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

Fitzgerald Research Paper Essays

Fitzgerald Research Paper Essays Fitzgerald Research Paper Paper Fitzgerald Research Paper Paper Essay Topic: Short Stories of F Scott Fitzgerald F. Scott Fitzgerald F. Scott Fitzgerald lived during the time of the Great Depression, where money was low In almost every household. This pushed Fitzgerald favorite topic of a poor boy becoming rich Into the American public. Dexter, the mall character In Winter Dreams went from being an average boy that was living a good life to a rich man because of the love he had for a wealthy girl named Judy Jones. Through, Winter Dreams Fitzgerald explained the major events of his own life. Although many critics believed that Fitzgerald had a great talent in writing and he lived a great life, some live that he wasted the talent that was given to him by drinking and shortening his life every day. Many believe that he was responsible for his own death. Fitzgerald did not come from a wealthy family; however the family was considered upper- middle class. Fitzgerald was born to Edward and Mollie Fitzgerald on September 24th 1896 In Saint Paul Minnesota. Since his parents were strong Catholics, they sent him to two different private schools. The first one was the Holy Angel in New York, and later after having some money problems they moved back to Minnesota and he tended SST Paul Academy. The most well known school that Fitzgerald went was Princeton. While he was there he wrote for the Nassau magazine as well as the Princeton Tiger school newspaper. He attended Princeton for a few years until World War One began. At the time of the war the country was flooding with nationalism and many young fit boys were enlisting to play their role for their country. And of course Fitzgerald Joins with his fellow classmates. : After Fitzgerald came home from the war, he started his writing career with his first novel, This Side of Paradise. This novel spooned greatly and was an instant, famous American novel at the time. After a few short stories for magazines such as Winter Dreams, he published his second novel, The Great Gatsby. This novel was also a great success and the American public loved his work. Fitzgerald wrote his best work when he was the most popular (Bryant and Pits 5). However, after The Great Gatsby, his career In writing started to go downhill E was dead as an author before he was dead (Chain. E. Charles 77). This was because he and his lovely wife were partying every day, and they had become heavy drinkers. By the near end of Fitzgerald life, everything was completely broken. His wife was in a hospital because she was having Psychotic episodes, and he had a really bad habit of abusing alcohol. He passed away by the age of forty four. Winter Dreams portrays an average American kid growin g up to living the American dream, or at least trying to do so. The story takes place in a few different states throughout the United States. Winter Dreams passes by summer, fall winter and spring quickly showing us how fast time is passing by in the story. Dexter, the main character starts if the story In the state of Minnesota. HIS part time Job was to be a caddie, and he was pretty good at his Job, Dexter falls In love with a beautiful, stunning girl named Judy Jones. However, the fantasies that Dexter has for Judy cannot play out because of the class difference between Judy and Dexter. Judos family is considered wealthy Judy Dexter decides to get rich and become part of the wealthy life. After college Dexter invests in a laundry business at a town near his home town in Minnesota. This brings Dexter a great deal of money and now he is considered rich. Due to the money e now has he tried his best to fit with the wealthy people in the town. However, he will never be like them because of the fact that he is new money while the others are old money. His plan of getting rich and then getting Judy somewhat plays out right; he gets invited to dinner with the Jones family by Judy. When Dexter is in Judy room he knows that she has had many lovers before but he does not seem to care. Time passes by and one day Dexter realizes that Judy does not actually love him, and he realizes how crazy he was being. To get away from his mistakes he marries a girl named Irene and attempts to forget everything he can about Judy. A few years after his marriage Dexter ends up having an affair with Judy, having realized once again how stupid he was being he moved to east New York with his wife. While he was there he decided to Join the army and take part in WWW. When he returns from the war he learns that Judy Jones is now married, and not only that she has lost the stunning beauty Dexter once loved her for. That is when Dexter knows that his Winter Dreams of being with Judy and all of her money is not gone and he cant ever get it back. Winter Dreams and Fitzgerald life have a direct connection to each other. Dexter lives in a Minnesota for most of the short story and then moved to East New York. These were also the two places that Fitzgerald lived during his life time, he was schooled in New York when he was a boy and later moved to Minnesota due to money troubles. The two main characters in the short story, Dexter and Judy, represent Fitzgerald own love life that he has with Zelda. In the short story Dexter proposes to Judy, and gets rejected. This also happened to Fitzgerald when he first reposed to Zelda. Winter Dreams also shows a direct connection to Fitzgerald personal life as well. Fitzgerald took part in World War One and Dexter also Joins the war in the story. Many critics viewed Winter Dreams as the start of Fitzgerald writing career. This was the story that made him popular with the American reading public. And some people believed that Fitzgerald wrote his best works when he was at his highest level of being an author (Bryant 6). The American public responded well to the Winter Dreams which inspired Fitzgerald to make it into a novel. This wows how Fitzgerald liked to use his short stories as experiments to see how the topic or theme is responded to by the readers. Although Fitzgerald wrote many great short stories and novels, some critics believed that, towards the end of his life his works were nothing compared to his earlier works (Bryant 60). Also many people believe that he was responsible for his own death, because of his drinking problems he was shortening his own life. It was considered wasting his great talent of writing stories and novels ( Chain 77). Fitzgerald was one of the greatest American writers to ever lived, he was brought up in an average family and turned out to be wealthy because he chased and earned the American dream. A few stories like, Winter Dreams represents the American dream and his own life. Although he had a tough adulthood with his wife being a in a hospital and him drinking more than ever, he still tried to keep his dream alive.

