Thesis I Had A Hard Time Picking - 915 Words

Thesis/Outline: I had a hard time picking which essays to use. I had a lengthy discussion with myself before I decided on â€Å"What Does It Means To Be Well-Educated† by Alfie Kohn. I do think that I’m well educated even though I didn’t learn anything from the school district that I was enrolled in I always said to myself that I wouldn’t want my children to have to go through the things I had to go through. How I became aware of things or learn things was because I do a lot of research and ask questions so I can find out more about what I need and wanted to know. What I think about the term â€Å"what does it mean to be well-educated† is I am aware that some believe, based on their own words, that if black children grow up to be adults who are well-educated, friendly, and polite, no harm won t come to them. If they obey the rules, they ll be safe. But recent news has proven that this isn’t always true. There aren’t any hard and fast rules, promises, assurance, or guarantees. Once we understand what â€Å"well-educated† actually means in the deplorable illiteracy age, we ll have an understanding that a good education will never decay. The two bumper stickers one that says who is â€Å"educated† in this way, will apparently believe that â€Å"Well-behaved women don’t make history.† This what we, the uneducated, call bad behavior, the liberal elite call being well-educated. The well-behaved women bumper sticker always makes me chuckle in an arrogant, Catholic, â€Å"my mother is better (i.e. WAY moreShow MoreRelatedReflection Paper : Barbie Q By Sandra Cisneros938 Words   |  4 PagesThe reason I am writing to you is to explain my development throughout the semester in the Advanced Composition course at Washburn University. The semester consisted of critically analyzing my selected story â€Å"Barbie-Q† by Sandra Cisneros through four assignments, the exploration paper, the reading and writing paper, the annotated bibliography, and the academic research paper. The semester began with basic lessons on general writing rules during class and progressed into a much more complex courseRead MoreCritical Writing Review Of Hamlet1260 Words   |  6 Pagessuch as Boston University’s and Harvard’s take on playing Hamlet as â€Å"a long-suffering Hamlet skulked around the stage in his pajamas† or by using â€Å"the other side of the bipolar coin† and playing Hamlet as exuberantly full of mad energy (Stone). Some time in the middle of his review he finally gives his clear argument that â€Å"Branagh’s film is nothing less than a monument to the highest art of the Western cannon† (Stone). Stone provides a generous amount of evidence in support of his opinion while discussingRead MoreProblem, Cause, Solution Template Outline Essay1351 Words   |  6 PagesProblem, Cause, Solution Template Outline I. Introduction A. Attention Getter (SLIDE TWO) â€Å"Never be bullied into silence. Never allow yourself to be made a victim. Accept no one’s definition of your life, but define yourself.† (SLIDE THREE) STOMP Out Bullying is an anti-bullying organization that has helped millions of lives. Not many people realize how a few words can have a big impact on someone. STOMP Out Bullying focuses on helping and trying to prevent abuse regards to racism, homophobia, sexismRead MoreAnne Frank Was A Dutch Girl Who Lived During The Jewish Antisemitism Period1296 Words   |  6 Pagesadventures and bad moments that she had to overpass. All of these horrible adventures that she went through were able to be known by the people thanks to a birthday present that she received. This birthday present was in fact a diary, in which she was going to write all her life, which unfortunately finished antes que previsto. It is thanks to that precious diary that we are now able to know better what happened during that terrible, hor rible period of history. She had la mala suerte to live in that centuryRead MoreAcademic Prose Vs. Writing873 Words   |  4 Pagesthan I have at any time outside of high school. While my job has required writing long documents, they are almost always persuasive or technical documents. I now reflect on my daily reading and writing in a different way as a result of this class. I can see how I have grown even from the first week to today. In each of the assignments below I can see my own growth and learning. When I read my first essay again for this assignment, I found myself picking it apart in a way I do not think I was capableRead MorePersonal Values And Moral Values Essay874 Words   |  4 Pagespeople have a harder time judging you for the things you have done. I use to not have a lot of great moral values. Once I became a Christian, my life turn around. I changed most of my bad habits. I started to feel like a better person when I became and Christian and developed good ethics. I couldn’t determine right and wrong without moral values. (Thesis) I remember a time when I found my faith and discovered what moral values were. Furthermore, I became a better person when I found my faith inRead MoreAfrican American During The Civil War1235 Words   |  5 PagesAfrican Americans Suffered During the Civil War Allison Wessels English 11- Period 5 Mrs. Blomme March 11, 2016 African American Suffered During the Civil War Outline: Thesis Statement: African American soldiers fighting in the Civil War. Introduction Introduce main points State thesis statement History of slavery Life of an African American slave Treatment Living conditions Work responsibilities African American soldiers Treatment of African American soldiers vs. WhiteRead MoreViolent Video Games: The Behavior Of Those Who Play Them1034 Words   |  4 PagesTitle : Violent Video Games: The Behavior Of Those Who Play Them I. Introduction A. hook / opening †¢With the recent violence across the world in schools, once again a concern has been stumbled upon in regards to whether or not video games can impact an individual’s demeanor, specifically in children and teenagers. However, when the concern is about children and violent video games, one thing is a sure fact: If parents keep getting these types of games the children will keep playing them, andRead MoreCultural Appropriation : Chill.1476 Words   |  6 Pageshaving a good time and so are you. You walked in with a ton of confidence as you love your costume but instead of getting a compliment, some random stranger taps you on the shoulder and says â€Å"your costume counts as cultural appropriation.† (Attention Getter) Let’s face it, cultural appropriation is a big deal nowadays. It’s in music videos, movies, cartoons, music, the list goes on and on and while some may claim that this issue has been blown out of proportion by overly sensitive people, I choose toRead MoreGodsgift Tamuno. Dr. Tweedy . English 102-11. 28 February1417 Words   |  6 PagesTamuno Dr. Tweedy English 102-11 28 February 2017 Thesis: Eudora Welty paints the picture of a life journey in the short story â€Å"A Worn Path† through the use of symbolism, imagery, and tone. I. Include a sentence describing symbolism here. A. Supporting information of how symbolism was used 1. First symbol of when the log was laid across the creek 2. Second symbol of the man she came across. (racism) 3. Third symbol the fact that she was picking up the coin B. All the symbols throughout the

Women s Benefits Of Women - 941 Words

Women do have advantages over men at times in the working environment, not many but some, some that may not be much of a change. Women do get maternity leave, which is in fact bonding time with the child before and after it is born. Men on the other hand receive this time off also, but it is not the same length. Men believe that it is an advantage over them, due to the fact that they are conceiving a child, it is truly and solely not a purposeful advantage. First off it is not a valid argument towards women’s advantages, second off God gave women the right to conceive a child she did not choose to. While a woman is pregnant, their bodies work about 57 percent more when they are pregnant than if they were playing a sport. (Bergeron, 2015) Causing emotional pain that lead to stressful sleeps, constant health exams, and restless nights. The argument is an invalid statement due to the fact that women can’t change the fact that they conceive children, and must take t ime off to heal their bodies to return to work being able to fulfill their job. Women have started movements in work unions back to the early 1900s, but wasn t a big concern till today.(Bergeron, 2015) Today the movement of labor has changed greatly and has increased in involvement with women. It is difficult for a lower educated person with a visa to look for work because they are looked at as less useful, rather than helpful to a company that doesn t require â€Å"runt work†. Social reductionShow MoreRelatedIs It Possible For Men And Women1589 Words   |  7 Pages 20 October 2015 Is it possible for men and women to be friends in the real world? I think not as I will demonstrate here. I’ll show some possible techniques to escape the friend zone and potentially turn from friend to boyfriend or girlfriend. Also, I’ll discuss this problem a bit more, sharing tips on how to avoid the friend zone in the first place. Research on Inter-Sexual Friendship Apparently this friend zone question has been on the table for about a decade. Bleske and Buss (2000) surveyedRead MoreNo Tolerance For A Lack Of Maternity Leave1312 Words   |  6 PagesThese women, expecting mothers, have to carry or have carried a child for roughly 9 months. Most if not all have done so by being on their feet all day and have only had the required minimum for breaks. Is it then wrong to ask for maternity leave? Should pregnant women not be allowed some work accommodations? Well, contrary to popular belief, maternity leave is more than just a time for a woman’s gestation period or relaxation. In a country with a population of more than 308 million women I thinkRead MoreGender Inequality Within Sports And Sports1197 Words   |  5 PagesAll women athletes worked extremely hard to get where they are now, but with gender inequality in sports their hard work will go to waste. Gender inequality is unlawful because of Title IX, a law that was passed in 1972, th at banned gender discrimination in sports (Buzuvis and Newhall). Even though it is against the law, many colleges and sports associations still give unfair benefits to men’s sports, such as more opportunities, better fields, higher salaries, etc, and are not getting punished forRead MoreWomen Of The Upper Ranks Of Corporate America Essay1157 Words   |  5 PagesWhy are there not more women in the upper ranks of corporate America? Is it because women slow down or stop career plans to spend more time caring for family? Or possibly because they are just less ambitious than men and don’t have the confidence? Simple answer: No. Something else is occurring whilst on their way to the top. Women are not surrendering their vocations in huge numbers. Parenthood actually builds their craving for winning advancements; and women by large don t lack of aspiration orRead MoreWomen And Employment Is Unfair1556 Words   |  7 Pagessociety women have more access to doing the same th ing as men such as working in higher positions. However, women are getting paid fifty five cents of every dollar that men make. The way society treat women with employment is unfair because as women we do the same work or sometimes twice as more. Even though time have change equality for the workplace only change by 6% of a 100% scale. We as individuals have so much work to do when it comes to improving our workplace not for just men but women too.Read MoreDifferences Between Men And Women1085 Words   |  5 Pages Both men and women have been inequalities in the workplace. Women are still are not receiving equal pay for the equal work and the equal pay of work of the equal value. Even though women have increased their presence in higher paying jobs that are dominated by men, still women continue to work in low paying occupations as men. For so long woman have received less pay in jobs. They have not been treated fair and equal as a man does in the same job fields. Woman has worked so hard and have accomplishedRead MoreWomen s Experience And Perceptions On Birthing Positions Essay1742 Words   |  7 Pagesexplore perceptions and experiences of women and nurse midwives on birthing positions at Mugana Designated District Hospital in Kagera Region. 1.6.2. SPECIFIC OBJECTIVES 1. To describe women s experience and perceptions on birthing positions. 2. To describe nurse midwives perception and experiences on birthing positions. 1.6. 3.RESEARCH QUESTION 1. What is the experience of women in birthing positions? 2. What is the perception of midwives regarding women on birthing positions during birth? Read More Jane Addams and the Progressive Movement Essay1388 Words   |  6 Pagesrecognized as a social and political pioneer for women in America. In her biography, which later revealed her experiences in Hull House, she demonstrates her altruistic personality, which nurtured the poor and pushed for social reforms. Although many of Addams ideas were considered radical for her time, she provided women with a socially acceptable way to participate in both political and social change. She defied the prototypical middle class women by integrating the line that separated private andRead MoreThe Old Private Pension System1012 Words   |  5 PagesThe old private pension system was created in the 1920’s and expanded throughout the 30’s and 40’s (McDonnell). Private pensions were considered one of the three income sources for retired elderly. Originally, private pensions had defined benefits. The employer and employee would agree to a percentage of salary that the em ployee would receive from the company annually during retirement. Contractually obligated, this placed the liability onto the employer. Estimates say that employees could receiveRead MoreLegal Workplace: Women Overcoming Obstacles Essay1375 Words   |  6 Pagesthat requires a lot of sacrifices to achieve success. Attorneys at law work over the standard forty hours per week, and have to sacrifices many parts of their social life for their jobs. Women in law find work even more stressful and difficult to balance with home life because attorneys have high demand jobs. Women attorneys have to find a balance between the demands of practicing law and the demands of their traditional gender roles on the homestead. The legal workplace is unfortunately victim to

