Heineken Environment Analysis Essay

The bargaining power of suppliers The suppliers of raw materials to Heineken Company are mainly farmers. Therefore, the threat for power of supplier is high. The bottle supplier for Heineken is provided by Heye Glas Nederland which is fully supplied the green bottle for the worldwide distribution of Heineken beer. In the past, Heineken kept only 33% its stake in Heye Glas in order to secure the supply of high quality export bottles at a lower cost to meet the needs for demand but now Heineken has kept 100% stake in 2002. Beer is produced by water, barley, hops and yeast. These ingredients are supplied by farmers. Heineken also mentioned that competition for agricultural products from the biofuels industry that is affecting their costs. The bargaining power of buyers The buyers in this industry have many choices as there are many companies serving beer. This will increase the choice of the customer and hence the threat for power of buyers is high. For example, for serving customer at the pub, there are a lot of beer brands for them to fit their taste such as Guiness, Carlsberg, Tiger. Therefore, buyers now have a choice to choose the one they like. As a result, choosing of customer for what kind beer they want to drink will bring threats for Heineken. The threat of potential new entrants Nowadays, an explosion of smaller brewers has entered the market during the past decade that making the industry much more competitive. Heineken is one of the largest brewers in the world and they have to share market with other brewer. The barrier in the beer market is low. Therefore, the threat of potential new entrants for Heineken is high. This will make Heineken considering to create innovation or uniqueness into their product that can  sustain competitive advantages in the beer market. The threat of substitutes Beer is a kind of beverage which contains alcohol. However, people can switch to drink wine which also is alcohol drink. Customer’s taste is not similar so that they have right to choose what they want to enjoy, so this will affect the beer market as well as Heineken Company. As a result, the threat of substitute for beer market is high. The extent of competitive rivalry Heineken has achieved the economy of scale in the market especially in Europe. It holds about 30% of market share in European beer market. Since the beer market is growing, so the competitors will try to attain their growth targets. The large brewer like Heineken tends to enforce their own strategies to the beer industry and due the economies of scale they will produce higher quality and unique products which can make their own place in the market, hence keep themselves growing to achieve their target. Internal analysis of the company Analysis the resources Tangible: Since Heineken know that their plant and equipment is a key for company production, they invest so much in the infrastructure to make sure that their operation is working efficiently. For example, Heineken have four breweries in Russia, all those use KHS Till plant technology. This equipment at Heineken’s packaging can processes 50 liter kegs in addition to 30 liter at an output of up to 140 kegs an hour. As a result, the two-lane machine can operate with one racking, six washing and sterilizing stations. Intangible: brand name is most valuable asset of the Heineken Company, they has built this name Heineken with premium brand. The company recognizes that brand is very important key for them to develop a strong presence globally in the beer market so that Heineken have a lot of marketing activities for its brand name. Furthermore, branding is also a highly defensible competitive advantage for Heineken; this would bring strength to company expansion. Hence Heineken Company can stretch their production internationally and add more money for company. Management capability: Heineken implemented a number of new initiatives in the area of leadership development in 2004. One is a new leadership competency model that defines behavior expectations from all senior managers at Heineken. The model takes Heineken company ambitions and values as a starting point and translates these into the leadership behavior required from senior managers. With marketing differentiation using different message within normal media advertising can also have differentiating effect. This differentiation will bring strengths for Heineken. When most advertisers are pursuing essentially the beer market with the same message like showing gregarious groups of males in public houses having an enjoyable night out. In the other hand, Heineken managed to differentiate its beer by using a series of advertisements employing humour and the caption Heineken refreshed the parts other beers can not reach. Organizational structure In 2005 Heineken announced that it was created a new top management structure, this would drive and support growth as a global organization. In order to connect functions, operation and finance in a more effective way, the company create a new more streamlines Executive Board. Hence change would lead to create strengths for operating regions and global functions. Furthermore, Heineken has grown substantially over the past four years. The new structure is better suited to the present organization and ensures faster decision-making. In the beer market where the consolidation process is accelerating and rapid introduction of innovations is essential, this is crucial to the achievement of Heineken’s long term ambitions. Culture Heineken is proud of they are one of the world’s great beer companies. Hence their culture will reflect the company view and values. These values create so many strengths for company to develop their environment within the  company. Heineken based on the value that they respect their employees, business partners, customers, shareholders and all others who are connected to the company. Furthermore, Heineken make life more enjoyable by bring enjoyment to life, they also encourage this core value within the working places and atmosphere within the company. In addition, company has a fundamental belief in the concept and delivery of quality, it is also reflected in their other activities such as their social and employment policies. This will create benefit and value both for Heineken and their reputation. As a result, these values define Heineken corporate culture and working methods which help company to do the business successfully.

Urbanisation has changed the face of Mumbai

After living in this busy metropolis, this island of islands for about 17 years I’ve realised one thing – your senses are automatically heightened. Whether it’s your eyes that are constantly alert in the fast paced traffic or your ears that are forced to hear a cacophony of trains, vendors and honking cars. Your mouth and taste buds that have grown accustomed to Mumbai’s spicy, flavoursome cuisine. And of course, we’ve all had the chance to travel in a packed local train, scared that we’d get pick-pocketed, it’s like we’re born with a heightened sense of touch too.But I perceive Mumbai to be a â€Å"city of smells†. By this, I don’t imply that ours is a city full of stench and smog, no it’s much more than that! Like each home has a distinct smell of its own, Mumbai has these particular aromas and scents that define the city and give it character. The moment you step into Mumbai, your impression about the cit y could vary, depending on whether you’re an optimist or a pessimist. A pessimist would complain about the foul odour that comes from the slums, (You should know that Mumbai is home to one of the largest slums in Asia – Dharavi, so that’s a lot of stink! , the amount of vehicular pollution and smoke from cigarettes, the malodour of overflowing sewage etc. An optimist, on the other hand would enjoy the sterile, sanitised smell of malls, hotels which are plenty in Mumbai. Or you could be a realist like me and believe the city has a dual identity with motley collection of fragrances and odours. But that’s a discussion for later. Urbanisation has changed the face of Mumbai entirely – quaint little bungalows with terracotta tiled roofs are replaced with high rises made of chrome and glass. Niwas-es† and ‘Sadans’ are pulled down to make way for ‘Towers’ and ‘Heights’. However there still are some remaining gar dens and patches of green like the Hanging Gardens, Jijamata Udyan, the Sanjay Gandhi National Park to name a few. Mumbaikars still visit these parks to get a whiff of nature. And how can I forget the numerous â€Å"Chaafa† or champa trees with their sweet smelling flowers! Ironically this fast pace of industrialisation and development hasn’t improved the condition of public toilets in the city. Most Mumbaikars still cringe at the stink that comes from our city’s ‘shauchalayas’.The part of Mumbai that I enjoy the most is the sea. As a child, I’d know that we were passing by some â€Å"Chowpatty† or beach by the crisp saltiness in the air. Mumbai’s fish markets smell of the salty sea too – it’s the smell of freshly caught fish. Most times these markets give off the odour of rotting fish – an odour I still find repulsive. And then there is the floating smell of sukka bombil or Bombay duck dried in the sun near the coast! Another way of knowing that you’re near a crowded beach is the inescapable smell of chaat.The aroma of herbs, garam masala, the tang of squeezed lemons in a plate of bhelpuri or sev puri are enough to set the juices going in your mouth! You’d also smell vadapavs being friend and pav bhaaji being prepared – taka-tak – two dishes that originated in Mumbai. And then there is the smell of piping hot ‘cutting chai’, (The term cutting chai is said to have originated in Mumbai too! ) sold at tea stalls at every nukkad of Mumbai. Every meal in India usually ends with â€Å"paan†. Another common feature on the streets and many walls of Mumbai are paan stains which have their own disagreeable stink.Sometimes I can tell which part of Mumbai I’m in only by the distinctive redolence of that part. I know my train is passing through Andheri when I get a whiff of baked biscuits because the Parle G factory is very close to Andheri st ation. I know that my taxi has taken a turn at King’s Circle because of the aroma of freshly ground coffee beans and the local cafes serving original south-Indian filter coffee. For that matter I still associate the aroma of freshly baked bread, cakes and cookies from the string of bakeries in my very own Orlem.Travelling in local trains has become a part of the daily routine of a large number of Mumbaikars. More than often these trains are overcrowded, filled with more passengers than can fit in. Now it’s not the sea of bodies that I have an issue with, it’s the smell of human sweat that’s the problem! At such times I dream of Mumbai during the monsoon. There is nothing more beautiful, more gratifying than rains in the city! It gives us Mumbaikars relief from the summer heat, the air smells fresh and clean. The smell of wet mud right after a shower is almost magical. Yes, such earthy fragrances are a part of Mumbai too!

