findings are recorded; nulls are not stored. Therefore, despite the extra space taken up by repetition of the entity and attribute columns for every row, the space is taken up is actually less than with a â€Å"conventional† design. Attribute-value pairs themselves are used in non-medical areas to manage extremely heterogeneous data, e.g., in Web â€Å"cookies† (text files written by a Web server to a user’s local machine when the site is being browsed), and the Microsoft Windows registries. The first major use of EAV for clinical data was in the pioneering HELP system built at LDS Hospital in Utah starting from the late 70s.[6],[7],[8] HELP originally stored all data – characters, numbers and dates– as ASCII text in a pre-relational database (ASCII, for American Standard Code for Information Interchange, is the code used by computer hardware almost universally to represent characters. The range of 256 characters is adequate to represent the character set of most European languages, but not ideographic languages such as Mandarin Chinese.) The modern version of HELP, as well as the 3M CDR, which is a commercialisation of HELP, uses a relational engine. A team at Columbia University was the first to enhance EAV design to use relational database technology. The Columbia-Presbyterian CDR,[9],[10] also separated numbers from text in separate columns. The advantage of storing numeric data as numbers instead of ASCII is that one can create useful indexes on these numbers. (Indexes are a feature of database technology that allow fast search for particular values in a table, e.g., laboratory parameters within or beyond a particular range.). When numbers are stored as ASCII text, an index on such data is useless: the text â€Å"12.5† is greater than â€Å"11000†, because it comes later in alphabetical order.) Some EAV databases therefore segregate data by data type. That is, there are separate EAV tables for short text, long text (e.g., discharge summaries), numbers, dates, and binary data (signal and image data). For every parameter, the system records its data type so that one knows where it is stored. ACT/DB,[11],[12] a sys tem for management of clinical trials data (which shares many features with CDRs) created at Yale University by a team led by this author, uses this approach. From the conceptual viewpoint (i.e., ignoring data type issues), one may therefore think of a single giant EAV table for patient data, containing one row per fact for a patient at a particular date and time. To answer the question â€Å"tell me everything that has happened to patient X†, one simply gathers all rows for this patient ID (this is a fast operation because the patient ID column is indexed), sorts them by the date/time column, and then presents this information after â€Å"joining† to the Attribute definitions table. The last operation ensures that attributes are presented to the user in ordinary language – e.g., â€Å"haemoglobin,† instead of as cryptic numerical IDs. One should mention that EAV database design has been employed primarily in medical databases because of the sheer heterogeneity of patient data. One hardly ever encounters it in â€Å"business† databases, though these will often use a restricted form of EAV termed â€Å"row modelling.† Examples of row modelling are the tables of laboratory test result and pharmacy orders, discussed earlier. Note also that most production â€Å"EAV† databases will always contain components that are designed conventionally. EAV representation is suitable only for data that is sparse and highly variable. Certain kinds of data, such as patient demographics (name, sex, birth date, address, etc.) is standardized and recorded on all patients, and therefore there is no advantage in storing it in EAV form. EAV is primarily a means of simplifying the physical schema of a database, to be used when simplification is beneficial. However, the users conceptualisethe data as being segregated into protocol-specific tables and columns. Further, external programs used for graphical presentation or data analysis always expect to receive data as one column per attribute. The conceptual schema of a database reflects the users’ perception of the data. Because it implicitly captures a significant part of the semantics of the domain being modelled, the conceptual schema is domain-specific. A user-friendly EAV system completely conceals its EAV nature from its end-users: its interface confirms to the conceptual schema and creates the illusion of conventional data organisation. From the software perspective, this implies on-the-fly transformation of EAV data into conventional structure for presentation in forms, reports or data extracts that are passed to an analytic program. Conversely, changes to data by end-users through forms must be translated back into EAV form before they are saved. To achieve this sleight-of-hand, an EAV system records the conceptual schema through metadata – â€Å"dictionary† tables whose contents describe the rest of the system. While metadata is important for any database, it is critical for an EAV system, which can seldom function without it. ACT/DB, for example, uses metadata such as the grouping of parameters into forms, their presentation to the user in a particular order, and validation checks on each parameter during data entry to automatically generate web-based data entry. The metadata architecture and the various data entry features that are supported through automatic generation are described elsewhere.