The Development And Evaluation Of Januvia Essay - 1202 Words

The development and evaluation of Januvia ® (Sitagliptin Phosphate) are illustrative of the activities that are needed to assess the efficacy, safety and effectiveness of a new product for treating type 2 diabetes milieus. It is the first drug of dipeptidyl peptidase-4 (DPP-4) inhibitors class that is approved as an adjunct to diet and exercise to improve the glycemic control.1 Januvia was developed by Merck Research Laboratories and received the FDA approval on 16 October 2006.2 Preclinical/Animal study: The animal study of MK-0431, the code name for Sitagliptin in early development phase, was done in mice, rat, and dog. Maximum recommended daily adult human dose (MRHD) of Sitagliptin was found 100mg/day and NOAEL 50mg/kg based on dog study.3 Two years of carcinogenic study was conducted on mice and rat. In rat, liver adenoma/carcinoma has been seen at 60 times of MHRD. This is probably due to chronic hepatotoxicity of the drug. No tumor incidence was observed in case of mice up to 70 times of MHRD. Both in vitro assay and in vivo mice assay was not suggestive of mutagenic and clastogenic nature of MK-0431. Fertility adverse effect was also not at 12 times of MHRD)3 and Sitagliptin was labeled as pregnancy category B.4 Based on these preclinical studies on animal, Merck submitted their Investigational New Drug (IND 65, 495) application to FDA was on August 2002.4 Phase I: Phase I of Sitagliptin study was done on 33 volunteer humans. Following 100mg of Sitagliptin oralShow MoreRelatedMba Spring2011 Merck Sample Group Project7196 Words   |  29 PagesInternal Strengths 16 Internal Weakness 20 External Factor Evaluation Matrix 21 Competitive Profile Matrix 23 Internal Factor Evaluation 24 Space Matrix 27 SWOT Matrix 29 Grand Strategy Matrix 31 Recommended Strategies 31 Recommended strategy No.1: 31 Recommended strategy No.2: 32 Projected Financial Statements 33 Projected Ratios 34 Company worth Analysis 34 Annual Objectives: 35 Strategic Review and Evaluation Procedures: 35 Bibliography: 36 Executive Summary: MerckRead MorePublic Awareness of Diabetes2445 Words   |  10 Pagesdiabetes (Centers for Disease Control and Prevention (CDC), 2011). Anyone who is 45 years or older should consider testing for diabetes, especially if he or she is overweight or has a family history of this disease. Race may also play a role in the development of this disease. Individuals who are African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino should also consider prescreening (CDC, 2011). Another group of people that are more susceptible to DM2 are lowerRead MoreMerck vs Pfizer7379 Words   |  30 Pagesfuture growth, Merck started focusing on reducing costs, making strategic investments in new product launches, and improving its research and development pipeline. Merck’s sales worldwide reached $48 billion in 2011, which was a 4% increase from 2010. With two drugs under review with the FDA, the company has 19 other drugs in the Phase III of developmen t. b. Pfizer Inc.: History And Background Information Found by Charles Pfizer and Charles Erhart in 1849 Pfizer, Inc. is the largest pharmaceutical

Vaccines Do Not Cause Autism Essay - 3070 Words

Vaccines have been used to prevent diseases for centuries, and have saved countless lives of children and adults. The smallpox vaccine was invented as early as 1796, and since then the use of vaccines has continued to protect us from countless life threatening diseases such as polio, measles, and pertussis. The Center for Disease Control and Prevention (2010) assures that vaccines are extensively tested by scientist to make sure they are effective and safe, and must receive the approval of the Food and Drug Administration before being used. â€Å"Perhaps the greatest success story in public health is the reduction of infectious diseases due to the use of vaccines† (CDC, 2010). Routine immunization has eliminated smallpox from the globe and†¦show more content†¦This led to the support of various unproven vaccine-autism theories by parents in both the UK and America. After findings of intestinal disease in children with autism, Wakefield claimed that separating the MM R into three different vaccinations would be safer. Since then, Wakefield’s research has been discredited, he was charged with serious professional misconduct by the General Medical Council for violating several ethical practices, and he was investigated for failing to disclose conflict of interest – a pending patent on a rival measles vaccine (Gross, 2009). Although false, many still believe wholeheartedly that vaccines are harmful. Wakefield’s Study In the 1998 article in the Lancet, Wakefield studied 12 children â€Å"who, after a period of apparent normality, lost acquired skills, including communication† (Wakefield, Murch, Anthony, Linnell, Casson, Malik, Berelowitz, Dhillon, Thomson, Harvey, Valentine, Davies, Walker-Smith,1998). All 12 children were reported to show behavioral symptoms after receiving the vaccination. After receiving the vaccination, the features associated with exposure collectively included fever/delirium, rash, self-injury, repetitive behavior, loss of self-help, convulsion, gaze avoidance, diarrhea, disinterest, lack of play, vomiting, and recurrent viral pneumonia. In 8 of the 12 children, the beginning of behavioral problems was linked to the measles, mumps, and rubella vaccination by either the parents or by the child’sShow MoreRelatedVaccines And Autism : Do Vaccines Cause Autism?1231 Words   |  5 PagesPseudoscience? I. Vaccines Autism Do Vaccines cause Autism? II. Abstract Do vaccines cause autism is a question that has been bouncing around for over twenty years. The increase in the number of diagnosed cases of Autism Spectrum Disorder has increased significantly and due to the impact this has in people’s lives several studies have been done in an effort to determine the cause. More specifically the MMR, Measles, Mumps, and Rubella, vaccination has been accused of being the cause of autism. This accusationRead MoreDo Vaccines Cause Autism?2029 Words   |  9 PagesEmily Peters Kiera Ball ENGL 101T 6 May 2015 Do Vaccines Cause Autism? Contrary to popular belief, autism