Free Essays on Ludwig Van Beetoven

Beethoven was born in Bonn. His father’s harsh discipline and alcoholism made his childhood and adolescence difficult. At the age of 18, after his mother’s death, Beethoven placed himself at the head of the family, taking responsibility for his two younger brothers, both of whom followed him when he later moved to Vienna, Austria. Beethoven’s music is generally divided into three main creative periods. The first, or early, period extends to about 1802, when the composer made reference to a â€Å"new manner† or â€Å"new way† in connection with his art. The second, or middle, period extends to about 1812, after the completion of his Seventh and Eighth symphonies. The third, or late, period emerged gradually; Beethoven composed its pivotal work, the Hammerklavier Sonata, in 1818. Beethoven’s late style is especially innovative, and his last five quartets, written between 1824 and 1826, can be regarded as marking the onset of a fourth creative period. The celebrated Symphony No. 5 in C minor op. 67 from 1808 is the most thematically concentrated of Beethoven’s works. Variants of the four-note motif that begins this symphony drive all four movements. The dramatic turning point in the symphony-where a sense of foreboding, struggle, or mystery yields to a triumphant breakthrough-comes at the transition to the final movement, where the entrance of the trombones reinforces the music. Beethoven uses here a large-scale polarity between the darker sound of C minor and the brighter, more radiant effect of C major, which is held largely in reserve until the finale. The series of gigantic masterpieces of Beethoven’s third period include the technically demanding Hammerklavier Sonata, completed in 1818, about which he correctly predicted on account of its challenges that â€Å"it will be played fifty years hence,† and the Diabelli Variations. The latter work for piano transforms a trivial waltz by Viennese publ isher Anton Diabelli into an ... Free Essays on Ludwig Van Beetoven Free Essays on Ludwig Van Beetoven Beethoven was born in Bonn. His father’s harsh discipline and alcoholism made his childhood and adolescence difficult. At the age of 18, after his mother’s death, Beethoven placed himself at the head of the family, taking responsibility for his two younger brothers, both of whom followed him when he later moved to Vienna, Austria. Beethoven’s music is generally divided into three main creative periods. The first, or early, period extends to about 1802, when the composer made reference to a â€Å"new manner† or â€Å"new way† in connection with his art. The second, or middle, period extends to about 1812, after the completion of his Seventh and Eighth symphonies. The third, or late, period emerged gradually; Beethoven composed its pivotal work, the Hammerklavier Sonata, in 1818. Beethoven’s late style is especially innovative, and his last five quartets, written between 1824 and 1826, can be regarded as marking the onset of a fourth creative period. The celebrated Symphony No. 5 in C minor op. 67 from 1808 is the most thematically concentrated of Beethoven’s works. Variants of the four-note motif that begins this symphony drive all four movements. The dramatic turning point in the symphony-where a sense of foreboding, struggle, or mystery yields to a triumphant breakthrough-comes at the transition to the final movement, where the entrance of the trombones reinforces the music. Beethoven uses here a large-scale polarity between the darker sound of C minor and the brighter, more radiant effect of C major, which is held largely in reserve until the finale. The series of gigantic masterpieces of Beethoven’s third period include the technically demanding Hammerklavier Sonata, completed in 1818, about which he correctly predicted on account of its challenges that â€Å"it will be played fifty years hence,† and the Diabelli Variations. The latter work for piano transforms a trivial waltz by Viennese publ isher Anton Diabelli into an ...

Wetware

Wetware Wetware Wetware By Maeve Maddox Computer-age coinages don’t usually strike me as â€Å"creepy,† but this one does. Formed on the model of software and hardware, wetware begins to soar into prominence on the Ngram Viewer in 1979. Both the OED and Merriam-Webster provide definitions of this new term. OED wetware noun: Chemical materials organized so as to perform arithmetic or logical operations; brain substance, as having this ability. M-W wetware noun: The human brain or a human being considered especially with respect to human logical and computational capabilities. Apparently the invention and continuing development of artificial intelligence (AI) has created the need for a retronym for human. In I, Robot, written between 1940 and 1950, Asimov referred to the brain of a robot as a â€Å"positronic brain.† In the dystopia of Terminator (1984), an intelligent computer is called â€Å"Neural Net CPU.† In the 2015 film Ex Machina, a substance made of a gel that causes artificial neural connections to form is called wetware. Here are examples of the usage of wetware I found on the Web: [Marleen Stikker] was director of multimedia art festival Zomerfestijn Amsterdam in 1990 and 1991 and organiser of the Wetware Conference (on hardware, software and physical interaction). Integrated IT Wetware/Software Solutions [headline on site of company offering digital services] Many, many teams just abandon this impossible wetware task and use each solution in isolation. [This is a consultant’s website. In the context, wetware seems to mean the aspect of online selling that involves human beings called â€Å"web customers† and â€Å"mobile customers† who are part of the â€Å"wetware task.†] The term wetware in its turn is spawning new meanings for the adjective wet. Dean Koontz uses (and defines) the expression wet intelligence in the following exchange between characters who are examining an alien creature: Linked up, maybe these hundreds of millions of nanocomputers functioned as this creatures brain or at least as the largest part of its brain, assuming there was also some wet intelligence in it. Wet intelligence? Biological brain matter. At first I thought that the term wet signature had a similar meaning, but several readers have informed me that the wetness of this term refers to ink and not to gray matter. For example: DocuSign is capable of keeping the entire transaction in the cloud. There are, however, rare occasions when a wet signature is necessary. Related post: What’s a Retronym? Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:5 Uses of InfinitivesWhat is the Difference Between Metaphor and Simile?50 Tips on How to Write Good