Informative Outline About Coco Chanel

Informative Presentation Outline Fundamentals of Oral Communication Topic: Coco Chanel General Purpose: To Inform Specific Purpose: By the end of my speech the audience will know better about Coco Chanel. Thesis: Coco Chanel brought the world of high fashion to the masses. Introduction I. Does anyone know what this logo is? A. I am assuming most of women in this room know what this is. B. This is Chanel logo, one of the most famous fashion brand in the world. C. A lot of women know Chanel and they are fascinated of Chanel products, but how many people know about Coco Chanel, the first designer of Chanel?II. Today, I am going to inform my audience about who Coco Chanel was, and her famous fashion product lines. III. Thesis statement: Coco Chanel brought the world of high fashion to the masses. Transition: Now, let’s begin with who Coco Chanel was. Body I. Who is Coco Chanel? A. She is a successful woman who overcame being an orphan. 1. Coco was born out of wedlock in the French town of Saumur in the Loire Valley on 19 August 1883 ( De La Haye, 2005). a. Coco was sent to an orphanage with her two sisters when her mom died of asthma at her age twelve, and her father left his children. b.In 1900, at her age seventeenth, she left the orphanage and attended the local convent school in Moulins (South of France) (De La Haye, 2005). c. Having been taught to sew by her aunts, her sister and she found work as dressmakers, assisting Monsieur Henri Desboutin of the House of Grampayre( De La Haye, 2005) 2. By 1903, Chanel moved to Paris and had become the mistress of a well-to-do young military officer, Etinenne Balsan (J. Baughman (Ed. ), 2001). a. She started designing hats for her friends. b. Around 1910 Balsan and her lover Capel helped Chanel set up a millinery shop at 21 rue Cambon in Paris (J.Baughman (Ed. ), 2001). c. Her Simple, elegant hats charmed the society women to whom Balsan and Capel introduced her, and by 1915 she was able to open additional shops in the resort towns of Deauville and Biarritz, France (J. Baughman (Ed. ), 2001). d. In that year she also moved into couture, designing dresses, skirts, and sweaters in jersey, a fabric not previously used in the French fashion houses (J. Baughman (Ed. ), 2001). B. She was the first woman to start a cosmetics line and the first to have a perfume named after her (Brownell, 2009). C. Coco Chanel’s real name is Gabrielle Chanel. . After she left the orphanage, she sang during evening concerts at a fashionable cafe called La Rotonde. 2. According to a quotation from a book â€Å"A Woman of Her Own† by Axel Madsen, â€Å"The only cabaret songs she knew besides â€Å"Qui qu’a vu Coco? † was â€Å"Ko ko ri ko† (Madsen, 26). 3. She earned her nickname ‘Coco’ from the songs that she sang at the cafe. Transition: Now that I’ve talked about who Coco Chanel was, now I will discuss her famous fashion product lines. II. What are her famous fa shion product lines? A. Chanel No. 5 is one of the most prestigious scents in the world (J.Baughman (Ed. ), 2001) 1. According to â€Å"The Secret of Chanel No. 5†, Chanel No. 5 is sold in nearly every country 2. One bottle is sold every 30 seconds (The Secret of Chanel No. 5). 3. More than 100 million dollars is made each year of this perfume (The Secret of Chanel No. 5). B. Coco Chanel’s â€Å"The Little Black dress† is thought to be element to the world of women’s fashion. 1. Almost a century after its real birthday in 1925, the Little Black Dress (LBD) is still the standard cocktail-party uniform for women the world over (Brownell, 2009). 2.According to Encyclopedia of clothing and fashion, American Vogue described the little black dress as â€Å"The Chanel ‘Ford’-the frock that all the world will wear† (De La Haye, 2005). Conclusion I. Today I discussed who Coco Chanel was, and her famous product lines. II. Coco Chanel brought the world of high fashion to the masses. III. Remember even though Coco Chanel was orphan she overcame and became one of successful women in the world, so do not give up on following your dream like Coco Chanel! References Brownell, G. (2009). Coco Puffs. Newsweek,  154(5), 58-59 Chanel, gabrielle ‘coco'.In (2001). J. Baughman (Ed. ),American Decades  (Vol. 3). Gale. Retrieved from http://go. galegroup. com. resources. kirkwood. edu/ps/retrieve. do? sgHitCountType=None&sort=RELEVANCE&inPS=true&prodId=GVRL&userGroupName=kirkwood_main&tabID=T003&searchId=R1&resultListType=RESULT_LIST&contentSegment=&searchType=BasicSearchForm ¤tPosition=3&contentSet=GALE|CX3468300801&&docId=GALE|CX3468300801&docType=GALE De La Haye, A. (2005). Chanel, gabrielle (coco). In S. Valerie (Ed. ),  Encyclopedia of Clothing and Fashion  (Vol. 1, pp. 49-254). Charles Scribner's Sons. Retrieved from http://go. galegroup. com. resources. kirkwood. edu/ps/retrieve. do? sgHitCountType=None;sort=RELEVA NCE;inPS=true;prodId=GVRL;userGroupName=kirkwood_main;tabID=T003;searchId=R1;resultListType=RESULT_LIST;contentSegment=;searchType=BasicSearchForm ¤tPosition=1;contentSet=GALE|CX3427500122;;docId=GALE|CX3427500122;docType=GALE Madsen, A. (1990). Chanel: A woman of her own. New York: H. Holt. The Secret of Chanel No. 5. (n. d. ). Hudson City School District. Retrieved from http://www. udson. edu/custom_users/mmtech/18011/18011/Chanel_No. 5. html Coco Chanel: My Hero. Retrieved March 6, 2013, from http://www. lovetwenty. com/2012/01/coco-chanel-my-hero/ Chanel Video Podcast. Retrieved March 6, 2013, from http://www. channels. com/episodes/show/13038194/CHANEL-Paris-Shanghai-12#/ajax/feeds/show/598/CHANEL-FASHION Famous French People, Coco Chanel. Retrieved March 6, 2013, from http://www. euroclubschools. org/page45. htm Chanel No. 5. Retrieved March 6, 2013, from http://www. chanel. com/en_US/fragrance-beauty/Fragrance-N%C2%B05-N%C2%B05-8818

Management Leadership Case Study Example | Topics and Well Written Essays - 500 words

Management Leadership - Case Study Example 2. The presence of Emaar in the United States having acquired John Laing’s homes in California is an indication of the strength of their brand. It means that since the company has such a huge investment in the biggest economy in the world, then it exhibits an international influence in the industry. Investors will ultimately have higher confidence in the company. In addition, it helps them establish a market niche, which is not only based in the United States but all across the world. When the United States develops policies to protect its businesses within the country and those based abroad, Emaar is included. Thereby the company gets much power and influence as a result of the association with US. 3. Using his power and influence and the contacts created, Alabbar can steer Emaar to greatness. First, he can consider getting into partnership with some of the biggest brands in the market in order to enhance his company’s penetration. Secondly, he can consider diversification to other lucrative sectors such as the energy sector. Thirdly, Alababar can establish collaborations with governments. Finally, he can develop sustainability programs such as the corporate social responsibility policy that helps the community relate with the organization. Implicit leadership theory- this theory helps analyze personal attributes of a leader, which may help understand d why they make the decisions that they make. In addition, the leader’s vision, behavior, skills, and deeds are analyzed. It is apparent that such personal attributes of Ed contribute to the performance in the organization. Leader-member exchange theory- this theory is geared towards analyzing a situation where there are subdivisions within a team. The group members get to separate into different groups just like is the case at Cromwell Electronics. In addition, Ed who is the leader seems to have a special focus on the team that has been in the