is the result of a specific genetic mutation where it makes the person diagnosed have an inability to interact with others. According to Kavin Senapathy, Validating â€Å"the fact that GMOs and vaccines don’t cause autism, scientists have now linked mutations in over a hundred genes to autism in two recent studies published in Nature†¦Ã¢â‚¬  †¦ â€Å"about 30 percent of those found in these studies occurredRead MoreVaccines Do Not Blame Vaccines For Children?1271 Words   |  6 Pagesautistic it is blamed on vaccinations. Autism comes from genetics also, so why not blame vaccines for making people short too? If parents do not blame vaccines on their kids shortness, why blame vaccines for autism?. For years there has been controversy about vaccines causing autism in children. The vaccine scare originally started when there was a report in 1998 on how the MMR vaccine can cause autism, which was later dismissed as false (Rao). The MMR vaccine is a vaccine that is used to protect againstRead MoreThe Vaccine And Autism Controversy1179 Words   |  5 PagesVaccine and Autism Controversy Many parents are skeptical about getting their children vaccinated because of the fear that it may cause autism. The question of whether vaccines cause autism is still a controversial subject among many citizens today especially parents. Some citizens argue that vaccines are not safe and could potentially cause autism. Parents believe that vaccine caused their child to develop autism because autism symptoms become apparent around the same time that children were gettingRead MoreHow Vaccines Don t Cause Autism849 Words   |  4 PagesKnott 1 Ethan Knott Engrish 9 2 June 2016 How Vaccines don’t cause Autism Imagine this, you have had your first child. You want to protect your child at all costs. Your child is young and innocent and you want them to be protected from all illnesses. The doctor asks if you want your child to be vaccinated. You do a search about the risks from getting vaccinated and you learn that it supposedly can cause autism. Even though you know that you want your child to live a healthy life Imagine this, youRead MoreAutism Is A Fast Growing Disorder1699 Words   |  7 PagesIntroduction: Autism is a fast growing disorder in the United States, the symptoms start occurring in between the ages of 2 to 3 years old. The cause of this epidemic has remained unknown, but several hypotheses have been studied. Throughout those couple of years, children get as many as 32 shots at least (â€Å"Child and Adolescent Schedule†). Parents all over the world have came to concern that vaccines can develop autism. Many studies have came about through this year with vaccines causing Autism in childrenRead MoreNo Link Between Receiving Vaccines And Developing Asd1572 Words   |  7 PagesVaccines Causing Autism For years there has been a debate as to if vaccines cause autism. There are people who claim their child has become autistic after being vaccinated. For example, Jenny McCarthy is a well-known case. She claims her son became autistic after being vaccinated, says he has seizures and developed symptoms of autism, she quote on quote said: â€Å" if you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the measles.† Although peopleRead MoreThe Mmr Vaccine Does Not Cause Autism873 Words   |  4 Pageschildren’s chance of getting autism. Studies have shown following the measles-mumps-rubella (MMR) vaccine children become diagnosed with autism. Parents are risking bringing back diseases that before vaccinations killed and threatened the lives of many people. The MMR vaccine does not cause autism, because the doctor who published the first study about this theory has since lost his medical license, many more studies have prov en the correlation is a myth, and Autism Speaks, an autism advocacy organizationRead MoreAutism Is A Neurodevelopmental Disorder962 Words   |  4 PagesAutism is a neurodevelopmental disorder. It is the most severe form of Autism spectrum disorder (ASD). This illness causes impairments of social abilities, language, speech, and behaviors (DeLong, 2011, p.903). Autism is growing rapidly in the United States beginning in the 1990s (DeLong, 2011, p.903). It becomes the great public health concern. The genetics plays a role in autisms. However, environmental factors also can trigger autism. So the question about whether vaccination is one of these environmentalRead MoreThe Anti Vaccine Movement1426 Words   |  6 Pagesdebunking. The anti-vaccine movement can credit its recent increase in successfully spreading fears that vaccines, and particularly either the MMR vaccine (mumps, measles, and rubella) or the vaccine preservative thimerosal, are linked to autism. The claim that the MMR vaccine causes autism is not backed by any scientific evidence and therefore should not be believed. Autism is a developmental disability that is caused by differences in how the brain functions. People with autism may communicate, interact

Persistent Systemic Inflammation Associated â€Myassignmenthelp.Com

Question: Discuss About The Persistent Systemic Inflammation Associated? Answer: Introducation The seventy three year old retired Susan Bennett has been diagnosed with COPD. COPD or chronic obstructive pulmonary disease is the disease of the lung that is characterized by the economics obstruction of the airflow to the lung. The normal breathing mechanism is greatly influenced by it and the patient who is suffering from the COPD often experiences shortness of breath which is increased gradually (Nordn et al., 2015). The client is complaining her GP of her breathlessness even while carrying out her regular life activities. Her GP interrogated her and came to know that she is also suffering from poor appetite and could not eat. She has a history of smoking which she quitted a year back. The pathophysiology of COPD is initiated with the airways and the air sac damage followed by the cough and the difficulty in the breathing (Agust et al., 2012). An additional interrogation is carried out by the attending GP of Susan Bennett. She complained of wheezing, frequent coughing which is sometimes accompanied by sputum and tightness in the chest. She also complained that her coughing is getting