Audio Strategy Free Samples for Students †MyAssignmenthelp.com

Questions: 1.Has the audio strategy been defined, and is it aligned to the key message of the film? 2.Has the student demonstrated within the audio section of the implementation plan how they intend to accomplish the audio strategy, in a creative and practical way? 3.Is the audio strategy in line with the other element of the implantation plan? Answers: 1. As a sound engineer in the film, I need to make sure that proper sound effects are given all throughout the film to engage the audiences and even promote the strategic intent properly. The major message that is to be delivered to the audiences is to adopt or consider their own flaws and overcome their self-esteem issues. An audio strategy is required to increase the favoring for new sound effects and connect with more people through a proper content consisting of a story. For this film, the media company and its filmmakers have tried experimental audio content to create and share the messages and information regarding the film to the audiences and influence them to watch the film. The audio strategy has allowed to overcome the audio fill gaps and supplemented other media to deliver the best content that are presented through audio effects displaying the importance of overcoming self-esteem issues and embrace their flaws (Ye et al. 2012). The audio strategy is effective enough to a ttract mass audience and even attract the advertisers and marketers to make the film successful as well as make people learn about embracing their flaws, not make self-esteem issues come in front and focus on the perfection. Thus, the audio strategies have been clearly defined and aligned with the strategic content of the film that has been delivered through messages (Kaliakatsos-Papakostas, Floros and Vrahatis et al. 2013). 2. To accomplish the audio strategies, it is important to evaluate the audio section of the implementation plan, furthermore make sure that the sound effects are aligned with the strategic content and messages delivered through the films release. To accomplish the audio strategy, it would be important to promote the brand of the movie production company and increase awareness among the audiences. This would be possible by creating better publicity and developing community to engage more prospects who could promote the film and act as major business stakeholders. The dates should be assigned for the accomplishment of audio strategies and ensure that proper sound effects were provided to the film. Creating list of resources like audiovisual equipments is important and must be ensured that the audio requirements requiring extra support would act according to the Equality Act and other legislations, laws and rules (Xie and Guan 2013). After all the necessary equipments are available, the audio toolsets including the Audio Middleware, Audio Graphical Editor, EAX2, Microsoft XACT and XAudio2 shall be used. All these tools could create convenience in accomplishing the audio strategy as well as add or remove additional functionalities with the advanced features of low-level audio libraries. A proper IT engineer should handle all these tools with support by me to audition environmental Reverb parameters and enable programming and middleware solutions to keep the sound frequencies under control and provide the best sound too (Luo, Yang and Huang 2014). 3. The audio strategies are in line with the various other elements of the implementation plan such as the use of sound toolkits have helped to maintain proper sound frequency and made sure that the scenes all throughout the film are provided with the right quality sounds without any noise. The audio strategy was aligned with the components, because of which, the sound propagation curves were controlled properly and the global variables had been managed properly as well including the Doppler and speed of sound. This provided initialization of the sound parameters, furthermore created beautiful sound effects that could match with the scenes present in the movie (Ye et al. 2012). Thus, it is evident that the audio strategy is in line with the various elements of the implementation plan and will be beneficial for making audiences understand the strategic content of the film too. References Kaliakatsos-Papakostas, M.A., Floros, A. and Vrahatis, M.N., 2013. A clustering strategy for the key segmentation of musical audio.Computer Music Journal,37(1), pp.52-69. Luo, D., Yang, R. and Huang, J., 2014, May. Detecting double compressed AMR audio using deep learning. InAcoustics, Speech and Signal Processing (ICASSP), 2014 IEEE International Conference on(pp. 2669-2673). IEEE. Xie, Z. and Guan, L., 2013. Multimodal information fusion of audio emotion recognition based on kernel entropy component analysis.International Journal of Semantic Computing,7(01), pp.25-42. Ye, G., Jhuo, I.H., Liu, D., Jiang, Y.G., Lee, D.T. and Chang, S.F., 2012, June. Joint audio-visual bi-modal codewords for video event detection. InProceedings of the 2nd ACM International Conference on Multimedia Retrieval(p. 39). ACM.

Nursing Care and Management

To ensure that residents are receiving a high quality of care, which fits their needs, I will use the methods presented below. They will guarantee that the team of hotel services, administration and activities as well as care staff delivers results, which have a positive outcome. First, each resident will receive a unique treatment based on his or her needs, preferences and interests.Advertising We will write a custom essay sample on Nursing Care and Management specifically for you for only $16.05 $11/page Learn More As head of care, my concern will dwell on improving the dialogue between the team and our residents. Secondly, I will maintain the training programs for staffs that are already in place. I will discuss with the team so that customized messages that embody the core values within the home become the first reference points for individual decision-making. My first goal would be to build trust with residents and the care team. I will therefore co nduct myself appropriately and offer a consistent approach to issues based on the home’s core values. Thus, I will be caring and compassionate to both residents and staffs. I will be accountable and attentive to feedback and work related details. I will remain reliable and responsive by availing myself for duties in time and attending to raised concerns within the shortest time possible. Lastly, I will ensure that I empathize with residents and the care team by recognizing their individuality, their work environment and personal challenges that they may be facing. Therefore, all personal communication will remain private and will not be used to judge a person’s work output or care expectation. Rather, the confidential social relations will inform my choice of conduct for delivering a personalized care and administration in the home. I will keep my engagements with staffs and residents morally upright. I will allow staffs to review job improvement suggestions, and conti nuously ask them how well they are relating to each other. This will show them that I care about their work. Moreover, when my decision has an impact on the team, I will discuss the underlying issues with them before the decision and after. Lastly, to build trust, I will use a participative leadership approach and acquaint myself with the various work assignments that people are doing in different departments. This will give me a better understanding of their condition of work and any arising work related issue. It will also demonstrate that I highly regard their value in the organization. To create an atmosphere of open communication, I will allocate a few hours per week for collecting staff ideas, feedback and any concern that they may harbour. This time would be separate from meetings and would allow for the discussion of matters that require more confidentiality that staff-meetings would not offer. During staff meetings, I will initiate a visualization exercise for the team to s ee what it would be like if it meets its goals.Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More The meetings will inform staffs of their importance in collectively fulfilling the home’s mission. I will continue reassigning the equivalent duties to the same person even when they make work-related mistakes as long as they take responsibility of their mistakes. This gesture would show them that I expect the best from them and believe they are capable of delivering. I will relate staff meetings and work-related discussions to the values of Fernhill. Although I will sometimes deal with team members independently, my actions and decisions will be informed by the need to foster a team spirit. This will include the recognition of exemplary or mediocre performance. Most importantly, I will strive to give my attention to the little details of affection such as asking about a person’s day. This would create an informal and free relation within the formal structure of Fernhill, and promote team values. Work efficiency and customer satisfaction requires constant improvement. My strategy would be to have daily activity benchmarks, especially at the point of contact with the residents. For example, I will lead the team in measuring how many accidents have been avoided in a day; how many residents with queries have been attended to and whether a routine on the condition of residents has highlighted negligence in care. Routines will be completed by checklists, which would reduce significantly cases of forgetfulness of staff and prevent rushed procedures in case of emergencies. A checklist will also assist my management of team affairs such as attending to raised issues during staff meetings, or ensuring that I do not miss any part of my job description while doing my routine. Colleagues will review team member appraisals, and the individuals will have the opportunity to giv e their remarks. This would provide a level playing field as reviewers would have the same job expectations and experience as the person receiving the appraisal. The exercise would prevent the placement of unmatchable demands on job performance and being a peer review. It would be more effective for identifying skill imbalances. Furthermore, I will review all appraisals, and make recommendations for training or work balance adjustments. Finally, I will lead the team in organizing and participating at ceremonial events for residents or team members to infuse fun and improve work relations through the informal gatherings. This essay on Nursing Care and Management was written and submitted by user Maximilian Duke to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

ACT Reading Test Questions, Content, and Scores

ACT Reading Test Questions, Content, and Scores Getting ready to master the ACT test? For those of you high school students who have decided to take the ACT as your college admissions test, and for those of you required to take it as a high school exit exam, youd better prepare yourself for the ACT Reading portion of the exam. The ACT Reading section is one of five sections upon which you will be during the ACT Test, and for many students, it is the most difficult. Not only will you need reading strategies to master it, you will need to practice, practice, practice! The other test sections are these: ACT EnglishACT MathematicsACT Science ReasoningThe Enhanced ACT Writing Test The ACT Reading Basics When you flip open your testing booklet to the ACT Reading portion, you will face the following:   40 questions35 minutes4 reading passages with 10 multiple choice questions following each reading passage.3 of the reading passages contain one long passage. 1 of the reading passages contains a pair of related passages.   Although it seems like it would be relatively easy to answer forty questions in 35 minutes, this test is difficult because you also must read the four accompanying passages or sets of passages in addition to answering the questions. Alone, or in pairs, the passages are roughly 80 - 90 lines in length.   ACT Reading Scores Just like the other ACT sections, the ACT Reading section can earn you between 1 and 36 points. The average ACT Reading score is about a 20, but your fellow test-takers are scoring higher than that to get into the really good schools. This score is also combined with the Writing score and English score to give you an ELA average score out of 36.   ACT Reading Skills The ACT Reading section does not test your memorization of vocabulary words in isolation, facts outside of the text, or logical skills. Here are the skills on which youll be tested, which are based on the reporting categories introduced in 2016: Key Ideas and Details: (approximately 22 - 24 questions) Finding the main ideaSummarizing  Making an inferenceUnderstanding sequence of eventsUnderstanding cause and effect relationshipsMaking comparisons Craft and Structure: (approximately 10 - 12 questions) Understanding  authors tone  Understanding  authors purposeAnalyzing characters points of viewUnderstanding vocabulary words in contextAnalyzing text structure Integration of Knowledge and Ideas: (approximately 5 - 7 questions) Analyzing and evaluating authors claimsDifferentiating between fact and opinionUsing evidence to connect texts ACT Reading Test Content So what will you be reading about? Good news! You will not have to interpret poetry. All the text on the ACT Reading section is prose. Whew, right? By the way, the information below is just for reference. As  stated before, you will not be held accountable for knowledge outside of the text, so you dont need to check out books from the library about this stuff. Just realize that you could be reading passages about one of the following subjects, so at least youll know what youre up against. Social Studies: anthropology, archaeology, biography, business, economics, education, geography, history, political science, psychology, and sociology.Natural Sciences: anatomy, astronomy, biology, botany, chemistry, ecology, geology, medicine, meteorology, microbiology, natural history, physiology, physics, technology, and zoology.Prose Fiction: short stories or excerpts from short stories or novels.Humanities: memoirs and personal essays and in the content areas of architecture, art, dance, ethics, film, language, literary criticism, music, philosophy, radio, television, and theater. ACT Reading Strategies Its imperative that you prepare for  ACT Reading strategies  for this test. Since youll have to answer 40 questions in just 30 minutes and read the four passages (either one long passage or two shorter, related passages), you will not have enough time to just go at it like you usually would in class. You must use some strategies before plunging in, or else you may only get to two or three of the passages! The link will take you to five reading strategies that can boost your score if you use them.   Thats about all you need to know about the ACT Reading section. Try your hand at the following reading comprehension worksheets to help prepare you for what you need to know!