Ethical and Legal Aspects of Healthcare Essay Example | Topics and Well Written Essays - 750 words

Ethical and Legal Aspects of Healthcare - Essay Example Additionally, the procedure, if widely available, would lessen the urgency to make available new medicines designed to extend life. Those who are against the procedure on religious grounds contend that it is ‘playing God’ consequently sinful. Health care professionals refer to the Hippocratic Oath which prohibits them from performing this procedure. This discussion will examine the moral and legal concerns surrounding euthanasia, explain the meaning of the term, give arguments for the practice and end with a recommendation to solve the issue. Euthanasia describes a circumstance in which an incurably ill patient is given a mortal dose of medication, is detached from a life-support system or is basically allowed to die without active involvement for example by resuscitation. A physician’s involvement in the procedure could be to either intravenously insert a needle into the terminal patient who themselves activate a switch that delivers the fatal dose or to order a lethal dose of drugs with the express intention of ending a life. (Naji et al, 2005). Euthanasia by doctors as well as non-physicians has been lawful in Switzerland since WWII. Additionally, three organizations within the nation have been formed to help terminally ill patients. They supply patient counseling in addition to the medications for use in the procedure. Lethal injections, however, are not permissible. The atypical situation in Switzerland holds that euthanasia is allowed as long as a doctor is not involved in the process (Hurst & Mauron, 2003). Euthanasia has been legally permissible in Belgium since 2002. Each circumstance must be reviewed by two doctors prior to the procedure being performed by either injection or ingestion. In The Netherlands, euthanasia has been legal for seven years but has been tolerated for a quarter century. The directive for physicians stipulated by the government include; â€Å"the patient must be suffering unbearably and have no hope of improv ement, must ask to die and the patient must clearly understand the condition and prognosis (and) a second doctor must agree with the decision to help the patient die† (â€Å"The Fight†, 2004). Advocates of euthanasia are concerned with people suffering. Many diseases such as cancer often result in a protracted and excruciatingly agonizing death. Witnessing a loved one as they slowly wither away from the malady eating away at their bodily organs is rough enough for their family members, but to see them in severe pain even when drugs are given is unbearable not to mention the agony the patient must endure. This physically and emotionally torturous circumstance occurs in every hospital, every day of the year yet serves no good purpose. To many people, it is unthinkable to allow anyone, for instance, a sweet grandmother who has spent her entire adult life caring for other people, to spend the last months of their life suffering from continuous pain, incapable of controlling bodily functions, coughing, vomiting, convulsing, etc. The emotional pain for both the patient and family is unimaginably horrendous as well. If grandma were an animal most all regardless of ideology would agree that the only compassionate choice would be to ‘put her to sleep.’ American citizens are guaranteed certain inalienable rights but not the right to ‘

Russian Space Exploration Research Proposal Example | Topics and Well Written Essays - 2500 words

Russian Space Exploration - Research Proposal Example Economic difficulties have caused problems for Russian space exploration efforts but commercialization has met with success and the space program still captures the imagination of the vast majority of the people of Russia. This essay presents a discussion about Russian space exploration efforts and questions if humanity can join in its efforts for the conquest of space to make the best of that which is available. Man has had an interest in space since time immemorial but the dream of space travel could only be satisfied when advances in rocket technology could make this dream possible (RussianSpaceWeb. com, â€Å"Pre-20th Century Developments†). Russia had established a rocket production plant as early as 1861 and Nikolai Ivanovich Kibalchich (1854 - 1881), a revolutionary who was to hang for his involvement in the assassination of Emperor Alexander II, had proposed the idea of slowly burning explosives as being useful for aeronautical applications. Thus, interest in space exploration had been present in Russia before the twentieth century but the practical realization of dreams could only be fulfilled because of advances in physics, chemistry and aeronautics, which were supported by economic development. Russia’s space exploration program was to receive a boost from efforts made in Germany to design long-range rockets during the Second World War (Harvey, â€Å"Russian Planetary Space Exploration† pp. 17 – 35). On May 4, 1945, Russian troops had occupied the German rocket research center at Peenemà ¼nde and this led to efforts directed towards improving on German rocket technology and incorporating the results in Russian technology (Chertok, pp. 1 – 15). Later, in 1950, a team led by Sergei Korolev was to study a multistage version of the R-3 rocket that was capable of launching a satellite into space and this was a departure from German efforts. However, Russian

Choose one of the following Essay Example | Topics and Well Written Essays - 750 words - 1

Choose one of the following - Essay Example These camps moved on when the food supply at one place had diminished and created tools that would help their hunting and gathering inspired by the horns and fangs nature had given the animals from stone. Thus the human brain acquired what it had not been given by nature and helped the human race survive the age of mammoths and bison i.e. the last cold spell of the Ice Age (Gascoigne). The social structure of these nomadic tribes was based usually on kin-ship, and these were in comparison much smaller to the settlements of the Neolithic period because of the unsettled nature of the former (D.Erdal and Whiten). These tribes however were not headed by a single leader; instead various occupations entitled more than one group leaders. In a similar way the men did not rule over the women, the women were autonomous in their own specialties i.e. gathering and rearing children, while the men brought home meat (Dahlberg). The meat brought in by the men was also sometimes exchanged and shared among the members of the tribe (Gowdy). The end of this spell, around 10,000 years from today, marks the beginning of the Neolithic Revolution in many places around the world, which can help us speculate the factors behind the change of lifestyle among the humans of the Stone-Age (Gascoigne). The animals that the men hunted had either become extinct or had moved to colder regions (Gascoigne). This forced the hunters to follow, but the gatherers discovered the abundance and variety in the supply of edible plants and different animals that survived on these plants also. Melting of ice led to growth of life in lakes and ponds, thus presenting the homo-sapiens with easier alternatives and reasons to stay. The focus on plants and the conditions needed for their survival inspired the human brain to evolve their hunting practices into

Coco Chanel & Vivien Westwood Essay Example | Topics and Well Written Essays - 2000 words

Coco Chanel & Vivien Westwood - Essay Example Modernism was not conceived as a style but a loose collection of ideas. Where and when it was born is anybody's guess, but it flourished in Germany and Holland, as well as in Moscow, Paris, Prague and New York. Modernists wanted to build a better world, a world that could achieve social improvement through technology. The modernist's principles were frequently combined with social and political beliefs which held that design and art could, and should, transform society. Gabrielle 'Coco' Chanel belonged to this school of thought. (V&A, Modernism-Designing a New World 1914-1939, www.vam.ac.uk)1. Modernism which presume the existence of clear-cut distinctions between different types of aesthetic endeavors, are perceived as elitist in comparison with postmodernism, in which high culture is no longer viewed as aesthetically superior to popular culture and dominant cultures are no longer more significant than minority cultures. The shift from modernist to postmodernist styles is viewed as a consequence of social, political, and cultural changes that have altered the relationships between different social groups and the dominant culture, as well as the ways in which these social groups can be plausibly represented by cultural categories (An Excerpt from Diana Crane’s 1933- "Postmodernism and the Avant-Garde: Stylistic Change in Fashion Design", . The reign of Prince Regent (1820-1830) came to be known as the Regency era. Empress Josephine, during Emperor Napoleon’s (1804) time was a great fashion leader for the slender fashions of the day designed by Leroy. From fak e pearls and strass paste gems to parures and Cameos, these fascinating jewellery made under the influence of Greek and Roman architecture, came to be symbolic of the 18th and 19th century fashion world. The high waist styles of early 19th century known as the Empire style, evolved in the late 1700s. It began as a chemise shift gathered under the breasts and at the neck.It had a very dcollet low square neckline, a short narrow backed bodice and separate skirt. The small neat puff sleeves barely capped the shoulder. They were pulled back by the narrow cut of the bodice and this restricted arm movement. The fabric for Empire dresses was usually made of fine white lawn, muslin or batiste. The predominant styles followed during the regency fashion period were those of Spencer, Pelisse, and Redingote (Pauline Weston Thomas, Regency Fashion History, 1800s Costume History, for Fashion-era.com, www.fashion-era.com). 2.0 Definition of Modernism and Post-Modernism Between World Wars I and II, there was the rise of a puritanical style of design popularly called Modernism or the International Style. Many designs during this period represented a form known for its overall severity and geometry, combined with symmetry, order and simplicity. What was conspicuous was the absence of colour and applied decoration. When colour was applied, it was rarely spontaneous, and seen in geometrical formats and clear-cut,