severe and it is making her difficult to eat. Her attending GP also observed that Susan has begun to lose weight significantly and Susan also complained of her loss of appetite (Lainscak et al., 2016). Her attending GP also examined that Susan is suffering from high blood pressure and that may lead to the condition known as pulmonary hypertension. COPD patients are often prescribed with exercises. Aerobic exercise is of much help to the patients suffering from COPD as it helps to improve the tolerance of exercise (Mohammed et al., 2017). They help to overcome the problem of breathlessness. Stretching of the arms and legs in order to lengthen the arms slowly is an effective measure to improve the motion and flexibility. Strengthening of the muscles by contracting the muscles repeatedly is helpful as it strengthens the respiratory muscle. Fatigue in leg is the outcome of the six minute walk in a patient suffering from COPD. Oxygen desaturation is also observed in COPD patients. Susan Bennett if suggested to have a walk every day, it is likely that she will continue to suffer from breathlessness and fatigue in leg. This would be tiresome for her and even after resting for some time after taking the walk; dyspnea or difficulty in breathing or labored breathing can be observed (Esser et al., 2015). The practice of exercise by a patient suffering from COPD has many goals. The first goal is the improvement of the circulatory system of the body and enables the body to use the oxygen (Troosters et al., 2016). The heart and the cardiovascular muscle are strengthened by regular exercising and the endurance power of the body is increased. The aim of practicing the exercise is to lower the blood pressure which tends to rise significantly in patients suffering from COPD. The benefit of exercising regularly by the COPD patient is that it helps to perform regular life activities without getting tired or suffering from breathlessness (Brusasco, 2012). The COPD patients thus if perform regular exercise can benefit them by improving the physical condition of the patient and making him fit enough so that he can carry out all the regular life activities. Physical exercise is one of the most important interventions suggested to the patients suffering from COPD. Physical exercise is suggested after carrying out a thorough check up of the patients physiological condition and his capability of performing exercise. Patients suffering from COPD are more often suggested to carry out aerobic exercise. Aerobic exercise helps to improve the circulations, thus enabling the body to efficiently use oxygen. The resting heart rate condition is improved and decreases the blood pressure thus helping the individual to breathe properly (Divo et al., 2012). Initial consultation A COPD- specific management program is carried out which provides lesson on exercise and educates the people and helps them in restoring a better quality of life. The main aim of the AEP service provision is to increase the capacity to work independently, educating the COPD patients about the symptoms and outcome of the COPD and give them the training to promote the long term self-management (Dransfield et al., 2013). The AEP reduces the risk factors of dyspnea and mortality which is associated with the COPD. Susan Bennett had a habit of smoking regularly and there were also a history of lung cancer in her family. She was also suffering from right ventricular ejection fraction and that requires an echocardiogram. Susan Bennett also had a healthcare history of depression and GORD or gastro-oesophageal reflux disease. Risk assessment Pre-exercise screening is important in assessing the physical condition of the COPD patients and their risk factors. Exercise may risk Susan Bennett because she is having a cardiovascular problem and is echocardiogram is suggested for her. Physical activity may pose risk to her as these may results in the condition of low buildup fatty plaques (Durup et al., 2012). The risk of cardiovascular diseases is greatly increased by vigorous physical activity. Susan Bennett is suffering from cardiovascular disease and is suggested echocardiogram. Any physical exercise may pose risk to Susan Bennett (Esser et al., 2015). Approach to exercise assessment One of the major causes of morbidity and mortality are chronic obstructive pulmonary disorder or COPD. The patient is suggested to carry out a regular physical activity as a part of the treatment. The exercise assessment is mainly done by the pulmonary rehabilitation which includes the supervision of the exercise training, psychological support o the COPD patients, a self-management education and a counseling process. The patients are meant to attend this session that would help to assess the exercise outcomes that they are undergoing. The assessments also includes the study and understanding of the patients medical history, the examination of the current breathing condition of the patient and identification of other limitations that may interfere with the rehabilitation process. The nutritional assessment of the patient is also carried out which becomes a part of the rehabilitation process. Client goals Susan Bennett was prescribed to do vigorous exercise after a pre-exercise screening was conducted. The goal of prescribing the physical activity is the improvement of the circulation and the COPD symptoms. The goal of the physical activity is to strengthen the cardiovascular system and help Susan Bennett to increase her power to endure. It also aims to lower the blood pressure that tends to increase in the patients suffering from COPD. Another most important goal of the physical exercise is that it helps to improve the oxygen utilization by the body (Galbn et al., 2012). Stretching exercise would help Susan Bennett to increase her flexibility as it involves the heart and lungs and thus in turn help to improve the endurance. Susan Bennett would get help if she performs aerobic exercise as it would help her to increase the endurance level of the heart and the muscle (Gloeckl, Marinov Pitta, 2013). Thus, one of the goals of the exercise intervention is met. The aerobic exercise would also help the body to use the oxygen efficiently