Free Essays on Does God Exist

EXISTENCE OF GOD Does God Exist? This is one of the questions in todays society that does not have any true answer. Fortunately, there are some of us who tend to question the who’s and how’s one actually came before us. People’s opinions on the existence of God may differentiate, because of the church they attend, their parents teachings, and the religion that they believe in. In this paper I will discuss the opinions of different people including myself, a famous philosopher, and a religion who are either for or against the existence of God. In my life I myself have always came to the question does God really exist. Where then I finally came to the conclusion, that I my self would not choose one side, and instead would argue both perspectives relating to the existence of God. One of the biggest reasons why I do believe in God is because that was something that I have been taught to believe ever since I was a young child. Attending a catholic church every Sunday is what also made me help make a decision, this is because I was preached too believe in the one thing all Catholics do, and that is that a being such as God does exist. Besides having reasons that God does exist, there are also times I would have to disagree and say that he does not. This is because I feel that no actual evidence has proved that God was the one being higher then all of us. It to me also seems impossible for one person to be held responsible for creating all things on this earth. Another thing is that if God was considered such a loving, and good person then what is the explanation for young innocent children who are being abused, and the incident that happened on September 11, 2002. So therefore God should free people on this earth from any pain and suffering and he doesn’t. A question that really leaves my mind confused is that if God did exist and die then why was his body missing from the tomb. ... Free Essays on Does God Exist Free Essays on Does God Exist Does God Exist? This is one of the questions in todays society that does not have any true answer. Fortunately, there are some of us who tend to question the who’s and how’s one actually came before us. People’s opinions on the existence of God may differentiate, because of the church they attend, their parents teachings, and the religion that they believe in. In this paper I will discuss the opinions of different people including myself, a famous philosopher, and a religion who are either for or against the existence of God. In my life I myself have always came to the question does God really exist. Where then I finally came to the conclusion, that I my self would not choose one side, and instead would argue both perspectives relating to the existence of God. One of the biggest reasons why I do believe in God is because that was something that I have been taught to believe ever since I was a young child. Attending a catholic church every Sunday is what also made me help make a decision, this is because I was preached too believe in the one thing all Catholics do, and that is that a being such as God does exist. Besides having reasons that God does exist, there are also times I would have to disagree and say that he does not. This is because I feel that no actual evidence has proved that God was the one being higher then all of us. It to me also seems impossible for one person to be held responsible for creating all things on this earth. Another thing is that if God was considered such a loving, and good person then what is the explanation for young innocent children who are being abused, and the incident that happened on September 11, 2002. So therefore God should free people on this earth from any pain and suffering and he doesn’t. A question that really leaves my mind confused is that if God did exist and die then why was his body missing from the tomb. On Wednesday March 2... Free Essays on Does God Exist EXISTENCE OF GOD Does God Exist? This is one of the questions in todays society that does not have any true answer. Fortunately, there are some of us who tend to question the who’s and how’s one actually came before us. People’s opinions on the existence of God may differentiate, because of the church they attend, their parents teachings, and the religion that they believe in. In this paper I will discuss the opinions of different people including myself, a famous philosopher, and a religion who are either for or against the existence of God. In my life I myself have always came to the question does God really exist. Where then I finally came to the conclusion, that I my self would not choose one side, and instead would argue both perspectives relating to the existence of God. One of the biggest reasons why I do believe in God is because that was something that I have been taught to believe ever since I was a young child. Attending a catholic church every Sunday is what also made me help make a decision, this is because I was preached too believe in the one thing all Catholics do, and that is that a being such as God does exist. Besides having reasons that God does exist, there are also times I would have to disagree and say that he does not. This is because I feel that no actual evidence has proved that God was the one being higher then all of us. It to me also seems impossible for one person to be held responsible for creating all things on this earth. Another thing is that if God was considered such a loving, and good person then what is the explanation for young innocent children who are being abused, and the incident that happened on September 11, 2002. So therefore God should free people on this earth from any pain and suffering and he doesn’t. A question that really leaves my mind confused is that if God did exist and die then why was his body missing from the tomb. ... Free Essays on Does God Exist God=â€Å"A being conceived as the perfect, omnipotent, omniscient originator and ruler of the universe, the principal object of faith and worship in monotheistic religions.† Only if everyone believed this. However, there are numerous reasons as to why and/or why not God’s existence can be valid. I plan to take the view of numerous authors who give endless reason as to the issue of God. But in the end I feel as if there clearly will be no justification into the matter, mainly due to the fact that I believe it difficult to prove let alone explain aspects of a mere belief. One particular author that grabbed my attention was Ramakrishna (1836-1886). Ramakrishna takes the view of God himself (assuming a male) mandating different religions to suit different aspects, different times, and even different countries. Ramakrishna speaks of ones ability to ultimately reach God if he/she follows any of the religious paths with â€Å"wholehearted devotion.† This particular statement denotes that God himself has mandated certain and particular religious paths in order to reach a religious summit. But how can such a being conceived as the perfect, enlist a path to perfection, but for those who are only as fortunate enough to achieve perfection. So if indeed God has mandated religions for particular peoples, is one religion harder to reach God as opposed to another religion? If a Jew and a Christian both were â€Å"wholehearted†, would one have an advantage or disadvantage over the other because perhaps God has chosen a better or easier religion? I believe that a â€Å"wholehearted† person needs neither particular religion nor correct path to reach God. Would a being conceived as the perfect, make it more difficult for one person to reach God rather than another? Ramakrishna also speaks of the methods in which man prays towards God. Is there a proper way to pray to a being conceived as the perfect? Perhaps ...

Organizational Culture Questions Essay Example | Topics and Well Written Essays - 500 words

Organizational Culture Questions - Essay Example This leadership empowerment committee allows the employees to be a part of the organizational culture and thus represent their truest form through inner leadership values. I take this as the basis of documenting the organizational culture because it gives me a chance to comprehend the real meaning of my organization and how I understand the related philosophy. As far as I am concerned, this leadership empowerment committee truly defines my organization and is a vital cog in the wheel of the business that we are all working for (House 2004). It is a cultural tenet that is appreciated by the employees at large. It represents their basis and gives them a chance to do something different every week. I opine that this leadership empowerment committee is an organizational cultural example that truly resonates with the meaning of the business. It has become a true cultural symbol of my organization over the years.I am of the view that the most significant part of an organizational culture i s the understanding that the varied elements echo together to form the organizational basis which highlights how well people understand the same (Brenton 2005). From my personal life, I have always focused on highlighting different agendas that are within the domains of time management. This is because I have valued time as a significant metaphor for my personality basis. It has allowed me to manage things on my own and hence I have prioritized quite a few things up my sleeves with the time management constructs that remain dear to me.

Whole Food Market Essay Example | Topics and Well Written Essays - 1500 words

Whole Food Market - Essay Example These two are then measured through the company’s financial performance. Identification of issues Whole Foods Market with its vision to become an international brand for natural and organic foods is also committed to become the best retailer in its community wherever it is located. In line with this, the company seeks to give significant higher value for its customers. This is evident in its core values in which there are two important points that are in line with quality of its products and giving the best for their customers (Whole Foods Market 6). Part of its core values is to sell highest quality natural and organic products available. Then there is a great detail of satisfying and delighting their customers. These are just some of the important values that they need to ensure in order to continue live and satisfy their vision. In the midst of this effort to focus on its vision, there are of course strategic issues that need to be taken into consideration. One of its essen tial goals in order to achieve its corporate goals is to continue grow its revenue. Furthermore, Whole Foods Market is also concern in educating the market with its significant definition about the quality of its product and service offerings. Thus, there are three essential issues that need to be understood at this point. The first issue is about its strategic move to highly differentiate its product and service offerings. The next significant issue is about understanding its customers and feeding them with the right information. Finally, the next consideration is its ultimate measure of success which the bottom line is to look closely at its revenue and generated profit. Analysis of issues Product and service differentiation There is a clear emphasis of this issue based on the vision of Whole Foods Market. In the first place, the Whole Foods Market is significantly trying to be a cut above the other by creating relevant changes in its service and product offerings. From its vision , it wants to become an international icon for natural and organic foods. Thus, as retailer it aims to give something new to its customers. However, it is not just enough to create something new for the customers, but there is a need to ensure a need for them. In other words, prior to providing something better in the market, Whole Foods Market should ensure that it has understood the prevailing demand or need of the customers. In the first place, there is going to be a challenge on the part of Whole Foods Market because it has to clearly define beforehand what natural and organic foods are all about. This is going to take enough of its time because customers need to be widely educated or well informed about its product offerings. In this level, the Whole Foods Market is trying to create a need for its product offerings in a way that there is a significant move to educate its customers. In today’s marketing activity, companies or organizations are able to successfully create a need for their product offerings. In fact, this is the basic and most common trend for them to be able to gain a high market share. Correspondingly, the Whole Foods Market needs to successfully create a need for its service or product offerings in order to successfully employ its product differentiation strategy. In this strategy, in order for it to be effective, the Whole Foods Market should try to promote products that matters to the customers. In other words, it is important that the needs of customers should be properly addressed. Fortunately, the Whole Foods Market is trying to establish a way to improve its customer service in the event of product assistance. It opens up its

Consensual Relationships Agreements ( CRA) Case Study

Consensual Relationships Agreements ( CRA) - Case Study Example In this connection, the Consensual Relationship Agreement (CRA) between the working people and the employer is generally regarded as a written contract in which the working people belonging to an organization agree to follow various policies relating to workplace that are established by the employer. The written agreement also states that the working people agree to discard certain attitudes or behaviors that might offend others in the working place. In this particular agreement, the employees or the staffs also agree to behave professionally and not to permit the relationship to hamper their work performances. Through this particular relationship agreement, the working people of a particular organization also promise to report any sort of harassments that might prevail in the working place to the higher authority of the organization (Appleby, 2007). Along with the need of executing consensual agreements in the workplace, there also lie certain different reasons which might possess negative impact for the employees with the implementation of Consensus Relationship Agreements (CRA) in any organization. The different reasons for the negative impact of the workplace agreement include unfavorable effect upon the morale of the employees, emergence of favoritism and potential interest conflicts among the staffs that ultimately can affect the working performances of the staffs (Edwards & Angell LLP, 2005). In this context, the morale of the employees who consent to be a part of Consensus Relationship Agreements (CRA) greatly suffers at a particular time when the other employees of the organization enjoy superior as well as well advanced job assignments along with other opportunities of working operations. This particular factor ultimately helps to raise the aspect of favoritism and also unfavorably affects upon the working performance of the employees due to the relationship agreement