[13] EAV is not a panacea. The simplicity and compactness of EAV representation is offset by a potential performance penalty compared to the equivalent conventional design. For example, the simple AND, OR and NOT operations on conventional data must be translated into the significantly less efficient set operations of Intersection, Union and Difference respectively. For queries that process potentially large amounts of data across thousands of patients, the impact may be felt in terms of increased time taken to process queries. A quantitative benchmarking study performed by the Yale group with microbiology data modelled both conventionally and in EAV form indicated that parameter-centric queries on EAV data ran anywhere from 2-12 times as slow as queries on equivalent conventional data.[14] Patient-centric queries, on the other hand, run at the same speed or even faster with EAV schemas, if the data is highly heterogeneous. We have discussed the reason for the latter. A more practical problem with parameter-centric query is that the standard user-friendly tools (such as Microsoft Access’s Visual Query-by-Example) that are used to query conventional data do not help very much for EAV data, because the physical and conceptual schemas are completely different. Complicating the issue further is that some tables in a production database are conventionally designed. Special query interfaces need to be built for such purposes. The general approach is to use metadata that knows whether a particular attribute has been stored conventionally or in EAV form: a program consults this metadata, and generates the appropriate query code in response to a user’s query. A query interface built with this approach for the ACT/DB system[12]; this is currently being ported to the Web. So far, we have discussed how EAV systems can create the illusion of conventional data organization through the use of protocol-specific forms. However, the problem of how to record information that is not in a protocol–e.g., a clinician’s impressions–has not been addressed. One way to tackle this is to create a â€Å"general-purpose† form that allows the data entry person to pick attributes (by keyword search, etc.) from the thousands of attributes within the system, and then supply the values for each. (Because the user must directly add attribute-value pairs, this form reveals the EAV nature of the system.) In practice, however, this process, which would take several seconds to half a minute to locate an individual attribute, would be far too tedious for use by a clinician. Therefore, clinical patient record systems also allow the storage of â€Å"free text† – narrative in the doctor’s own words. Such text, which is of arbitrary size, may be entered in various ways. In the past, the clinician had to compose a note comprising such text in its entirety. Today, however, â€Å"template† programs can often provide structured data entry for particular domains (such as chest X-ray interpretations). These programs will generate narrative text, including boilerplate for findings that were normal, and can greatly reduce the clinician’s workload. Many of these programs use speech recognition software, thereby improving throughput even further. Once the narrative has been recorded, it is desirable to encode the facts captured in the narrative in terms of the attributes defined within the system. (Among these attributes may be concepts derived from controlled vocabularies such as SNOMED, used by Pathologists, or ICD-9, used for disease classification by epidemiologists as well as for billing records.) The advantage of encoding is that subsequent analysis of the data becomes much simpler, because one can use a single code to record the multiple synonymous forms of a concept as encountered in narrative, e.g., hepatic/liver, kidney/renal, vomiting/emesis and so on. In many medical institutions, there are non-medical personnel who are trained to scan narrative dictated by a clinician, and identify concepts from one or more controlled vocabularies by looking up keywords. This process is extremely human intensive, and there is ongoing informatics research focused on automating part of the process. Currently, it appears that a computer program cannot replace the human component entirely. This is because certain terms can match more than one concept. For example, â€Å"anaesthesia† refers to a procedure ancillary to surgery, or to a clinical finding of loss of sensation. Disambiguation requires some degree of domain knowledge as well as knowledge of the context where the phrase was encountered. The processing of narrative text is a computer-science speciality in its own right, and a preceding article[15] has discussed it in depth. Medical knowledge-based consultation programs (â€Å"expert systems†) have always been an active area of medical informatics research, and a few of these, e.g., QMR[16],[17] have attained production-level status. A drawback of many of these programs is that they are designed to be stand-alone. While useful for assisting diagnosis or management, they have the drawback that information that may already be in the patient’s electronic record must be re-entered through a dialog between the program and the clinician. In the context of a hospital, it is desirable to implement embeddedknowledge-based systems that can act on patient data as it is being recorded or generated, rather than after the fact (when it is often too late). Such a program might, for example, detect potentially dangerous drug interactions based on a particular patient’s prescription that had just been recorded in the pharmacy component of the CPRS. Alternatively, a program might send an alert (by pager) to a clinician if a particular patient’s monitored clinical parameters deteriorated severely. The units of program code that operate on incoming patient data in real-time are called medical logic modules (MLMs), because they are used to express medical decision logic. While one could theoretically use any programming language (combined with a database access language) to express this logic, portability is an important issue: if you have spent much effort creating an MLM, you would like to share it with others. Ideally, others would not have to rewrite your MLM to run on their system, but could install and use it directly. Standardization is therefore desirable. In 1994, several CPRS researchers proposed a standard MLM language called the Arden syntax.