Sunday, June 21, 2020
I am an honors kid. I take the hardest classes I can and do well. Because of this I am labeled a Ã¢â¬Å"good kid.Ã¢â¬ And itÃ¢â¬â¢s the truth. IÃ¢â¬â¢ve kissed one guy, IÃ¢â¬â¢ve never drunk, never smoked, never had a detention, and never been grounded. IÃ¢â¬â¢m a parentÃ¢â¬â¢s dream child.My grades have always been important and school a top priority. My mom often teases me about what a perfectionist I am, asking to see Ã¢â¬Å"some variety on my report cardÃ¢â¬ instead of just AÃ¢â¬â¢s. IÃ¢â¬â¢ve never needed to be pushed to do my homework or make good grades. The sacrifice of staying home on weekends to finish projects instead of going out has been made many times.I am self-motivated and ambitious, as well as independent. My G.P.A. satisfies me and I am content with being ranked tenth in my class. Still, something is missing. I havenÃ¢â¬â¢t truly been happy.While looking for a quote to begin an essay, I came across: Ã¢â¬Å"YouÃ¢â¬â¢ve got one life to live. If you died today, would you be satisfied?Ã¢â¬ I sat and reread that for an hour, trying to take in what it meant. And then I realized, I wouldnÃ¢â¬â¢t be satisfied. In fact, IÃ¢â¬â¢d be downright furious if I died now. I havenÃ¢â¬â¢t experienced anything. IÃ¢â¬â¢ve always played it safe ... always. And high school isnÃ¢â¬â¢t about playing it safe, it is about taking chances and enjoying your adolescence. Yes, school is important, but itÃ¢â¬â¢s life that should be a priority. I needed to start living, experiencing new things. IÃ¢â¬â¢m supposed to get in trouble once in a while, screw up a couple of times. I know a whopping 16 years of life on earth can only hold so much, but I was seriously lacking in the enjoying life part. I donÃ¢â¬â¢t want to look back on my life and regret what IÃ¢â¬â¢ve done. I want to look back and be able to say I had fun. I canÃ¢â¬â¢t say my life has changed drastically since my revelation. Honestly, it hasnÃ¢â¬â¢t changed much at al l. IÃ¢â¬â¢m still striving for those straight AÃ¢â¬â¢s and IÃ¢â¬â¢m definitely not the biggest risk-taker, but I have noticed IÃ¢â¬â¢m a little more easy-going and a little happier. IÃ¢â¬â¢ve come to realize that itÃ¢â¬â¢s a life lived that matters to me, a life that I can enjoy.
Saturday, May 23, 2020
When looking at the social changes in American culture at the turn of the century, we see extraordinary differences in the accepted behaviours and thoughts of American citizens. The century saw a major shift in the way that people lived, with changes in politics, society, culture, economics, and technology. At the beginning of the century, discrimination based on race and sex was significant, but by the end of the 20th century, women had the same legal rights as men and racism had come to be seen as detestable. African Americans had a major role in the development of popular entertainment in America. Following the Civil War, black Americans, developed a new style of music called ragtime which eventually evolved into what we now know as Jazz. In developing Jazz, African Americans contributed knowledge of the dance and folk music of people across Africa. Together, these musical forms had a major influence on the development of music within the United States and around the world during the 20th century. Early jazz and blues recordings were made in the 1920Ã¢â¬â¢s and the early part of the 20th century saw a constant rise in their popularity. In addition, African Americans were making dramatic strides in the world of concert music at the turn of the 20th century. Black people formed their own symphony orchestras and began to perform regularly in major cities such as Chicago, New Orleans, and Philadelphia. By the mid 20th century cover versions ofShow MoreRelatedAfrican Americans During The 20th Century1667 Words Ã |Ã 7 Pagesfor a better part of the 20th century, that what defined a person was merely the color of oneÃ¢â¬â¢s skin. It is actually more complex than the definition provided. It is oneÃ¢â¬â¢s life experiences, such as where one lives and the things one deals with. The experiences of African Americans in the 20th century have been similar, mostly experiencing lives filled with affliction. Rather than their skin color, it was the hardships they faced that define what being an African American was all about. On a moreRead MoreAfrican Americans During The 20th Century Essay948 Words Ã |Ã 4 Pagesby the media? There are a number of stereotypes associated with African Americans in our society such as African American men are athletes, rappers, criminals, deviant, streetwise, uneducated, and unemployed just to name a few. African Americans in the media have changed thro ugh the years. The history of African Americans on TV or minorities in general is hampered by the racial conflicts and segregation that are embedded in American society. Historically, black actors have been grouped stereotypicallyRead MoreAfrican Americans During The 20th Century1261 Words Ã |Ã 6 Pagesthe most influential time frame for African-Americans in the United States would be from 1940-1970. During this time in America, Blacks everywhere were fighting against segregation and discrimination of their race. Consequently, the timeline of events