which gradually increase the breathing capacity of Susan Bennett. Susan Bennett is also suffering from cardiovascular disorder and is also suggested to take rest and is not encouraged to perform her physical activity in a continuous process. A continuous physical activity would pose a threat to Susan Bennetts life. Susan Bennett is also suggested to have a walk regularly which is also a part of the aerobic exercise and proves to be one of the most effective measures for the treatment of the patients suffering from COPD (Kerwin et al., 2012). Strengthening exercise involves the tightening of the muscle and Susan Bennett is suggested to do this. Strengthening exercise would increase the capability of the breathing muscle and helps in the greater uptake of water and helps to breathe effortlessly. Susan Bennett would be benefitted if she carries out this physical activity as a part of her treatment. The goals of the physical exercise can be achieved by performing these exercises and would help to control and minimize her COPD symptoms (Lainscak et al., 2012). Exercise interventions Susan Bennett has been diagnosed with COPD. She has complained of breathlessness and that she is becoming tired even when she is carrying out her daily life activities. She is also suffering from poor appetite and coughing. After a thorough physical examination, an electrocardiogram has been suggested for Susan Bennett. Susan Bennett also has a medical history of depression and GORD (Magnussen et al., 2014). She has been suggested for some physical activity which would help her to overcome her COPD symptoms. Patients suffering from COPD are suggested to carry out physical exercises. Susan would gradually be able to improve her physical condition. Exercise training can greatly increase the quality of life in relation to health of the patient and enhance the exercise tolerance by the patient suffering from COPD. Susan Bennett has a history of depression and pulmonary rehabilitation would be of much help to her. Pulmonary rehabilitation is a treatment procedure of the COPD patient that includes the psychological counseling and exercising training for the COPD patients (Menezes et al., 2014). It is one of the most important parts of the treatment of the COPD patient and becomes a significant management programs that is carried out to control the chronic obstructive pulmonary disorder. Susan must consult with her physician before she starts her physical exercise in order to undergo a thorough a check up of her physiological condition. Her physician must consult with her to set the goals to enhance her body fitness and enables her to breathe effortlessly. They should discuss if there is any risk factors of her doing the physical exercise. It is the duty of the physician to inform Susan Bennett that she should adjust the amount of physical exercise she should carry out according to her physiological condition (Mohammed et al., 2017). Stretching exercises is one of the best options available for the COPD patients; it helps in lengthening the muscles of the patients and increases their flexibility as well, these aerobic exercises are known to increase the endurance and functionality of the heart and lungs and are known to be extremely beneficial for the COPD patients. Aerobic exercises increase the capability of oxygen saturation of your body allowing you to use more of the oxygen consumed and improves the breathing as well. Walking and using stationary bikes are other alternatives applicable for COPD patients to try as well (Nordn et al., 2015). Pursed lip breathing is another highly effective breathing exercise for the COPD patients, this exercise is advised by respiratory disease experts to utilize while doing other exercises as well, to improve breathing and increase the functionality of the lungs as well. However, pursed lip breathing can be exercised in any condition, at any time of the day and the patient can do it as many times in a day as preferred (Soler-Cataluna et al., 2012). In order to do this exercise the patient will need to follow three simple steps, relaxing the neck and shoulder muscles, followed by breathing in for 2 seconds through nose, and then breathing out via pursed lips for 4 seconds. Diaphragmatic breathing is an exercise that can be performed by the COPD patients as well. It has to be understood that diaphragm is the most vital respiratory muscle, which is the most affected after an episode of chronic obstructive pulmonary disorders. Exercising diaphragmatic breathing can revive the potentiality and functionality of the diaphragm slowly but steadily, however this particular exercise is a little more complicated than rest of breathing exercises and the patient must pay attention to the details in order to get the most benefit out of it (Suissa et al., 2013). The patient will need to lie down bending her knee placing one hand below the rib cage and breathe very deeply through the nose and hold the breath for three seconds allowing the rib cage expand and then very slowly exhale through the slightly puckered lips; it will stretch the diaphragm and revive its functionality that has been lost due to COPD. There are some exercise-induced risk factors identified among the patients who are suffering from COPD and Susan Bennett can also be the victim of this. These risk factors include exercise-induced hypoxemia, sympathetic overactivity and progressive respiratory acidosis. The exercise-induced hypoxemia reduces the quality of life in the COPD patients. They also results in diminishing the level of the exercise tolerance, reducing the function of the skeletal muscle. These conditions would significantly increase the risk of death to the COPD patients (Troosters et al., 2016). Cardiovascular functions are often affected by the sympathetic over- activity in the patients who are suffering from the chronic obstructive pulmonary disorder. Susan Bennett was suggested to undergo electrocardiogram and maybe she is also suffering from cardiovascular disorder. Over exercising may also become a threat to Susans life. Exercise induced sympathetic over- activity may also results in the significant cardiovascular diseases like stroke, heart failure and many others