The Grapes of Wrath Analysis

The Grapes of Wrath Analysis The Grapes of Wrath, describes the difficulty of migrant labors during the Great Depression. Written by, John Steinbeck, this novel went on to receive many awards. Generally viewed as Steinbecks best and most striving novel, The Grapes of Wrath was published in 1939. Stating the story of an expelled Oklahoma family and their fight to form a reestablished life in California at the peak of the Great Depression, the book captures the sorrow and anguish of the land throughout this time-period. The bank forecloses on the Joads land, so they decide to move west in search of new jobs. Though the Joads travel west in expectations of creating a restored life, the American Dream avoids them, their journey to California proves to be sorrowful and disappointing. Though they find some comfort in a camp and eventually get jobs, the life they dream of has only slipped further away. The parallels between John Steinbecks life and the narrative story he carved are apparent and distinct. Steinbeck used imagery to paint a picture of current world situations that were going on in his life during the 1930s. His goal in writing this novel was to paint a picture and make his readers experience the life of the Dust Bowl immigrants. Though not a Dust Bowl immigrant himself, he spent a lot of time with them and got to know their anguish well. From the first chapters, to the unforgettable ending, The Grapes of Wrath remains a debated work in critical discussions, with themes and a setting that are uniquely American Beginning to write the novel in the mid to late 1930s, Steinbeck was surrounded by poverty, and hardship, and as are the Joads in the novel. Steinbeck modeled the setting to represent how things really were for migrant workers during this period. The Grapes of Wrath takes place during the Dust Bowl era of the 1930s. After being released from jail, protagonist, Tom Joad, quickly realizes that his familys farm has been repossessed by the bank. Tom finds the family at Uncle Johns home as they get ready for a long journey to California in search of work, a journey numerous desperate families are also taking. Route 66 provides the transportation by which the migrants will arrive to California. It is the path of a people in flight, refugees from dust and shrinking land, from the thunder of tractors and shrinking ownership,. from the floods that bring no richness to the land and steal what little richness is there (Steinbeck 118).In California, there was a Hooverville on the edge of every t own, where migrant individuals camp all together and care for one another (Steinbeck 234). The Joads experience the surroundings of a Hooverville when they cross the desert into California, There was no order in the camp; little gray tents, shacks, cars were scattered about at random (241). Steinbeck was inspired to write the novel after researching and producing a series of articles for the San Francisco News about migrant workers in California (Conder 248). Throughout the 1930s, due to drought and years of agriculture without crop rotation or other destruction prevention, severe dust storms blew away the lives of many in many areas of the central plains, which developed into what is known as the, Dust Bowl. Tied with the economic catastrophe of the Great Depression, this crisis forced thousands of people, many of them agriculturalists, off their property, wandering from place to place in hunt of work to survive. Several of these people, attracted by promises of opportunity, moved to California. Although they were from several states, the term Okie coined for a native of Oklahoma, one of the hardest-hit areas was attached to the waves of families desperately heading West, their few remaining possessions piled high on old, barely operating vehicles. Those who made it to California found little work, poor living conditions, a great deal of resentment and prejudice, and even violence directed against them.(The Grapes of Wrath) John Steinbeck formed a fictional plot using current realities of the Dust Bowl. The exposition begins when Tom gets out of jail for good behavior and he realizes that everything he left was now different and his family is absent as well. The conflict arises when, Tom is out on parole, and he strictly cannot leave Oklahoma. However, his family is planning to move to California, where a government program offers a beautiful future for emigrant sharecroppers. The entire family and Casy, a longtime family friend, fit into a small truck to travel across the country. The rising action occurs when, the Joads set off for California, where many others are migrating west. As the Joads drive on, they begin to hear rumors that there arent enough jobs in California. The climax is revealed when they arrive in California. As they go from place to place, searching for work, Casy, former reverend and current friend of Toms, leads a strike against the owners of Weedpatch, which in conclusion costs hi m his life. Tom spurs to lead the people, but the Joads must leave again when Tom thoughtlessly kills the corrupt policeman who murdered Casy. The falling action is seen when the Joads move onto a cotton-picking field where Tom hides out until his wounds are healed from the conflict. The resolution occurs when the Joads come to a farm where they find a barn. Inside the barn, they find a young boy and a man. They are sick from starving, and the man is not able to eat solid foods anymore without getting ill. Rose of Sharon gives the fading man her breast, which has milk from her recent birth, and comforts him with a blanket. They are all strangely at peace. The push for writing The Grapes of Wrath came out of John Steinbecks involvement of studying and publishing Harvest Gypsies, a seven-part San Francisco News series about the plight of agricultural migrant workers in California (Steinbecks Use). While leading that research, Steinbeck met and traveled with a man named Tom Collins, the manager of the Arvin Migrant Camp (informally known as Weedpatch Camp) (Steinbecks Use). The relationship Steinbeck formed with Collins grew between 1936 and 1938, when the two began traveling over the San Joaquin valley to gather information and offer aid to migrant families in crisis. He wrote about the Okie exodus by the seat of his pants, as it happened (OConnell 60). The Associated Farmers of California terminated the book as a pack of lies and communist propaganda' (The Grapes of Wrath). Steinbeck was put under surveillance of the FBI and received many death threats. The book was banned in many libraries and copies were burned in towns across The Un ited States (Conder 248). Steinbecks speech, is found in Tom Joad, the novels protagonist. ( McCarthy) Tom Joad is the novels protagonist .Joad is first seen coming home to Oklahoma after jail time for killing a man in a brawl, only to find an overcome land with local farms being repossessed by the banks. Tom and his family begin on their trek to California over highway 66. Tom Joad, Steinbecks figure of smoldering witness, the passive observer turned violent activist and communitarian conscience, has been grabbed by figures right and left to stand for something, represent something, or, in recent vintage, to represent nothing at all, rendered void of the political meaning deliberately invested in him by John Steinbeck (and others) (Simon and Deverell 181). Through Tom Joad, Steinbeck builds anger and a sense of injustice over the migrants misery. (McCarthy) Rose of Sharon is always watching out for the greatest interests of her unborn child and its seems to symbolize motherly instinct and protection. Steinbeck departs from strictly Biblical imagery in portraying Rose of Sharon as an earth mother. (Rombold 161). Her natural protective nature over her baby, makes it even more heartrending when it is delivered as a stillborn. By letting the stillborn child go upon the waters in its apple box, Uncle John inverts the story of baby Moses let go in a basket upon the Nile (Rombold 160). The symbolism of the earth mother is also a strong context within which to understand the final scene (Rombold 162). Steinbeck ends the novel by having Rose of Sharon nurse a dying man from her breast. Rose of Sharon loosened one side of the blanket and bared her breast. She looked up and across the barn, and her lips came together and smiled mysteriously (Steinbeck 455). A symbol of hope is understood through Rose of Sharons fostering actions in reviving the s tarving man. By ending the novel this way, Steinbeck continues his literary references to the Bible as it provides symbolic resurrection of humanity and steps towards societies regrowth ( Taliawaite). Jim Casy is an ex-preacher who knew the Joads as far back as Toms childhood, claims that he has totally given up preaching I aint preachin no more. (Steinbeck 20). Casy now places his faith in the astonishing power of human spirit. Steinbeck is representing Casey as a parallel to Jesus as his character carries optimism to the people that are in misery (Taliawaite). A more literal similarity that Steinbeck indicates to is his name, Jim Casey, which fatefully, has the same initials as Jesus Christ. I aint sayin Im like Jesus. But I got tired like Him, an I got mixed up like Him, an I went into the wilderness like Him. (Steinbeck 81). Although he still did not believe himself to be a preacher, he had the courage to stand up to the corruption and the unfairness. Casey planned on leading the people in a strike that would help the laborers attain reasonable wages however he gets murdered during the objection. The preacher, ony he was a-leadin the strike. They come for him. They killed im . Busted his head (Steinbeck 390). Like Jesus who sacrificed himself on the cross, Caseys death is a sacrifice for the wellbeing of others. Caseys last words were You don know what youre a-doin (Steinbeck 386) which can be paralleled to Jesus last words. Father, forgive them; for they know not what they do (Luke 23:24) (Rombold 157). Casey dies with honor and self-respect, as Jesus did. John Steinbeck says that in growing up he absorbed the Bible through his skin (Rombold 146). Characters from the book mimic real life people suffering through the Depression. They had a reason to believe that there was a higher power watching over them during this time of hardship (Rombold 146). While Steinbeck used Biblical references, he chooses to keep God as an absent character, For Steinbeck, the people themselves are the agents of change and the parties responsible for action. His use of Biblical allusions which generalize and deepen the Joads experience within the tradition of the mythos, place this novel within a very broad context. (Rombold 147). Readers were shocked by the notion of neglecting God, but they had to consider the source, and learned to accept that it was Steinbecks (Rombold146). Land and place are so more than just passive settings in The Grapes of Wrath. A mans connection to land is a very important theme, Mans love of the land, his need not so much to own it as to embrace it, to sink his hands and feet in it, to cry for joy when the corn is peeking through and to sleep like a dead man when the last load is in the silo- this is the strongest force in the book (OConnell 59). Despite the ruggedness of the landscape, it develops the backdrop in contradiction of a wide range of human concern. Famers and country men had a very strong relationship to the property they grew to know. When they lose their land, the Joads not only lose their means of support, but they also lose their home. California is supposed to be a land flowing with milk and honey, a place of chance and change(McCarthy). For a farmer, land is opportunity, and therefore land is money. The Grapes of Wrath, Steinbeck endorses the philosophy that economic, legal, religious, and societal forces large ly control individual destiny, but lays out a philosophy to rise above those forces and achieve personal freedom (Conder 260). The American dream is unattainable to immigrants. In The Grapes of Wrath, Steinbeck often challenges whether or not California is the, promise land. He questioned if the whole thing of life, liberty, and the pursuit of happiness are achievable. For so many, the American Dream is a capitalist dream. Instead, Steinbeck, through his characters and themes, sought the dream of unity and compassion. Through Jim Casy and Tom Joad, it is seen that their passion lays in standing up for what is right, rather than sitting back and taking the hit. But that wasnt always the case for them, towards the beginning of the novel, all of them were eager to reach this so called, promise land. But eventually, they came to the realization that they were indeed just chasing an unrealistic dream. The Joad family is leading down something of a problematic golden road- a path of escape from destitution to an ambiguous Californian deliverance. when the only option becomes putting the family on the road to a str ange and unknown destination, problems are compounded (Spangler). The Joads persistent letdown to find supportive work and pay led to economic decay, lessening the likelihood that the American Dream would come to completion. Arthur G. Neal stated, [the] economic hardships after the Great Depression fell disproportionately on the family unit (Spangler). Throughout all the economic struggle and failures on finding the American Dream, the Joads managed to stick together through the triumph. John Steinbeck emphasized the theme of the unattainable American Dream; however, he added in that maybe people can achieve their own dream just by sticking together and never giving up. From the Joad family leaving Oklahoma, to the struggles in California, The Grapes of Wrath remains a moving and an extremely well written piece of art. The plot, setting, and characters are very expressive, and Steinbecks fascinating writing techniques give the themes of the book a distinct feel. The parallels between John Steinbecks life and the narrative story he carved are apparent and distinct. Throughout the 1930s, real people with real problems faced issues like what the Joad faced. John Steinbeck wrote a brilliant piece work in expressing the economic and emotional anguish the Oakies experienced. Chronology February 27,1902- John Steinbeck was born in Salinas, California. He was the third of four children and the only son of John Ernst II and Olive Hamilton Steinbeck. He spent his childhood in the Salinas Valley (John Steinbeck). 1919- Steinbeck attended classes at Stanford University, and left without a degree. During these years Steinbeck dropped out for several months, and was employed intermittently as a sales clerk, farm laborer, ranch hand, and factory worker (John Steinbeck). January 14,1930- John Steinbeck marries Carol Henning (John Steinbeck). Winter of 1934- He gathered information on farm labor unions. Interviews labor organizer in Seaside(John Steinbeck). April 1939-  The Grapes of Wrath, was published by Viking (John Steinbeck). Spring of 1941- He separated from Carol; fall, later he moves to New York City with singer Gwyndolyn Conger (John Steinbeck). 1943- He marries Gwyn Conger in New Orleans (John Steinbeck). August 2, 1944- birth of first son, Thom (John Steinbeck). June 12, 1946 birth of second son, John IV (John Steinbeck). September 14, 1964- presented with United States Medal of Freedom by President Lyndon B. Johnson (John Steinbeck). December 20, 1968- dies of arteriosclerosis in New York (John Steinbeck). Work Cited Conder, J John. Grapes of Wrath. Literary Themes for Students, Vol. 1, edited by Anne Marie  Hacht, 2007, pp. 248-263. John Steinbeck: A Brief Chronology. Monterey County Historical Society, Local History  Pages, Montrerey Country Historical Society , 2010, mchsmuseum.com/steinbeckchronology.html. Date accessed 8 January, 2017. McCarthy, Paul. John Steinbeck. Contemporary Literary Criticism, edited by Sharon R.  Gunton, vol. 21, Gale, 1982. Literature Resource Center, go.galegroup.com/ps/i.do?p=LitRCsw=wu=pikev=2.1id=GALE%7CH1100000796it=rasid=427c16e5f57e22fd0bc6c3cbf3811a0c. Originally published in John Steinbeck, by Paul McCarthy, Ungar, 1980. Date accessed 9 Nov, 2016. OConnel, Mike. An American Farmer Looks at The Grapes of Wrath. The Steinbeck  Review, vol. 6, no. 2, 2009, pp. 56-63. www.jstor.org/stable/41582115. Date accessed November 14, 2016. Rombold, Tamara. Biblical Inversion in The Grapes of Wrath. College Literature, vol. 14,  no. 2, 1987, pp. 146-166. www.jstor.org/stable/25111734. . Date accessed November 19, 2016. Simon, Bryant, and William Deverell. Come Back, Tom Joad: Thoughts on a California  Dreamer. California History, vol. 79, no. 4, 2000, pp. 180-191. www.jstor.org/stable/25463704. Date accessed November 10, 2016 Spangler, Jason. WeRe on a Road to Nowhere: Steinbeck, Kerouac, and the Legacy of the  Great Depression. Studies in the Novel, The Johns Hopkins University Press, 19 Feb. 2009, muse.jhu.edu/article/259422. Accessed 14 Feb. 2017. Steinbecks Use of Nonfiction Sources in The Grapes of Wrath | EDSITEment.  EDSITEment! The Best of the Humanities on the Web, 17 Sept. 2012, edsitement.neh.gov/lesson-plan/steinbecks-use-nonfiction-sources-grapes-wrath#sect-introduction. Date accessed 16 January, 2017. Steinbeck, John. The Grapes of Wrath. New York, NY, Penguin Group, 2006. Taliawaite. A Look at Biblical Allusions. The Angry Grapes, 1 Dec. 2012,  taliawaite.wordpress.com/2012/11/29/did-you-know-a-look-at-biblical-allusions/. Date accessed 5 December, 2016. The Grapes of Wrath: 10 Surprising Facts about John Steinbecks Novel . The Telegraph,  Telegraph Media Group, www.telegraph.co.uk/books/authors/john-steinbeck-grapes-of-wrath-what-you-should-know/. Date accessed 10 December, 2016.