that occurred during this time uncovers the numerous battles that African-American people fought in order to gain their freedom, and their rights as Americans. While these battles seemed everlasting, African-Americans were more persistent than ever inRead MoreRacism Against African Americans Became A Major Issue During The Mid -20th Century1032 Words Ã |Ã 5 PagesRacism against African Americans became a major issue during the mid -20th century. Blacks became tired of the mistreatment they had to face every day, which is why multiple civil rights activists and groups were created in order to change the system. One of these activists, or should I say extremist, was known as the most noble after presenting his 17 minute speech Ã¢â¬Å"I Have a Dream,Ã¢â¬ given in 1963. He begins his speech painting a passionate picture of racial injustice. He talks about his dream thatRead MoreAfrican American Mothers in Movies662 Words Ã |Ã 3 Pagesbirth. As people have certain ideas of how a mother acts and presents herself, there is a unique depiction particularly of African American mothers during the 20th century. At the Mothers in Movies event, we were presented with different clips to analyze and discuss. The compilation of these clips surfaced different ideas held of African American mothers during the 20th century, such as conformity to social norms, aggressiveness, and tough love. In the clip from Love and Basketball, Monica and herRead MoreThe Jim Crow Laws And School Segregation810 Words Ã |Ã 4 PagesDiscrimination was everywhere in the 20th century, and the population most affected by this were African Americans. Two of the most critical injustices committed in America during the 20th century were the development of the Jim Crow laws and school segregation. However, these injustices have been rectified as a result of the Civil Rights Movement and the decision of the supreme court of Brown v. Board of Education which brought important changes to African Americans. African Americans were deprived of many rightsRead MoreHuman Progress in the Twentieth Century Despite Two World Wars953 Words Ã |Ã 4 Pages The world in the 20th century went through the destruction of World War I and World War II and the hazard of a nuclear war in the course of the Cold War and coped to revolutionize themselves with essential developments within their societies. The world, as a whole, has advanced more than it has suffered during the turbulent 20th century because of the advancements of innovations and human right, despite the demolition of the two World Wars. The 20th century inflicted the greatest suffering to theRead MoreThe Nadir of Race Relations by John Boles: Article Analysis897 Words Ã |Ã 4 PagesRace Relations is to depict the social, economic, and, to a lesser extent, the political conditions for African Americans in the Southern part of the United States from approximately 1870 to 1930. These dates are of fairly significant importance, since they signal the historical epoch after the end of Reconstruction in which several laws and were passed to help enfranchise African Americans throughout the country and in the South in particular and the start of the Great Depression, the latter ofRead MoreThe Tyranny Of White Majority Essay1511 Words Ã |Ã 7 Pagesand discrimination throughout the 19th and 20th century. Democratic reform throughout the century were implanted to eliminate the Ã¢â¬Å"tyranny of the white majorityÃ¢â¬ Yet many scholars like Tocqueville, Fredrick Harris and WEB DuBois have challenged these results. The r eality is that the tyranny of white majority has continued throughout the 18th to the 21st century resulting in a society that has suppressed and constantly failed to integrate African American into the white society by neglecting the raceRead MoreLatino Americans And Hispanic Americans1114 Words Ã |Ã 5 PagesHispanic Americans are the largest minority group in the United States. They make up approximately 16 percent of the country s population. They are considered both an ethnic and a racial minority group. Their language, a cultural characteristic, identifies them as an ethnic minority group. Their physical appearance identifies Hispanic-Americans as a racial minority group (Healy 2012). The majority of the Hispanic American population is located in the southwest part of the country. The three largest
Monday, May 18, 2020
Underage Drinking Anyone who is below eighteen years of age is considered as underage and laws in many countries prohibit such a person from consuming alcohol. Alcohol happens to be the most commonly abused drug not only among the youth but also among adults. This paper explores underage drinking, its effects on the society and outlines what can be done to curb it. Young people are considered to constitute the largest number of alcohol consumers and they account for a large portion of alcohol sales. This is despite the strict drinking laws that govern many countries as regards alcohol purchase and consumption. Underage drinking, which has been on the increase, is allegedly the major cause of alcohol-related problems facing the modernÃ¢â¬ ¦show more contentÃ¢â¬ ¦Social influences include low socio-economic status of the