Should English be declared as an official language in the United Research Paper

Should English be declared as an official language in the United States - Research Paper Example On the other hand, people are arguing that English should be made an official Language because it promotes the cohesiveness of the country. I feel that immigrants should learn English at their own will and benefit. Though Official English cohorts assert that America needs English-Only as law as making it the official language will segregate the immigrants, English needs no defender as it is the language with the fastest expanding usage worldwide. While the English cohorts also argue that Official English will speed up English assimilation, statistics prove otherwise by the waiting list for English as a second language, which would be cut down by law. Statistics show that in that last two centuries, proponents for having English as an official language have justified their position by stating only tow main themes, patriotism and rational and racism. Official English also can contribute to segregation of U.S. citizens from noncitizens, despite their country of residence. Let us have Be lgium, Turkey and Canada as examples: In these countries, no hitch was experienced and benefit achieved by the proposed law on having one official language. This should to be taken as a lesson to the Americans. Having English as an official Language will make communication for non-English speaking immigrants extremely hard. Federal publications in other languages, for instance, are used to clarify tax laws, veterans’ benefits, consumer protection, medical precautions, fair housing rules, and business regulations. The process involved in enacting the rules governing law, and its implementation is also wanting. Yaldem points out that there will be need to have departments to define English and how it must officially be used. Alignment on how it is to be taught in schools and creating a list of possible exceptions with the likes of airport signs should also be implemented. Such processes are too involving and costly thus not worth it. The most affected are non English speaking i mmigrants because accessing and rendering services becomes a significant problem. Communication is an essential aspect of the day to day life. Without it, it leads to frustrations and other adverse psychological traumas associated. Making English as an official Language in America will deny foreigners a chance to live in United States as the foreigners will be expected to be in a position to speak English before they are allowed entry into the country. Immigration interpreters who help during mental and physical examination of aliens seeking entry to the State will not be availed which means the burden of communication lies squarely on the foreigners. The immigrants involved in court cases will also have a rough time in defending themselves because of lack of interpreters in civic, federal and criminal proceedings. Accessing social and health care services becomes a problem too. Employing people with a variety of languages is advantageous especially in public places such as in hospi tals as it makes communication easy among people from different backgrounds hence this should be taken into consideration by those proponents of a single official language. Since early 19th century, United States has been allowing immigrants to the country. An analysis made from the census report indicates that there has been a fast growth in immigrants learning English. The number of immigrants who have developed interest in learning English has grown from 1.9 percent to 6.2 percent

Marketing Strategy for Burke Museum Assignment Example | Topics and Well Written Essays - 4500 words

Marketing Strategy for Burke Museum - Assignment Example The report will also define the segments which need to be addressed by the museum in order to enhance its business. The later part of the report explains the marketing plan which needs to be implemented by the Museum which would be helpful to achieve targets, and finally it concludes with the sales forecast and the Marketing Mix. Although museum visiting trends patterns are substantial in Australia, still there are many factors which will play an important part in the acceptance of the Museum in a society where visiting library is a preferred leisure activity for people. Museums play an important role in providing the people with entertainment in their leisure time. In order to enhance their market share Museums should focus on implementing new marketing strategies in order to attract more customers and increased market share (Peschiutta, 2001). Many established museums and cultural organisations cannot only rely on income generated; the public funds are decreasing with an increase in the attendance of people visiting these museums. With the increasing demands of greater accountability from government and funding bodies the planning and implementation of successful marketing strategies has become more important (Laczniak and Murphy, 1977). Weak or no marketing practice can lead to a big trouble for even a well-established Museum. The challenges facing the Museums are to adopt appropriate marketing strategies and technologies in order to make its presence well felt by the customers to generate and get as much. Burke Memorial Museum, Loch Street, Beechworth, Victoria 3747. Over the past several decades the Historical Burke Museum has served the purposes of research and education of the local community related to the history of Australian culture. Furthermore, without neglecting the necessity to provide knowledge, education, and entertainment through a highly aesthetic presentation, the museum's directorate is also seeking to blend the new concepts of muse ology and the scientific theories regarding the interpretation and presentation of material and immaterial cultural heritage in a way that the modern visitor can understand. Privately founded Museum has a total of 7 staff members with 15,000 objects in the collection and a current income of approximately 136.500,00 AUS$. The Museum is now aiming at increase in the revenue at least to 800.000,00 AUS$ in order to bear the expenses in new building. To achieve the purpose it is important to plan a marketing strategy, which can eke the management in acquiring the desired target. Mission Statement of Burke Museum: Burke Museum aims to: - Collect, keep, and preserve objects from the area of Victoria as well as related evidence of the life of the local people in the pre-industrial and early industrial period - Help the local people to become aware of their cultural identity and its history - Promote education - Introduce visitors from Victoria and all over Australia to local culture. 1.2 Objectives: The museum's broad objectives are: - To increase visitor numbers by a policy of communication, public relations, and

