Diabetic With Exertional Dyspnea and Anasarca: Case Study

Diabetic With Exertional Dyspnea and Anasarca: Case Study A fifty year old gentleman, a known diabetic and hypertensive presented with exertional dyspnea and fluid overload. He was detected to have renal failure and associated evidence of cardiac disease, cardiorenal syndrome Type 4. He improved with decongestive therapy and conservative management. In view of the presence of microvascular complications of diabetes, he was diagnosed as diabetic nephropathy stage 5 and initiated on maintenance haemodialysis. The approach to diabetics with renal involvement and the issues in their management is discussed. Case summary A fifty year old gentleman a known diabetic and hypertensive for eight years presented with exertional dyspnea of one month duration. Dyspnoea on exertion had been progressively worsening for one month with orthopnea for one day. He complained of cough accompanied with  ½ a cup per day of mucoid non foul smelling, non blood stained sputum for last one month. He complained of swelling feet with worsening of dyspnoea for last four days. No h/o chest pain, PND, syncope, wheeze or fever. He was a chronic smoker (25 pack yrs) and a reformed alcohol consumer 240 gms/day for 15yrs. What would be your analysis of symptoms? The exertional dyspnea is suggestive of cardiovascular system involvement. In a diabetic, hypertensive and chronic smoker, coronary artery disease or hypertensive heart disease would be common possibilities. Cough with wheeze in a smoker could be COPD in exacerbation with cor pulmonale accounting for the exertional dyspnea and swelling feet, however orthopnea, a sign of left sided cardiac involvement would be uncommon. Additionally, the duration of cough is too short to qualify for COPD. Infective causes of cough like tuberculosis need to be excluded although they cannot account for all symptoms. He also complained of decreased urine output and puffiness of face for last four days. There is no history of altered behaviour, haematuria, smoky urine, nocturia, dysuria, hesitancy or precipitancy. Two years ago patient during evaluation prior to surgery for prolapsed disc was found a creatinine of 1.5mg%. Does the differential diagnosis change in the light of the additional information? The complaints of oliguria and puffiness of face suggests renal failure with fluid overload state. It is common for Type 2 diabetics, especially with accompanying hypertension to present with early renal involvement. Therefore, although the duration of diabetes is only eight years, the cause of renal failure could still be diabetic nephropathy. The presence of renal involvement two years ago is a clue to the chronic nature of renal involvement. An acute on chronic renal failure due to respiratory tract infection could account for the sudden worsening over one month. On examination, pulse 84 / min, regular, BP 190/110 mm Hg, respiratory rate 28/min, thoraco abdominal , JVP 8 cm above sternal angle, Facial puffiness, pallor and pitting edema in upper and lower limbs noted. Trophic skin changes in lower limb were present. No asterixis, Icterus, clubbing, cyanosis or lymphadenopathy seen. Respiratory system examination revealed extensive wheeze and coarse crackles. The heart sounds were normal with no pericardial rub. Liver was enlarged, span 15cm,soft, nontender and ascites was not elicitable. Fundoscopy revealed early nonproliferative diabetic retinopathy. Rest of neurological examination was normal. What is your analysis with the given clinical findings? The patient has anasarca with pallor and hypertension. The presence of diabetic retinopathy also suggests microvascular complications have set in. Diabetic nephropathy with fluid overload state can explain most of the signs and symptoms. An associated cardiac disease like coronary artery disease may be present. Diastolic heart failure is common accompaniment that may be contributing the signs of right heart failure. Cardiac asthma can account for the new onset wheeze in a diabetic. Diabetic nephropathy with a possible cardiac pathology, cardiorenal syndrome is the most likely diagnosis. What is cardiorenal syndrome? Cardiorenal syndrome (CRS) is a pathophysiologic entity involving the heart and kidneys where acute or chronic dysfunction of one organ may result in acute or chronic dysfunction of the other. CRS Type 1 reflects an abrupt worsening of cardiac function as is seen in acute cardiogenic shock or in a patient of congestive heart failure who has decompensated leading to acute kidney injury. CRS Type 2 comprises the group of patient with chronic congestive heart failure resulting in progressive chronic renal failure. CRS Type 3 consists of an abrupt worsening of kidney function (e.g., acute renal failure or glomerulonephritis) causing acute cardiac dysfunction (e.g., arrhythmia, ischemia, heart failure). CRS Type 4 refers to a state of chronic kidney disease (e.g., chronic interstitial nephritis, chronic glomerulonephritis) contributing to left ventricular hypertrophy and poor cardiac function. CRS Type 5 reflects a systemic condition like sepsis resulting in simultaneous cardiac and renal dysfunction. Our patient seems to have Cardiorenal syndrome Type 4. The biochemical parameters, ECG and echocardiography will be needed to make a firm diagnosis. Investigations revealed Hb 10.5g/dl, TLC 13300/cumm, DLC P91L7, platelets 2.78lac/cumm, Urine albumin 4+, granular casts+, blood urea 89mg/dL, serum creatinine 5.8mg/dL, serum Na 115mmol/L, serum K 3.1mmol/L, blood sugar fasting 102mg/dL, postprandial 156mg/dL,HbA1C 6.6%, serum bilirubin 0.5mg/dL, calcium 8.4mg/dL, phosphate 3.2mg/dL, iPTH 6.9pg/ml, CKMB 19mg/dL, serum iron 48  µg /dL, serum TIBC 243 µg/dL, transferrin saturation 19.7%, HBsAg negative, Anti HCV Negative, HIV Negative. Ultrasound revealed medical renal Disease with bilateral renal cysts, size of right kidney 8.5 cms left kidney 9.5 cms. Chest radiograph showed cardiomegaly with prominent hilar markings. ECG showed T wave inversion in I, aVL,V4- V6 suggestive of strain pattern and left ventricular hypertrophy by voltage criteria. 2-D ECHO showed concentric LVH, No RWMA, EF 0.65,diastolic dysfunction, trivial TR and no AS/AR. Could this patient have nondiabetic renal disease? Is there an indication for kidney biopsy to confirm renal diagnosis in this patient? In a diabetic with kidney disease, it would be presumed that the proteinuria and azotemia is due to diabetic nephropathy especially if there is associated retinopathy and normal sized kidneys. There is no necessity to perform a kidney biopsy to confirm diabetic nephropathy as it would make no difference in the management. However, a diabetic is also prone to other nondiabetic renal diseases as in the general population that may need histopathological examination and warrant specific therapy. The clues that the renal failure is due to nondiabetic renal disease requiring a biopsy are summarised. Asymmetric kidneys or small sized kidneys are also clues to a nondiabetic renal disease but donot warrant biopsy. Our patient has near normal sized kidneys (right kidney small) with proteinuria and nonproliferative retinopathy, hence there is no requirement to biopsy. Retinopathy is present in 65% of cases of DMType2 with nephropathy, hence absence of retinopathy doesnot rule out nephropathy. Biopsy not indicated when Typical evolution of renal disease Concomitant retinopathy Biopsy should be considered when Renal manifestations are seen atypically (5-8 g/day) persists despite lowering of blood pressure * Only for Type 1 diabetes What are the stages of diabetic nephropathy? What stage is the patient in? The stages of diabetic nephropathy are as summarised in the table. Microalbuminuria is the earliest clinically detectable evidence of onset of nephropathy in a diabetic. About 20-25% of diabetics develop nephropathy in their lifetimes. The time after diagnosis has been validated after followup of Type1 diabetics and doesnot hold true for type 2 diabetics because the the time of onset of diabetes is not clearcut ina given case. It is not uncommon for clinically evident nephropathy to be present when type 2 diabetes is detected. Our patient has established renal failure, hence is in stage 5 diabetic nephropathy. Stage Glomerular filtration Albuminuria Blood pressure Time interval 1 Renal hyperfunction Elevated Absent Normal At diagnosis 2 Clinical latency High normal Absent 3Microalbuminuria Within the normal range 20-200 ÃŽ ¼g/min (30-300 mg/day) Rising within or above the normal range 5-15 years 4 Proteinuria (overt nephropathy) Decreasing 200 ÃŽ ¼g/min (300 mg/day) Increased 10-15 years 5 Renal failure Diminished Massive Increased 15-30 years What is the difference in nephropathy in Type 1 diabetes and type2 diabetes? Type 1 Diabetes with nephropathy Type 2 Diabetes with nephropathy Follows classical stages Hypertension is usually due to renoparenchymal aetiology Retinopathy 90-100 % concordance Non diabetic renal disease rare Less consistent Primary hypertension commoner (metabolic syndrome) Retinopathy 60% concordance Non diabetic renal disease 20-30% Define microalbuminuria. What is the relevance of finding microalbuminuria in a diabetic? Microabuminuria is defined as the presence of 30-300 mg albumin/24 hrs urine collection or 20-200microgm/mt in a timed urine sample in atleast 2/3 samples over 6 months in the absence of fever, infection, physical exercise, uncontrolled blood pressure or sugar, cardiac failure or haematuria. The importance of the finding is that it indicates endothelial dysfunction and is a predictor of diabetic nephropathy in 80% and 40% Type1 and Type2 diabetics. It is also is a predictor of cardiovascular mortality and is strongly associated with insulin resistance and hypertension. In a given patient it is a clue to the clinician to institute aggressive control of blood pressure and hyperglycemia to prevent progression of diabetic nephropathy. The patient was managed with loop diuretics, plain insulin, inhaled bronchodilators, nitroglycerine drip and oxygen therapy. After initial stabilisation, he continued to have raised serum creatinine, hence was initiated on maintenance haemodialysis as a case of diabetic nephropathy with ESRD. What happens to the hyperglycemia with the onset of diabetic nephropathy? What treatment modifications are required to be made for glycemic control? With the onset of nephropathy, the insulin requirement decreases and patient becomes more prone to hypoglycaemia because the half life of insulin is prolonged, renal gluconeogenesis decreases, food