individual, low levels of parental guidance and education, family or domestic issues at home, presence of a history of alcoholism in the family, lack of rules on alc ohol use in the family setting and peer pressure. The cultural norms in which one has been brought up also play a major role in how one develops and oneÃ¢â¬â¢s behavior towards alcohol abuse. Being a very big problem to the society and government at large, underage drinking may not be totally eradicated but can be reduced to manageable levels. To do this, a collective approach has to be used in implementing the various recommended prevention measures. The best approach towards reducing adolescent drinking is through numerous strategies which include school-based strategies, family, and community as well as extracurricular strategies (Komro and Toomey 3). The family strategy basically involves the parents and other family members creating a good relationship with the adolescents under their care. The parents and guardians should be good role models to their children in terms of their alcohol related behavior (Bonnie and OÃ¢â¬â¢Connell 19). For example, if a parent is an alcoholic, the child is bound to get the wrong picture about the parent and eventually get into alcohol in later stages of life as they argue that, alcohol is not bad since their parents also drink. Good rapport between parents and adolescents is vital as it sets a foundationShow MoreRelatedThe Plague Of Underage Drinking1356 Words Ã |Ã 6 PagesThe Plague of Underage Drinking Ã¢â¬Å"Every year in the U.S., roughly 5,000 people under the age of 21 die from an alcohol-related incident including car crashes, homicides, suicides, alcohol poisoning and other related injuriesÃ¢â¬ ( Ã¢â¬Å"11 Facts About Alcohol AbuseÃ¢â¬ ). That is 5,000 more teens or young adults that could be saved from this plague in this society (11 Facts About Alcohol Abuse). Underage drinking and alcoholism is a huge problem in the United States, and as a society need to make a change withRead MoreEssay about A Better Solution to the Underage Drinking Problem759 Words Ã |Ã 4 PagesA Better Solution to the Underage Drinking Problem Recently, the issue of underage drinking has become a major problem for our society. According to the National Institute on Alcohol Abuse and Alcoholism (2009), about 10.4 million young people between ages 12 and 20 have drank more than Ã¢â¬Å"just a few sipsÃ¢â¬ of alcohol. Moreover, 5,000 people under the age of 21 die each year in alcohol-related deaths including car crashes, homicides, and other injuries such as falls (NIAAA, 2009). When adolescentsRead More The Harms of Underage Alcohol Consumption Essay examples826 Words Ã |Ã 4 PagesThe Harms of Underage Alcohol Consumption Alcohol use is extremely prevalent in our society. Young people grow up seeing their parents and other adults make toast of wine and champagne at special occasions, as well as casually enjoying a few beers at a picnic. Today alcoholic beverages are frequently as common at business lunches as they are at college frat parties. Underage drinking is a huge problem which everyone must face. Under age drinking not only has devastating effects on those whoRead MoreUnderage Drinking868 Words Ã |Ã 4 Pagesextremely prevalent in our society. Young people grow up seeing their parents and other adults make toast of wine and champagne at special occasions, as well as casually enjoying a few beers at a picnic. Today alcoholic beverages are frequently as common at business lunches as they are at college frat parties. Underage drinking is a huge problem which everyone must face. Under age drinking not only has devastating effects on those who drink but also on our society. Young people illeg ally consumeRead MoreCause and Effect of Underage Drinking780 Words Ã |Ã 4 Pagespaper I will exam the causes of underage drinking and they effects that this may place on the individual, their families, and society. According to the United States Department of Health and Human Services, Young people begin to take risks and experiment as they transition from childhood to adulthood. Without support and guidance, some young people may engage in behaviors that place them and others at risk Ãâ" including using alcohol. (Youth and Underage Drinking: An Overview, 2004). As a childRead MoreUnderage Drinking As A New Phenomenon1475 Words Ã |Ã 6 PagesUnderage drinking in the US is one of the social issues, which has been responsible for numerous economic losses, accidents, deaths and crimes. Youth have become actively involved in drinking abuse, where they lose their sense of understanding and comprehension. To eradicate the social issue of underage drinking, numerous strategies have been implemented by the US government, where some of them were successful, while others were not able to produce significant reduction in underage drinking. TodayRead MoreThe Legal Drinking Age Of The United States920 Words Ã |Ã 4 Pages The legal drinking age has always been a debatable topic that people argue about all the time. Alcohol has been a drug problem for the majority of our young adults all around the world. The goal is to decrease the effects of underage drinking In the United States by keeping the