AMERICAN HISTORY Essay Example | Topics and Well Written Essays - 1000 words

AMERICAN HISTORY - Essay Example easingly removal under compulsion after his term, resulting in a deteriorating relationship between the Native Americans and the government and erupting oftentimes into bloody battles like the Battle of Tippecanoe and the loyalty of the American Indians to the British in the War of 1812 (Harrell 261-262) Jefferson had misgiving about the Louisiana Purchase because of serious constitutional issue attached to it. However, he viewed it as vital strategically to the US because of the New Orleans port directly accessing the Mississippi River, outlet for American trade with the outside world. He feared France’s control of the Mississippi. Thus, he justified the Purchase as an exercise of extra-constitutional power by the presidency (Harrell et al 247-248). Q1b. Discuss the impact of the Louisiana Purchase and Andrew Jackson’s removal policies on the Native Americans. Discuss the long term impact of Worcester v. Georgia on both Native Americans and the checks and balances system. In 1830, Congress passed the Indian Removal Act, a law strongly supported by President Andrew Jackson. The Act provided for the voluntary removal of the North American Indians from the east of the Mississippi to the west of it. The Louisiana Purchase in 1803 had long encouraged the belief that this was possible. The removal law worsened the tension between the North American Indians and the United States which was already palpable even before its enactment as can be evinced from cases like the Cherokee Nation v Georgia, 30 US 1 [1831], and Worcester v Georgia, 31 US 515 [1832] (Norgren et al 6-7). The Worcester case, together with the Cherokee Nation case, established the legal framework with which the American Indians are to be governed with respect to their political and property rights. In the Worcester case, Chief Justice Marshall declared the possessory rights of the Cherokee Indians, a right which they can however relinquish in favor of the White Americans. The implication of the

Cyber schooling in education Essay Example | Topics and Well Written Essays - 750 words

Cyber schooling in education - Essay Example One of the biggest problems with cyber schooling is that there are not many opportunities for students to interact with each other. This interaction plays a significant role in motivating the students to continue schooling because they feel that the university is offering them more than just an educational experience. According to Lee and Chan (2007), â€Å"Students of all kinds want a sense of belonging to a larger university community, rather than simply being an enrollee, or worse still, a statistic, in a course". According to several studies, as argued by Lee and Chan , â€Å"this can be attributed in large part to the isolation experienced by these students†. In addition to contact with other students, people who are enrolled in online courses have to compromise on another vital interaction, that is, communication with their teachers. Face-to-face interaction can reveal emotions related to learning; however, cyber school teachers cannot see their students. Due to this li mitation, they cannot pick up on whether their students are interested in the class, as can teachers in a traditional classroom setting.Therefore, cyber schooling does not give its students equal footing with other students learning in person because they do not get the same kind of attention. Especially in classes where some students are learning online and others are learning in person, there can be "serious concerns of fairness and equity" .

Paper Essay Example | Topics and Well Written Essays - 250 words - 23

Paper - Essay Example He embodies the transformational democratic leadership style that allows people within the company to exercise better control of their visions as a whole. Ideally, his transformation comes with selling out his vision and inspiring workers to participate in the building of the company. He is empathetic and knows that people only grow if they have the right training and vision to achieve their goals. His communication strategy is from top-to-bottom and bottom-to-top (Hackman, & Johnson 256). He knows that the only way of achieving success is by allowing people to be involved in the process of running the company. He offers the guidance and allows everyone to make contributions. He also values quality and does not seem perturbed by allowing others to chip in. This kind of emotional stability has made it easier to push the company to higher heights and attaining the intended growth with the company for the longest time possible (Hackman, & Johnson

CTA #4 Essay Example | Topics and Well Written Essays - 250 words

CTA #4 - Essay Example This is because most of his behaviours were contrary to how a coach should be. The coach should be available for the function of reinforcement, provide feedback to the employees with respect to their performance and motivate them. Instead, the supervisor was rarely available to act as reinforcement and feedback was provided rarely. My goal in future is to ensure that I function as a coach who understands the importance of coaching and the aspects involved that include feedback and motivating. This will ensure that I become a better leader in the organization. The time frame for submitting feedback to the employees would be the shortest possible because they like keeping track of their performance so that they can improve in the areas that are proven wanting. Success would be measured through comparing present and previous employee performances. If anticipated outcomes are realized, then the practice is maintained. If otherwise, additional strategies are applied until the expected results are