Compare newspaper articles: “Asylum meltdown” (the sun 20/01/03) with “The fight for tolerance” the (guardian 20/01/03)

As part of my GCSE Citizenship coursework I had to compare two newspaper articles [â€Å"Asylum meltdown† (the sun 20/01/03) with â€Å"The fight for tolerance† the (guardian 20/01/03)] and discuss to an extent their point of views, their language, effectiveness, typographic techniques, and persuasiveness on the issue and then give my point of view, explaining clearly my ideas with references to evidence. The sun gives an angry report of the increasing number of asylum seekers and the immense irreversible damage this is causing our economic system shaking its very foundations. The article is completely one sided i.e. anti asylum seekers, labelling them all under one group – illegal immigrants who are causing terror and most are Muslims (Algerians, Ethiopians†¦) To get its point across it uses exaggerated facts and charts which will only help it get its readers angry and outraged. It used couched in vocabulary, designed to inflame anti- asylum seekers feelings. It describes asylum seekers with words or phrases such as ‘illegal immigrants that swarm into Britain', ‘claiming benefits at the expense of tax payers', ‘taking advantage', ‘using Britain as doormat ‘, ‘asylum madness', etc. It uses bold letters to emphasise the failure of our government to control the problems , ‘fails', ‘generous handouts', ‘time for action'. The sun has titled its article ‘Asylum meltdown' reflecting that the situation needs to be cracked, asylum seekers need to be sorted and the government needs to be revived. They used a picture effective in its purpose to support a negative and imbalanced article. The picture shows asylum seekers masked and crossing barriers, a representation of the border of the country, showing us that instead of using the gate they are coming in illegally. Its banner â€Å"Read this and get angry† is bold and highlighted summarising the whole article. The article is about how, now it's time for action against asylum seekers, for they are going to lead our economy to a downfall. The whole affair is causing us great loses, it implies as new school, houses and hospitals would need to be build to suffice the added demand on these already stretched resources. The letter to the Prime minister is the pushing object of the article. The guardian's â€Å"fight for tolerance† takes a different prospective on the issue. It say's that ‘the panic over asylum seekers is only the first part of a war that will be waged against liberal values'. M. Bunting is saying that this problem over asylum seekers is not something that is new but has always been the case, that is, natural fear like at the time of the Nazis. The newspapers are making the situation worse (like the Sun) by exaggerating and interpreting the wrong ideas. One minute the Algerians were considered terrorist the next moment all the asylum seekers are classed as terrorist. Not just one but lots of newspapers are doing this which is causing unwarranted panic. It does not matter if an immigrant changes his name today, for he cannot escape the racial suspicions surrounding asylum seekers. Today there is a risk of interracial terrorism it does not matter which side of the political system a person stands. There are two sides to the problem, asylum seekers have the right to seek help and asylum but under the suspicion of terrorism. The fact that Islamic foreigners can be terrorist seems frightening. As the economy grew, many thought that things would improve but that does not seem to be the case. Liberal views have led to many problems for they have no qualms about allowing people of different race and nationality to immigrate but doctrine religious intolerance. The in secularity needs to be lost, what remains is to ask ‘is individual freedom is more important than national security'? The Guardian places a rational argument which lays out facts and historical data than is asking the reader to exercise his mind and be tolerant. The readers of the guardian are the middle class well educated people who would not accept the Sun's point of view since it is bias and directed towards the lower working class individuals who are â€Å"sheep that are lead†. The Guardians language is to stir intellectual abilities. They have a sophisticated vocabulary and a complex argument. The poster they use is quite reprehensive of a disaster or a chaotic situation. The poster is screaming out â€Å"What is the world coming to?† Both the sun and the guardian have a different target audience and are persuasive in their area. The sun is for the lower working class as already understood and thus it is stirring its readers just to believe what they read. The sun does not allow its readers to think for them selves and they will not think for themselves. The sun exaggerates and is unbiased. The guardian though is asking its readers to think and thus they both have a different point of view with different motives and aims. Therefore it is debateable as to which of them is more persuasive. I personally am a strong supporter of the guardian's article which argues that what we are doing is wrong. As a nation we need to consider our security and safety but we cannot class all asylum seekers as terrorists for they have rights over us and we need to understand their pain or suffering that have lead many genuine asylum seekers here, which we cannot understand sitting in a centrally heated house with all the basic luxuries and talking. Thus we need to â€Å"fight for tolerance†.

Accredited & Deluxe Hotels for Tourism Essay

1. Century Park Hotel 599 Pablo Ocampo Str. Manila 1004Â  2. Crowne Plaza Manila Galleria – Ortigas Avenue, Corner Asian Dev., Bank Avenue, Quezon City 3. Diamond Hotel Phillippines – Roxas Boulevard cor. Dr. J. Quintos St., Manila, Philippines 1000 4. Dusit Hotel Nikko Ayala Center Makati City Metro Manila, Makati, 1223, Philippines 5. EDSA Shangri- La Hotel – 1 Garden Way Ortigas Center, Mandaluyong City, Manila 1650 6. Holiday Inn galleria Manila – 1 Asia Development Bank Avenue, Ortigas Center, Pasig City, 7. Hotel Intercontinental Manila – 1 Ayala Avenue, Makati, Luzon 1226, Philippines 8. Hyatt Hotel and Casino Manila – 1588 Pedro Gil Corner MH Del Pilar, Malate, Manila 1004 9. Makati Shangri- La Manila – Ayala Avenue corner Makati Avenue, Makati City 1200 10. Mandarin Oriental Manila – Makati Ave, Makati City 1226 11. Pan Pacific Hotel – Gen M Malvar, Manila 1004Â  12. Renaissance Makati City hotel – Esperanza Street corner Makati Avenue, Ayala Center, Makati City 1228, Philippines, Manila 13. Sofitel Phillipine Plaza Manila – Ccp Complex Roxas Boulevard, Pasay – Manila 1099 14. The Bellevue Manila – North Bridgeway, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines 1781 15. The Manila Hotel – One Rizal Park 0913 Manila Po Box 307 Philippines 16. Heritage Hotel – Manila – Roxas Boulevard corner Edsa Pasay City 1300 17. The Peninsula Manila – Ayala Museum, Makati Ave, 1226 See more:Â  First Poem for You Essay 18. Vivere Suites – 5102 Bridgeway Avenue corner ASEAN Drive, Filinvest Corporate City, Muntinlupa City 1781 Accredited First Class Hotels in the Philippines 1. CSB International Conference Center – Arellano cor Estrada Sts | Malate, Manila, Luzon 1004, Philippines 2. Discovery Suites – Ortigas Center, Pasig City 1600 Philippines 3. Great Eastern Hotel – 7842 Makati Avenue, 1200 Manila 4. Manila Pavilion hotel – United Nations Avenue, Corner Ma. Orosa Str Manila 1000 , Philippines 5. The Linden Suites Hotel – 37 San Miguel Avenue, Ortigas Centre Pasig City 1600 6. The Pearl Manila Hotel – General Luna Str., Corner Taft & United Nations Avenue, Ermita, Manila, Luzon 1000, 7. The richmonde Hotel – 21 San Miguel Avenue Pasig City‎ 8. Traders hotel Manila – 3001 Roxas Boulevard, Pasay, Manila, 1305 Philippines Accredited Standard Hotels in the Phillipines 1. Aloha Hotel – 2150 Roxas Boulevard, Cor. Quirino Ave.,Malate Manila, 1004 Philippines. 2. Bayview Park Hotel – 1118 Roxas Boulevard Cor., United Nations Avenue, 1000 Manila 3. Best Western hotel La Corona – 1166 M. H. Del Pilar St. cor. Arquiza St. Ermita, Manila, Philippines 4. Camelot Hotel 5. CEO Suites 6. Cherry Blossoms Hotel – 7. City Garden Suites – 8. Citystate Towe Hotel – 9. Garden Plaza Hotel – 10. Hotel Las Palmas –

Princess Olga of Kiev Also Known as Saint Olga

Princess Olga of Kiev Also Known as Saint Olga Princess Olga of Kiev, also known as St. Olga, is sometimes credited as founding, with her grandson Vladimir, what has come to be known as Russian Christianity (the Moscow Patriarchate within Eastern Orthodoxy). She was the ruler of Kiev as regent for her son, and she was the grandmother of St. Vladimir, great-grandmother of Saint Boris and Saint Gleb. She lived  about 890 - July 11, 969.  Dates for Olgas birth and marriage are far from certain.  The Primary Chronicle gives her birth date is 879. If her son was born in 942, that date is certainly suspect. She was also known as  St. Olga, Saint Olga, Saint Helen, Helga (Norse), Olga Piekrasa, Olga the Beauty, Elena Temicheva. Her baptismal name was Helen (Helene, Yelena, Elena). Origins Olgas origins are not known with certainty, but she may have come from Pskov. She was probably of Varangian (Scandinavian or Viking) heritage. Olga was married to Prince Igor I of Kiev in about 903. Igor was the son of Rurik, often seen as the founder of Russia as Rus. Igor became the ruler of Kiev, a state which included parts of what is now Russia, the Ukraine, Byelorussia, and Poland. A 944 treaty with the Greeks mentions both baptized and unbaptized Rus. Ruler When Igor was murdered in 945, Princess Olga assumed the regency for her son, Svyatoslav. Olga served as regent until her son was of age in 964.  She was known as a ruthless and effective ruler.  She resisted marrying Prince Mal of the Drevlians, who had been the killers of Igor, killing their emissaries and then burning their city in revenge for her husbands death. She resisted other offers of marriage and defended Kiev from attacks. Religion Olga turned to religion, and specifically, to Christianity.  She traveled to Constantinople in 957, where some sources say that she was baptized by the Patriarch Polyeuctus with Emperor Constantine VII as her godfather. She may have converted to Christianity, including being baptized, before her trip to Constantinople, perhaps in 945. There are no historical records of her baptism, so the controversy wont likely be settled. After Olga returned to Kiev, she was unsuccessful in converting her son or very many others. Bishops appointed by the Holy Roman Emperor Otto were expelled by Svyatoslavs allies, according to several early sources.  Her example, however, may have helped to influence her grandson, Vladimir I, who was the third son of Svyatoslav, and who brought Kiev (Rus) into the official Christian fold. Olga died, probably on July 11, 969. She is considered the first saint of the Russian Orthodox Church. Her relics were lost in the 18th century.

Rollo the Walker - Scandinavian Founder of Normandy

Rollo the Walker - Scandinavian Founder of Normandy Rollo of Normandy was also known as Rolf, Hrolf or Rou; in French, Rollon. He was sometimes called Robert and was also known as Rollo the Viking.  It was said Rollo was too tall to ride a horse without his feet reaching the ground, and it was for this reason he was known as Rollo the Walker or Rollo the Gangler or Ganger.   What Was Rollo of Normandy Known for? Founding the duchy of Normandy in France. Although Rollo is sometimes called the first Duke of Normandy, this is somewhat misleading; he never held the title of duke during his lifetime. Occupations RulerMilitary Leader Places of Residence and Influence FranceScandinavia Important Dates Born: c.  860Died:  c. 932 About Rollo of Normandy Leaving Norway to embark on pirating expeditions and raid England, Scotland, and Flanders, Rollo headed into France around 911 and settled along the Seine, besieging Paris. Charles III (the Simple) of France was able to hold Rollo off for a while, but he eventually negotiated a treaty to stop him. The treaty of Saint-Clair-sur-Epte gave Rollo part of Nuestria in return for his agreement that he and his fellow Vikings would stop pillaging any further in France. It is believed that he and his men may have converted to Christianity, and it is recorded that he was baptized in 912; however, the available sources conflict and one states that Rollo died a pagan. Because the region was settled by Northmen or Normans, the territory took on the name Normandy, and Rouen became its capital. Before Rollo died he turned over the governance of the duchy to his son, William I (Longsword). A rather questionable biography of Rollo and other dukes of Normandy was written in the eleventh century by Dudo of St. Quentin. Three Sources on the Ravages of the Northmen in Frankland, c. 843 - 912includes information on Rollo from the Chronicle of St. Denis; at Paul Halsalls Medieval Sourcebook.