legal drinking law 21. Every state had the rig ht to their own legal drinking age, therefore during the 1970 1980Ã¢â¬â¢s some states had 21 while others had 18. This problem was carried over when teenagers got behindRead MoreDrinking Age1012 Words Ã |Ã 5 PagesDrinking Age The drinking age was moved from 18 to 21 for a reason. The higher drinking age of 21 has saved many lives, helped reduce the amount of underage drinking, and therefore should not be lowered. Many studies from a large variety of sources have proven higher drinking ages have a positive effect on society. Alcohol is harmful to the development of younger people. Research has shown that an adult is less likely to bingeRead MoreUnderage Drinking Essays1216 Words Ã |Ã 5 Pageswho is under the legal alcohol drinking age. Fewer situations are more life threatening than when an underage driver has been illegally consuming alcohol, yet persists in the belief that he or she retains the ability to drive safely. Thoughts along this line are foolish at best and deadly at worst. Unfortunately the worst case scenario is all to often a common occurance among intoxicated teenage drivers. Obataining a complete grasp of the effects of underage drinking and driving require not only simpleRead MoreLowering The Minimum Drinking Age1429 Words Ã |Ã 6 Pagesand Thailand are others Ã¢â¬â with a minimum drinking age over 18Ã¢â¬ (Griggs, 1). When Ronald Reagan signed the National Minimum Drinking Age Act in 1984, its goal was to reduce less-mature adults from consuming alcohol an d performing reckless acts (Cary, 1). However, despite the current drinking age, 17.5 percent of consumer spending for alcohol in 2013 was under the age of 21. It is estimated that Ã¢â¬Å"90 percent of underage drinking is consumed via binge drinkingÃ¢â¬ ¦with alcohol abuse becoming more prevalent
Monday, May 11, 2020
Structural equation modeling is an advanced statistical technique that has many layers and many complex concepts. Researchers who use structural equation modeling have a good understanding of basic statistics, regression analyses, and factor analyses. Building a structural equation model requires rigorous logic as well as a deep knowledge of the fieldÃ¢â¬â¢s theory and prior empirical evidence. This article provides a very general overview of structural equation modeling without digging into the intricacies involved. Structural equation modeling is a collection of statistical techniques that allow a set of relationships between one or more independent variables and one or more dependent variables to be examined. Both independent and dependent variables can be either continuous or discrete and can be either factors or measured variables. Structural equation modeling also goes by several other names: causal modeling, causal analysis, simultaneous equation modeling, analysis of covariance structures, path analysis, and confirmatory factor analysis. When exploratory factor analysis is combined with multiple regression analyses, the result is structural equation modeling (SEM). SEM allows questions to be answered that involve multiple regression analyses of factors. At the simplest level, the researcher posits a relationship between a single measured variable and other measured variables. The purpose of SEM is to attempt to explain Ã¢â¬Å"rawÃ¢â¬ correlations among directly observed variables. Path Diagrams Path diagrams are fundamental to SEM because they allow the researcher to diagram the hypothesized model, or set of relationships. These diagrams are helpful in clarifying the researcherÃ¢â¬â¢s ideas about the relationships among variables and can be directly translated into the equations needed for analysis. Path diagrams are made up of several principles: Measured variables are represented by squares or rectangles.Factors, which are made up of two or more indicators, are represented by circles or ovals.Relationships between variables are indicated by lines; lack of a line connecting the variables implies that no direct relationship is hypothesized.All lines have either one or two arrows. A line with one arrow represents a hypothesized direct relationship between two variables, and the variable with the arrow pointing toward it is the dependent variable. A line with an arrow at both ends indicates an unanalyzed relationship with no implied direction of effect. Research Questions Addressed by Structural Equation Modeling The main question asked by structural equation modeling is, Ã¢â¬Å"Does the model produce an estimated population covariance matrix that is consistent with the sample (observed) covariance matrix?