intake is decreased, half life of oral hypoglycemics is prolonged, diabetic gastropathy delays gastric emptying and patient frequently vomits food due to uraemia. Infact if a well controlled diabetic develops episodes of unexplained hypoglycaemia, then one needs to look for evidence of nephropathy. Biguanides and long acting sulfonylureas are contraindicated in the presence of renal failure. Glimepride and glipizide may be used if serum creatinine is less than 2mg/dL. With more advanced renal failure, patient should be shifted to insulin therapy. What are the measures that can prevent the progression of diabetic nephropathy? Large randomised control trials like IDNT and RENAAL have provided clear evidence that angiotensin receptor blockers help to prevent progression of diabetic nephropathy. The ADVANCE trial provided similar evidence for angiotensin converting enzyme inhibitors. A target blood pressure of 130/80 mmof Hg is recommended for diabetics with proteinuria. Intensive treatment of hyperglycemia with tight blood sugar control has shown to reduce the incidence of micovascular complications including nephropatrhy in multiple studies like DCCT, UKPDS and ADVANCE. Cessation of smoking, avoidance of high protein diet and control of hyperlipidemia also seem to be beneficial. Once overt renal failure has set in then tight blood sugar control may not prevent further progression of nephropathy and the risk of hypoglycaemia increases, hence the physician should use discretion in prescribing antidiabetic therapy. What are the issues in dialysis of patients with diabetic nephropathy? Although diabetics with ESRD are candidates for all renal replacement therapy (RRT) options as nondiabetics, there are many factors that make it challenging to provide RRT in a diabetic. Associated coronary artery disease and diastolic dysfunction, high incidence of fistula failure due to atherosclerosed vessels, heparin (given during haemodialysis) related bleed due to associated retinopathy, decreased osmotic gradient and poor clearance in CAPD, poor tolerance to uraemic symptoms, diabetic cystopathy and gastroparesis, preponderance to low turnover bone disease, higher incidence of infections, autonomic neuropathy, elderly age group of patients with attendant social and logistic issues all contribute to poor survival in diabetics compared to nondiabetics. Final diagnosis Diabetic nephropathy in end stage renal disease with Cardiorenal syndrome Type 4 Commentary Diabetic nephropathy has become the commonest cause of chronic kidney disease in both the western world and developing countries. Classical stages of diabetic nephropathy described in Type 1 diabetics may not be evident in the progression of kidney disease associated with Type 2 diabetics. Measures to prevent progression of diabetic nephropathy should be aggressively instituted. Patients of diabetes Type2 with kidney disease additionally have associated cardiac disease making the management of such patients challenging. Cardiorenal syndromes encountered in various situations have been recently described that have improved our understanding of the complex pathophysiology and may open new avenues of treatment in the future. Take home message Diabetic nephropathy is the commonest cause of ESRD and developing countries are likely to face an epidemic in the next two decades. Cardiorenal syndrome (Types1-5) is a recently described pathophysiological condition that has furthered our understanding of the complex interrelation between heart failure and kidney failure in diverse clinical settings. Why Are Informal Networks Important? Why Are Informal Networks Important? Introduction Informal organizations affect decisions within the formal organization but either, are omitted from the formal scheme or are not consistent with it. They consist of interpersonal relationships that are not mandated by the rules of the formal organization but arise spontaneously in order to satisfy individual members needs Ever since the Hawthorne Studies (Mayo, 1949) and the development of the Human Relations school of thought, there has been a widespread tendency towards adopting a less scientific view of organisations. There has also been a relaxation of the assumption of rational behaviour by employees and behaviour that is strictly in tune with the goals of management and the rest of the organisation. As Mayo states: In every department that continues to operate, the workers have, whether aware of it or not, formed themselves into a group with appropriate customs, duties, routines, even rituals; and management succeeds (or fails) in proportion, as it is accepted without reservation by the group as authority and leader (Mayo, 1949) This indicates that individuals in organisations do not stop being social beings while at work. This in turn relates to the very core of the essential question of how to define an organisation. The underlying assumption in this paper will be that organisations are basically a web of coalitions and that coalition building is an important dimension of all organisational life (Morgan, 1997). In consequence, various approaches have been undertaken in order to try and understand organisations. By mainly focusing on communication as the vehicle of social structures, sociologists have described organisations as structures of social interactions in a specific organisational context or culture (White, 1970). Psychologists relaxed and redefined the assumption of rational behaviour in order to understand and describe the needs of individuals in organisations. This has led to a multitude of ways to describe organisational structures, often through metaphors (Morgan, 1997). There has been a shift in the traditional view of the role of the manager and his or her workday (Mintzberg, 1973). By not relying on the normative division of work into planning, organising, coordinating and controlling, Mintzberg suggested that the workday of a manager was much less structured and based on intuition rather than formal decision making processes. What becomes apparent regardless of the method of analysis of the underlying premise is that no organisation can be described or mapped in a satisfactory manner using just formal organisational methods, let alone be managed on that basis. The Structure of Informal Networks It is important to present the concepts associated with intra-organisational social networks. The optimal terminology to describe the informal organisation depends on the purpose of the analysis. There is no one best way to interpret informal networks (Mintzberg, 1989). Informal networks in organisations are likened with the nervous system of a living organism, whereas the bones represent the formal organisation (Krackhardt and Hanson, 1993). Staying with the analogy of the human body, a superficial comparison can be made between the skeleton and the nervous system, and informal/ formal networks within organisations to help understand the function of these networks. The formal organisation is compared to a skeleton which is a strong and rigid frame and the informal organisation is compared to the nervous system which is fragile yet flexible. The skeleton is visible, whereas the nervous system is an entity with no structure without definite subdivisions. Without determined, close obse rvation, it might be difficult to recognise (Han, 1983). Why do Informal Networks Exist? Informal networks exist in every organisation and are an inevitable function within them. Individuals do not stop being social beings when placed in a formal work setting. When highlighting some of the motives for the creation and maintenance of informal networks within organisations, it is important to distinguish between unconscious and conscious reasons for their existence. Affiliation needs: To satisfy the need for belonging to a group, individuals will tend to join networks of friendship and support. As a result, a part of ones individuality is sacrificed to conform to group norms. Identity and self-esteem: Belonging to a group or informal network can develop, enhance and confirm an individuals sense of identity as a result of the personal interaction. Social needs: Traditional formal networks within organisations often offer little room for emotions, feelings or sharing of personal thought, informal networks serve as an agent for structuring and supporting a shared social reality. By relying on this social reality, individuals can reduce uncertainty and stress. Informal groups also help members to compensate for feeling of dissatisfaction with the formal leader, organization or official communication system (Han, 1983). Defence mechanism: In the face of perceived threat or general uncertainty, group cohesion can act as a defence mechanism to reduce (perceived) uncertainty and strengthen each individuals ability to respond to the threat. Risk reduction: Through diluting blame and aggregating praise, a group of workers perceive risk to a lesser extent than they would as individuals. Thus unconscious efforts of individuals to control the conditions of their existence will lead to the creation of informal groups. In addition, often more practical and very clear unambiguous conscious reasons for the creation and development of informal networks also exist. The need to know: One of the primary characteristics of the informal structure within organisations is their communications network, often referred to as the grapevine. Studies have shown grapevine communication to be both fast and surprisingly accurate (Crampton et al., 1998). And in situations when information is critically needed by an individual to perform the task at hand, the grapevine can prove and efficient vehicle for news and information, thus bypassing the formal channels of communication (Mintzberg, 1973). Politics: One of the more conscious reasons for the use of informal networks within organisations is that employees might choose to use informal channels of communication to influence colleagues or superiors in order to gain an advantage in organisational politics. Politics refers to individual or group behaviour, that is informal, ostensibly parochial, typically divisive, and above all, in the technical sense, illegitimate, sanctioned neither by formal authority, accepted ideology, nor certified expertise (though it may exploit any one of these) (Mintzberg, 1983) What is the Informal Organisation? Chester Bernard, a pioneering management theorist who studying organisational behaviour, in the classic The Functions of the Executive, described the informal organisation as any joint personal activity without