Paper Essay Example | Topics and Well Written Essays - 250 words - 23

Paper - Essay Example He embodies the transformational democratic leadership style that allows people within the company to exercise better control of their visions as a whole. Ideally, his transformation comes with selling out his vision and inspiring workers to participate in the building of the company. He is empathetic and knows that people only grow if they have the right training and vision to achieve their goals. His communication strategy is from top-to-bottom and bottom-to-top (Hackman, & Johnson 256). He knows that the only way of achieving success is by allowing people to be involved in the process of running the company. He offers the guidance and allows everyone to make contributions. He also values quality and does not seem perturbed by allowing others to chip in. This kind of emotional stability has made it easier to push the company to higher heights and attaining the intended growth with the company for the longest time possible (Hackman, & Johnson

Information Security Physical Security models Essay

Information Security Physical Security models - Essay Example It achieves this by describing steps followed to achieve security goals of an institution. Security models are great tools in evaluating the security in place. Gregory (2010) outlines information various security models that have been developed such as the following: The Bell-LaPadula model is evidently a notable achievement in computer security. Several other models followed suit, with either improvements on their predecessors or variations. The Harrison-Ruzzo-Ullman (HRU) is an example of a general model in comparison to the Bell-LaPadula model which captured confidentiality aspects of access control. There emerged other models such as Chinese Wall model, the Biba and Clark-Wilson models that were more integrity based as well as the Information flow and non-interference models that centered on perfection. All these models were developed to safeguard information and information systems from leakages, unauthorized access and rights violation. However, the above models are more software based rather than physical. Threats to physical security involve disruption of services, theft, malicious physical damage, unlawful leakage and loss of system reliability. In any case, however, similar to general information security, physical security calls for a layered defense model. A layered security model will emanate from the perimeter and zero in on the asset; in this case, information. Layered security models will serve to achieve: deterrence, delaying, detection, assessment and response in a bid to fulfill the security objective. A physical security model must, therefore, be able to address the above threats efficiently and comprehensively. According to the US Army Field Manual 3-19.30 (2001, January 8) physical security is that part of physical measures designed to ensure the safety of personnel; to thwart unlawful access to equipment, the installations

Number Sense, Numercay & Place Value Essay Example for Free

Number Sense, Numercay Place Value Essay Once a basic number sense has developed for numbers up to ten (see Developing Early Number Sense) a strong sense of ten needs to be developed as a foundation for both place value and mental calculations. (This is not to say that young children do not have an awareness of much larger numbers. Indeed, there is no reason why children should not explore larger numbers while working in depth on tenness). Ten-Frames Ten-Frames are two-by-five rectangular frames into which counters are placed to illustrate numbers less than or equal to ten, and are therefore very useful devices for developing number sense within the context of ten. The use of ten-frames was developed by researchers such as Van de Walle (1988) and Bobis (1988). Various arrangements of counters on the ten frames can be used to prompt different mental images of numbers and different mental strategies for manipulating these numbers, all in association with the numbers relationship to ten. For example, examine the three ten-frames below. What numbers are illustrated? What does the particular arrangement of the counters prompt you to think about the numbers? What can you say about each numbers relationship to ten? Frame A: There are five counters; perhaps seen as a sub-groups of three and two, either by looking at the clusters at either end of the frame, or by looking at the number in the top and bottom rows. Frame B: Again there are five counters; perhaps seen as three in top row and three in the bottom, or as four and one, or two and two and one. It is also noticeable that there are five empty boxes remaining, in a similar shape to the full boxes. This prompts the awareness that five and five make ten. Frame C: This arrangement strongly illustrates the idea that five and five make ten. It also suggests the idea that half of ten is five. This type of thinking would not occur if the five counters were presented without the context of the ten-frame. Plenty of activities with ten-frames will enable children to automatically think of numbers less than ten in terms of their relationship to ten, and to build a sound knowledge of the basic addition/subtraction facts for ten which are an integral part of mental calculation. For example, a six year old child, when shown the following ten-frame, immediately said, Theres eight because two are missing. This child had a strong sense of ten and its subgroups and was assisted by the frame of reference provided by the ten-frame. Once this type of thinking is established, the ten-frame is no longer needed. Although dealing with whole numbers initially, the part-part-whole thinking about numbers supports the understanding of fractions, in particular tenths. Place Value Ten is of course the building block of our Base 10 numeration system. Young children can usually read two-digit numbers long before they understand the effect the placement of each digit has on its numerical value. For example, a 5 year-old might be able to correctly read 62 as sixty-two and 26 as twenty-six, and even know which number is larger, without understanding why the numbers are of differing values. Ten-frames can provide a first step into understanding two-digit numbers simply by the introduction of a second frame. Placing the second frame to the right of the first frame, and later introducing numeral cards, will further assist the development of place-value understanding. Games Ten-Frame Flash (5-7 years) 4 players Materials: A dozen ten-frames with dot arrangements on them, a blank ten-frame for each child, counters. Rules: One child shows a ten-frame for a count of three, then hides it while the other children place counters in the same positions on their frames from memory. The flasher shows the card again and helps each child check his/her display. After three cards the next child becomes the flasher and so on, until everyone has had a turn.