Ã¢â¬ After this, there are several other questions that SEM can address. Adequacy of the model: Parameters are estimated to create an estimated population covariance matrix. If the model is good, the parameter estimates will produce an estimated matrix that is close to the sample covariance matrix. This is evaluated primarily with the chi-square test statistic and fit indices.Testing theory: Each theory, or model, generates its own covariance matrix. So which theory is best? Models representing competing theories in a specific research area are estimated, pitted against each other, and evaluated.Amount of variance in the variables accounted for by the factors: How much of the variance in the dependent variables is accounted for by the independent variables? This is answered through R-squared-type statistics.Reliability of the indicators: How reliable are each of the measured variables? SEM derives reliability of measured variables and internal consistency measures of reliability.Parameter estimates: SEM generates parameter estimates, or coefficients, for each path in the model, which can be used to distinguish if one path is more or less important than other paths in predicting the outcome measure.Mediation: Does an independent variable affect a specific dependent variable or does the independent variable affect the dependent variable though a mediating variable? This is called a test of indirect effects.Group differences: Do two or more groups differ in their covariance matrices, regression coefficients, or means? Multiple group modeling can be done in SEM to test this.Longitudinal differences: Differences within and across people across time can also be examined. This time interval can be years, days, or even microseconds.Multilevel modeling: Here, independent variables are collected at different nested levels of measurement (for example, students nested within classrooms nested within schools) are used to predict dependent variables at the same or other levels of measurement. Weaknesses of Structural Equation Modeling Relative to alternative statistical procedures, structural equation modeling has several weaknesses: It requires a relatively large sample size (N of 150 or greater).It requires much more formal training in statistics to be able to effectively use SEM software programs.It requires well-specified measurement and conceptual model. SEM is theory driven, so one must have well-developed a priori models. References Tabachnick, B. G. and Fidell, L. S. (2001). Using Multivariate Statistics, Fourth Edition. Needham Heights, MA: Allyn and Bacon. Kercher, K. (Accessed November 2011). Introduction to SEM (Structural Equation Modeling). http://www.chrp.org/pdf/HSR061705.pdf
Wednesday, May 6, 2020
- MASTER OF ARTS IN INTERNATIONAL BUSINESS - - LITERATURE REVIEW- Attitudes and motivations that influence the selection of organic food among consumers Adeline MariÃ © Supervisor : M. Bloom ETU 20030459 SUMMARY General Background 4 1 Market development and cultural factors. 5 1.1 Culture influences the food choice. 5 1.2 The level of development of the country market influences organic food choice 6 1.2.1 A cross- national study of Danish and New-Zealand organic consumers. 6 1.2.2 The moderators of consumption depend on the market development 7 2 The attitudes that influence consumer 9 2.1 Attitudes and the Theory of Planned Behaviour 9 2.1.1 Attitudes 9 2.1.2 The Theory of Planned Behaviour andÃ¢â¬ ¦show more contentÃ¢â¬ ¦In a first part, we will try to understand the impact on culture on consumption and then the need to look at each country particularly. Then we will discuss the main factors that influence the consumers that is to say: attitudes, values and motivations (combined with socio-demographic factors). Eventually, we will present and analyse the research we decided to base our study on in order to develop the constructs and the propositions of the conceptual framework. 1 Market development and cultural factors. 1.1 Culture influences the food choice. The most primary factor that gives a direction to an individual is certainly is culture or region of origin. Solomon (1991, chap 15) defines it as a society s personality. It s the sharing among a population of traditions, norms, beliefs and attitudes in one country or in one specific region. Culture is the first socio-demographic factor that would affect the decision to purchase. Socio-demographic factors (Mac Carthy and Perreault, 1990, p79-81) are the dimensions that affect the consumer act of purchase in a specific consumption context. The typical ways to segment and define consumers are presented in the exhibit 1: the socio-demographic factors. Regarding this postulate, we can assume that the behaviour will be different from a country to another. For instance, Aarset et. Al (2004) highlighted that from a country to another, organic products are not seen to be
Washable wool suits with finest material and craftsmanship are very popular among men. Many Australian and Chinese companies are now introducing machine washable new blend of wool suits for increasing the sale of these suits among professionals. In 2005, a Chinese businessman and movie star in joint venture with Helain Group introduced washable wool blend suits with high quality, special performance and easy care. We will write a custom essay sample on Is there a market for wool suits that are washable? or any similar topic only for you Order Now Helian group is ChinaÃ¢â¬â¢s one the largest manufacturers and retailers of menswear. They have around more than 250 retail shops in all over China and production of 3 million per year (Yin introduces, 2005) These suits were made with special blended material to maintain their style and shape even after machine wash. Retailers have always been interested in buying and merchandising