Character Profile Essay Example | Topics and Well Written Essays - 1250 words

Character Profile - Essay Example Now after her death, the daughter has to deal with her grief, frustration, and other questions. The difference between the mother and her daughter can be accounted in terms of age, culture and identity related with it. These features are familiarized by most Chinese-Americans who are going through a confused status of identity crisis. Jing’s mother Suyuan established the Joy Luck Club along with other three Chinese ladies settled in America with an aim to remind them of their origin and cultural background. In other words, the club plays the pivotal role of bridging the gap between China and America, particularly between old and young Chinese-Americans. While Suyuan is excited about her story of â€Å"In China, everybody dreamed about Kweilin†, Jing-Mei feels strongly that her â€Å"mother’s Kweilin story was anything but a Chinese fairy tale† (Tan 1989, p. 22-25). The young Chinese-Americans often seem to have deliberately rejected their Chinese identity whereas their older counterparts are still trying to retain their identity even in the cosmopolitan foreign environment. However, the film portrays a positive outlook for the Chinese-Americans who finally come to realize their original identity. After the demise of Suyuan, Jing-Mei begins to realize the truth of her mother’s miserable history of which she is a part too. When Jing finally meets her estranged twin-sisters in China, she feels like she has her mother back. Jing’s visit to China guides her through her culture and origin. At the end of her journey, Jing-Mei realizes â€Å"what part of me is Chinese. It is so obvious. It is my family. It is in our blood.† (Tan 1989, p. 288) The cultural clash and generation shock come to both young and old Chinese-Americans as it tends to create the generational gap between the two age groups. While the older generation is desperately seeking to retain their cultural values, young Chinese-Americans find their traditional customs

Global warming and the blame game Research Paper

Global warming and the blame game - Research Paper Example The major blaming debate is whether global warming is majorly accelerated by the developed countries or developing countries. It is for sure known that the problem comes from both sides of the world but determining the greatest accelerators still remains a debate in the global environment arena. To discuss this paper, the major objective is to determine whether the developed countries are the major accelerators of global warming. This leads to the discussion question, Is global warming mostly accelerated by the developed countries? The thesis that will help find the answer to this question will be: The developed nations majorly cause global warming. To support this claim, the paper discusses the various activities in developed countries that might cause global warming. One of the major causes of global warming is the emission of greenhouse gases especially Carbon dioxide (CO2) due to the huge coal burning power plants and many industries. The developed countries are the greatest emitters of these gases. The data collected from 1900 to 2004 indicates that the United States of America produced carbon dioxide that amounted to 314,772 million metric tons (The World Bank 3). Germany also produced three times as much as China that only produced 89,243 million metric tons. The World Bank report added that it is important to note that these gases stay in the atmosphere for centuries; it can take more than 30 years to remove 50% of the emissions (5). This led to increased global temperature from back in 1800s to date. The graph below shows the gradual increase in the global temperature between 1880 and 2010. Developed countries are also the greatest consumers of the environmental resources. U.S, Canada, Europe and many more nations being with less population compared to developing countries, are the greatest consumers of environmental resources such as trees, raw materials for manufacturing and in turn has led to increased

Physics paper Essay Example | Topics and Well Written Essays - 1000 words - 1

Physics paper - Essay Example Another area of research will be determining the different between resistance and current. The distinct properties of resistance and current will be considered in order to identify various types of resistance in conductors of electricity. Resistivity and conductivity are also studied in this research; the factors which influence the conductivity for instances temperatures are also studied.in addition to exploring various types of applications which has high resistance and current consumption the knowledge of electric generation will be featured (S. Knight). For further understanding of resistance and current, an experiment is performed in the laboratory in order to analyze the effects of resistance and current in electricity transmission. The following apparatus and materials required while carrying out the experiment (S. Knight). In the above set up, while the electrons are passing through thin metal filament of the lamp, the electrons face more opposition because the filament is thinner when compared to the wire used in the experiment. The opposition to electric current depends on the type of material, cross-sectional area and its temperatures (Jeong). Basically it can be said the conductors have low resistance while insulators have low resistance. The resistance reduces amount of current through the circuit and the bulb will glow depending on the amount of electrons passing through the wire. When electrons are moving against the same direction it causes friction, this is manifested in form of heat.at the same time the readings of ammeter changes. The concentration of heat in filament will force the bulb to glow. In the cases of short circuit, the bulb will stop glowing because there is no complete flow of electrons. There will be any resistance because the circuit is incomplete. When we use batteries in the above set up, the battery will run short of the charge because the

Contributing factors toward SWB of the Institutionalized Elderly Essay Example for Free

Contributing factors toward SWB of the Institutionalized Elderly Essay Apart from delineating the cognitive and affective indicators of SWB, this study also attempted to identify the possible factors which contribute to SWB. A host of factors were identified in the largely western literature. These are presented in the succeeding pages. Physical Health: Health is one of the most important variables in predicting whether people are happy (Campbell et al. , 1976). The World Health Organization defines health as, the optimal functioning of the human organism to meet biological, psychological, ethical and spiritual needs (Emeth Greenhut, 1991). In this study the elderly were said to have ‘optimal functioning’ when he or she had basic competence, which was necessary for maintenance of independent living (Martin, 2001). In the case of the elderly in the study it was denoted by their ability for personal care on their own. It also pertained to mental health, which was a state where the elderly were not prone to depression, or other mental illness, and did not have any major cognitive impairments. Autonomy: Autonomy could be equated to having the capacity for selfdetermination, independence, internal locus of control, and internal regulation of behavior (Ryff, 1989). Having a sense of being in control (autonomy) means that one’s thoughts and actions are one’s own and not determined by others. It is related to physical health too as it gives a sense of mastery over situations. It is important for all and particularly for the elderly to maintain that sense of control or autonomy because a sense of losing control of one’s life or one’s power is to in some ways lose one’s worth, which can have detrimental effect on one’s physical as well as psychological health. Money/Income: Income or money is importantly related to a sense of well-being in old age (Diener, 1984) and the elderly in the study may or may not enjoy financial security Money is important probably because of the sense of security that they experience when they have enough money which could implicitly affect their sense of autonomy and self-worth. Family Relationships: Family is a natural institution constant across time and space which is a very close and intimate group and one’s sense of well-being is sustained by membership in this primary group, as it provides a sense of security, connectedness, and belongingness to the aged. There are no substitutes for the close relationship in the experience of well-being in the case of the aged. In the case of the elderly in the study, family relationship is limited to this intimate group consisting of the spouse, children and grandchildren as the extended family is almost nonexistent in the given context. Friendship: Friendship or close relationship with members of the same age group often sharing personal characteristics, life styles, values and experiences is a source of enjoyment, socializing, and reminiscing the past; promote a higher satisfaction among the older adults (Sorensen Pinquart, 2000). In the given situation it could be long standing friends from the past, and or the friendship developed among the co-residents of the home. Social Support and Social Interest: To experience a sense of well-being persons should have deep feeling of sympathy, and affection for human beings (social interest/altruism). That is, their ability to go beyond the personal to interpersonal establishing deep, profound interpersonal relationships and social support, to transpersonal, which is relating to the Divine in the social context of one’s life. These play a significant role in maintaining their psychological, social, and physical integrity over time (Witmer Sweeny, 1992) and consequently the sense well-being. Attitude toward Death: Death can be understood as a natural process of transition from one stage of life to another. Depending on the meaning people attach to death, they fear death or embrace it as a natural transition with a sense of acceptance and surrender (Atchley, 1997). Accepting old age and death meaningfully makes life happier. Fear or acceptance of death is closely related to general satisfaction. According to (Moberg, 2001), when life is lived to the full, death becomes a fulfillment, a completion. Religion and Spirituality: Subjective aspects of religion and spirituality include religious identification, religious attitudes, values, beliefs, knowledge, and mystical/religious experiences. Religious experience provides a sense of meaning and purpose in daily life (Polner, 1989). Spirituality usually refers to a unique, personally meaningful experience of a transcendent dimension that is associated with wholeness and wellness (Westgate, 1996). Spiritual wellness is the dimension that permits the integration of one’s spirituality with the other dimensions of life, thus maximizing the potential for growth and self-actualization (Westgate, 1996). At this point of SWB research, there is already an idea of the variables which correlate with SWB. However, a better understanding of parameters that influences the relationships, the directions of influences between variables, and the different influences interact are still needed (Diener, 1984). Given the assumption that these features are deep cross-cultural, universally applicable, core characteristic features of well being sought by the aged, the researcher believed that the institutionalized care for the aged and their subjective sense of well-being is also context specific. An understanding of psychological well-being necessarily rely upon the moral visions that are culturally embedded and frequently culture specific (Christopher, 1999). In this context, one might ask how the institutionalized aged of Gladys Spellman experience the transition from mathru-pithru devobhava (mother and father are like gods) to institutionalized care, what their experience of the subjective well-being consisted in, and what might be the specific factors that would contribute to their sense of well being. It is possible that the western culture-specific factors of subjective well-being outlined above may not have the same relevance for the population under investigation. This study was expected to help understand the contextspecific aspects of well-being of the institutionalized aged.

Gitlow vs New York Essay -- communism, freedom of speech, criminal anar

In the twenty century, the U.S society was in the period of tending to be a human base society. The laws in America were introduced to create a fair and regulated society for its citizens. The First and Fourteenth Amendment of Constitution granted that the U.S citizens have the freedom of speech. And the New York State had its law of Criminal Anarchy Act since 1902 for â€Å"organized government should be overthrown by force or violence, or by assassination of the executive head or of any of the executive officials of government, or by any unlawful means (n.p).† The citizen in the any state of the U.S should always both obey the state law and follow the national constitution. Otherwise, the citizen would get corresponding punishment for jail, community service or even death for most states. However, the case of Gitlow vs New York happened in 1925 that majorly argued about the U.S citizens’ guaranteed freedom of speech in the First Amendment of Constitution and the New Y ork State’s Criminal Anarchy Act. Gitlow vs. New York is a case that influences the integrity of U.S legislative system importantly. In the 1925s, Benjamin Gitlow, a left wing socialist, published speeches of anti-government to advocate a new better communist government. His action caused the charge as unpopular and dangerous speech for the whole society from the New York state government, and his behavior became a court case. According to the website thefreedictionary.com, that â€Å"The opinions expressed in† â€Å"The Revolutionary Age† and â€Å"The Left Wing Manifesto† â€Å"formed the bases for the defendant's convictions under Sections 160 and 161 of the penal law of New York, which were the criminal anarchy statutes† (n.p). â€Å"The Revolutionary Age† and â€Å"The Left Wing Manifesto† ar... ... his action could actually be really harmful for the society. Gitlow defended him as not guilty merely depends on the part of the context of the First Amendment of Constitution about U.S citizens’ freedom of speech. It is actually make a deliberate misinterpretation out of the context. Gitlow’s claims that he is innocent might because of his less awareness and misunderstanding of the laws. Or, he might believe that the faults of the Constitution would help him escape from the punishment. However, in my point of view, Gitlow fail to consider the primarily goal of the U.S Constitution that is to protect the best profit of its majority. Bibliography http://legal-dictionary.thefreedictionary.com/Gitlow+v.+New+York http://principlesofafreesociety.com/freedom-of-speech/ http://www.aynrand.org/site/PageServer?pagename=objectivism_nonfiction_the_ayn_rand_column

Book Review: When Genius Failed Essay

Lowenstein’s ability to come up with a concise, coherent story and his experience in financial journalism is strongly evident in this book. Not only can Lowenstein weave together and tell a great story (this author felt he was being led through the history of the fund and its characters by one of its inner partners while reading through this book), he also pays attention to details whenever it is needed – and he succeeds greatly by catching many important subtleties (such as in the beginning of Chapter one when he used one of those â€Å"subtleties† in Meriwether’s early areer to explain the basis of LTCM’s core business model and the subtle, but gradual â€Å"style drift† that brought down the hedge fund afterwards) as well as making many interesting observations along the way (such as the fatal flaw LTCM committed when it started engaging in stocks arbitrage as opposed to sticking to bond arbitrage). 7. Concept: Unsystematic Risk. A specifi c risk is a risk that affects a very small number of assets. This is sometimes referred to as â€Å"unsystematic risk†. In a balanced portfolio of assets there would be a spread between general market risk and risks specific to individual components of that portfolio. Unlike systematic and market risk, specific risk can be diversified away. A diversified portfolio is the realisation of the proverb â€Å"don’t put all your eggs in one basket†. As Irish investors become more sophisticated in their strategies, they look beyond the risks of stock-picking to managing risk through diversified, balanced investment portfolios. Mr. Fitzgerald, portfolio manager for Hibernian Investment Managers said that often the first step in reducing risk is investing in pooled investments like mutual funds, unit trusts and unit-linked funds. It’s a toe-in-the-water position, they begin with cautiously-managed funds, and then as they grow in wealth or experience they may choose a managed fund with higher equity content† Source: Margaret E. Ward, The Irish Times, 2nd July 1999. 10. Concept: The Capital Asset Pricing Model (CAPM). William Sharpe the Capital Asset Pricing Model in 1964. Parallel work was also performed by Jack Treynor, John Lintn er and Jan Mossin. CAPM is used in finance to determine a theoretically appropriate required rate of return of an asset. It considers a simplified world where there are no taxes and transaction costs, all investors have identical investment horizons and identical opinions about expected returns, volatilities and correlations of available investments. This model states that the expected return on a specific asset equals the risk-free rate plus a premium that depends on the asset’s beta and the expected risk premium on the market portfolio. CAPM extended Harry Markowitz’s modern portfolio theory and of diversification to introduce the notions of systematic and specified risk. Source: www. google. com 11. Concept: Capital Budgeting. Capital Budgeting or Investment Appraisals are the planning processes used to determine a firm’s long term investments such as new machinery, replacement machinery, new plants, new products and research and development projects. This is the process of identifying which long-lived investment projects a firm should undertake. US entertainment giant Warner Brothers investigated a possible high-tech back office studio development in Belfast. Executives from the group conducted an appraisal of possible investment opportunities on the site. The group planned a high-tech quarter in Belfast, which it hoped would attract multimedia, informatics and telecoms firms to set up in Northern Ireland. Source: Francess McDonnell, The Irish Times, 7th August 2001. 18. Concept: Financial Management. This is managing a firms internal cash flows and its mix of debt and equity financing, both to maximise the value of the debt and equity claims on firms’ and to ensure that companies can pay off their obligations when they come due. This is illustrated through financial reporting; the dream of consistent and uniform systems of financial reporting around the world is a seductive one. It is also elusive. The problem is that, however great the attempts at providing a universally acceptable standard, the differing goals of the world’s reporting regimes get in the way. Europe and about a 100 other countries go for the International Financial Reporting Standards (IRFS) whereas, the US stand alone and stick to their US generally accepted accounting (GAAP) yet seek reconciliation from the IRFS. It is the electronic tagging and analysis system XBRL that will enable the elements of a company’s financial reports to be accessed by users and reconfigured to provide whatever information the user wants. Mr. Cox, the Securities and Exchange Commission chairman said he was â€Å"looking forward to a future in which XBRL, US GAAP and IFRS would be interconnected and hence the problem of global comparability would be solved†. Source: Robert Bruce, Financial Times, 4th January 2007.