Environment issues and energy saving methods

Environment issues and energy saving methods Environment issues and energy saving methods Hotels and resorts use intense amounts of natural resources (e.g., water, electricity) in providing luxurious accommodations for guests. These practices pose risks to the natural environment, on which the tourism industry relies. Energy management has been an important part in the environmental protection and welfare of human being. Due to the unprecedented rise in prices of some sources of energy use and their non-renewable characteristic (UK uses 95% of the energy source come from non renewable energy), therefore there is a need to preserve, reduce and to find alternative source of energy (Energy Efficient Office, 1994; Chan Lam, 2002; CHOSE, 2001; Verlag, 2003; Verginis Wood, 2001). There are many factors such as size, occupancy, age of facility and geographical location; can contribute to the energy consumption of a hotel and thus with a proper energy management can help to reduce the cost and magnitude of savings. For a hotelier to successfully develop an environmental friendly hotel, he first need to create an environmental policy-is an agreed documented statement of a companys stance towards the environment in which it operates (www.environmentalpolicy.org.com) which include its intent to reduce waste, encourage recycling and carbon footprint and uses of natural resources on a daily basis and this will in turn be passed onto the staff. The company can then use this environmental policy to apply for ISO 14001, -is a guide to environmental management principles, systems and supporting techniques. ISO 14001 is the internationally recognised specification for an environmental system within the organisation. This gives a company the accreditation that it is in accordance with the legislation and is environment friendly (www.environmentalpolicy.org.com) How the accommodation manager at operational level can reduce energy consumption? There are mainly four areas of a hotel that the accommodation manager can save energy namely: Lighting Heating, ventilation and air conditioning ) Laundry and kitchen General operations (such as, pumps, steam boilers swimming pools Lights -represent approximately 15-20% of hotel electricity consumption Halogen lights sources generally last 2-3 times longer than incandescent lights and are 10-50% more efficient. Long product life reduces the amount of solid waste generated and maintenance costs associated with changing bulbs. Periodic cleaning may be necessary to keep them of peak rated efficiency(my ton.1996.greening your property). Lights can be switched off in areas not in use and if occupancy is low, the some floors can be closed to access and do not need lighting or few and heating. Other ways to save on electricity could also be to install switches, timers, dimmers and motion detector. By regularly cleaning light fixtures, replacing light shades with translucent types and using brighter colours on walls will also improve efficiency of lighting. Bedroom the most important part of a hotel Natural carpeting can be use instead of those made from wool, sisal or coir, which uses lots of energy for its manufacturing and also uses non-renewable products as raw material. Instead of changing bed linen daily, it can be kept for a longer period of time unless objected by the guest and thus the hotel will save on water and might as well wash linen at a temperature of 40Â °C instead of 60Â °C resulting in a third less energy being used.) The heating ventilation and air conditioning system uses between 25-40% of total energy of a hotel. A proper energy management will involve regular maintenance, sensors and other smart controllers, load reduction measure and fan motor and chillers replacement or upgrades or better indoor air quality (my ton.1996.greening your property). Kitchen and laundry Hotel laundry and kitchens can consume lots of energy and water as well as detergents and other chemicals. By maintaining the equipment as well as their proper use, energy can be save and also improve their efficiency for example keeping the oven away from the refrigerator. General operations During periods of low occupancy, group guests in relation to mechanical and electrical system this will result in energy savings in unused areas (my ton.1996.greening your property) Laundry can be done at night times when the energy rates are at lower prices examples British gas rates are cheaper after 9am (off-peak). Equipment that are energy efficient can be brought for examples those who have the sleep feature when not in use Bathroom Using towels for more than one day, vanity packs that contain shower case, cotton wool and sewing kits can be given only on request of the guest wastage, shower gels might as well be given in refillable dispensers instead of small pack thus preventing and saving natural resources. Product use in cleaning contain toxic chemicals instead hotel can use those that are non bio-degradable and are dispensed in sprays instead of aerosol cans thus contributing to the environmental protection and safety of staff Examples of hotel in UK 1)The Wyndham worldwide brand for example, Travelodge in the UK, work globally and locally with environmental best practise and product along with the help of employees and abide to the legislation, they focus on Educating and influence all internal and external stakeholders Reducing energy consumption and track performance Reduce water usage and recycle Improve air quality Minimise waste and reusing material Implement sustainable procurement practises Some action they undertaking to educate the customer are To encourage them in giving some advice on how to save energy To encourage them to use the same sheet and thus save energy and water usage Turn off lights, air conditioner or heater and turn off water when brushing teeth and have quick shower Bring own toiletries (Source from uk green hotels, eco-friendly. www.wyndham.com) 2) Number 43 a small boutique hotel in UK intends to save energy by these following procedures: Replacement of light bulbs with energy saving ones Encourage staff and guests to switch off unwanted appliances or equipment Make sure that staff are aware and the importance to turn radiator down/off thermostat when room are unoccupied Closing curtains where