washable wool suits to enhance their sales and popularize their use among new generation. Washable wool suits are marketed in key regions of China and Australia and displayed at several trade shows and exhibitions in retail stores. Washable wool suits, which were introduced in China, were made with Australian Marino wool. As these suits were introduced it was expected that demand for Australian Marino wool will increase. These wool suits were specifically introduced for increased performance and new innovative styles (Yin introduces, 2005). In 2003, Australian company AWI and Berkeley were the first to develop the technology of these suits. Later these were introduced in China in order to increase demand for Australian wool. Currently China is the largest buyer of Australian wool. Washable wool suits are also becoming popular among other Asian countries. According to Furong, President of Heilan, introduction of machine washable wool blend suits has put Heilan group at edge of others and a major step in improving their market share. Ã In addition, he believes that the suits they produced were easy to care, easy washable, convenience and cost effective and has huge market potential in China (Yin introduces, 2005). The need for machine washed and dried suits was also felt among American and UK professionals. Men are usually looking for suits that can be machine washed, dried and can be worn without the needed of ironing. However, one problem they face is wrinkles that appear soon after machine wash ruining the expensive fine suit. The second thing of concern to men is the need of well creased and pressed suits during their jobs and business meetings. Young professionals are more interested in having such suits. For some people suits are not just for convenience but they are worn to increase your reputability and status while you work among the company of respectable people, as noticed by a fashion historian, Anne Hollander (Rohwedder, 2006). Many professionals prefer machine wash than going to dry cleaner because its easy, fast and cost effective for them. Ã¢â¬Å"Kenny Cook, a 37-year-old desk clerk for Royal Mail in London, plans to buy one of the new suits for a friendÃ¢â¬â¢s wedding later this month. Mr. Cook says he eats lunch at his desk and often drops a piece of his sandwich on his suits. Ã¢â¬ËI canÃ¢â¬â¢t be bothered to go to the dry cleaners,Ã¢â¬â¢ says Mr. Cook. Ã¢â¬ËBut IÃ¢â¬â¢ve mastered a washing machine.Ã¢â¬â¢Ã¢â¬ (Rohwedder, 2006) According to a report the new machine washable and dryer-friendly wool suits are made with 45% wool, 52% polyester and 3% lycra. That prevents wool to become as a wet as in its original form. Sale of such suits is also going high in UK and USA. However, most men think that these suits are not very hot, scratchy or shiny (Rohwedder, 2006). US retailers like Nordstorn Inc think that wash and dry suits is a great innovation and needs more development. But Catherine Hayward who is director of fashion design at British magazine thought that there is no need to have machine washable suits as these are needed to work at reputable organizations not for gardening or meat market (Rohwedder, 2006). However, different people have different thinking and many have considered a need for machine washable suits. Sales in China, USA, UK, and even in other Asian countries is gradually increasing. Works Cited Australia : Yin introduces HeilanÃ¢â¬â¢s washable wool blend suits (2005) . Retrieved from World Wide Web: http://www.fibre2fashion.com/news/textile-news/newsdetails.aspx?news_id=10076Ã Beyond the Bale Ã¢â¬â Issue 16 Ã¢â¬â Wool Suits Chinese Buyers. Suitable Attire? Suit Goes in Washer, Dryer, But Traditionalists Recoil: Ã¢â¬ËThis is the AntichristÃ¢â¬â¢ (2006) Retrieved from http://online.wsj.com/article/SB114548666330130509.html?mod=todays_us_marketplace How to cite Is there a market for wool suits that are washable?, Essay examples
Question: Discuss about theCongestive Hear Failure for Alcohol and Drugs. Answer: Congestive heart failure (CHF) is a chronic disease that is mainly caused due to the inability of the heart to pump adequate amount of blood for meeting the oxygen demand of various organs (Kemp Conte, 2012). The case study reveals the fact that Mrs. McKenzie has been suffering from diastolic cardiac failure as she has hypertension and her respiratory rate is 30 bpm. Congestive heart failure can be brought about by several causes. It can be caused by cardiomyopathy (weakening of the heart muscles), damaged valves of the heart, Ischemic cardiomyopathy, where the blood vessels supplying the coronary arteries gets blocked (Kemp Conte, 2012). Toxic exposure to alcohol and drugs can also cause this disease. Left ventricular hypertrophy (thickening of the heart muscles) that is caused due to hypertension may also act as the contributing factor. The risk factors contributing to CHF are equal to the risk of stroke, coronary heart disease. According to Kemp Conte, (2012) hypertension is the most important risk factor accounting for about CHF in 59 % of women and 39% of men (Dib, Matin, Luckert, 2012). Elevated cholesterol, diabetes and obesity are the other factors. It is evident that Mrs. Sharon McKenzie already