Life of Quaid E Azam

ACCF/AHA Pocket Guideline Adapted from the 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy November 2011 Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons  © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc.The following material was adapted from the 2011 ACCF/AHA Guidelines for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (J Am Coll Cardiol 2011;XX:XX–XX). This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (www. cardiosource. org) and the American Heart Association (my. americanheart. org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: [ema il  protected] com; phone: 212-633-3813; fax: 212-633-3820.Permissions: Multiple copies, modification, alteration, enhancement, and/ ordistribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at [email  protected] com. Contents 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Clinical Definition †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 6 3. Genetic Testing Strategies/Family Screening †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4. Genotype-Positive/Phenotype-Negative Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 5. Echocardiography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 10 6. Stress Testing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 14 7. Cardiac Magnetic Resonance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15 8. Detection of Concomitant Coronary Disease †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 9. Asymptomatic Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 10.Pharmacologic Management†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 21 11. Invasive Therapies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 26 12. Pacing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 29 13. Sudden Cardiac Death Risk Stratification †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 30 14. Selection of Patients for Implantable Cardioverter-Defibrillators †¦ 32 15. Participation in Competitive or Recreational Sports and Physical Activity †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 16. Management of Atrial Fibrillation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 38 17. Pregnancy/Delivery †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 2 1. Introduction The impetus for the guidelines is based on an appreciation of the frequency of this clinical entity and a realization that many aspects of clinical management, including the use of diagnostic modalities, genetic testing, utilization of implantable cardioverter-defibrillators (ICDs), and therapies for refractory symptoms lack consensus.The discussion and recommendations about the various diagnostic modalities apply to patients with established HCM and to a variable extent to patients with a high index of suspicion of the disease. Classification of Recommendations The ACCF/AHA classifications of recommendations and levels of evidence are utilized, and described in more detail in Table 1. 3 Applying Classification of Recommendations and LevelRecommendations and Level of Evidence Table 1. Applying Classification of of Evidence Table 1. Applying Classification of Recommendations and Level of Evidence S i z e Class I Benefit >>> Risk f T r e a T m eSni T ee f ffe c T e a T z o Tr Class IIb Class IIa Benefit >>> Risk Benefit Risk Additional studies with broad Additional studies with objectives objectives needed focused needed; additional registryreasonable to perIt Is data would be helpful Class IIa Class I Benefit >> RiskRisk Benefit >>> Additional studies with Procedure/Treatment focused objectives needed should be performed/ Procedure/Treatment should be performed/ administered It administered Is reasonable to perform procedure/administer treatment n Recommendation favor n Recommendation in thatProcedure/Treatment form procedure/administer may be ConsIdered treatment n n Rec ommendation Recommendation’s eSTimaTe of cerTainTy (PreciSion) of TreaTmenT effecT a populations d* ived from multiple zed clinical trials analyses Recommendation that level a procedure or treatment Multiple populations is useful/effective evaluated* n Sufficient evidence from Data randomized multiple multiplederived from trials randomized clinical trials or meta-analyses or meta-analyses n of procedure or procedure treatment treatment is useful/effective being useful/effective n Sufficient evidence from n Some conflicting evidence n favor usefulness/efficacy less of treatment or procedure well established being useful/effective conflicting evidence evidence from multiple from multiple randomized randomized trials or trials or meta-analyses meta-analyses in favor of treatment or procedure usefulness/efficacy less being useful/effective well established conflicting evidence from single evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomi zed studies in favor usefulness/efficacy less of treatment or procedure well established being useful/effective opinion, case studies, or opinion, case studies, standard of care care or standard of may/might be considered is reasonable may/might be reasonable can be useful/effective/beneficial usefulness/effectiveness is is probably recommended unknown/unclear/uncertain or indicated or not well established n n Some Greater multiple randomized trials from multiple randomized or or meta-analyses trialsmeta-analyses b populations d* ived from a ndomized trial ndomized studiesRecommendation that level b procedure or treatment Limited populations is useful/effective evaluated* n Evidence from single Data derived or randomized trialfrom a single randomized trial nonrandomized studies or nonrandomized studies n n Recommendation in that n Recommendation favor n n Recommendation Recommendation’s of procedure or procedure treatment treatment being useful/effective is useful/effective n Some conflicting single n Evidence from n n Some Greater evidence from trial or randomized single randomized trial or nonrandomized studies nonrandomized studies n Recommendation favor n Recommendation in that C ited populations d* sensus opinion ts, case studies, ard of careRecommendation that level C procedure or treatment is Very limited populations useful/effective evaluated* n Only expert opinion, case Only consensus opinion studies, or standard of care of experts, case studies, or standard of care n n n Recommendation Recommendation’s of procedure or procedure is treatment treatment useful/effective being useful/effective n Only expert expert n Only divergingopinion, case studies, or studies, opinion, casestandard of care or standard of care is reasonable should can be useful/effective/beneficial is recommended is probably recommended is indicated oris useful/effective/beneficial indicated n n Only diverging expert Only diverging expert d phrases for commendations shou ld Suggested phrases for writing recommendations is recommended is ndicated is useful/effective/beneficial s treatment/strategy A is Comparative recommended/indicated in effectiveness phrases†  preference to treatment B treatment/strategy A is probably treatment/strategy A is recommended/indicated in in recommended/indicated preference to to treatment B preference treatment B it is reasonableshould be chosen treatment A to choose treatment A over treatment B over treatment B treatment/strategy A is probably recommended/indicated in preference to treatment B it is reasonable to choose treatment A over treatment B ive ess phrases†  4 treatment A should be chosen over treatment B e T menT e ffe c T A recommendation with Level of Evidence B or CClass IIIIIb Benefit Class No orBenefit > Risk Class III Harm Procedure/ Additional studies with broad test treatment objectives needed; additional Cor III: Not No Proven be helpful noregistry data would Benefit benefit Helpful Class II I No Benefit or Class III Harm Procedure/ test Cor III: Not no benefit Helpful Cor III: harm treatment No Proven Benefit does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Procedure/Treatment Cor III: Excess Cost Harmful harm be w/o Benefit to Patients may ConsIdered or Harmful n n Recommendation’s Recommendation that Excess Cost Harmful w/o Benefit to Patients or Harmful Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †  For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. n procedure or treatment is usefulness/efficacy less not useful/effective and may well established be harmful conflicting n Greater n evidence from multiple Sufficient evidence fromRecommendation that procedure or treatment is not useful/effective and may be harmful Sufficient evidence from multiple randomized trials or meta-analyses Recommendation that procedure or treatment is not useful/effective and may be harmful Evidence from single randomized trial or nonrandomized studies Recommendation that procedure or treatment is not useful/effective and may be harmful Only expert opinion, case studies, or standard of care COR III: Harm potentially harmful causes harm associated with excess morbidity/mortality should not be performed/ be done administered/ other n multiple randomizedor randomized trials trials or meta-analyses meta-analyses n n Recommendation’s Recommendatio n that n sefulness/efficacy less procedure or treatment is well established not useful/effective and may be harmful conflicting n Greater n evidence from single Evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomized studies n Recommendation’s Recommendation that usefulness/efficacy less procedure or treatment is well established not useful/effective and may n Only diverging expert be harmful opinion, case studies, or n Only expert opinion, case standard of care studies, or standard of care n n n n COR III: COR III: may/might be considered Nomay/might be reasonable Benefit Harm usefulness/effectiveness is is not potentially unknown/unclear/uncertain recommended harmful or indicated not well established harm is not causes associated with excess morbidity/mortality should not be done COR III: No Benefit is not recommended is not indicated should not be performed/ be done administered/ is not useful/ other beneficial/ is not useful/ effect ive bene? cial/ effective should not be done s not useful/ beneficial/ effective 5 2. Clinical Definition The generally accepted definition of hypertrophic cardiomyopathy (HCM), is a disease state characterized by unexplained left ventricular (LV) hypertrophy associated with nondilated ventricular chambers in the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient. Clinically, HCM is usually recognized by maximal LV wall thickness ? 15 mm, with wall thickness of 13 to 14 mm considered borderline, particularly in the presence of other compelling information (e. g. , family history of HCM), based on echocardiography.In terms of LV wall-thickness measurements, the literature has been largely focused on echocardiography, although cardiovascular magnetic resonance (CMR) is now used with increasing frequency in HCM. In the case of children, increased LV wall thickness is defined as wall thickness ? 2 standard deviations above the mean (z score ? 2) for age, sex, or body size. However, it should be underscored that in principle, any degree of wall thickness is compatible with the presence of the HCM genetic substrate and that an emerging subgroup within the broad clinical spectrum is composed of family members with disease-causing sarcomere mutations but without evidence of the disease phenotype (i. e. , LV hypertrophy). 6 3. Genetic Testing Strategies/Family Screening Class I 1.Evaluation of familial inheritance and genetic counseling is recommended as part of the assessment of patients with HCM. (Level of Evidence: B) 2. Patients who undergo genetic testing should also undergo counseling by someone knowledgeable in the genetics of cardiovascular disease so that results and their clinical significance can be appropriately reviewed with the patient. (Level of Evidence: B) 3. Screening (clinical, with or without genetic testing) is recommended in first-degree relatives of pati ents with HCM. (Level of Evidence: B) 4. Genetic testing for HCM and other genetic causes of unexplained cardiac hypertrophy is recommended in patients with an typical clinical presentation of HCM or when another genetic condition is suspected to be the cause. (Level of Evidence: B) 7 Class IIa 1. Genetic testing is reasonable in the index patient to facilitate the identification of first-degree family members at risk for developing HCM. (Level of Evidence: B) Class IIb 1. The usefulness of genetic testing in the assessment of risk of sudden cardiac death (SCD) in HCM is uncertain. (Level of Evidence: B) Class III: 1. Genetic testing is not indicated in relatives when pathogenic mutation. (Level of Evidence: B) 2. Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. Level of Evidence: B) No Benefit the index patient does not have a definitive 8 4. Genotype-Positive/Phenotype-Negative Patients Class I 1. In individuals with pathogenic mutat ions who do not express the HCM phenotype, it is recommended to perform serial electrocardiogram, transthoracic echocardiogram (TTE), and clinical assessment at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status. (Level of Evidence: B) 9 5. Echocardiography Class I 1. A TTE is recommended in the initial evaluation of all patients with suspected HCM. (Level of Evidence: B) 2.A TTE is recommended as a component of the screening algorithm for family members of patients with HCM unless the family member is genotype negative in a family with known definitive mutations. (Level of Evidence: B) 3. Periodic (12 to 18 months) TTE screening is recommended for children of patients with HCM, starting by age 12 or earlier if a growth spurt or signs of puberty are evident and/or when there are plans for engaging in intense competitive sports or there is a family history of SCD. (Level o f Evidence: C) 4. Repeat TTE is recommended for the evaluation of patients with HCM with a change in clinical status or new cardiovascular event. (Level of Evidence: B) 5. A transesophageal echocardiogram (TEE) is recommended for the intraoperative guidance of surgical myectomy. (Level of Evidence: B) 10 6.TTE or TEE with intracoronary contrast injection of the candidate’s septal perforator(s) is recommended for the intraprocedural guidance of alcohol septal ablation. (Level of Evidence: B) 7. TTE should be used to evaluate the effects of surgical myectomy or alcohol septal ablation for obstructive HCM. (Level of Evidence: C) Class IIa 1. TTE studies performed every 1 to 2 years can be useful in the serial evaluation of symptomatically stable patients with HCM to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function. (Level of Evidence: C) 2. Exercise TTE can be useful in the detection and quantification of dynamic left ventricular outflow tract (LVOT) obstruction in the absence of resting outflow tract obstruction in patients with HCM. (Level of Evidence: B) 11 3.TEE can be useful if TTE is inconclusive for clinical decision making about medical therapy and in situations such as planning for myectomy, exclusion of subaortic membrane or mitral regurgitation secondary to structural abnormalities of the mitral valve apparatus, or in assessment for the feasibility of alcohol septal ablation. (Level of Evidence: C) 4. TTE combined with the injection of an intravenous contrast agent is reasonable if the diagnosis of apical HCM or apical infarction or severity of hypertrophy is in doubt, particularly when other imaging modalities such as CMR are not readily available, not diagnostic, or contraindicated. (Level of Evidence: C) 5.Serial TTE studies are reasonable for clinically unaffected patients who have a first-degree relative with HCM when genetic status is unknown. Such follow-up may be considered every 12 to 18 months f or children or adolescents from high-risk families and every 5 years for adult family members. (Level of Evidence: C) 12 Class III: 1. TTE studies should not be performed more HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. (Level of Evidence: C) 2. Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. (Level of Evidence: C)No Benefit frequently than every 12 months in patients with 13 6. Stress Testing Class IIa 1. Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with HCM. (Level of Evidence: C) 2. Treadmill testing with monitoring of an electrocardiogram and blood pressure is reasonable for SCD risk stratification in patients with HCM. (Level of Evidence: B) 3. In patients with HCM who do not have a resting peak instantaneous g radient of greater than or equal to 50 mm Hg, exercise echocardiography is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction. (Level of Evidence: B) 14 7. Cardiac Magnetic Resonance Class I 1.CMR imaging is indicated in patients with suspected HCM when echocardiography is inconclusive for diagnosis. (Level of Evidence: B) 2. CMR imaging is indicated in patients with known HCM when additional information that may have an impact on management or decision making regarding invasive management, such as magnitude and distribution of hypertrophy or anatomy of the mitral valve apparatus or papillary muscles, is not adequately defined with echocardiography. (Level of Evidence: B) Class IIa 1. CMR imaging is reasonable in patients with HCM to define apical hypertrophy and/or aneurysm if echocardiography is inconclusive. (Level of Evidence: B) 15 Class IIb 1.In selected patients with known HCM, when SCD risk stratification is inconclusive after docume ntation of the conventional risk factors, CMR imaging with assessment of late gadolinium enhancement may be considered in resolving clinical decision making. (Level of Evidence: C) 2. CMR imaging may be considered in patients with LV hypertrophy and the suspicion of alternative diagnoses to HCM, including cardiac amyloidosis, Fabry disease, and genetic phenocopies such as LAMP2 cardiomyopathy. (Level of Evidence: C) 16 8. Detection of Concomitant Coronary Disease Class I 1. Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with HCM with chest discomfort who have an intermediate to high likelihood of coronary artery disease (CAD) when the identification of concomitant CAD will change management strategies. (Level of Evidence: C) Class IIa 1.Assessment of coronary anatomy with computed tomographic angiography is reasonable for patients with HCM with chest discomfort and a low likelihood of CAD to assess for possible concomitant CAD. (Level of E vidence: C) 2. Assessment of ischemia or perfusion abnormalities suggestive of CAD with single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (because of excellent negative predictive value) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD. (Level of Evidence: C) 17 Class III: 1. Routine single-photon emission computed echocardiography is not indicated for detection of â€Å"silent† CAD-related ischemia in patients with HCM who are asymptomatic. (Level of Evidence: C) 2.Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by positron emission tomography is not indicated for the assessment of prognosis in patients with HCM. (Level of Evidence: C) No Benefit tomography myocardial perfussion imaging or stress 18 9. Asymptomatic Patients Class I 1. For patients with HCM, it is recom mended that comorbidities that may contribute to cardiovascular disease (e. g. , hypertension, diabetes, hyperlipidemia, obesity) be treated in compliance with relevant existing guidelines. (Level of Evidence: C) Class IIa 1. Low-intensity aerobic exercise is reasonable as part of a healthy lifestyle for patients with HCM. (Level of Evidence: C) Class IIb 1.The usefulness of beta blockade and calcium channel blockers to alter clinical outcome is not well established for the management of asymptomatic patients with HCM with or without obstruction. (Level of Evidence: C) Class III: Harm 1. Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. (Level of Evidence: C) 2. In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. (Level of Evidence: C) 19 Fi gure 1. Treatment Algorithm HCM PatientsACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; DM, diabetes mellitus; EF, ejection fraction; GL, guidelines; HCM, hypertrophic cardiomyopathy; HTN, hypertension; and LV, left ventricular. Treat comorbidities according to GL [HTN, Lipids, DM] Obstructive Physiology No Heart Failure Symptoms or Angina No Yes Yes Avoid vasodilator therapy and highdose diuretics Systolic Function Annual clinical evaluation No Heart Failure Symptoms or Angina LV EF 50 mm Hg) for whom standard medical therapy has failed. (Level of Evidence: C) 4.When surgery is contraindicated or the risk is considered unacceptable because of serious comorbidities or advanced age, alcohol septal ablation, when performed in experienced centers, can be beneficial in eligible adult patients with HCM with LVOT obstruction and severe drug-refractory symptoms (usually New York Heart Association functional classes III or IV). (Level of Evidence: B) 26 Class IIb 1. Alcohol septal ablation, when performed in experienced centers, may be considered as an alternative to surgical myectomy for eligible adult patients with HCM with severe drug-refractory symptoms and LVOT obstruction when, after a balanced and thorough discussion, the patient expresses a preference for septal ablation. (Level of Evidence: B) 2. The effectiveness of alcohol septal ablation is uncertain in patients with HCM with marked (i. e. , >30 mm) septal hypertrophy, and therefore the procedure is generally discouraged in such patients. (Level of Evidence: C) Class III: Harm 1.Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. (Level of Evidence: C) 2. Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. (Level of Evidence : C) 27 3. Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. (Level of Evidence: C) 4. Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (e. g. coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. (Level of Evidence: C) 5. Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. (Level of Evidence: C) 28 12. Pacing Class IIa 1. In patients with HCM who have had a dualchamber device implanted for non-HCM indications, it is reasonable to consider a trial of dual-chamber atrial-ventricular pacing (from the right ventricular apex) for the relief of symptoms attributable to LVOT obst ruction. (Level of Evidence: B) Class IIb 1.Permanent pacing may be considered in medically refractory symptomatic patients with obstructive HCM who are suboptimal candidates for septal reduction therapy. (Level of Evidence: B) Class III: 1. Permanent pacemaker implantation for the performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. (Level of Evidence: C) 2. Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction in patients who are candidates for septal reduction. (Level of Evidence: B) No Benefit purpose of reducing gradient should not be 29 13. Sudden Cardiac Death Risk Stratification Class I 1.All patients with HCM should undergo comprehensive SCD risk stratification at initial evaluation to determine the presence of: (Level of Evidence: B) a. A personal history for ventricular fibrillation, sustained ventricular tach ycardia, or SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * b. A family history for SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * c. Unexplained syncope. d. Documented nonsustained ventricular tachycardia (NSVT) defined as 3 or more beats at greater than or equal to120 bpm on ambulatory (Holter) electrocardiogram. e. Maximal LV wall thickness greater than or equal to 30 mm. Appropriate ICD discharge is defined as ICD therapy triggered by VT or ventricular fibrillation, documented by stored intracardiac electrogram or cycle-length data, in conjunction with the patient’s symptoms immediately before and after device discharge. 30 Class IIa 1. It is reasonable to assess blood pressure response during exercise as part of SCD risk stratification in patients with HCM. (Level of Evidence: B) 2. SCD risk stratification is reasonable on a periodic basis (every 12 to 24 months) for patients with HCM who have not under gone ICD implantation but would otherwise be eligible in the event that risk factors are identified (12 to 24 months). (Level of Evidence: C)Class IIb 1. The usefulness of the following potential SCD risk modifiers is unclear but might be considered in selected patients with HCM for whom risk remains borderline after documentation of conventional risk factors: a. CMR imaging with late gadolinium enhacement. (Level of Evidence: C) b. Double and compound mutations (i. e. , >1). (Level of Evidence: C) c. Marked LVOT obstruction. (Level of Evidence: B) Class III: Harm 1. Invasive electrophysiologic testing as routine SCD risk stratification in patients with HCM should not be performed. (Level of Evidence: C) 31 14. Selection of Patients for Implantable Cardioverter-Defibrillators Class I 1.The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient’s active participation in decision making. (Level of Evidence: C) 2. ICD placement is recommended for patients with HCM with prior documented cardiac arrest, ventricular fibrillation, or hemodynamically significant ventricular tachycardia. (Level of Evidence: B) Class IIa 1. It is reasonable to recommend an ICD for patients with HCM with: a. Sudden death presumably caused by HCM in 1 or more first-degree relatives. (Level of Evidence: C) b. A maximum LV wall thickness greater than or equal to 30 mm. (Level of Evidence: C) c. One or more recent, unexplained syncopal episodes. (Level of Evidence: C) 2.An ICD can be useful in select patients with NSVT (particularly those 30 mm or Recent unexplained syncope No Yes ICD reasonable Nonsustained VT or Abnormal BP response Yes Other SCD Risk Modifiers* Present? Yes No ICD can be useful Legend Class I Class IIa No ICD not recommended Class IIb Class III Role of ICD uncertainRegardless of the level of recommendatio n put forth in these guidelines, the decision for placement of an ICD must involve prudent application of individual clinical judgment, thorough discussions of the strength of evidence, the benefits, and the risks (including but not limited to inappropriate discharges, lead and procedural complications) to allow active participation of the fully informed patient in ultimate decision making. BP indicates blood pressure; ICD, implantable cardioverter-defibrillator; LV, left ventricular; SCD, sudden cardiac death; SD, sudden death; and VT, ventricular tachycardia. 35 15. Participation in Competitive or Recreational Sports and Physical ActivityClass IIa 1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (e. g. , golf and bowling). (Level of Evidence: C) 2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 2. (Level of Evidence: C) Class III: Harm 1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverterdefibrillator for high-risk status. (Level of Evidence: C) 36 Table 2. Recommendations for the Acceptability of Recreational Noncompetitive) Sports Activities and Exercise in Patients With HCM* Intensity Level High Basketball (full court) Basketball (half court) Body building†¡ Gymnastics Ice hockey†¡ Racquetball/squash Rock climbing†¡ Running (sprinting) Skiing Soccer Tennis (singles) Touch (flag) football Windsurfing § Moderate Baseball/softball Biking Modest hiking Motorcycling†¡ Jogging Sailing § Surfing § Swimming (laps) § Tennis (doubles) Treadmill/stationary bicycle Weightlifting (free weights)†¡|| Hiking 2 4 4 3 3 3 2 5 4 5 1 3 (downhill)†¡ Skiing (cross-country) 0 0 1 2 0 0 1 0 2 2 0 0 1 1 Eligibility Scale for HCM†  Intensity Level Low Bowling Golf Hor seback riding†¡ Scuba diving § Skating ¶ Snorkeling § Weights (nonfree weights) Brisk walking 5 5 3 0 5 5 4 5 Eligibility Scale for HCM†  *Recreational sports are categorized according to high, moderate, and low levels of exercise and graded on a relative scale (from 0 to 5) for eligibility, with 0 to 1 indicating generally not advised or strongly discouraged; 4 to 5, probably permitted; and 2 to 3, intermediate and to be assessed clinically on an individual basis. The designations of high, moderate, and low levels of exercise are equivalent to an estimated >6, 4 to 6, and