appropriate Make sure staff are aware not to overfill kettle Heaters or air conditioners are off on floors are not in use Installation of double glazing where possible Ensuring all new appliances are energy efficient Using Dryer Balls in laundry operation (Saves 25% on running time) Check the levels of thermal insulation on all cooking appliances to avoid unnecessary heat loss. Avoid opening oven doors by using the viewing windows to inspect food. (Source from environmental policy of number 43 boutique hotel www.no43.org.uk) Details of how the structure and design can help with environmental issues? Hotels consume more energy (Â £/m2) than industrial buildings, naturally ventilated officers and secondary schools, according to the Energy Efficiency Office). Structure of an eco friendly hotel.. The structure of a hotel can be altered in such a way so that energy can be save and thus reducing the cost. As mentioned before practises such as changing bulbs to compact fluorescent bulbs, or sensitive motion lights, key cards that monitor the switching of electrical appliances and so on, a hotel can do a lot more about its structure, for example Use of furniture made up from recycle product for e.g. in bedroom, bathroom and all around the hotels Use of low emission paint for interior decoration and artist paintwork so that it ensure low carbon emission, does not contain solvent or release harmful gases or compound that can cause environmental effect. Carpets mattress can be made from natural fibre such as horsehair, flooring if of carpet can be use with new technology that is under floor heating and act as an insulator, green carpets can be made from recycle product as well.(www.greenfloors.co.uk) The Pavafloor Thermal System is a thermal insulation system for solid floors where a solid wood or dry fix tile system is specified. Wood fibre boards have particularly good health and environmental benefits, helping to control internal moisture levels, being entirely non toxic, and also locking up carbon in their use.(www.greensteps.co.uk) The wall- different product can be use for insulation for inside and outside of a hotel, it can be made of wood fibre and be placed on masonry wall to cover and protect it.(www.greensteps.co.uk) The key card system that can activate room services such as lights, TV and other electrical equipment can reduce the CO2 emission. By using a programmable thermostat, hotels can save a lot on energy for heating and air conditioning since they can preset the temperature as per the time of day or season and temperature of the day. Setting a thermostat two degrees cooler in winter and 2 degree warmer in summer saves 2,000 lbs (909kg) of CO2 a year. (www.IHG.co.uk) A displacement air conditioning system uses less energy than a window unit one and also makes less noise. Other practises such as using recycle product such as furniture help to save energy and resources. (www.IHG.co.uk) Water efficient showerhead contains vacuum flow valves which pumps air into water stream, it is as refreshing and powerful as normal ones except that it uses less water thus less energy, this can also be done to the tap used in bathroom as well High efficiency toilet uses up to 6 litres and new one with dual flush uses as little as 3 litres. The Interflush enables the WC, which would usually release the entire contents of the cistern when flushed, is converted to one, which only releases water whilst the flush handle is depressed. Therefore, only the exact amount of water required to flush the pan is released. Once the pan is clear, simply release the handle to stop the flow of water. (www.greensteps.co.uk) Roofs planted with low-maintenance plants such as sedums improve the thermal performance of buildings, helping to keep them cool in warm weather and insulating them in winter.-The plants and the thin layer of soil also work like a sound barrier, especially when its wet, thus helping to reduce noise pollution. Other environmental benefits include improvements to air quality, biodiversity and storm water runoff.(www.ihg.co.uk) Recovery of exhaust heat from air conditioner or heater can be used to warm or cool adjacent rooms by using a method that do not mix the incoming and outgoing of air and transferring and thus save energy(www.uswitch.co.uk) Natural lava stone signage at the entrance and on the lawns replaces traditional plastic and metal signs use in gardens and pools can use water that move in cycle and there is no wastage,encouraging plant growth and green vegetation may help in soil erosion and noise pollution and save as well on The design of a building Climate-responsive design is based on the way a building form and structure moderates the climate for human good and well-being(www.facilitiesmanagement/greenbuilding) Construction The building as a core The roof can be made up of different kind of material that can help to insulate, look trendy, waterproof and is also resistant and lasting, such an example will be the pavaproof pitched roof system for flat or any other type of roof. Pavaroof system uses rigid, waterproof and breathable insulation boards. The boards are tongue and grooved on all edges, allowing for rapid and simple installation.( http://www.natural-building.co.uk/pavatex_roof_systems.htm) The wall can be made up of wallpaper that is eco friendly, made from recycle materials or low emission paint examples of these paints will be oikos or NBT paint and finishes. NBT systems naturally regulate moisture to protect the building fabric while offering excellent levels of thermal and acoustic performance( http://www.natural-building.co.uk/ecopaint.html) Windows and doors- the use of double glazing and triple glazing are the most common ones use for good insulation, triple glazed gives extra thermal and acoustic performance and need not be more expensive than the double glazing one. . (www.greensteps.co.uk) The doors can be made of material such as timber withy all joints sealed and prevent heat loss; manufacturer that provides a rot and fungal decay warranty can be use. Energy efficient lift can help to save energy particularly in big hotels Volume shape and layout of the building envelope Smaller volumes give better energy economy. Smaller surface areas reduce heat loss . Open planned buildings require additional heating, orientation of windows affect solar gain (accommodation management- Christine Jones- Val Paul new edition 1996) Sitting of a building Exposed sites with high wingspreads gives reduced U values and increased ventilation rates. Elevated sites are cooler, polluted sites, e.g. noises or air, will require ventilation (accommodation management- Christine Jones- Val Paul new edition 1996). However temperature cannot be control by natural ventilation and wind effect, thus other factors such as the opening size of windows, when to open it, location, size, and indoor temperature need to be taken into consideration. Therefore cooling/heating systems need to be in place. It is important to carefully select the type of heating system use, if it is an HVAC system (a computerised control system for climate control in building) being use, care should be taken so as the appropriate temperature is being use and thus save energy, that is a set temperature and set points, Limitation of the thermal output and ventilation rates. Use of timers, motion sensitive and thermostat can be an advantage New innovative heating system such as the Underfloor heating system seems to be a good investment, it uses a ground source heat pump to supply hot water and heating, enhancing the buildings energy efficiency and reducing its impact on the environment.(www.uswitch.co.uk) Solar system can be use to generate the energy required for a hotel and this source of energy is readily available and renewable. It can be install on roof of building where there will be a big areas for the panels. . Water plant can be installed in a garden underneath and it help to collect rain water, this can be use for irrigation, toilets and other purposes thus saving energy. Other example can be the use of biogas, geo-thermal , bio-mass boiler and insulation and wind power but all these will depend on the location of the building and the capital available to invest in these and might be use for future source of energy The legislation Eco design for energy-using products regulation 2007 SI 2037- sets out requirements for energy-using product manufacturers to reduce the negative environmental impacts of their products, and to ensure free trade of these products throughout the EU.( www.netregs.co.uk) It came in force in august 2007 and implement that an authorised person need to inspect that the product being bought and carry out test and ensure it is in comformity with the product requirement that is being eco friendly. Buildings Regulations 2000, SI 2531-Introduces requirements for builders to calculate and display energy ratings on new or altered buildings (www.netregs.co.uk) It implement that the building for example a hotel need to be of the specific height, floor area and so on, be in accordance to the UK law Energy information (household air conditioners)(no2)regulations 2005 SI 1726-Requires household air conditioner suppliers to provide labels showing energy consumption, and dealers to display this information to potential buyers (www.netregs.co.uk) Energy information (lamps) regulations 1999 SI 1517-Requires regulated lamp supplier to include a label showing the energy efficient, luminous flux, wattage and average rated life on the lamp or its packaging. Dealers must ensure lamps are labeled with this information (www.netregs.co.uk) Energy performance of buildings (certificates and inspection) (England and wales) regulations 2007 SI 991- Expands energy efficiency ratings for certain appliances and requires household refrigerator and freezer suppliers to provide energy consumption information to potential buyers. (www.netregs.co.uk) EU regulation on a revised community eco-label award scheme 1980/2000-Expands energy efficiency ratings for certain appliances and requires household refrigerator and freezer suppliers to provide energy consumption information to potential buyers (www.netregs.co.uk) Environmental Permitting (England and Wales) Regulations 2007 SI 3538-Introduces a new system for environmental permits for industrial activities and waste operations in England and Wales, including landfill and waste incineration, and sets out the powers, functions and duties of the regulator. (www.netregs.co.uk) Clean Neighborhoods and Environment Act 2005- Introduces additional noise, litter and waste controls including site waste management plans, and classifies artificial lighting and insects as statutory nuisances. (www.netregs.co.uk) Control of Pollution (Amendment) Act 1989 c.14- Requires carriers of controlled waste to register with the Environment Agency or SEPA and outlines the penalties (including seizure and disposal) for vehicles shown to have been used for illegal waste disposal.( www.netregs.co.uk) Controlled Waste Regulations 1992 SI 588- Defines household, industrial and commercial waste for waste management licensing purposes (www.netregs.co.uk) Environmental Protection (Duty of Care) Regulations 1991 SI 2839- Imposes a duty of care on any person who imports, produces, carries, keeps, treats or disposes of controlled waste to ensure there is no unauthorised or harmful depositing, treatment or disposal of the waste. (www.netregs.co.uk) Conclusion: The importance for saving energy cannot be stretched enough, by saving energy we ensure a better future for the forthcoming generation as well as the current one in terms of our environment we living in. This report have given a general idea how energy is being saved and can also be saved in future but it also point out how difficult it can be if planning for a long term plan to save energy, to switch to renewable energy, we need to invest in solar, wind turbines and so other alternative sources, but this require investment, expertise and it also depend on the location and generating power. For short term plan, we can see that hotel are successful in adopting the new ways since it is cost effective for them and switching price is not that high and by working closely with the staff and guest of a hotels, it is easily achievable. Many hotels and customer are being environment conscious and it have become important to show their concern and also participate in the protection, thus we can see nowadays that hotel are now after the designation of being called green and that will contribute to enhance their marketing strategy and gives them an advantage to competitors as well as promote a good image of the hotel.