had a past history of Myocardial infarction at the age of 65. CHF occurs in about half of the patients with MI. With CHF the stroke volume de creases but the cardiac index is maintained by an increased heart rate. The minute work and the stroke work of the left ventricles are decreased significantly further decreasing the end-diastolic pressure of the left ventricle. This complicates the myocardial infarction causing CHF. The prevention and the treatment of CHF have risen to a burgeoning public health problem. There are almost 20 million people worldwide who are affected by CHF. According to the Australian commission for health and safety, about 5.2 millions of Australians suffer from CHF, much of which is due the obesity and diabetes (Australian heart Foundation, 2018). The estimated mortality due to CHF is about 286000. It follows an exponential pattern affecting 6-10 % of the population over the age of 65. The expected cost to the disease in Australia has been recorded to be $34.8 billion (Australian heart Foundation, 2018). CHF have not only affected the physical health of Mrs. Mackenzie, but also contribute to her emotional burden. Sense of inferiority complex or discontent may come due to the inability to do daily chores. Furthermore it will also contribute to the emotional burden. CHF failure requires regular monitoring and costly medications and even hospital stay. Hence this would also affect the economic condition of the family. The patients husband may suffer from anxiety and may be perturbed about her wellbeing. Some people even face from high levels of depressive symptoms. Symptoms Underlying pathophysiology Shortness of breath Shortness of breath, which is associated to the early stage of exertion. Difficulty in breathing is related to the recumbent position due to the augmentation of the venous return to the heart (Kemp Conte, 2012). Paroxysmal nocturnal dyspnea can be caused by the pulmonary congestion with the accumulated fluid in the alveolar and the institial spaces developing pulmonary edema. Lack of appetite and nausea Fluid buildup around the liver and the gut can interfere with the process of digestion that may cause changes in the appetite (Katz Konstam, 2012). Nausea is a complex act that needs central neurologic coordination. The neurologic coordination of the components of nausea is provided by the emetic center. The onset of nausea can also be due to the changes in the hormonal levels of arginine vasopressin (Cowie Poole-Wilson, 2013). Sleeping disorders and nocturia Accumulation of the extra fluid s may increase the rate of urination at night leading to sleeping disorders (Sobotka et al., 2013). Some finds it difficult to sleep without sitting upright. Renal perfusion may increase when the patient is in a supine position as when a patient lies down the blood that has been accumulated in the extremities return back to the heart and the cardiac output increases (Sobotka et al., 2013). Compared to the daytime. The augmented cardiac output perfuses the kidney to produce more urine for decreasing the work load of the heart. Swelling of ankles Edema in congestive heart failure is due to the activation of a number of humoral and non humoral mechanisms promoting re-absorption of the sodium and water by the kidneys and the expansion of the extracellular fluid (Kemp Conte, 2012). As the right ventricle of the heart begins to fail fluid begins to collect in the feet (Kemp Conte, 2012). Fatigue Fatigue during congestive heart failure is mainly caused due to the reduced cardiac output. CHF is linked with the disruptive perfusion of the vital organs, vasoconstrictive drive and diversion of the blood flow away from the skin and muscle circulations. This diversion causes muscular fatigue. Reduced oxygen delivery can fatigue and exhaustion (Mebazaa et al., 2015). Common classes of drugs Furosemide is a diuretic drug that is normally used for eliminating the water and salt from the body (Bikdeli et al., 2013). It is used against the accumulation of the fluid in the blood. It inhibits the re-absorption of the water in the nephron by the blockage of the potassium- chloride co-transporters (NKCC22) in the Henle's loop of the nephron. This mainly occurs due to the competitive inhibition occurring in the chloride binding site of the cotransporter (Felker Mentz, 2012). It prevents the transport of the sodium from the Henle's loop in the basolateral interstitium. As a result the lumen becomes hypertonic and the interstitium becomes less hypertonic, diminishing the osmotic gradient for the absorption of the water in the nephron. The salt, water and other molecules are normally filtered out of the blood in the kidneys and the filtered fluid ultimately becomes the urine (Bikdeli et al., 2013). The sodium, chloride that has been filtered out of the blood is reabsorbed in the b lood and before the conversion of the filtered fluid in to urine. Furosemide blocks the absorption of sodium, chloride and water from the filtered fluid from the kidney leading to a profound increase of urine. Thus this medicine can be used to cure the edema in the patient with CHF and fluid retention (Felker Mentz, 2012). ACE inhibitors like lisinopril, can be