Organisational purposes and swot analysis Essay

Organisational purposes and swot analysis - Essay Example 3 Mission, Vision and objective of the company 3 SWOT (Strength, Weakness, Opportunity and Threats) analysis 4 Strategic recommendations 7 8 Conclusion 8 References 9 Introduction Established in 1945, Tata Motors is one of the leading vehicle manufacturers of India with consolidated revenue of $32.5 billion in the financial year 2011-2012. The company is a leader in passenger and commercial vehicles and is also the fourth largest bus and truck manufacturer in India. The company is listed on the New York Stock Exchange and manufactures approximately 7.5 million vehicles annually (TATA Motors, 2013a). Mission, Vision and objective of the company The vision of the company is to develop the TATA Motors into a world class vehicle manufacturer which believes in manufacturing superior and innovative value vehicles. TATA believes that it can be a world class manufacturer by giving the cars a product appeal at a lower ownership cost (TATA Motors, 2013b). The mission and objectives of Tata Mot ors are stated below 1) To create shareholder’s value by generating revenue in excess or equal to WACC (Weighted Average Cost of Capital) during the business downfall. 2) To strengthen the brand value of the company and build an everlasting relationship with the customers by working closely with the business partners. 3) It believes in creating an organization which believes in innovation, excellence and complying with the core values of the company. 4) The company believes in enhancing and developing a long lasting relationship with the vendors and channel partners of the company that would ultimately benefit the customers and stakeholders in the long run. 5) The company believes in promoting the economic growth and development by initiating environment protection and awareness measures (TATA Motors, 2013c). TATA Motors believes that a company can achieve efficiency only if it practices ethical and transparent policies and develops a congenial working atmosphere which believ es in excellence, integrity, passion for work, innovation, concern for the environment (TATA Motors, 2013g). SWOT (Strength, Weakness, Opportunity and Threats) analysis The results derived from the SWOT analysis helps in accomplishing the mission of the company by utilizing the opportunities and strength of the company, avoiding the threats and rectifying the weakness of the company (Griffin, 2011). Strength Research and Development: The company is the leader in the manufacturing of light commercial vehicles in each segment and among the top three in passenger vehicles in India. The company owes its credit to the exquisite research and development team. The engineering and research centre of the company was established in the year 1966 and is equipped with more than 4500 engineers and scientists (TATA Motors, 2013b). Currently, the research and development team of the company has emerged with a Hybrid series car named TATA Manza which was displayed at the Auto Expo exhibition in Del hi. The research and development team is also planning to manufacture fuel efficient buses, the program will be supported by the government of India. The company has spent 15.49 billion in research and development activities during in the year 2011 (TATA Motors, 2013d). Globalization: The company has acquired several foreign brands to increase its presence globally and has a strong presence in UK, South Korea, Thailand, Spain, South Africa and Argentina and further plans to set up its plant in Turkey, Eastern Europe and Indonesia (TATA Motors,

Global operation and supply chain Essay Example | Topics and Well Written Essays - 500 words

Global operation and supply chain - Essay Example nventory can be referred to as the quantity of goods and materials on hand.   A stock includes finished products, goods undergoing production process, and raw materials. The main purpose of inventory management is to keep enough inventories to meet customer demand, maintain independence of operations, allow flexibility in product scheduling and be cost effective (Allen, 2008: 881).   Inventory management usually ensure the availability of raw materials in sufficient quality and quantity, thus it is of great importance to have a proper control and management inventory (Axs.ater, 2010: 1329). Inventory management is necessary as it prevents leakage, deterioration, spoilage and wastage of materials. Its aim is to improve material handling, saving in material cost, increase production and large profits (Allen, 2008: 883). First-In, First-Out method: this is a method of valuing the cost of goods sold that uses the cost of the oldest items in inventory first.   This is based on the assumption that goods that are sold or used first are those goods that are bought first (Axs.ater, 2010: 1330).   Last-In, First-Out method: This is an inventory valuing method that assumes that the last items placed in inventory are the first sold.   Therefore, when the Last in First Out method is applied, the year-end inventory consists of the goods placed in inventory at the beginning of the year, rather than at the end.   During inflation, when prices are rising, this method yields a lower ending inventory, lower gross profit, higher cost of goods sold and a lower taxable income (Anderson and Narus, 2011: 99).   This method is preferred because it reduces a company’s taxes and increases cash flow. Specific Identification method: this is the simplest method of valuing inventories.   The sale of inventory requires the inventory account to be credited or reduced, and cost of goods sold should be debited or increased for the amount paid for each inventory item.   This method works

Critically evaluate the current status of the setting including policies and practices Essay Example for Free

Critically evaluate the current status of the setting including policies and practices Essay Self-reflection is a very important tool to be used in order to keep the nursery up to date with current legislation and to raise service standards. By regularly looking at where we are as a setting we can ensure that we continue to offer high quality education to our children. â€Å"Research has proven that self-reflection and evaluation both support good practice within a setting as a part of continual development. Importantly this self-reflection supports good outcomes for children.† (Barber and Paul-Smith 2009, pg. 8) We have been using Ofsted SEF to evaluate where we are doing well and assess where we need to improve. â€Å"The self-evaluation form is designed to help early years providers to review and improve their practice, so that it is of the highest standard and offers the best experience for young children. Importantly it is a useful tool for you and any assistants or staff to evaluate the impact of what you do on children’s welfare, learning and development.† (Ofsted 2009, pg.13) PEST ANALYSIS POLITICAL ï‚ · Politically unsettled ï‚ · Arab spring ï‚ · Benevolent dictatorship ï‚ · No pressure groups ï‚ · Frequent change of legislation but no clear guidelines ï‚ · No official body or organization to refer to ï‚ · Government policies are not consistent and not properly disseminated ECONOMICAL ï‚ · Unsecure financial world markets ï‚ · Fluctuating exchange rates ï‚ · Expensive living ï‚ · Uncertainties in the economy ï‚ · No direct income taxes or VAT ï‚ · Several indirect taxes ï‚ · Increasing running costs ï‚ · Rapid expansion of Early Years industry ï‚ · Increasing competition SOCIAL ï‚ · Increasing number of working mothers ï‚ · Wider range of people ï‚ · Image of good standard of living and overall safety ï‚ · People moving and settling in the area ï‚ · Increased focus on Early Years Education ï‚ · Attractive area for different nationalities ï‚ · Broad spectrum of curriculum covered in the country TECHNOLOGICAL ï‚ · Easier information access (internet) ï‚ · Wider audience ï‚ · Better ability to reach out to the Community ï‚ · Blogging (positive and/or negative) ï‚ · Personal Technology ï‚ · CCTV cameras (name of city) is a safe place, its economy is considered ever flourishing but due to the ongoing global economical crisis it has its financial restraints. This analysis has also outlined how a business can be easily set up but also how difficult it is for it to thrive due to frequent changes in the legislation and the lack of consistent guidelines. Nevertheless, the increased interest in Early Years Education will soon allow practitioners to offer to all children high standards of learning. SWOT ANALYSIS STRENGTHS ï‚ · Well trained, qualified and experienced staff ï‚ · Impressive facilities ï‚ · Outstanding outdoor area ï‚ · Central location ï‚ · Extra-curricular activities ï‚ · Early years themed workshops and professional advisors WEAKNESSES ï‚ · Turnover of staff due to economic situation ï‚ · Policies and Procedures (only few in place) ï‚ · Being tenant of the facilities ï‚ · Old building badly maintained ï‚ · Lack of training opportunities ï‚ · Limited parental involvement ï‚ · Managerial limited decision making ability OPPORTUNITIES ï‚ · Several marketing options ï‚ · Exponential growth of market ï‚ · Partnership with professionals in childcare ï‚ · Diversified skills of staff with different backgrounds ï‚ · Wide professional network THREATS ï‚ · Extremely high price of rent ï‚ · Frequent new regulations with high implement costs ï‚ · New nurseries poaching staff and rising salary expectations ï‚ · Loss of key staff ï‚ · Frequent families’ relocations (name of nursery) is a newly established nursery in (name of city) that was initially planned with a greater focus on business rather than learning. Policies and Procedures were compiled and printed out hastily, without team brainstorming or subsequent effective compliance. The absence of specific legal requirements in the country makes it possible for nursery and day cares to operate, though in the best interest of children, without proper policies and procedures in place. Going through the process of self-evaluation has been the most valuable eye opener possible for me. I now know where we are and where we want to be. PEST and SWOT analysis have  allowed me to celebrate our strengths and pinpoint our weaknesses. Generally all policies will need to be rewritten, implemented and properly disseminated, but priority will be given to Child Protection and Behaviour Management Policies. A Staff training plan also needs to be put in place in order to ensure high standards in care and education of all children. Last but not least, it will be paramount to monitor progress and ensure that our procedures reflect our policies and that good practice is consistent throughout the academic year by gathering evidence regularly.