conscious joint purpose, even though it contributes to joint results. Thus, the informal relationships established between groups of colleagues going for a drink after work on a Friday may actually help in the achievement of reaching organisational goals (Barnard, 1938). More recently the informal organisation has been described as a network of personal and social relations not established or required by the formal organization but arising spontaneously as people associate with one another (Davis and Newstrom, 1985). Thus, informal relationships do not appear on the organisational chart but do include relationships such as chatting together, having lunch or even getting together outside of work hours to socialise together. Informal Group Dynamics at Work Managers are often not aware that within every organisation there are group pressures that influence and regulate employee behaviour, performance and motivation. Informal groups can form their own code of ethics and an unspoken set of standards in establishing acceptable behaviour. Manager needs to be aware of the power and influence informal groups have and that they will almost inevitably form if the opportunity arises. These groups can have an extremely powerful impact on the achievement of organisational effectiveness. However the influence of these groups can be controlled and resisted if handled efficiently. The impact of informal behaviour within the formal organisational setting depends on the norms that the group adheres to. As this is the case it can be surmised that the informal organisation can make the formal organisation either more or less effective depending on how it is managed and controlled and interacts within a company. References BARNARD, C. I. 1938. The functions of the executive, Cambridge, Harvard university press. CRAMPTON, S. M., HODGE, J. W. MISHRA, J. M. 1998. The Informal Communication Network: Factors Influencing Grapevine Activity. Public Personnel Management. DAVIS, K. NEWSTROM, J. 1985. Human Behavior at Work. New York: Mc Graw Hill. HAN, P. E. 1983. The Informal Organization Youve Got to Live With. Supervisory Management 28. KRACKHARDT, D. HANSON, J. R. 1993. Informal networks : the company behind the chart, Harvard Business Review. MAYO, E. 1949. The social problems of an industrial civilization. Routhledge. MINTZBERG, H. 1973. The nature of managerial work, New York ; London, Harper and Row. MINTZBERG, H. 1983. Power in and around organizations, Englewood Cliffs ; London, Prentice-Hall. MINTZBERG, H. 1989. Mintzberg on management : inside our strange world of organizations, New York London, Free Press ; Collier Macmillan. MORGAN, G. 1997. Images of Organization. Thousand Oaks: CA: Sage Publications. SIMON, H. A. 1976. Administrative Behavior. New York: The Free Press. WHITE, H. C. 1970. Chains of Opportunity: System Models of Mobility in Organizations. Cambridge: Harvard University Press.

Emily Bronte and Wuthering Heights – the authors personal experiences in the play

Critiques say that Emily Bronte overshadowed her sister, although when compared to her more outgoing sisters, Emily was a seemingly trapped young woman. She expressed her wildest dreams through her writing. Emily, born on July 30th, 1818 in Thorton, Yorkshire, had four sisters and one brother. (Encyclopedia Americana PG 596. ) The female authors of the family included Charlotte, Anne, and Emily. Charlotte's most famous novel The Professor, along with Jane Eyre were highly praised. Anne wrote Agnes Gray. The Bronte family lived in Haworth. Mrs. Bronte died during Emily's third year. She first attended Cowan Bridge School, where she received a fairly good education, although her time there broke of early, she returned home due to her sister's death. After returning home focused more on her writing. She focused on her poetry. The imaginary village of Gondal influenced her poems. Her sister Anne co wrote some of these poems with her. She later attended a school by the name of Roe Head, but became deeply home sick and returned home. (Stapleton, Michael PG 99. Her final attempt to go to school was at Law Hill, where her and Charlotte taught. Later their brother Branwell tried influencing them to begin publishing novels because it promised a lot of money. The three sisters formed a publishing company of their own. (Encyclopedia Americana PG 597. ) Then Emily began her work on the famous well-known novel of Wuthering Heights. At first, her novel received little praise compared to her sister's books. But its acknowledgment came later. Soon Emily no longer focused on her family, writing, or school. She withdrew herself from the world around her. Her brother Branwell died on October 1st 1848, after drunken rages, that same year Emily became diagnosed with inflammation of the lungs. She died that same year on December 19th. (Www. lang. nagoya-u. ac. jp. ) Although Emily is gone, her novel Wuthering Heights will always be a legend, with its twisted passion, and compelling opposites of Emily's own life. The story begins in 1801, with a man named Lockwood who comes to rent a room at Thrushcross Grange. Lockwood then meets the master of the Grange and of Wuthering Heights. On his journey to the heights he sees the haunting ghost of Catherine, Heathcliff's long lost love. While lying in bed, he hears branches tapping the window, to put them to a halt he reaches to grab them, but to his surprise he grabs the hand of a person instead! â€Å"†¦ Instead of which my fingers closed on the fingers of a little, ice cold hand! † (Emily Bronte PG 30. ) After this astonishment and returning to Thrushcross Grange, Lockwood asks the housekeeper, Nelly to tell him the tale of Heathcliff. The story begins when Mr. Earnshaw, Catherine and Hindley's father returns home with an orphan. The boys name is Heathcliff. Hindley hates him, but Catherine comes to love him. With the death of both Mr. nd Mrs. Earnshaw, Hindley inherits Wuthering Heights. On one evening Heathcliff and Catherine go to Thrushcross Grange to pick on Edgar and Isabella, the rich children that live there. Catherine is forced to stay there after a dog bites her. After a month or so she returns and has lost her love for Heathcliff. Hindley has a son named Hareton, who he calls upon Nelly to take care of since his wife, Frances, died giving the birth. Heathcliff over hears Catherine telling Nelly about her engagement to Edgar, and runs away. He returns some years later as a young man. He plans to seek revenge on Hindley and Edgar. He soon inherits Wuthering Heights after Hindley dies, and marries Isabella to insure his ownership of Thrushcross Grange. Catherine becomes unhappy with Edgar and her love for Heathcliff returns with his arrival, although her pride will not allow her to follow her heat. She dies giving birth to her daughter Cathy. The story with Cathy begins when Edgar takes Linton, Heathcliff and Isabella's son, into their home. Heathcliff soon claims him and forces a marriage between Cathy and Linton. Edgar and Linton soon die, one right after the other, and then Heathcliff takes control of Thrushcross Grange. Which is then rented to Lockwood. Shortly after Lockwood returns to London. On returning to Wuthering Heights he sees that Heathcliff has become obsessed with the ghost of Catherine and soon dies. Cathy and Hareton, Hindley's son, are in love and plan a wedding. The story ends with Lockwood at Heathcliff and Catherine's graves. Emily's life and experiences had much to do with the writing of Wuthering Heights. Emily used her own life to fuel the writing of Wuthering Heights. Her family, her experiences, her religion, and her bottled up, neglected personality all contributed to her writing of Wuthering Heights. First of all, Emily's religion played a huge part in the story of Wuthering Heights. Emily did not limit her religion to one particular form, but when asked how she worshiped, she replied, â€Å"That is between me and god. † (Critical Essays on Emily Bronte PG 8. ) Emily beheld three main beliefs. One; that Hell exists only on earth, and no souls suffer torments after death, two; A soul that has suffered sufficiently on earth attains its heaven, Three; A soul that has not suffered is in limbo for a time, but is redeemed by others' sufferings if not by its own, after enduring the poena damni, deprivation of the desired heaven. Critical Essays on Emily Bronte PG 9. ) These â€Å"rules† are often reflected in Wuthering Heights. With Catherine, she does not go to either Heaven nor Hell, but remains on earth by the wish of Heathcliff, and states herself in the novel she deserves no Heaven. The only time she achieves heaven is when Heathcliff dies and they are once again united, even if it may not be in actual heaven. Emily also refers to Heathcliff as the devil. (Critical Essays on Emily Bronte pg13. ) When Mr. Earnshaw returns home from a trip, he brings with him a boy, â€Å"†¦ you must e'en take it as a gift from God, though it's as dark almost as if it came from the devil. (Pg 40 of Wuthering Heights) Referring to him, as a devil, but yet a gift from God is actually quite complex. It utters Heathcliff's two personalities, as God, his undying love for Catherine and his ability to control people. With his ability to manipulate a situation, he also portrays devil like qualities. Also, in the book, there is a part where Cathy and Linton are comparing their perfect ideas of a hot summer day in July. Linton's idea was a more peaceful one, while Catherine only wanted to dance and sparkle. † I said his heaven would only be half alive, and he said mine would be drunk. (Pg 237 of Wuthering Heights) Emily immediately relates the differences in their ideas of summer evenings to Heaven. Which implies that Cathy and Linton are not meant for each other. Like every one of us, family holds very important quality. Emily's family played an important role in Wuthering Heights. Influences for character mainly included her family. Emily was brought up in a large family, which was not uncommon for that day and age. As in the story, all the children were close in age. But, in Wuthering Heights, there were only two or three children in each family. Maybe this distinguishes an idea that Emily wished she had so she put it into her novel. Emily's brother Branwell fell victim to drugs, alcohol, and sex. This notes a direct portrayal to Catherine's brother Hindley. Hindley has more evil to him than Branwell, but takes on drinking and gambling. He soon blows all of his money and dies when he has no place in the world. Exactly like Branwell. Patrick Branwell, Emily's father, and an Irish man, took