used for patients having CHF, as Angiostenin converting enzymes reduce the formation of the heart damaging hormones (McMurray et al., 2013). It dilates the blood vessels to lower the blood pressure in order to lessen the heart workload. It helps in blocking the formation of angiostenin II, which narrows the blood vessels and increases the blood pressure. It works by controlling the activity of the renin- angiostenin-aldosterone system (RAAS). RAAS controls the bllod pressure fluctuations. Renin in secreted in the juxtaglomerular structure of the kidney and this then produces the angieostenin. The angiostenin is converted in to angiostenin II by the ACE which increases the fluid retention and increased blood pressure. The ACE inhibitor blocks the conversion of the angiostenin I to angeostenin II. Thus it can be considered as a suitable class of medication for Mrs Mackenzie (McMurray et al., 2013). Nursing care strategies: - At the time of admission a registered nurse should first evaluate and treat the precipitating factors that have caused the heart failure right after the admission the patient, the cardiac status of the patients should be evaluated by electrocardiogram, echocardiogram (Krim et al., 2015). The immediate drug that can be administered right after the hospital admissions are furosemide, ethacrynic acid in order to inhibit the reabsorption of the sodium , potassium and the chloride from the Henle's loop (Australian heart Foundation, 2018). Nurses should be careful regarding the dosing of the diuretics, as it is vital in maintaining the normal volume status in patients with heart failure. After the initiation of the diuretics, there should be a careful monitoring of the hemodynamics (Krim et al., 2015). Bed rest is necessary during the hospital admission for improving the diuresis, physical therapy with early ambulation is required in the first 24 hours of the admission. Foley catheter can be used if the accurate assessment of urine cannot be done due to factors such as incontinence (Krim et al., 2015). The volume status should be assessed at least once in a day, including the assessment of the peripheral edema, ascites, jugular venous pressure, hepatimegaly and body weight (Feltner et al., 2014). The symptoms should be reevaluated and focus should be given on the symptoms that triggered the hospital admission. There should be a close monitoring of the vital signs in order to see the effects of diuretics in hypotension and urine output (Bradley et al., 2013). The renal output and the balance in the electrolytes should be maintained in order to ensure the replacements of the electrolytes. At the time of the admission all the guideline directed therapies should be assessed and evaluated and should be adjusted depending on the patient's condition (Bradley et al., 2013). Beta blockers and ACE Inhibitors can be used to allow diuresis and perfusion of the target organs (Feltner et al., 2014). ARBs can be used in patients who cannot tolerate ACE inhibitors. The nurses should be cautious wh ile applying the Beta blockers to the patients who have taken inotropic therapy at the time of their index hospitalisation and those with newly diagnosed cardiac failure (Bradley et al., 2013). Reduced cardiac output, decreased ambulation increases the risk of thromboembolic events. In order to mitigate the risk, thromboembolism prophylaxis has to be administered to the patients (Feltner et al., 2014). Nurses should ausculate the breathe sound frequently for any crackles or wheezes, assess the bowel sounds for visceral congestion can change the intestinal function and hence any signs of anorexia should be reported. Nurses should encourage the patient to verbalize the feelings (Mebazaa et al., 2015). The abdomen should be palpated and any reports of right upper quadrant pain and tenderness should be reported (Feltner et al., 2014). The dietician should be consulted with for providing the necessary diet to the patient that meets her caloric needs within restricted sodium level. Nurses should be able to provide a holistic care approach to the patient, which involves provision of a calm and quite environment, helping the patient to manage stressful conditions, listen and respon d to their feelings (Rustad et al., 2012). References Alt, E. (2014). U.S. Patent No. 8,777,851. Washington, DC: U.S. Patent and Trademark Office. Australian Foundation, T. (2018). Heart attack treatment. 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J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., ... Zile, M. R. (2014). Angiotensinneprilysin inhibition versus enalapril in heart failure. New England Journal of Medicine, 371(11), 993-1004. Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., ... McDonagh, T. (2015). Recommendations on pre?hospital early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European journal of heart failure, 17(6), 544-558. Rustad, J. K., Stern, T. A., Hebert, K. A., Musselman, D. L. (2013). Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature. The primary care companion for CNS disorders, 15(4). Sobotka, P. A., Krum, H., Bhm, M., Francis, D. P., Schlaich, M. P. (2012). 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