Cebu My Hometown Essay Example for Free

Cebu My Hometown Essay Cebu is located in central visayas approximately 1 hour from manila via airplane, Cebu is known for delicious roasted pork and famous in the works of guitars and delicious pastries. Cebu is one of the famous cities around the country as Famous Places in Philippines by ShareRanks three years ago. I will tell you the beautiful sights and relaxing places located in Cebu but not all. First is the Trans-central Highway a 33 kilometer long road from barangay Lahug Cebu city to Balamban(my home town). Some views in Trans-central are breath taking, and it is a 930 ft. above sea level highway. Island in the Sky is one of the best place to visit in Trans-central Highway, they have a small swimming pool and a short hanging bridge, and cottages that you can hang out and eat with your family and friends. Adventure Cafe also located in Trans-central Highway, walking distance from Island in the Sky, and good thing about Adventure Cafe is their adventure base activities such as zip line, wall climbing, rappelling, and stress walk, but honestly haven’t tried their activies, maybe when I go back. There are more place to visit in Trans-central Highway, buy i can only mention two places you can visit. And the last place I want to share is the Whale shark watching, it’s not in Trans-central Highway, there is no whales in 930 ft. above sea level. (haha) It is located in Tan-awan, Oslob, Cebu, 2-3 hours travel or around 177 kilometers south from the Cebu City. There are beaches that offers a tour and rentals for motor banka, but it is very expensive for non-Oslob residents. Whale shark watching is not only available in south side Cebu, but also in north side Cebu. So today I told you the beauty that you can find in my home town, But that’s not all, there are plenty of places you can discover by yourself.

Advantages of Cooperative Learning for English Language Learners

Advantages of Cooperative Learning for English Language Learners Cooperative learning is a successful teaching strategy in which small teams, each with students of different levels of ability, participate in a variety of learning activities to improve their understanding of a subject (Noyes, 2010). Each member of a team is accountable not only for learning what is taught but also for helping teammates learn, thus creating an environment of success (Kagan, 2002). Students work through the task or assignment until all group members successfully understand and complete it. For English language learners, cooperative learning is critical, because it truly accelerates learning. There is no better way to learn language, other than using it. Teachers often model language but, hamper students by not providing them with opportunities to apply it and master aspects of the language as rapidly as possible (Noyes, 2010). Cooperative learning provides the opportunity for English language learners (ELL) to accelerate learning of the language skills required to be doing well in academic subjects. The purpose of cooperative learning is each member of the team is accountable for not only learning what is taught, but also helping their teammates learn. It creates an atmosphere of community and achievement (Kagan, 2002). The students are actually teaching each other and a function thats community based and builds collaboration. Cooperative learning is a strategy that can be used with all students. Benefits for English Language Learners Cooperative learning is usually valuable for any student learning a second language. Cooperative learning activities support peer communication, which helps the expansion of language and the learning of concepts and content (Kagan, 2002). It is essential to assign ELLs to different teams so that they can benefit from English language role models. ELLs learn to convey themselves with greater independence when working in small teams. In addition to picking up vocabulary, ELLs benefit from observing how their peers learn and explain problems. Roles need to be assigned and rotated each week or by activity. By rotating, students increase skills they mainly need to perform. Cooperative learning builds learning communities as students grow to be experienced at how to get along, how to be concerned for themselves and for each other and how to deal with their own performance as they work on the way to a common objective (Kagan, 2002). Cooperative learning groups make best use of the swift attainment of English because it provides students with understandable contribution in English in encouraging, non-threatening surroundings (Noyes, 2010). Academic and language learning requires that students have opportunities to figure out what they hear and read as well as express themselves in significant tasks (McGroarty, 1993). Cooperative learning creates normal, interactive contexts in which students have bona fide reasons for listening to one another, asking questions, expounding issues, and re-stating points of observation. The foundation of school achievement is academic literacy in English; age appropriate comprehension of English is a requirement in the accomplishment of content standards. We learn mainly through language and use of language to convey our knowledge. Cooperative learning increases opportunities for students to construct and figure out language and to gain modeling and criticism from their peers. A great deal of the significance of cooperative learning lies in the way collaboration encourages students to connect in such high level thinking skills as analyzing, explaining, synthesizing, and elaborating (McGroarty, 1993). Teachers Role in Cooperative Learning Standards must be taught. The rules of learning groups must be understood by all students (Noyes, 2010). The learning groups must be free from negative comments which hinder learning and growth. Everyone must be active listeners; each team member must participate, and help everyone understand the objective and what is being learned. Additionally, noise levels must be kept in perspective and the group needs to keep on the assignment. Schools must provide teaching that assists ELLs in acquiring content area comprehension along with resources for becoming skilled in English (NCLB, 2001). Cooperative learning is not just group work (Noyes, 2010). For it to be effective, the teacher must teach high utility words that appear within the content areas that are a means to comprehension along with definitions and examples of use in context. The group must engage each member in learning words through an assortment of methods of comparing, analyzing, and using target words because academic language is important for reading and mastery of skills in all subject areas. Careful planning is a must for cooperative learning to be effective. ELLs working in cooperative learning groups must be given assignments according to their levels of English proficiency. The teacher must be aware of their stages of language acquisition. Class building and team building activities such as mix pair share, mingle and match, give one/get one, find someone who, think pair share, round table, and roam the room are useful ways to integrate cooperative learning into the classroom (Noyes, 2010). Conclusions Research suggests that cooperative learning techniques boost ability for all students (Noyes, 2010). Cummins (2001) considers cooperative learning an empowerment pedagogy because students have greater opportunities to practice oral language. Cooperative learning is a successful approach in which small teams, each with students of diverse levels of capability, use a range of learning activities to advance their understanding of a topic (Noyes, 2010). Each member of the team is accountable not only for learning what is taught, but also for helping teammates learn through the formation of an environment of accomplishment (Kagan, 2002). Cooperative efforts result in members motivated for mutual achievement so that all gain from each others efforts, recognize that all members share a common fate, know that ones performance is caused by each other working together and feel proud and jointly celebrate when one is recognized for success. Cooperative learning is not just group work or a way to keep students busy. Teachers must provide key instruction in phonemic awareness, phonics, fluency, vocabulary, and comprehension and allow the dynamics of cooperative learning to provide practice for proficiency.