care of his family and loved his children. He also died early on in Emily's life, as did Mr. Earnshaw. Mr. Earnshaw devoted himself to his children. I am going to Liverpool today, what shall I bring you? You may choose what you like† (Wuthering Heights pg 40. ) With the death of Mr. Earnshaw turmoil boils among the family; it brings Hindley's hatred toward Heathcliff to the surface, similar to the Mrs. Earnshaw in Wuthering Heights. At the age of two, Emily's mom died. Mrs. Earnshaw is also not noted in the book for more than one or two pages before her death. Emily gave both the Earnshaw's and the Linton's lives with out parents. Probably because she would not of known how to write parents into there lives not knowing hers very well at all. Other factors that have affected Wuthering Heights are her family history, the novel Bridegroom and Barna, and her experiences at Law Hill School. One even her father was telling his children about their ancestors. One of the stories must have connected with Emily because she used it as an outline for her novel. The story goes that his uncle Welsh abused Patrick's father Hugh Branty, who happened to be adopted. Welsh, a representative of Heathcliff, was found on a boat and adopted by Hugh's Grandpa. Welsh later took over the household, and married the daughter of the house. Pyckett, Lyn PG 3-9. ) The Bridegroom and Barna is a story of Emily's time about two star-crossed lovers from rivaled families. Who are only united in death. Just like the Earnshaw's and the Linton's, their children fell in love and only found peace after death. While Emily attended Law Hill School, the owner of the school had two sons, one adopted and one by birth. The son by birth constantly argued and was jealous of the adopted son. This relates directly to Hindley and Heathcliff, two sons arguing for the love of their own father. (Pyckett, Lyn pg10-15. ) The last found influences towards Wuthering Heights are the traits of Emily herself. She was the only child out of six to be given a middle name. It seems as if her parents knew she would be different. She was a very quiet person who kept to her self. And when her own sister came upon her poems she was furious. (Pyckett, Lyn PG 8. ) During her life she experienced a lot of death. Death is also a main factor dealt with in Wuthering Heights. The amount of characters was cut in half by the end of the book. It also reflects the time period where people all died much earlier than they do today. Wuthering Heights was written towards the end of Emily's life. Which may be the reason the story has no theme of hope. Emily knew she was going to die, and did not want a doctor to be called in her last hours. (Critical Essays on Emily Bronte PG 51. ) She was also in a state of delusion. Probably living out the lives of her characters in her dreams. Wuthering Heights only has two main settings, Wuthering Heights and Thrushcross Grange. This portrays an example of how Emily felt trapped in her own home. She wrote to venture out. She had no love of her life yet wrote one the most passionate stories ever. In conclusion Emily's experiences, her feelings of being alone, the characteristics of her family members, and her relationship with God, all affected the outcome of Wuthering Heights. Using her religion in her novel allows you to connect with her. It could not have been written the same by any other person; because only she beheld these imaginative believes. The story is extremely personal, using references to her family member, not caring if it affected them, which may exemplify why it was written in the last stage of her life. Instead of writing about a tremendous love she had experienced, this way she has no boundaries, she may write whatever her mind will let her. Being an outsider, she enabled herself to express how she really felt, how she wished she could be. All in all, Emily Bronte and Wuthering Heights will always be remembered for their originality, and their unique qualities, not for their popular, common traits. Emily's legend lives on just like Catherine's. Lingering on Earth even after death.

Different types of stereotyping Essay

In My essay I will discuss stereotyping and different types of stereotyping. I will discuss how in todays society people are stereotyped in different many ways. In today’s society, there are stereotypes for almost any groups that individuals belong to. At some point in any person’s life, they would have experienced stereotyping. For instance, it is often said that all African Americans are good at basketball, males are more aggressive than females, Lawyers are deceitful, and the list goes on. Stereotypes are so wide spread and used so often that they seem to be a natural behaviour for human beings. (Kassin, Fein, & Markus, 2008) So, what is stereotyping? Why do we categorize individuals into groups? How do stereotypes form? Are all stereotypes accurate summations of groups? These are some of the questions that are discussed in this essay. The purpose of this essay is to give a clear explanation of stereotyping. There is a discussion of a particular incident of stereotyp ing, and this incident is applied to theories relating to stereotyping. Finally, comments are given on the effectiveness of the theories of stereotyping. â€Å"Stereotyping is a form of pre judgement that is as prevalent in today’s society as it was 2000 years ago. It is a social attitude that has stood the test of time and received much attention by social psychologists and philosophers alike. Many approaches to, or theories of stereotyping have thus been raised. This essay evaluates the cognitive approach that categorisation is an essential cognitive process that inevitably leads to stereotyping. Hamilton (1979) calls this a ‘depressing dilemma’. â€Å" â€Å"The Psychology of Stereotyping David J. Schneider p37† â€Å"Brown’s (1995) definition of stereotyping through prejudice is the ‘holding of derogatory social attitudes or cognitive beliefs, the expression of negative affect, or the display of hostile or discriminatory behaviour towards members of a group on account of their membership to that group’. This definition implies that stereotyping is primarily a group process, through the individuals psyche’s within that group. A further idea of stereotyping, defined by Allport (1954) as ‘thinking ill of others without warrant’, is that people ‘make their mind up’ without any personal  experience. This pre judgement about a whole group is then transferred to the stigmatisation of any individuals in that group. It is these ideas that the essay aims to evaluate, through the cognitive process of categorisation and the above definitions that bring about three distinct features of stereotyping, that our cognition can be demonstrated through.â €  The New Economic Sociology: Developments in an Emerging Field (edited by Maruo F. Guillen, Randall Collins, Paula England p224,225)† Media Stereotypes â€Å"Media stereotypes are inevitable, especially in the advertising, entertainment and news industries, which need as wide an audience as possible to quickly understand information. Stereotypes act like codes that give audiences a quick, common understanding of a person or group of people—usually relating to their class, ethnicity or race, gender, sexual orientation, social role or occupation.† Stereotypes are deeply embedded in every society in numerous ways. The dictionary definition of a stereotype is â€Å"one that is regarded as embodying or conforming to a set image or type.† Stereotyping or Labeling is a technique that â€Å"attempts to arouse prejudices in an audience by labeling the object of the propaganda campaign as something the target audience fears, hates, loathes, or finds undesirable.† These stereotypes become so clichà © that they begin to form daily thoughts and views and one is unable to look beyond them. Racial stereotypes specifically function mostly through propaganda of the media, due to the unlikelihood of every man travelling to every country, using the technique of ‘misinformation’ through movies, shows, and news reports. Egyptians have been stereotyped as desert residents for many years regardless of the reality and actual state of Egypt as a country. For instance, the stereotypes pointing that Egyptians are mostly uneducated due to their ignorance of the importance of education is proven false by studies of trustworthy sources. Among those studies, the one conducted by the American university in Cairo , Egypt . Al-Ahram weekly, a credible newspaper known all across the Arab world, has posted in its October issue of 1998 the following: â€Å"According to Sahar El-Tawila, the principal researcher on the team, interviews conducted with girls and boys nationwide show conclusively that work and marriage were rarely stated by boys and girls respectively as reasons for leaving school. These may be options for those who have already left school, but they are not the impetus behind their decision to leave† (Al-Ahram 1998). â€Å"Remembering Cosmopolitan Egypt: Literature, Culture, and Empire By Deborah Starr page 183† Stereotypes can have excessive damage and it can have a very negative effect on the person in view or as a whole group. Stereotyping is not just another form of making fun of people, it also encourages rejection and outcast. Stereotyping is not only cruel and harmful to people, it can also have major effects on how a person behaves and acts towards other people. It also makes who ever is stereotyping look like a fool. It also forms barriers in communication and everyday life. Conclusion To conclude, the cognitive approach alone does not give us an understanding of stereotyping. However, it does anchor the fact that through our ‘natural’ thought processes we do categorise, which leads to stereotyping. It also highlights the importance of the individual and the group. There are, however, problems that have been overlooked by cognitive psychologists which we need to understand, in order to fully understand the ‘changing dynamics and nature of stereotyping in our society’ (Howitt, et al., 1989). There is also the need to look further than the causes of stereotyping and into its effects in order to understand the processes of our thought, of stereotyping. Bibliography (Al-Ahram 1998). The Psychology of Stereotyping David J. Schneider â€Å"The New Economic Sociology: Developments in an Emerging Field (edited by Maruo F. Guillen, Randall Collins, Paula England p224,225)† Remembering Cosmopolitan Egypt: Literature, Culture, and Empire By Deborah Starr

The first thing that they said, when I told my friend I...