and may even lead to death. Hence she will have to undergo exercise activities that will not exacerbate her cardiovascular risk factors or will not cause any potential harm to her cardiovascular conditions (Weiss et al., 2013). Progressive respiratory acidosis is also another type of exercise-induced risk factors that may result in the patients who is undergoing chronic obstructive pulmonary disease. It is a condition where a disturbance occurs in the balance of the acid and base as a result of the alveolar hypoventilation. This also proves to be fatal to the COPD patients and is often life threatening. These drug-induced risk factors in the COPD patients can be treated by pulmonary rehabilitation (Wells et al., 2012). Susan Bennetts physician therefore must be careful enough in prescribing her the type of physical exercise she would carry out by assessing thoroughly the physiological condition. She must also remember that Susan has a history of intense smoking and that she also suffered from depression and GORD. There are a few exercises that Susan must avoid at all costs unless completely recovered from her respiratory disorder, such as heavy lifting, push- ups, isometric exercises, running, steep walking, shoveling, etc. Susans physical exercise is monitored by the Follicks diary, Physical activity scale for the elderly and many others. These methods fall under the physical activity monitoring which is carried out on the COPD patients to monitor the physical activity that they are capable to do. Self-motivated exercise program may also be suggested for Susan. These monitoring techniques are affordable and effective to monitor the physical activities that Susan will carry out as a part of treatment for COPD (Boerrigter et al., 2012). References Agust, A., Edwards, L. D., Rennard, S. I., MacNee, W., Tal-Singer, R., Miller, Nursing., ... Crim, C. (2012). Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PloS one, 7(5), e37483. Boerrigter, B. G., Bogaard, H. J., Trip, P., Groepenhoff, H., Rietema, H., Holverda, S., ... Vonk-Noordegraaf, A. (2012). Ventilatory and cardiocirculatory exercise profiles in COPD: the role of pulmonary hypertension. CHEST Journal, 142(5), 1166-1174. Brusasco, V. (2012). Spirometric definition of COPD: exercise in futility or factual debate?. Divo, M., Cote, C., de Torres, J. P., Casanova, C., Marin, J. M., Pinto-Plata, V., ... Celli, B. (2012). Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.American journal of respiratory and critical care medicine,186(2), 155-161. Dransfield, M. T., Bourbeau, J., Jones, P. W., Hanania, N. A., Mahler, D. A., Vestbo, J., ... Lettis, S. (2013). Once-daily inhaled fluticasone furoate and vilanterol versus vilanterol only for prevention of exacerbations of COPD: two replicate double-blind, parallel-group, randomised controlled trials.The Lancet Respiratory Medicine,1(3), 210-223. Durup, D. J. H. C. J. S. P. H. A. L. B., Jrgensen, H. L., Christensen, J., Schwarz, P., Heegaard, A. M., Lind, B. (2012). A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study.The Journal of Clinical Endocrinology Metabolism,97(8), 2644-2652. Esser, R. W., Stoeckel, M. C., Kirsten, A., Watz, H., Lehmann, K., Taube, K., ... Von Leupoldt, A. (2015). Neural correlates of dyspnea in COPD. Galbn, C.J., Han, M.K., Boes, J.L., Chughtai, K.A., Meyer, C.R., Johnson, T.D., Galbn, S., Rehemtulla, A., Kazerooni, E.A., Martinez, F.J. and Ross, B.D., 2012. Computed tomography-based biomarker provides unique signature for diagnosis of COPD phenotypes and disease progression.Nature medicine,18(11), pp.1711-1715. Gloeckl, R., Marinov, B., Pitta, F. (2013). Practical recommendations for exercise training in patients with COPD. Kerwin, E., Hbert, J., Gallagher, N., Martin, C., Overend, T., Alagappan, V. K., ... Banerji, D. (2012). Efficacy and safety of NVA237 versus placebo and tiotropium in patients with COPD: the GLOW2 study.European Respiratory Journal,40(5), 1106-1114. Lainscak, M., Schols, A., Farkas, J., Sulz, I., Themessl-Huber, M., Laviano, A., ... Schindler, K. (2016). Weight loss, food intake and mortality in hospitalized patients with chronic obstructive pulmonary disease (COPD): the NutritionDay survey analysis. Magnussen, H., Disse, B., Rodriguez-Roisin, R., Kirsten, A., Watz, H., Tetzlaff, K., ... Chanez, P. (2014). Withdrawal of inhaled glucocorticoids and exacerbations of COPD.New England Journal of Medicine,371(14), 1285-1294. Menezes, A. M. B., de Oca, M. M., Prez-Padilla, R., Nadeau, G., Wehrmeister, F. C., Lopez-Varela, M. V., ... Tlamo, C. (2014). Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma.CHEST Journal,145(2), 297-304. Mohammed, J., Derom, E., Van Oosterwijck, J., Da Silva, H., Calders, P. (2017). Evidence for aerobic exercise training on the autonomic function in patients with chronic obstructive pulmonary disease (COPD): a systematic review. psychology. Nordn, J., Grnberg, A., Bosaeus, I., Forslund, H. B., Hulthn, L., Rothenberg, E., ... Slinde, F. (2015). Nutrition impact symptoms and body composition in patients with COPD.European journal of clinical nutrition,69(2), 256. Soler-Cataluna, J. J., Coso, B., Izquierdo, J. L., Lpez-Campos, J. L., Marn, J. M., Agero, R., ... Gonzlez, M. C. (2012). Consensus document on the overlap phenotype COPDasthma in COPD.Archivos de Bronconeumologa (English Edition),48(9), 331-337. Suissa, S., Patenaude, V., Lapi, F., Ernst, P. (2013). Inhaled corticosteroids in COPD and the risk of serious pneumonia.Thorax,68(11), 1029-1036. Troosters, T., Lavoie, K., Leidy, N., Maltais, F., Sedeno, M., Janssens, W., ... Bourbeau, J. (2016). Effects of bronchodilator therapy and exercise training, added to a self-management behaviour-modification programme, on physical activity in COPD. InAbstract presented at the ERS International Congress(pp. 3-7). Weiss, D. J., Casaburi, R., Flannery, R., LeRoux-Williams, M., Tashkin, D. P. (2013). A placebo-controlled, randomized trial of mesenchymal stem cells in COPD.CHEST Journal,143(6), 1590-1598. Wells, J. M., Washko, G. R., Han, M. K., Abbas, N., Nath, H., Mamary, A. J., ... Beaty, T. H. (2012). Pulmonary arterial management and acute exacerbations of COPD.New England Journal of Medicine,367(10), 913-921.