Walt Whitman: Homoeroticism in Leaves of Grass Essay -- Poetry Analysi

Leaves of Grass is Walt Whitman’s life legacy and at the same time the most praised and condemned book of poetry. Although fearful of social scorn, there are several poems in Leaves of Grass that are more explicit in showing the homoerotic imagery, whereas there are several subtle – should I say â€Å"implicit† – images woven into the fabric of the book. It is not strange, then, that he created many different identities in order to remain safe. What Whitman faced in writing his poetry was the difficulty in describing and resonating manly and homosexual love. He was to find another voice of his, a rhetoric device, and his effort took two forms: simplified, and subverted word play. The first was to understand and render the experience in everyday terms, as in the poem Behold This Swarthy Face. Whitman puts emphasis on masculinity â€Å"in this swarthy face, these gray eyes† (149), and other words, too, are expressive enough to explain to the reader what kind of person is to be loved. What is not as subtle as in some other of Whitman’s poems is the idea in the second part of the poem: â€Å"And I on the crossing of the street or on the ship’s deck give a kiss in / return† (149) – the meeting of the two is to be recognized anywhere, be it on the street or on a ship's deck. When it comes to the second form, Davidson notices that â€Å"The other and far more prevalent form of presented homoerotic love was by means of terms of oppression, subversion† (54). Exemplar poem of this form is Not Heaving from My Ribb’d Breast Only. In it the lyrical subject is trapped in fears and must break out of suppression in order to be himself. In the end of the poem there is a sudden release: â€Å"O pulse of my life! / Need I that you exist and show yourself any more than in... ...d Bergman, David. Choosing Our Fathers: Gender and Identity in Whitman, Ashbery and Richard Howard. American Literary History 1.2 (1989): 383-403. JSTOR. Web. 29 March 2012. Davidson, Edward H.. The Presence of Walt Whitman. Journal of Aesthetic Education 17.4 (1983): 41-63. JSTOR. Web. 29 March 2012. Herrman, Steven B.. Walt Whitman and the Homoerotic Imagination. Jung Journal: Culture & Psyche 1.2 (2007): 16-47. JSTOR. Web. 29 March 2012. Maslan, Mark. Whitman and His Doubles: Division and Union in Leaves of Grass and Its Critics. American Literary History 6.1 (1994): 119-139. JSTOR. Web. 29 March 2012. Metzer, David. Reclaiming Walt: Marc Blitzstein’s Whitman Settings. Journal of the American Musicological Society 48.2 (1995): 240-271. JSTOR. Web. 29 March 2012. Whitman, Walt. Leaves of Grass. Pennsylvania: the Pennsylvania State University, 2007. Print.

Lord Of The Flies - Setting Essay -- essays research papers

In the novel Lord of the Flies, by William Golding the setting had a very strong influence in the actions and attitudes of the characters. Setting is the defined in literature as where the story takes place. In Lord of the Flies, the setting is on a deserted tropical island in the middle of the ocean, where a microcosm is able to be established. Three specific examples of how setting influenced the actions and attitudes of the characters are: The isolation from a civilized world, the mysteries of an unfamiliar place, and different social types being forced to live with one another. How these examples are to be proven will be developed in the following paragraphs. Being on an island in the middle of the ocean, cut off the life line, of a highly civilized society, that took hundreds of years to develop. Due to the age and experience of the boys, such ideals of what it takes to be civilized are not developed to that of an adult’s. When the boys are put in a world without rules, punishment, and order, it leads to a very progressive deterioration of what they have learnt to be "civilized". Without boundaries from authority figures, the boys feel as if they can do what ever they want, or as how they put it "to have fun". In the beginning things where fine. An organized society had been formed where Ralph was elected chief, and others where assigned specific duties. However as time goes by, things start to deteriorate, the boys are sick of doing their dut...

Antony and Cleopatra :: essays research papers

The representations and interplay of types of power: In Shakespeare’s famous play Antony and Cleopatra, the powerful are portrayed including their personalities, their reactions to other powerful figures and the interplay of these powers as the characters interact. Antony’s Power: Shakespeare uses Rome and Egypt as binary opposites not just to reflect qualities inherent in the two places, but the changes that come upon Antony depending on which place he is in. The changes in Antony’s behaviour and power-usage patterns can be seen through Shakespeare’s constant juxtaposition of the Egyptian and Roman worlds. Antony’s behaviour tends to change as in the exotic place that is Egypt Antony is allowed to escape from his Roman self : "I will to Egypt†¦I'th' east my pleasure lies.â€Å"2.3.38-40. The word â€Å"pleasure† indicates that Egypt has a sexual appeal to him in the form of Cleopatra. He adores his role as king in Egypt, being the self-indulgent lover of Cleopatra. However in Rome, Antony must attend to his political ambitions, duty to administration, his citizens and soldiers. These are duties he does not wish to be burdened with: "Let Rome in Tiber melt and the wide arch / Of the ranged empire fall!† Antony describes his feelings while in Egypt as a hyperbole, which reflects how his behaviour becomes irrational. Moving on to Cleopatra’s Power, it can be seen that she uses her coercive sexual power to entice and manipulate Antony’s behaviour and decisions, inevitably ending in the weakening of their relationship. Cleopatra knows her powers of manipulation: "I drunk him to bed;/ Then put my tires and mantles on him, whilst I wore his sword Philippan.â€Å"2.5.21-23. She makes a mockery of him as he is the Philippan victor that is metaphorically stripped of his sword and therefore his political and sexual power, by a woman. She is described by him in a metaphor, as an â€Å"enchanting queen† which connotes a sense of uncontrolled mesmerisation with a powerful figure. To those removed from the situation, such as Caesar, she is described as a â€Å"whore† and Antony's life with her is full of â€Å"lascivious wassails† demonstrating the wanton behaviour that Cleopatra has almost imposed on Antony.

Scrapbooking Essay

Scrapbooking Scrapbooking is a great way for me to capture the special people and events I encounter in my life. Many times I like to take pictures of family traditions, favorite things, children and my accomplishments. When creating a scrapbook, I’m able to pass down memories from my experiences to my children. Scrapbooking is a creative way to relax and have fun. The first time I started scrapbooking was after my wedding. I had many beautiful photos that were sitting inside an envelope that I wanted to put onto display. It was very easy to get started because the craft stores have pre-made kits that I could use to get my ideas started.I finished my wedding album and wanted to immediately start another one! I was at the time in the military and deployed to Iraq. This was a perfect opportunity for me to express myself. I went to the craft store and got tons of things that I thought would turn into a great scrapbook. During my time in the military I had a lot of opportunities t o travel. The places I have been are great experiences to talk about and share with family members but when I have a personally made book with photos to go along with my stories makes for a great time.Scrapbooking is a great way for me to preserve my many memories and pass down to my children. Making scrapbooks is more than just a book that will sit on my shelf. Scrapbooks are personal books with great memories preserved in a way that will make them memorable to children. Whenever my family visits they enjoy looking at what new books I have made or what I’m working on. I enjoy putting together books for family members when we get other for family traditions and I want to share our memories together. My personal time is very important to me.When I need time to get away from the craziness of daily life and raising kids, scrapbooking is the first activity I will turn too. Scrapbooking for me is a great way to relax and let my creativity fly! Although scrapbooking is one of my fa vorite things to do, it can become very costly. When working on a scrapbook I will normally only do a few pages at a time, then wait a few weeks to finish the rest. Mostly so that I can spread the cost out over a period of time, but also to give myself time to figure out how I’m going to plan the rest of the book. In conclusion, scrapbooking is a great way to relax and be creative!It can sometimes be very costly and time consuming. If you set yourself a budget and time frame of how you get your books done it will not interfere with your life. So many times people have boxes and boxes of photos under their beds or in the attic that are getting damaged and are a huge mess when trying to look at them. Scrapbooking is a awesome creative way to preserve your memories and display your own creativity. I enjoy scrapbooking for the reason of getting to pass down my greatest memories to my children in a unique way that I created that they will have for a lifetime.