The first thing that they said, when I told my friend I wanted to further my studies in Reading is: â€Å"even in Malaysia you haven’t finished your studies how come you want further studies in England? And suddenly my face became white as sheet and my heart seemed like to stop beating immediately†! How could my close friend really say â€Å"rude words† to me without caring for my feelings? After this happened to me, those really mean words kept playing on my mind. Sometimes I heard people whispering in my ear and it make me harder for me to get to sleep. In spite of this, if he knew what I felt would he feel guilty? Everyday before I went to sleep, I will cry until I fell asleep because those words kept playing on my mind. When I woke up, I felt†¦show more content†¦He’s the only one can makes me happy without thinking my problems. He knows everything about my problems, especially in FCE class. I told him I couldn’t get along with FCE. Each time on Thursday I refused to come to class because I hated my self. When it speaking time I will felt aversion and embarrassed to myself. I’m the only one can’t speak properly. Without further ado I changed my mind and whispered to myself â€Å"that’s you studying English† and sometimes I felt weary because always remind my mind these words. But a sense of inferiority and shyness still reoccur. One day on Friday, which is the tutorial time. I spoke to my teacher, Ruth. She seemed like knows what is my problem. After a few minutes we was talking about my problem, then she came out with the pulchritudinous ideas which is, she asked me to tried participate with activities outside the classroom, to read a lot of books, buy a grammar book (Raymond Murphy), and so many things she asked me to do it! So I took her challenges and I test the waters. The first things I did it is I read a lot of books, I studying grammar book by myself and showed to her my notes, I wrote a diary, I went to French class and the last thing I did is I go to music class which is cello class. Now she’s really happy with me because I’m totally changed and too many improving and exulted! Now I’m not looked sad or upset in class, but I still cant changed my bad attitude such as rather quiet andShow MoreRelatedMy Personal Experience : My Experience In Nursing School1068 Words   |  5 PagesThere are many things throughout life we all look back on and really can not understand how we made it through that time in our life. My hardest time would have been the period when I was in nursing school for me. So let us start from the beginning so you may have the view that I had, not so many years ago.      Ã‚   In 2013 I was attending Walter State in the pre-nursing program, upon applying for the nursing program there I was told that they did not believe it was a good idea I attended nursing schoolRead MoreThe Most Punctual Recollections Of My Life1573 Words   |  7 Pagesrecollections that I have about learning to read and write throughout most of my life wound up being exceptionally unpleasant for me. I assume that in a manner you could even say that some of these encounters were very traumatizing for me, yet that may be a slight distortion. I can remember is as though it was genuinely the first time that I can ever recall feeling second rate about myself. I can think back about trying to figure out how to read and it seemed to be so natural, I thought I was comprehendingRead MoreAnalysis Of Augustine s Augustine 863 Words   |  4 Pagesstates, For as I became a youth, I longed to be satisfied with worldly things, and I dared to grow wild in a succession of various and shadowy loves (24). Any young adult experiences the same things that Augustine is going through. Augustine struggled with knowing the difference between pure affection and unholy desire. He becomes ashamed of himself and goes into a spiral of sorrow. In chapter one Augustine says, If only there had been someone to regulate my disorder and turn to my profit the fleetingRead MoreShort Story1728 Words   |  7 PagesAND I WAS CARRIED AWAY Ug Gianod Ako Marcel Navarra I do not want to see you again. I am angry at myself for what I have done. We haven’t seen each other for five months or more. But last night, we met at Letoile Parlor. I didn’t expect to see you there, but I found you seated in front of me. You probably noticed that I immediately look down the minute I saw you. Why I behaved that way, you will soon know. For the time being, it is enough for you to know that something had sneaked into my breastRead MoreEssay On Importance Of Reading1301 Words   |  6 Pagesif you want to develop and further your skills you need to motivate your self to read or write. You cant just assume that if you push off your reading assignments and just read quick descriptions of page numbers or articles online or just not read it at all that its better off because you will get the same grade or so on. As people always say the more you read the better you develop as a reader and writer. If you keep pushing it off over time you will regret it whe n you have to analyze hard piecesRead MoreNarrative of the Life of Frederick Douglass1581 Words   |  6 PagesPatrick Henry once said, â€Å"give me liberty, or give me death.† In the eyes of Frederick Douglass and countless others enslaved, this took on a much deeper meaning to them. â€Å"It was doubtful liberty at most, and almost certain death is we failed.† [51] Frederick Douglass was one of the most commonly known slaves to have existed. Slavery has been around since the 1700s, but the subject of slavery is controversial because it not only includes information written from former slaves, but information acquiredRead MoreThe Pursuit Of Happiness : Time, Money, And Social Connections1570 Words   |  7 Pagesbeing happy as â€Å"feeling pleasure and enjoyment because of your life, situation, etc..† Although there are a few set definitions for the word, the definition of happiness can range from person to person. Most people define happiness by naming ma terial things in their life as well as people. Setting goals to achieve one’s definition of happiness can cause them to alter their definition later on and want more than what they already have. This brings to question whether anyone is ever truly happy. In theRead MoreDescriptive Essay - Original Writing1262 Words   |  6 Pagessilently I pick up the very same pen that I had just recently moments ago put down in frustration. I go in for another attempt to write and build up a large assortment of words. As a few seconds pass, with the pen firmly gripped in my right hand, the pen and paper come together. Disregarding my momentary lapse of a creative flow, I stare down at the endless rows of horizontal blue lines. Memories surface of myself being in this situation many times over, especially being creatively stuck before I breakRead MoreBecoming A Medical Doctor1368 Words   |  6 PagesAlthough I have wanted to become a medical doctor since a young age, I have constantly challenged my career choice, but my experiences have shown me that becoming a medical doctor is still the career I want to pursue. Being a small child with parents still in school gave me many unique experiences. For example, my mother would take me with her when she would teach a late-night nutritional science lab at South Dakota State University, which was where she studied, to give my father silence to study. OftenRead MoreThe Importance Of Life In Todays Life1692 Words   |  7 PagesIt is said to never judge a book by its cover. The same should really be said in regard to the human person. Unfortunately, all too often first impression judgements are made which can fix the tone of someones entire existence. Behind his big blue eyes and under his bleached white hair, is a mind of a man who for most of his life has dealt with struggle and turmoil in regards to being comfortable in his own skin. If only humanity could look past what is seen of someone on the outside and begin to

Electronic Medical Records a Cure for Health Care Case...