Environmental Education Program Evaluation †MyAssignmenthelp.com

Question: Discuss about the Environmental Education Program Evaluation. Answer: Introduction Environmental sustainability issue is a major issue in the recent years in Australia. However, it is important to create awareness among the individuals regarding the protection of the environment (Adapa et al. 2016). In order to maintain the environmental sustainability, people need to preserve the natural resources. Among the various natural resources, water is crucial. Excessive consumption of the water leads the individuals to face water scarcity. This study deals with the water consumption and its effect on the people living in the context of Perth. To make a balance between the environmental resources it is important to use the natural resources in a proper way. High water consumption is big environmental sustainability issue in Perth. The climate of this place is dry and the water consumption is very high. This generates water scarcity in this place. The major environmental problem regarding the high water consumption is the storage of water for the future generation (Alcamo et al. 2017). Conservation of water is affected due to the excessive use of water, which results into water scarcity in this particular place. However, it is a great concern that water scarcity may lead a country towards the destruction. To reduce the sustainability issue environmental resources should be protected by the human being. The domestic process of water use in Australia is a big reason for water consumption. This current topic helps to identify the major factors of the water consumption in Australia. Therefore, the existing social activities behind the water consumption has been determined in this study. On the other hand, the impact of water consumption is addressed in this section. Apart from these possible recommendations to reduce the water loss has been carried out in this project. This topic is helpful to increase the awareness among people of Perth regarding the high water consumption and its effect on near future (Amos et al. 2017). This can be helpful to increase the accountability and responsibility of Australian people by reducing the water loss in their community. This research study aims to identify and understand the historical and the social processes of the domestic water use in Australian city and the policies regarding the intervention. To identify the social processes of water consumption in Australian cities To critically evaluate the impact of water consumption in Australia in near future To reveal the future policies and interventions regarding water loss To provide recommendation to reduce the water loss in Australia What are the social processes of huge water consumption in Australian cities? What is the effect of water consumption in Australia? What are the major policies regarding high water consumption? The educational goal of this current project refers to the reduction of huge water consumption by estimating the water use in Perth. However, to measure the consumption of the water in Perth it is important to measure the amount of water that is consumed by the residents in this particular place. Water is considered as the valuable resource of nature. However, excessive use of the water affects the water conservation process for the future use. Australia relies on water as the input of every industry apart from the drinking and household use (Berger et al. 2014). According to the statistical data, it has been found almost 50% water is consumed for the gardening purpose, which is a big social process of Australia. Industrial, commercial, residential and institutional water consumption Industries of any country consume a huge amount of water for its manufacturing purpose. On the other hand, for commercial use 7%, and for residential use, 10% of water is used. Institutions play a major role in water consumption (Do et al. 2015). However, population number and distribution are the major factors of water consumption. People, those are living in the urban areas have different ways of water consumption. On the other hand, people use different quantities of water living in agricultural and rural areas. Australia depends on the water for its industrial and agricultural operation. In the previous Australia uses water as the free natural resources. However, excessive use of water results in drought in many areas of Australia in the year 2002 (Abs.Gov.Au. 2017). Therefore, water restriction also occurs in many areas of Australia. Such incidents highlight on the adverse effect of huge water consumption in Australia. It has been recognized widely that too much squeezing of water from the Australian river and groundwater system generate environmental as well as several economic consequences in Australian cities (Haddeland et al. 2014). On the other hand, the plant and animal lives are destroying day by day. Apart from these, the major issue of huge water consumption in Australia is the difficulties in the water conservation for the future generation. However, excessive use of water affects the river health. Therefore, shortage of water takes place, which indicates the water scarcity for t he future generation. To reduce the water scarcity in near future it is important to make a balance between the various demands. Based on the high water consumption, Australian government proposed National Water Initiative or NWI in the year 2004 (Abs.Gov.Au. 2017). This is built on the council of Australian Government framework that is the COAG. The aim of such regulation is to maximize the efficiency of the water use and the river health of Australia. National water commission or NWC and Australian Water Resource 2005 influence the implementation of NWI regulation to protect the groundwater system as well as the river health. Water Act 2007 is considered as the key element to develop Australian government national plan for Water Security. Such regulations are helpful to increase the availability of the quality information regarding water at the national level (Hof, Angela and Nils Wolf 2014). Research methodology is a crucial part of any project. However, in this current project positivism philosophy, deductive approach and descriptive design method have been selected. In order to achieve the project goal, the researcher has conducted both primary and secondary research methodologies. However, primary and secondary methodologies both are crucial to getting valid data (Mekonnen et al. 2016). The secondary data has been collected to conduct the literature review by reviewing the journals and articles. In order to collect primary data, the researcher has conducted the survey in the seven households in Caversham. In this survey method, the 7 households are taken as the sample size to collect data. Survey is an effective method to collect data regarding a topic from the population. However, based on the feedback of the participants the information is gathered (Qureshi et al. 2013). A meeting is conducted with the households about the water consumption in their domestic use. On the other hand, the researcher visited the household and talked them individually to identify the number of people who are washing by running the tap and blocking the sink. On the other hand, it is important to identify the amount of water that is used for the showering and gardening in this particular community. However, such measurement is required to understand the water consumption rate in this particular area. The researcher has given the water meter reading during the first survey and the survey is conducted for two times. The water meter reading is a process through which the use of water in commercial and residential buildings can be determined (Rathnayaka et al. 2014). In this survey, the use of water meter reading enables the researcher to measure the high consumption of water in Perth. In order to increase the awareness among the public regarding the water shortage, it is important to develop necessary strategies. Effective communication is helpful to collect feedbacks during the survey (Stern et al. 2014). The researcher communicated with the households in order to depict their