[18],[19],[20] Arden resembles BASIC (it is designed to be easy to learn), but has several functions that are useful to express medical logic, such as the concepts of the earliest and the latest patient events. One must first implement an Arden interpreter or compiler for a particular CPRS, and then write Arden modules that will be triggered after certain events. The Arden code is translated into specific database operations on the CPRS that retrieve the appropriate patient data items, and operations implementing the logic and decision based on that data. As with any programming language, interpreter implementation is not a simple task, but it has been done for the Columbia-Presbyterian and HELP CDRs: two of the informaticians responsible for defining Arden, Profs. George Hripcsak and T. Allan Pryor, are also lead developers for these respective systems. To assist Arden implementers, the specification of version 2 of Arden, which is now a standard supported by HL7, is available on-line.[20] Arden-style MLMs, which are essentially â€Å"if-then-else† rules, are not the only way to implement embedded decision logic. In certain situations, there are sometimes more efficient ways of achieving the desired result. For example, to detect drug interactions in a pharmacy order, a program can generate all possible pairs of drugs from the list of prescribed drugs in a particular pharmacy order, and perform database lookups in a table of known interactions, where information is typically stored against a pair of drugs. (The table of interactions is typically obtained from sources such as First Data Bank.) This is a much more efficient (and more maintainable) solution than sequentially evaluating a large list of rules embodied in multiple MLMs. Nonetheless, appropriately designed MLMs can be an important part of the CPRS, and Arden deserves to become more widespread in commercial CPRSs. Its currently limited support in such systems is more due to the significant implementation effort than to any flaw in the concept of MLMs. Patient management software in a hospital is typically acquired from more than one vendor: many vendors specialize in niche markets such as picture archiving systems or laboratory information systems. The patient record is therefore often distributed across several components, and it is essential that these components be able to inter-operate with each other. Also, for various reasons, an institution may choose to switch vendors, and it is desirable that migration of existing data to another system be as painless as possible. Data exchange/migration is facilitated by standardization of data interchange between systems created by different vendors, as well as the metadata that supports system operation. Significant progress has been made on the former front. The standard formats used for the exchange of image data and non-image medical data are DICOM (Digital Imaging and Communications in Medicine) and HL-7 (Health Level 7) respectively. For example, all vendors who market digital radiography, CT or MRI devices are supposed to be able to support DICOM, irrespective of what data format their programs use internally. HL-7 is a hierarchical format that is based on a language specification syntax called ASN.1 (ASN=Abstract Syntax Notation), a standard originally created for exchange of data between libraries. HL-7’s specification is quite complex, and HL-7 is intended for computers rather than humans, to whom it can be quite cryptic. There is a move to wrap HL-7 within (or replace it with) an equivalent dialect of the more human-understandable XML (eXtended Markup Language), which has rapidly gained prominence as a data interchange standard in E-commerce and other areas. XML also has the advantage that there are a very large number of third-party XML tools available: for a vendor just entering the medical field, an interchange standard based on XML would be considerably easier to implement. CPRSs pose formidable informatics challenges, all of which have not been fully solved: many solutions devised by researchers are not always successful when implemented in production systems. An issue for further discussion is security and confidentiality of patient records. In countries such as the US where health insurers and employers can arbitrarily reject individuals with particular illnesses as posing too high a risk to be profitably insured or employed, it is important that patient information should not fall in the wrong hands. Much also depends on the code of honour of the individual clinician who is authorised to look at patient data. In their book, â€Å"Freedom at Midnight,† authors Larry Collins and Dominic Lapierre cite the example of Mohammed Ali Jinnah’s anonymous physician (supposedly Rustom Jal Vakil) who had discovered that his patient was dying of lung cancer. Had Nehru and others come to know this, they might have prolonged the partition discussions indefinitely. Because Dr. Vakil respected his patient’s confidentiality, however, world history was changed.