1.) Identify and describe the problem in this case. The problem in this case is medical record keeping. About 12 percent of healthcare spending goes towards medical recordkeeping. Medical records have been kept in files and folders, which causes difficulty in accessing and sharing information. This problem could be maintained with electronic medical systems. 2.) What people organization and technology factors are responsible for the difficulties in building electronic medical record systems? Explain your answer. Building an electronic medical record (EMR) system comes with difficulties. These difficulties include; people, organization and technology factors. The people factor in this involves, doctors, government agencies,†¦show more content†¦This leads into the technology factor in building these systems. The technology within these different systems may not be compatible. Doctors and patients will have online access to there information within that facility, however it will limit what can be accessed with in other facilities. The goal is to make this work nation wide. With all of these different systems out there this is going to cause a huge barrier for this to happen. 3. What is the business, political, and social impact of not digitalizing medical records? Not digitalizing effects, physicians, hospitals, insurers, patients, and the US government. Physicians will continue to have to thumb through paper records if they do not digitalize medical records. This allows for error and the cost of time it takes to look through paper files. Having EMR systems gives the physician all the information they need regarding a patient at their fingertips. Hospitals will be able to reduce administrative and medical record keeping costs. With out an EMR system again errors are more likely to be made with in that hospital. Having paper files of medical records is no longer a reality. Insurers will continue to have the delay in processing claims, whereas with a digital system claims can be authorized in real-time. Patients will not be able to access medical records online and may cause error in what medications they need or are currently taking. AsShow MoreRelatedThe Importance Of A Better Care System For The Modern Age Of E Health Within The Online Medica l And Public Domains1514 Words   |  7 Pagesand employees recently the corporate office contacted our offices in regards to CEO Chief Executive Officer Beranger, †HIPAA Health Information Portability and Accountability Act information request, she is requesting research information from us on the topic. Her plans include moving the health care organization toward the modern age of e-health within the online medical and public domains on the web. The goal is within reach of building sustained longevity within hippa guidelines and federal regulationsRead MoreLong Term Complication Of Diabetes1969 Words   |  8 Pagesbody s cells do not respond properly to insulin and sometimes in both cases the blood sugar is disturbed. As suggested by Harvey, Rebecca A., et al. The patients of high blood sugar often report frequent urination and thirst and hunger more than the usual patterns. The long term complication of diabetes cause many diseases like chronic kidney failure, foot ulcer s, damage to the eyes and cardiovascular disease. In some cases the patients experience Strokes (2010). History Diabetes is one of theRead MoreIntroduction To Health Informatics Course Has Provided A Broad Range Of Health Information1051 Words   |  5 PagesReflection Paper The Intro to Health Informatics course has provided a broad range of health information that introduces the core concepts in the biomedical community. Throughout this course, my learning experience in health informatics has advance, for I was able to learn a list of materials including: the relationship of biomedical informatics and its related field; the roles of informatics in decision support systems and related health IT applications; and the importance of biomedicine and theRead MoreMedical Technology And The Future Health Of The Human Race1354 Words   |  6 Pagesand experimentation, there is no effective way to fight against them. In like manner, medical technology does not yield to other complications, such as those presented in the working environment of hospitals and nursing homes. Though some may argue that medical technology is too expensive, there is no monetary value to the future health of the human race. Medical technology does not fail to increase general health, productivity in the workplace, and more importantly, save lives. According to the CDCRead MoreHealthcare Management Systems: Features Capabilities and Operational Benefits1434 Words   |  6 PagesPatient care applications 2 Management and enterprise system 2 E-Health applications 2 Strategic decision support applications 3 2- Need of Strategic plan for IM/IT in healthcare industry 3 Rationale 4 3- Systems development life-cycle in healthcare industry 4 4- Key elements for secure access to health care and patient information 5 5- Application of systems theory in healthcare governance of IT/IM 6 References 7 1-Features, capabilities, and operational benefits Patient care applications Read MoreEssay about Management Information Systems1818 Words   |  8 PagesWeek 5- Case Studies Chasity Fenn American Intercontinental University October , 2011 ABSTRACT This paper will discuss the questions asked about the four different case studies we are to read this week. The case studies are When antivirus software cripples your computers, How secure is the cloud, Are electronic medical records a cure for heath care, and JetBlue and WestJet: A tale of two IS projects (Laudon amp; Laudon, 2012, pgs 304, 321, 522 amp; 556). WEEK 5 CASE STUDIES WHEN ANTIVIRUSRead MoreDiabetes In Diabetes741 Words   |  3 Pagesaccess to diabetes-related health care and treatment, dietary and lifestyle changes; and family and social supports from individuals living with diabetes† (Anita, Miranda, Cody, Peter, 2012). Actualizing administration programs for diabetes for underserved populations, in this case, the indigenous populations in Guatemala are consequently a global health challenge.  Population Authors Anita, Miranda, Cody and Peter constructed a mixed- methods preliminary study consisting of 23 indigenousRead MoreHcs 571 Essay3296 Words   |  14 Pagespurchased to improve quality of care, or to provide needed equipment for a new service or expansion of an existing service. The key element in capital budgeting is that the building or piece of equipment being acquired has a lifetime that extends beyond the year of purchase and it is a capital asset or long-term investment for the hospital. Capital assets are good fina ncial investments for the organization.(Finkler, Ward, amp; Baker, 2007). The Electronic health record software system is one of theRead MoreHealth Information Technology ( Hit ) Essay1862 Words   |  8 PagesExecutive Summary: Health information technology (HIT) involves trading of health information in an electronic format to advance health care, reduce health expenditures, improve work efficiency, decrease medication errors, and make health care more accessible. Maintaining privacy and security of health information is crucial when technology is involved. Health information exchange plays an important role in improving the quality and delivery of health care and cost-effectiveness. â€Å"ThereRead MoreBackground On Hiv / Aids1755 Words   |  8 PagesHIV/AIDS in promoting and sustaining health. The advances of HIV/AIDS over the years have been a step in the direction of understanding of how best to deliver primary care while at the same time give the accessibility of new medication regimens. People living with HIV/AIDS are now living longer lives through medical advancements through medication therapy and by practicing a healthy lifestyle. A first step in ensuring that patients are actively i nvolved in their care is to create systems that include

Cause And Effect Of Lung Cancer - 985 Words

Introduction The second leading cause of death in the United States as of 1933 is cancer .During this period advancements took place in treatment of infectious diseases such as pneumonia and influenza. Cancer, in turn, took its place and is a chronic illness that has no known cure. There are many different types of cancer that affects different parts of the body but lung cancer is the leading cancer killer in the United States . Cancer of the lungs also known as pulmonary carcinoma is caused by a mutation in a gene known as the oncogene that when expressed at high levels has the potential to cause an overgrowth of cells leading to the formation of a tumor. There are two different forms in which tumors maybe present; a benign tumor is one that doesn’t have the potential to metastasize, or spread. A malignant tumor is the most dangerous form of tumor that can spread to surrounding tissue and other parts of the body making the condition much harder to treat and control. The indicators or sym ptoms of lung cancer is a cough that doesn’t go away, chest pain, hoarseness, difficulty breathing or wheezing, coughing up blood or rust colored sputum, shortness of breath and reoccurring infections of pneumonia or bronchitis . Early detection of lung cancer in an individual is very hard and most people do not exhibit any signs or symptoms indicating that they have the disease. The etiologic risk factors of the disease vary from person to person and have to do with the quality of airShow MoreRelatedLung Cancer : Causes And Effects1329 Words   |  6 PagesThe leading cause of cancer death for both men and women in the United States and worldwide is lung cancer. Lung cancer is responsible for thirty percent of cancer deaths in the United States. The deaths caused by breast cancer, colon cancer and prostate cancer combined do not add up to the deaths that lung cancer causes. In 2007, 158,683 people, 88,243 men and 70,354 women died from lung cancer in the United States (Eldr idge, 2012). Out of the 158,683 people that died from lung cancer in 2007, 135Read MoreCause And Effect Of Lung Cancer1612 Words   |  7 Pagespercent. In addition, since emphysema is said to be one of the causes of lung cancer, it can be said that smoking is also related to lung cancer. As is well known, currently, there are no effective treatment for cancer. Smoking habit is the main cause of lung cancer. The probability of a smoker becoming lung cancer is said to be about ten times more than that of a non-smoker. Also, smoking hurts their own DNA, that is, the risk of lung cancer extends to offspring. There may be people who think smokingRead MoreCause And Effect Of Lung Cancer Essay1334 Words   |  6 Pages Lung cancer is one of the most lethal cancer known throughout the world. The most common suspect of that is smoking, then what happens to the people who inhales the smokers’ smoke? Are they also at risk for developing lung cancer from being a victim? The answer to that right now is that secondhand smoke alone is just a risk factor, there are no evidence right now that currently show that secondhand smoke alone can cause lung cancer by itself. This means that we need to encourage studies that areRead More lung cancer Essay1459 Words   |  6 Pagesnbsp;nbsp;nbsp;nbsp;nbsp;Lung cancer is the most common cancer-related cause of death among men and women. Lung cancer can be undetected for many years causing it to become more dangerous and possibly fatal. There is not cure for lung cancer or any cancer, but if detected in an early stage the lung cancer can be detected, treated, and hopefully terminated. There are many new and developing treatments being tested now that may save li ves in the future. Through understanding what the lung cancer is, doctors canRead MoreEssay Smoking and Lung Cancer1540 Words   |  7 Pages Oscar Wilde had no idea that smoking caused lung cancer. Lung cancer is one of the most preventable diseases that exist, yet people continue to voluntarily put themselves at risk, and it still has tragic effects on the person and their family even though there are ways to treat it. The disease itself