The Impact Of The Revolutionary War On American

American Revolution was key factor for setting up elementary and long lasting change in the values of Americans. During the period 1775-1800, the revolutionary war played a vital role in the drastic change of American society in each of the following sectors: the American economy due to increased taxation and inadequate money, the American legal system with its establishment of the Electoral College and constitution, and finally; the American culture with its ideas related to racial and gender discrimination.Even though the revolutionary war lasted for only a few years, the Revolution itself lasted for more than a century and its impact can still be seen today. A lot of early settlers who had to go through great difficulties while distancing themselves from Britain for their freedom had a feeling of revolt. The revolutionary war greatly influenced the American society and finally resulted in an economically stable and independent country that has achieved victory in spite of facing m any hardships. Impact of American Revolutionary WarBy the time American Revolution came to an end, the American economy had extremely weakened because there was a dearth of currency and trade. This is opposite to the commonly held conviction that the economy of America flourished after the revolution due to the influx of taxes. Britain exported a huge amount of goods to American after the revolutionary war. This resulted in a great loss to the local American industries. Moreover in 1784, Spain blocked its Mississippi River to all of the American trade, and asserted for a part of land close to the Gulf of Mexico that had been actually allotted to America by Britain.Not to forget this piece of land was given up by Britain in order to persuade America to stop coalition with France. America was discouraged from stopping its nation because of the restive Indians, who were really encouraged to do so by France and England. The Indians held up to Britain as they thought that if they would w in in case, the development of America into the West would stop, and they would be able to save their Indian land. France claimed the money America had owed to France; nevertheless America was not stable enough economically to ay off their debts.America said no to pay back the taxes. Still in the war, America had made their own currencies and tax barriers, as a result of which extra taxes were not privileged to citizens. Most of the states of America were doubtful regarding the taxes on good from other states. In few of the states, a lot of farmers were losing their land because they did not have the funds for these taxes. This problem caused the well-known â€Å"Shays' Rebellion† in 1786, where citizens actually assaulted the tax collectors.The terror of that kind of cruel violent behavior persisted and aggravated the fear of society. Due to the debts from the war, the British government forced more taxes on its American settlers, firstly on sugar in the â€Å"the Revenue A ct†, then on all business deals involving paper in the â€Å"the Stamp Act†. Mostly in Virginia, people were protesting against these taxes. In 1764 the General Assembly officially concluded that only the Virginia House of Burgesses had the legal rights to tax the people o Virginia.The upcoming resolutions and sanctions welcomed each of the new taxes imposed. In conditions of lawful concerns, the American Revolution significantly affected the American society with the formation of the Articles of Confederation, the Constitution and other official documents, in addition to the foundation of the Electoral College. The founding of the recent American democratic system greatly relied on these precious papers. The new Constitution was commenced in 1789, this was the time when the population was increasing at an astounding speed and public was adhering to the laws.By 1791, America acquired a â€Å"Bill of Rights† that modified all the issues and is still followed today . Such official documents are still conserved today as they were prepared originally as the still have the same regard as lawful and ethical codes for society today. Due to the revolutionary war many people had to migrate to America and most of the early permanent colonists in America showed signs of preliminary hate for Britain when they went through the strenuous and lengthy migration to states. As the â€Å"Pennsylvania Packet† describes, America was the homeland of free people.Despite the fact that the document is partial, as the author conveys intense hostility for Britain, it has helped in explaining the nationalism of the settlers who preferred the idea of democratic system and wanted to be free from Britain's tyrannical rule. Conclusion The American Revolution had a greatly affected the American society in different ways. The war resulted in a weak economic system, suffering due to excessive migration of people to America, unemployment, taxes, debts and gender and rac ial discrimination.But with the help of great political leaders and national heroes America was able to form the basis for its current Constitution and legal values, and encourage women and other races to fight for their rights. The well established Constitution was the main pillar towards the regeneration and development of the state without which the survival would have been impossible. Endnotes 1. Ward, Harry M. Between the Lines: Banditti of the American Revolution (Westport, Conn. , 2002), pg 311. 2. Kierner, Cynthia A. Southern Women in Revolution, 1776-1800: Personal and Political Narratives (Columbia, S.C. , 1998), pg 176. 3. Wood, Betty. Gender, Race, and Rank in a Revolutionary Age: The Georgia Lowcountry, 1750-1820 (Athens, Ga. , 2000), pg 121. 4. Coulter, E. M. American Revolution: The Story of the Growth of a Tradition,† GHQ 39 (June 2003): 118-51. 5. Davis, Derek H. Society and the American Revolution. Journal of Church & State, 0021969X, 2001, Vol. 36, Issue 4, pg 19. 6. Ibid pg 23-27. 7. Hahn, Steven. The Effects of American Revolution. New Republic, 00286583, 2006, Vol. 235, Issue 6, pg 12. 8. Ibid pg 15-18. 9. Gross, Robert. Origins Of The American Revolution.Virginia Quarterly Review, 0042675X, 2001, Vol. 77, Issue 1, pg 48. 10. Merrill Jensen, The Founding of a Nation: A History of the American Revolution, 1763-1776 (New York, 1999), pg 436-38. 11. Richard, Alden, The American Revolution, 1775-1783 (New York, 1997), pg 7. Bibliography Alden, K. A History of the American Revolution (New York, 1999), pg 325. Coulter, E. M. , American Revolution: The Story of the Growth of a Tradition,† GHQ 39 (June 2003): 118-51. Countryman, A. People in Revolution: The American Revolution and Political Society in New York, 1760-1780 (New York, 1999), pg 193.