domestic water use. On the other hand, effective communication enables the researcher to increase awareness among the households regarding the water scarcity by showing them the current rate of the water consumption. The individual should be proactive while conducting a research or meeting (Van Der Linden 2015). The researcher included good knowledge about the project as well as the effect of high water consumption. The researcher has shown proactive approach during the survey to distribute knowledge among the people of such specific community. A community meeting has been arranged during the survey to increase the knowledge of the 7 households about the water scarcity and the necessity of the water consumption. The main goal of the project is to create awareness among the people of Perth regarding the shortage of water in near future. However, it is a major challenge for the society to conserve water by reducing its unnecessary consumption (Stern et al. 2014). During the meeting, the researcher has shown video, distributed the leaflets and pamphlets to generate knowledge regarding the high consumption of water and its effect on coming future. Knowledge gathering is essential to complete a research project (Qureshi et al. 2013. In this current project, water conservation is the main aim. Hence, the researcher has contacted to the water corporation and also gathered knowledge by interacting with the people those have retired from the water corporation. After the conduction of the first survey, a second-time survey has been conducted to analyze the collected result. Households Types of the water consumption via domestic use Total Usage Gardening Showering Washing Other use Household 1 20% 5% 10% 7% 42% Household 2 25% 10% 6% 10% 51% Household 3 15% 5% 5% 8% 33% Household 4 30% 4% 10% 5% 49% Household 5 10% 5% 9% 5% 29% Household 6 25% 5% 10% 2% 42% Household 7 20% 5% 10% 7% 42% Table 1: Water use for domestic purpose (Source: Author) The above data focuses on the total water use in domestic households in this research survey. However, it has been found that household 2 has consumed maximum water while household 6 consume less water in domestic purpose. On the other hand, it has been detected that people use much water for gardening purpose according to the result. Households Standard Rate of water meter Rate of the water use Water use (gallons) Household 1 1=1356411 gallons 0.30 406,923.3 Household 2 1 0.35 474,743.85 Household 3 1 0.25 339,102.75 Household 4 1 0.28 379,795.08 Household 5 1 0.32 434,051.52 Household 6 1 0.30 406,923.3 Household 7 1 0.30 406,923.3 Table 2: Reading of water meter in context of seven households (Source: Author) According to the above data, it has been received that household 2 uses maximum water that is 474,743.85 gallon of water while house 3 uses the minimum water that is 339,102.75 gallon for the domestic purpose. However, 1 is the standard rate of the water meter reading that means 1356411 gallons. If the water consumption rate is more than 1 in water meter than it shows the high water consumption. Based on such survey data it can be said that the households have used a huge amount of water for their domestic activities, which may cause water scarcity in Perth. Huge consumption of the water indicates difficulties in water conservation in future (Haddeland et al. 2014). This current result has increased awareness among the people in Perth. During the second survey, the water consumption rate was lower than the previous survey, which indicates the previous survey has influenced and created awareness among the people regarding the water conservation. Households Standard Rate of water meter Rate of the water use Water use (gallons) Household 1 1=1356411 gallons 0.25 339,102.75 Household 2 1 0.30 406,923.3 Household 3 1 0.20 271,282.2 Household 4 1 0.25 339,102.75 Household 5 1 0.32 434,051.52 Household 6 1 0.20 271,282.2 Household 7 1 0.30 406,923.3 Figure 1: Result of second survey (Source: Researcher) According to the second survey it has been seen that household 2 has been reduced their water use in compare to their previous water consumption. On the other hand, household 3 also reduces their water consumption. However, the overall consumption of the water in this particular community has been reduced as per the data of second survey. Recommendations By using alternative water sources will be helpful to reduce the water scarcity in near future in Australia. Knowledge distribution will be helpful to increase the knowledge among the people about the necessity for the water conservation for near future. Conduction of the educational program will be beneficial to generate awareness among the people about the negative impact of the high water consumption among the Australian cities. Conclusion The current piece of study focuses on the negative effect of the excessive water consumption in the Australian cities. However, it is a major concern that high consumption of water may create the water deficiency for the future generation. Therefore, a survey has been conducted in Perth to understand the water consumption rate for the domestic purpose. This study shows that gardening is a big factor of water consumption. Hence, this report is helpful to increase the awareness about the water scarcity among the people, which may influence them to conserve water by minimizing its use in their domestic work. References Abs.Gov.Au. 2017 "ISSUE: WATER".. https://www.abs.gov.au/AUSSTATS/abs@.nsf/7d12b0f6763c78caca257061001cc588/330bc8fdfd50bee4ca2573c6001049f9%21OpenDocument. Adapa, Sujana, Navjot Bhullar, and Simone Valle de Souza. "A systematic review and agenda for using alternative water sources for consumer markets in Australia." Journal of Cleaner Production124 (2016): 14-20. Alcamo, Joseph, Thomas Henrichs, and Thomas Rsch. "World water in 2025: Global modeling and scenario analysis for the world commission on water for the 21st century." (2017). Amos, Caleb Christian, Ataur Rahman, and John Mwangi Gathenya. "Economic Analysis of Rainwater Harvesting Systems Comparing Developing and Developed Countries: a Case Study of Australia and Kenya." Journal of Cleaner Production (2017). Berger, Markus, Ruud van der Ent, Stephanie Eisner, Vanessa Bach, and Matthias Finkbeiner. "Water accounting and vulnerability evaluation (WAVE): considering atmospheric evaporation recycling and the risk of freshwater depletion in water footprinting." Environmental science technology 48, no. 8 (2014): 4521-4528. Do, Loc, and A. John Spencer. "Contemporary multilevel analysis of the effectiveness of water fluoridation in Australia." Australian and New Zealand journal of public health 39, no. 1 (2015): 44-50. Haddeland, Ingjerd, Jens Heinke, Hester Biemans, Stephanie Eisner, Martina Flrke, Naota Hanasaki, Markus Konzmann et al. "Global water resources affected by human interventions and climate change." Proceedings of the National Academy of Sciences 111, no. 9 (2014): 3251-3256. Hof, Angela, and Nils Wolf. "Estimating potential outdoor water consumption in private urban landscapes by coupling high-resolution image analysis, irrigation water needs and evaporation estimation in Spain." Landscape and Urban Planning 123 (2014): 61-72. Mekonnen, Mesfin M., and Arjen Y. Hoekstra. "Four billion people facing severe water scarcity." Science advances 2, no. 2 (2016): e1500323. Qureshi, M. Ejaz, Munir A. Hanjra, and John Ward. "Impact of water scarcity in Australia on global food security in an era of climate change." Food Policy 38 (2013): 136-145. Rathnayaka, Kumudu, S. Maheepala, B. Nawarathna, B. George, H. Malano, M. Arora, and P. Roberts. "Factors affecting the variability of household water use in Melbourne, Australia." Resources, Conservation and Recycling 92 (2014): 85-94. Stern, Marc J., Robert B. Powell, and Dawn Hill. "Environmental education program evaluation in the new millennium: what do we measure and what have we learned?." Environmental Education Research 20, no. 5 (2014): 581-611. Van Der Linden, Sander. "Exploring beliefs about bottled water and intentions to reduce consumption: The dual-effect of social norm activation and persuasive information." Environment and Behavior 47, no. 5 (2015): 526-550.