is categorized into two types, but both are eventually fatal. The cancer has several causes, but is mainly due to smoking. It has many numerous effects, both physical and emotional. However, there areRead MoreLung Cancer : What Causes It?1420 Words   |  6 PagesLung cancer is any type of cancer that begins in the lungs, although it is still considered lung cancer after it spreads to other parts of the body. Lung cancer is one of the most common cancers in the U.S. and worldwide. Forty percent of people will be diagnosed with lung cancer with in their life span. Lung cancer, as with all cancers, is very complex, so the best way to comprehend it is to break it down into easily analyzed topics. The first topic that must be analyzed is cancer as a whole-whatRead Morelung cancer927 Words   |  4 Pagesï » ¿ Lung Cancer By Brayan Almora and Hector Aparicio Pedroza Ms. Powell, 7th Language Arts Problem – Solution Paper May 15, 2014 Lung Cancer Causes and Treatments Lung cancer is defined as abnormal cell tissue that forms in tissues of the lungs. It is estimated that there are 224,210 new cases every year, while the estimated deaths are numbered at 159,260 per year . There are several options of treatment and are as follows: Surgery, Chemotherapy, Radiation TherapyRead MoreThe Leading Causes Of Lung Cancer1350 Words   |  6 PagesCenter September 2, 2014 The Leading Causes of Lung Cancer State Standard: 6.4.A Cancer is a disease that plagues millions of people annually (â€Å"Lung†). Lung cancer develops when healthy cells in the lungs are compromised by chemicals, pathogens, or radiation (Henderson). In the early twentieth century, before cigarette smoking and toxic man-made air pollutants became more commonplace, lung cancer was relatively rare (Henderson). It is now the leading cause of cancer deaths worldwide, resulting in anRead MoreThe Effects of Smoking on the Body Essay748 Words   |  3 PagesThe Effects of Smoking on the Body Almost one third of the World’s population are smokers for one reason or another, appearance, reduce stress etc. However, I, and many others, find it very difficult to believe smoking can aid anyone’s appearance as it encourages early ageing, and I do not believe that any of the risks that smoking has is worth any amount of stress relief that it can provide. Cigarette smoking can have serious health effects on the human body. Read MoreHow The Lungs Are Responsible For Both Ventilation And Respiration888 Words   |  4 Pages 2014 â€Æ' The lungs are responsible for both ventilation and respiration. Ventilation is the mechanical act of bringing breath into the body and expelling it. Respiration is the detailed work of lung tissue, using the air brought into the body, making it available to the body through the highly vascular lung parenchyma. Lung cancer impacts both of these functions. To understand the disease, it is important to understand the causes of lung cancer, the types of lung cancer, lung cancer disease â€Å"staging†

Analyzing The Different Approaches To Leadership †Free Samples

Question: Discuss about the Analyzing The Different Approaches To Leadership. Answer: Leadership is a process in which the employees are influenced by the leaders towards achieving overall goals and objectives of the organization. It is the capability of a supervisor to encourage the subordinates to conduct the activities with confidence and dedication towards the activities assigned to them. In this paper, the first phase will discuss whether the leadership can be taught or learned by analyzing the different approaches to leadership (Johnston Marshall, 2016). Are leaders born or made? This statement has always dominated and now also dominates the study of leadership. In the next phase, different theories will be discussed and the last phase will be related to the conclusion. It is important for the leader to direct their employees so that success can be achieved. In a recent scenario, it is seen that if anyone wants to achieve success in any field it is important to have skills which can offer a chance to be a leader. It helps an individual to climb up the organization ladder. Leadership can be measured as the asset which should be there in a leader to become successful. According to Theo Haimann "Leadership is the process in which the supervisor's guides and influence the work of the others so that goals and objectives can be achieved"(Alvesson Sveningsson, 2015). Leadership is an influential process in which leader helps to regulate, control and change the behavior and performance of the overall team. It is essential for the employees to follow the instructions given by the leaders so that activities can be conducted smoothly. It is important for the leader to maintain proper relation with the employees so that it can be easy to work according to the given direction by the leader. It is analyzed that in a group, a leader has various power by virtue of which he is on the top level and also influences the behavior of the team members (Neatby, Rioux Aub, 2015). A leader has the knowledge and information about the activities and also has a formal authority to manage the activities of the organization.Management takes into consideration effective and efficient way to attain overall organizational objectives through planning, organizing, staffing and controlling the organizational resources. Leadership can be presented as a process which influences the thoughts, attitude, and behavior so that goals and objectives can be attained of the organization. It is seen that leadership can enhance the confidence and train the employees to enhance the overall output by creating trust and good atmosphere which helps to feel safe for their jobs. It is seen that leaders improve their leadership abilities through the life learning experiences and also through training and coaching. Some individuals seen that leaders are born naturally by having intelligence and visionary. It is often said that "leaders are born to lead" but it not only means that leaders are born only, but not made as to be a good leader it is important to be a follower as it is seen that true leaders do not walk in the front, they only follow the rest. In the present scenario, many corporations consider that if there is no leadership inmanagement then it is known as an ineffective activity. If there is no leadership then it is difficult to manage the resources of the organization. It is also analyzed that without leadership the activities are conducted slowly and which may result in a loss of the business. A Leader is a person who is trustworthy, confident and fulfills all the responsibilities made and manages the work seriously. It is seen that different people have a different attitude so it is important to manage them accordingly. Therefore, leadership is an important skill so that other people do right things. It is seen that it is a challenging task for many organizations to select a better leader. So, if the organizations have the right team with the inspired employees and good leadership abilities then it can be easy to enhance the overall reputation and productivity of the company (Donate de Pablo, 2015). There are some researchers who stated that leadership as a personal perspective like as a trait or behavior whereas many think that leadership is an information processing perspective. Therefore, in this paper study will be made that whether leaders are born or made? Are leaders born? In the recent scenario, there are various self-made leaders who are popular in the organization. It has become a debatable topic whether they become top by born or experience achieved. To support this argument trait theory can be taken into consideration. The trait theory of leadership is an assumption in which the leaders are born and due to this factor, the leaders who possess the qualities and traits are better suited to leadership. This theory focuses on the concept that many leaders are successful and unsuccessful and it is used to predict the effectiveness of the leadership. Common leadership traits of Trait theory are energy, creativity, flexibility and knowledge of the activities. This theory often elaborates the behavioral characteristics that are common in the leaders. In this theory, it is explained that traits are the personal characteristics a leader should have like: confidence and trustworthiness. It states that trait theory focuses on leaders are born". The advantage of this theory is that it is one of the natural pleasing theories and is valid. It helps to provide knowledge and understanding of the leader element in the process of leadership. Trait theory helps to provide constructive information about the leadership and also it can be implemented by people who are conducting their routine activities. Managers can use the information by taking into consideration this theory to analyze their position in the company and to evaluate how their position can be made stronger in the company. They can also have good knowledge of their identity and the way they will impact others in the company. By this theory the managers are aware of their strength and weaknesses and also they can understand that how they can create leadership qualities. So, this is one of the questionable statements to analyze that whether people are born as a leader. There are five aspects of emotional intelligence like self-awareness, motivation, self-regulation, empathy and social skills. This concept is also related to the trait theory (Komives, 2016). It is seen that traits are essential in the development and deployment of the individual skills. Many individuals stated that leadership is born by taking into consideration some characters like artists and players. Therefore, it is analyzed that leadership is actuall y not born. There are various examples related to this argument like: Tiger woods who is golf champion. He is born with good capability to play sports. His father worked with efficiency from his early ages to make him a golf champion. Next example is of Mozart, the musician. He was also born with the skills related to music. His father wanted to make him a good musician from his childhood. He made the efforts to train him by considering various music instruments. By analyzing the examples it is seen that their natural talent and qualities are enhanced through hard work of many years. The improvement is made by their parents and also by the influencing ability. According to Northouse (2009)," leadership is a process in which a person influences a group of individuals to accomplish the goals and objectives of the organization". This definition states that leadership is a process which states that it is not a trait or leadership characteristic but it is a relation between leader and the followers. Also it shows that leadership is not a linear event but it is a communicating event. So, it states that leadership style can be improved by practice and continuous training (Goleman, 2017). Leaders are made A successful organization needs a good leader so that the organization can achieve success in the market. To achieve this it is important for a leader to have good qualities. Some states that good leaders are made not born. If any individual needs to be a good leader then it is important to improve the leadership abilities such as goals and values. Bateman Snell (2009), states that a leader who emphasizes on affecting the company towards achieving goals can minimize the barriers by enhancing the motivation level of the employees. So, leaders should motivate others and create a cooperative environment so that activities can be conducted smoothly. It is important for the leaders to make friends rather than enemies. It is important for the leaders to create a friendly approach so that success can be achieved (Cameron, Quinn, DeGraff, Thakor, 2014). It is important for a leader to create friendly approach so that success can be achieved. In order to be a good leader, it is important to provide good training so that success can be achieved. A leader should create positive thinking so that better training can be offered to the employees. So, it is