Consider knowledge issues Essay

â€Å"That which is accepted as knowledge today is sometimes discarded tomorrow.† Consider knowledge issues raised by this statement in two areas of knowledge. Nowadays, due to for example technological development, every day can bring us a new knowledge. Something that yesterday was unthinkable, today turned into reality. Does that work in the opposite way? Does knowledge from hundreds of years ago is still considered as truth? Does knowledge have a period of validity? I found it very interesting considering the fact that most people believe in everything what famous scientists say. They are learning things, which are written in books or newspapers and they consider it as truth. But how do we know that something is truth? There are various of theories which are created every day and overturned after few days or even hours. While thinking about all knowledge theories, one question is coming to our mind, how do we know that previously accepted knowledge is timeless, and when it is accountable to be inverted as new thinking emerges? On those questions I will try to answer in my essay. To accurately answer the question posed in the task, areas of knowledge to which I am going to relate my work are history and human sciences. Technological development which was mentioned before allowed us to verify whether created theories are true or false. Theories from which we obtains our knowledge are changing constantly. Some of them could be overturned after they were assessed as unreliable. Such assessment can be done due to development which we already obtained. However, technology can also be used to improve the reliability of such knowledge. As an example of such theory I will use biological cell theory. In 1590, Hans and Zacharias Janssen invented a microscope under which in 1665 Robert Hooke firstly discovered cells, the basic units of structure and function of all living organisms. There was not many informations about this new discover. For years, scientists have expanded their knowledge about cells and they are doing it even now. Thanks to technology, now we know almost everything about cells. How they replicate, what they contain inside of them. The theory has been improved so this is still considered as reliable knowledge. Another example of improvement in sources of knowledge could be found in physics. In ancient Greece, Democritus discovered the smallest unit of matter – atom. Due to  many various experiments performed till now, theory about atom has changed many times and it is still not over. Scientists are always looking for new informations, therefore they are collecting new knowledge. From this knowledge new theories are created and then, by new technologies those are considered as true or false or improved. Another example of knowledge which was discarded after a long time is psychoanalysis. Psychoanalysis is a method of understanding and treatment of human psychology and the theory allows to explain the different social and cultural phenomena. It was begun in the late nineteenth and early twentieth century by the Viennese physician Sigmund Freud. For many years, psychoanalysis was considered as the best method of treatment of mental disorders based on assumptions psychoanalytic theory. It assumes that the primary cause of the symptoms is unconscious memory, which involves strong emotions, resulting in a traumatic situation. Goal of psychoanalysis as a therapeutic method is to restore the consciousness of those memories. Critics of psychoanalysis as a scientific theory argue that it cannot be verified experimentally, so it cannot be classified as science, but only to literature, pseudoscience or para-science. In addition, many authors believe that Freud in many places falsify his observ ations to confirm his theory. Karl Popper took example of psychoanalysis as a theory unfalsifiable, and therefore unscientific. Unfalsifiable of psychoanalysis can be represented by the following example. A person smokes a cigar. Psychoanalysis claims that in this way this person satisfies his oral needs. If this person confirms, it would constitute proof of the veracity of the claims of psychoanalysis. If, however, deny that the reasons for the denial of that to be found in ignorance and denial. Thus, it also confirms the truth of the claims of psychoanalysis. Except Freud, there are many other psychoanalysts. As an example I will use Alfred Adler. Alfred Adler was an Austrian medical doctor and psychotherapist who found school of individual psychology. Different case in point how knowledge can be discarded we can find in case of penicillin. It was the first antibiotic found in 1928 by Alexander Fleming. Firstly, it was considered as the best known to humanity treatment for almost all the diseases. The mechanism of action of penicillin as  antibiotics by blocking the activity of bacterial enzymes. It lend a hand to a lot of people with their diseases and sufferings and it brought a great success to scientists which found it. They even got the Nobel Prize in 1945 for inventing penicillin. However, after a few years when penicillin was on the market, many people started to complain on side effects of penicillin. It turned out that a lot of them are allergic to penicillin and therefore they have huge problems with their health. Some people even had anaphylactic shock after first dose. Moreover, users of penicillin were complaining from fever, chilling, profuse sweating, cyanosis or hypotension. These facts have rejected the recogniti on of penicillin as the best antibiotic and therefore knowledge that penicillin is the best antibiotic was discarded. Nowadays due to technology we have much better kinds of antibiotics. Many of them are antiallergic and therefore may be used by all people suffering from different diseases. Except science, knowledge changes also on historical ground. It mainly refer to revisionist historians. History we learn is changing all the time, as revisionist historians change things so as to fit the truths more likely than it is. As it is known, history is always incomplete. There are many facts about we do not have a clue or we don’t know why something happened. Thanks to revisionist historians, old theories are in fact changed into the new ones, which are considered as better and therefore more accurate truth of the world is created. In this case, old theories are not discarded, but evolved to adjust to the flow of time and new informations possessed. Therefore, theories created by earlier generations are accepted but changed in future to fit the truth more likely. This brings us to consensus that even though a few years ago something was considered by historians as truth, today due to technology and revisionist historians it may be considered as totally different. As we can see, nothing stays forever on our planet. Everyday everything changes, new knowledge is discovered and new theories are created. World is constantly evolving and brings us new technology by which we can discover new informations and therefore knowledge. Psychoanalysis, discover of penicillin, cell theory, revisionist historians and discover of atom are all  an examples of how can knowledge change due to the passage of time and technology development. Taking this into consideration, the statement mentioned in the subject â€Å"That which is accepted as knowledge today is sometimes discarded tomorrow.† perfectly represents the idea and speed of development of modern world. Even though today we think that something is true and different theory is unacceptable, in few years or centuries it could be discarded or evolved into the new theory.

American Psycho: Obsession comes from the inability

To be successful and functional members of society, we must always be evolving with its changes. But once we grow negligent towards other aspects of our lives, and focus on one only, negative effects inevitably follow. Obsession renders us dysfunctional citizens due to our inability to maintain balance in our lives, and to accept understand ourselves as we are. In the novel, American Psycho, by Bret Gaston Ellis, Patrick Bateman, a Manhattan socialite, Is a caricature by which the horrors of obsession are demonstrated.These fixations demonstrate that obsession comes from the inability to accept oneself. In the following paragraphs, we support our argument by considering the fixations of Bateman with physical beauty, success and Jealousy, and murder and gore. Batsman's fixation with physical beauty are clearly seen when he Is engaged in bragging and putting his wealth on display for the audience and later, for emphasis, cleansing with expensive products. Bateman spends his days In Ind ulgence of wealth; he snorts cocaine, goes to clubs, and feeds his addiction to expensive labels. Take the ice-pack mask off and use a deep-pore cleanser lotion, then an herb-mint facial masque†¦ I use the Bright tooth polisher and next the Interplay tooth polisher†¦ In the shower I use first a water-activated gel cleanser, then a honey- almond body scrub†¦ L always use an aftershave lotion with little or alcohol, because alcohol dries your face out, and makes you look older. † (26-27) He is motivated by his need for physical beauty to spend hours of every day fulfilling extensive cosmetic and exercise rituals.He is very specific about his products, settling for no less than â€Å"a deep-pore cleanser lotion,† and â€Å"an herb-mint facial masque. † HIS routines are detailed carefully so as to avoid any damage to his beauty, such as using alcohol, which â€Å"dries your face out, and makes you look older. † This obsession Is born from his In security about his physical attractiveness. Throughout the book, Bateman is portrayed as being anxious about his looks, asking, â€Å"WOWS my hair? † (232) on numerous occasions. When he is uncomfortable in a social situation tit an ex-girlfriend, Pee immediately becomes self-conscious, â€Å"What? I panic, immediately touching my hair. â€Å"Too much mousse? † (236). Later in the book, he expresses his concerns about becoming addicted to exercise. When confronted, he states, â€Å"You can always be thinner, look better. (372)† This obsession with his physical appearance clearly derived from his inability to accept himself physically. Batsman's dissatisfaction with his career is apparent when he expresses his frustration about being a useless member of the Pierce & Pierce firm which his father rustically owns.This dissatisfaction cultivates into an obsessive Jealousy of Paul â€Å"Hello, Owen,† I say, admiring the way he's styled and slicked back his hai r, with a part so even and sharp it†¦ Devastates me and I make a mental note to ask him where he purchases his hair-care products, which kind of mousse he uses, my final guess after mulling over the possibilities being Ten -X. â€Å"(1 1 1) From the introduction of Paul Owen in the novel until his murder, Bateman remains fixated on Omen's success and handling of a prestigious account.There are numerous occasions in which he asks or thinks about this such as, â€Å"Owen is standing near the bar†¦ I'm about to walk over and mention something about that damned Fischer account†¦ † (185). Batsman's obsession with Omen's successful career comes from the dissatisfaction with his own. This is apparent when asked about work Patrick expresses frustration saying, â€Å"l Just don't want to talk about†¦ Work†¦ I hate it. â€Å"(237). As Batsman's fixation with Paul Owen and his success grows, he is less and less able to accept himself, and his failing career u ntil he is able to murder Owen ND rid himself of his obsession.Such actions clearly imply that Batsman's obsession was born from his inability to accept himself. Batsman's inability to accept and understand himself cultivates in an obsession with murder and gore. This is demonstrated throughout the novel when he murders, rapes, and tortures several people for little to no reason. He is incapable of accepting and coping with his pain and thus becomes fixated on inflicting it upon others. â€Å"My pain is constant and sharp and I do not hope for a better world for anyone, in act I want my pain to be inflicted on others.I want no one to escape, but even after admitting, I gain no deeper knowledge of myself†¦ † (201) Bateman expresses sorrow over not being able to understand himself, or to cope with and accept the pain of psychopaths. This lack of connection with himself results in his dissatisfaction with his life, because of which he does not hope for â€Å"a better world for anyone† and inflicts his pain unto others. His inability to accept and understand his own pain is the origin of his uncontrollable obsession with murder and gore.Patrick Batsman's insecurities and the obsessions derived from them are reflective of the issues modern society is confronted with. The obsession with physical beauty as a product of low self-esteem, the obsession with others' success as a product of one's inability to achieve their own, and the obsession with bringing pain upon others as a product of pain within oneself are the struggles that Patrick Bateman represents that will perhaps resonate forever with mankind; all of which support the argument that obsession originates from the lack of acceptance and understanding of oneself.

Cardiovascular Diseases

Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and