Three Qualities You Value in True Friend free essay sample

There are many ways to value quality of true friend. Personally, I highly value three qualities of my true friend. True friend is a kind of person who difficultly to find in your whole life. He or she is a person who cries or has fun with you. The three qualities that I would like to a true friend has such as trust worthy, dependable, and unselfish. The first important quality of a true friend is trust worthy. In friendship, true friend should able to keep secrets or promises. When you have problems, you go to talk with him or her and he or she will not do around talking a bout you. Second true friend should be honest in friendship. Without honesty the friendship will be fall a part. To be honest, true friend should tell the truth that is the third point. Your friend has better not lie each other so, it will not have suspicion in friendship. We will write a custom essay sample on Three Qualities You Value in True Friend or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page To sum up, trust worthy is a important quality that can not be lacked in friendship. The second important quality is dependability. I look for in a friend who can help each other. Friend should be helpful with each other when you have problems. Plus, friend needs to give thoughtful advice to friend who is in trouble and he or she help you to corrects your mistakes. Additionally, forgiving is the necessary in friendship. A dependable friend should forgive or do not mind with small problems. To summarize, dependability is consequentially required in your friendship. Unselfishness is the last important that I determine in a true friend. Your friend should be a kind person. Sharing is the best example for kindness such as sharing food or sit. Moreover, supportability is a good thing that true friend always do to his or her friend. When your have problems, true friend will stay by your side and encourage you. The last point is envy. If he or she is a really your friend, he or she will not be jealous with you, but he or she should be happy for you. In summary, unselfishness is a good thing that a true friend should has in his or her mind. All in all, the qualities I highly value in a true friend are trust worthy, dependable, and unselfish. If you have a really true friend, your life might not loneliness or boredom. I believe these qualities are really necessary for friendship. They are also a great foundation of being a true friend.

Writing a Social Media Essay - Tips For Writing a Social Media Essay in Your Educational Essay

Writing a Social Media Essay - Tips For Writing a Social Media Essay in Your Educational EssaySocial media in education is all about creating relationships, even though you're the only one involved. While the resources are there to make this more efficient and effective writing a real effective essay without using social media can be quite difficult. Here are a few tips for you to get started using social media in education essay sample essay.First, the internet is an invaluable resource. It can save you a lot of time. You can research and find everything that you need to write an essay. In addition, using the internet can give you access to advanced research tools that could help your essay better your essays.Secondly, try to keep your email addresses private. This may sound quite strange, but you need to try to make your essay as personal as possible so that it doesn't affect your ability to write your essay well.Third, in order to make use of the tools you found on the internet, y ou have to use the search engines. Don't just blindly go for the first results that you come across, you must do a little bit of research to make sure that the web page you are on has the proper resources. If you don't, you'll only waste your time and energy searching for something that you already know.Fourth, think about using social media in education essay sample when you need to write an essay. It's all about relationships. The better relationship you have with your reader, the more they will be able to connect with you when you're writing the essay.Fifth, when you are finished writing your essay, try to not copy and paste what you wrote. It's very tempting to do this, but the text you copy and paste will become very hard to read. Instead, let the text speak for itself, and make the essay readable.As you can see, there are many ways to use social media in education essay sample. Using this method will help you make the process of writing easier and more efficient. It will also increase the level of interaction between you and your reader, and this will greatly increase the chance that your essay will be noticed.

Protecting Our children essays

Protecting Our children essays The overlap between domestic violence and child abuse has been well documented; where one form of family violence exists, there is a likelihood the other does as well. Child abuse and domestic violence often occur in the same family and are linked in several ways that have serious consequences for the safety of children. First domestic violence may directly result in physical and/or psychological harm to the child. Second, even though a child may not sustain physical injuries, domestic violence can interfere with parenting to the point that the child is neglected. Third, if child abuse and domestic violence are present in a home, both problems must be addressed to effectively Children can be injured as a direct result of domestic violence. Batterers may physically, emotionally, and sexually abuse children in order to control the actions of their spouse. Children may also be injured by objects or weapons used to attack their mother. Assaults on younger children may occur if the mother is holding the child while being attacked. Older children who try to break up violent disputed between parents may Children of all ages are affected by domestic violence. Infants exposed to violence may not develop the attachments to their caretakers which are critical to their development. Preschool children regress developmentally and suffer sleep disturbances. Schoolage children who are exposed to violence may exhibit depression, anxiety, and violence towards peers. Later in life, these children are at risk for incorporating violence into their own relationships. There is also evidence that children exposed to domestic violence are at greater risk for abusing drugs and alcohol and for committing violent The most effective way to help mothers and children is to combine child protective and domestic violence programs. This way both victims are pro ...