seen that one's own skills and traits are not sufficient to become a good leader. In a recent scenario, the most common phrase is "he is born to be a leader". It states that traits perspective takes a major portion of the leadership. It states that a specific person may have qualities that are inborn that can assist them to be a good leader. But training is one of the important factors that help to enhance the overall skill and knowledge (Hartnell, Kinicki, Lambert, Fugate Doyle Corner, 2016). So, training is important to be a good leader. Trait leadership states that individuals who have exceptional and inborn talent can be a good leader. Some traits are related to intelligence and height. But process concept states that leadership is an interaction between the followers and leaders. It is said that leaders require followers and also followers require leaders so that communication can be done properly and relation can be maintained effectively. Northouse (2009) suggests that leadership can also be related to the two aspects of theory X and Theory Y. Theory X focuses on the workers who are shy and want assessment by the leaders. While theory Y takes into consideration the responsibility and of some people so that organizational goals can be achieved. Also by taking into consideration theory Y, it is seen that employees are motivated (Jaques, 2017). The managerial grid is also one of the aspects of leadership in which there are various aspects of behavior related to leadership are elaborated like production and worry of an individual. Production factor is related to the task-oriented behavior like managing work and also clarifying the roles. Next factor is related to the concern for people in which the focus is given on creating trust and friendly atmosphere. As this is more related to the individual as it helps to enhance the motivation level of the employees so that vision and strategies can be achieved by the company (Fairhurst Connaughton, 2014). Next theory is related to a behavioral theory in which it is seen that individuals can become a good leader through the process of teaching, learning, and innovation. It is related to a set of skills that can be learned with proper training and learning (Eisner, 2016). Leadership learning is a lifetime activity in which the leaders learn new ways to manage and direct the employees of the organization. Good leaders seek out development opportunities that will assist them to acquire new skills. It is seen through training and coaching leaders are made (Bolden, 2016). Like for instance: If a person is promoted to a post of a leader then it is important to explain the duties and responsibilities so that activities can be conducted smoothly. Training is given to an individual so that activities can be completed with efficiency and also if proper training is given to a leader then responsibilities can be completed with efficiency. It is important to offer training to a leader because it not only enhances the knowledge but also confidence level is enhanced effectively (Clinton, 2017). To be a leader it is important to give formal training as there are many people who can manage to learn and lead the team. Since goodmanagement is related to the rules and rules can be learned and mastered only. So, a leader is an individual who comes forward to take a challenge and overcome the problem with the skills that are learned from training (Fullan, 2014). Training programs With the growing popularity of leadership theories such as behavioral theory and Theory X and Theory Y, the concept of leadership training is growing between organizations as well. In today's competitive business world, companies focus on gaining a competitive advantage based on the effectiveness of leadership styles of their executives. The corporations focus on providing appropriate training to their current executives for improving their leadership approach. Organizations can implement appropriate programs for teaching and improving the leadership style of their managers. The popularity of leadership training programs is growing continuously as the requirement of leadership grooming grows as well. Caprino (2014) provided that developing a leadership mindset is a first step for starting leadership training. Effective leadership is different from managing daily tasks at the workplace. Effective leaders encourage and inspire employees to improve their performance and achieve common o rganizational goals. However, it is not guaranteed that just implementing a leadership training program will improve the leadership qualities of managers in a company. It is necessary that the firm evaluate different factors before implementing a leadership training program such as understating difference between leadership and management, evaluating good leadership behavior, assessing organizational requirements, defining manager qualities and strengths, gaining insights, polishing interpersonal skills and others (Mitgang, 2012). These factors improve the effectiveness of training program which enables leaders to enhance their leadership traits as well. In recent years, leadership training program focus on polishing and improving specific leadership traits of candidates in order to improve their leadership approach. Leadership traits include integrity, authenticity, empathy, good communication, flexibility, compelling presence, humor, charisma, and others. The leadership training program focuses on improving these traits of candidates which improve their leadership approach (Micari, Gould, Lainez, 2010). However, most programs are unable to improve the leadership approach of candidates since it is difficult for them to indulge candidates in the learning process. Simply gaining theoretical knowledge regarding effective leadership approach did not improve leadership style of candidates. It is necessary that a customized training program is established by the company which addresses the issues faced by its managers and which focuses on improving their leadership style. The leadership program should be small, focused and supportive (Yahaya Ebrahim, 2016). It is necessary that each individual in the program must have added attention and proper time to work and improve his/her skills. A small group also facilitates greater connection and support among candidates. A strong central leader is another key requirement of an effective leadership program. For example, General Electric (GE) has implemented an intense five-year training program for its executives who get training from professional experts from different fields (Kosur, 2015). The expertise of teachers directly influences the effectiveness of the training program. During leadership training, the teachers should use multiple methods of learning leadership concepts because when it comes to leadership, one size does not fit all. It means that each person has different characteristics and traits which influence their leadership style. Leadership skills are influenced by behavior and also the skills that are possessed by an individual. Therefore, teachers should assess these qualities and implement a customized program for different candidates. Clearly describing goals and milestones for all leader participants also assist in improving leadership training effectiveness (Solansky, 2010). Teachers should set small and long-term goals for each leader participant that encourages them to achieve them and improve their leadership qualities. Effective leadership program also improves retention program in the company which enables them to preserve leaders. However, these elements did not guarantee the success or failure of a program, but it can bring leade rs closer to becoming successful which is beneficial for the entire company (Sadri, 2012). Therefore, it can be stated that leadership can be taught by implementing a training program in a company. Training programs also help to enhance the working pattern of the employees. It is seen that training helps to enhance the overall confidence level and also working structure can be managed effectively (Frich, Brewster, Cherlin Bradley, 2015). To be a good leader it is important to work with dedication and confidence so that team members can be inspired easily. However, the effectiveness of a training program depends upon a number of factors which are necessary to be evaluated by the corporation before implementing a training program (Dopson, Ferlie, McGivern, Behrens Fischer, 2016). There are various characteristics of a good leader. As it is seen, leaders are diverse and they are of different nationalities, gender and personality profiles. Effective leaders are clear about what needs to be done. It is seen that they can express their vision of a desirable future in a simple way (Bolman Deal, 2017). Leaders are ideas generators and they inspire other people to follow them. They can easily convince other to work according to them and also they have the quality to manage the conflicts that are prevailing in the organization. Leaders know how to stay calm and also they inspire others with the same technique. They use the technique that "when you lose your temper, you are not able to achieve a goal". Self-evaluation is considered as a strong characteristic of an effective leader. A good leader takes critics and tries to work on it. It is seen that no one wants to be corrected but effective leaders want to be corrected so that growth can be achieved. If negative fee dbacks are taken from the people then it can be converted easily into a positive one (Antonakis Day, 2017). It is seen that good leader manage their work life with their personal life. They do not ignore their work life for their personal life and personal life for their work life. They know how to keep up their good health by managing the work. A good leader is a good communicator. He knows how to communicate with the team members and also knows that communication is not solely conversation (Goldman, 2016).The leader focuses on making the message understandable for every team member so that activities can be conducted accordingly. Leaders listen more than they talk with the members. It is the duty of the leader to communicate effectively with each and every one within the organization. A Good leader conducts the activities as per the rules and regulations of the organization. A good leader is the one who finds a solution to each and every problem prevailing in the organization. It is also important that good leader should have a strong moral base so that their decisions can be valued in t he organization. It is also essential for a good leader to be very creative so that failure can be reduced and productivity can be improved of the workers who are working in the business (Koseoglu, Liu Shalley, 2017). Conclusion So, by analyzing the paper it is seen that leadership can be taught. It is seen that leaders can be made by bringing change in their behavior and also through training. There are no born leaders. Individuals are born with a strength that helps them to be a good leader. Leadership is considered as a skill. A good leader can be made by improving the qualities of practice. It is seen that more experience person is, more productivity can be achieved. A good leader can be made with more experience and also by improving the leadership skills. In many situations the organizations have leaders but their capability is not identified. In this case, the organization can create a good leader by offering them proper training and also by performance evaluation. If proper training is given to them, then it can be possible to conduct the activities with efficiency. This states that individuals are not born leaders. It is analyzed that individuals are born with the personal qualities that help them t o be a good leader. When duty is assigned to an individual it offers an opportunity to learn new skills and being coached by someone to inspire them. Hence, it is seen that individuals can be inspired and achieve their skills so that success can be achieved easily. References Alvesson, M., Sveningsson, S. 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