Risk Factors of Cardiovascular Drugs

Risk Factors of Cardiovascular Drugs Characteristics and risk factors of Cardiovascular Drugs induced Adverse Drug Reactions: Hospital based Active Surveillance Study. Abstract: Background: Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. Several studies report the incidence various from 10 50% of all hospital admissions due to ADRs and no recent data available on the safety of cardiovascular drug from India. Aim: This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs. Methods: A prospective active surveillance study was carried out in the cardiology department of a south Indian tertiary care teaching hospital for eight months. Population averaged Poisson regression [Generalized Estimating Equation (GEE)] models was used to estimate the adjusted relative risk associated with ADR. Results: The overall incidence of cardiovascular drug induced ADRs was 31.8%. A total of 757 patients treated cardiovascular medications. Of which 241 patients (31.8%) including 122 (16.1%) females and 119 (15.7%) males reported at least one ADR. Aspirin produced the highest number of ADRs (150; 38.7%) followed by Heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%). The causality assessment reveals that 85.3% of ADRs were probable in nature. GEE was used to estimate the adjusted relative risk of each covariate associated with ADRs. The predictors of ADRs identified were: female gender, age > 60 years, multiple drug therapy (p= 0.0231) and concurrent diseases like diabetes, drugs like Heparin (RR-2.90, 95% CI 2.22-3.8) and Enalapril (RR-1.95, 95% CI 1.34-2.83). Conclusion: The incidence of cardiovascular ADRs was 31.8%. The most common drugs causing ADRs were the anti- platelet and anticoagulant class of drugs. Female gender, age > 60 years, multiple drug therapy, concurrent illness and certain drugs like heparin were identified as potential predictors for adverse reactions. Keywords: adverse drug reactions, hospitalized patients, cardiovascular drugs, pharmacovigilance, Risk factors Key Messages: This study reports the risk factors for adverse reactions to cardiovascular drugs from an Indian clinical setting. The incidence of cardiovascular drugs induced ADRs was 31.8%, which is higher than many reported studies. Anti-platelet and anticoagulant drugs were commonly associated with ADRs in the study population. Introduction: Adverse Drug Reactions (ADRs) is one of the major drug-related problems in hospitalized patients. ADRs are one of the major drug-related problems, resulting in increased morbidity and mortality and healthcare costs.[1-3]The WHO defines an ADR as a response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function.[4] The prevalence of cardiovascular diseases (CVDs) has increased in recent years and it has been estimated that CVDs are the most common cause of death.[5] Reports on drug related problems including adverse drug reactions associated with cardiovascular pharmacotherapy are available.[6-10]Studies report that cardiovascular drugs may account for 10 to 50% of all hospital admissions due to ADRs.[11-13] There are reports of serious adverse drug events with cardiovascular drugs.[14]Continuous monitoring of ADRs are important in patients treated with cardiovascular drugs since, these patients who need multiple drug therapies to treat their comorbid conditions and other related risks[15] Various methods are used to detect ADRs in hospitalized patients.[16] Analyzing the adverse reaction data in relation to the presence of risk factors provide the link between the ADRs and the associated factors. Such analysis might help to identify patients who are at increased risk for the adverse reaction and therefore employing suitable monitoring and the preventive procedure is possible.[17] Reports are available on the risk factors for adverse reactions.[18-20] Studies have shown that the cardiovascular drugs are most common cause of ADRs.[6,21]A university hospital-based studies report 49 % ADRs are due to commonly used cardiovascular drugs (nitrates, digoxin, propranolol, heparin, warfarin, anti-hypertensive and anti-arrhythmic drugs)[22] A number of studies are available on the adverse effects of cardiovascular drugs. In the Indian context data on adverse effects of the cardiovascular drugs is not available. Therefore, the current study was planned to evaluate ADRs due to cardiovascular drugs in hospitalized patients. This study aims 1). To estimate incidence and characteristics of ADRs due to cardiovascular drugs in patients admitted in cardiology unit of a tertiary care teaching hospital. 2) To identify the risk factors for ADRs in hospitalized patients treated with cardiovascular drugs. Subjects and Methods: A prospective active surveillance study was carried out in the department of cardiology of a tertiary care teaching hospital for eight months (Feb to Sep 2009). The study protocol was reviewed and approved by the institutional ethical committee. All patients admitted to the cardiovascular units were monitored and evaluated for cardiovascular drugs induced adverse reactions. Patients who were previously treated or newly prescribed with cardiovascular drugs were monitored and followed for detecting and recording of ADRs. Adverse drug reactions were identified by conducting a daily patient charts review, patient interview, and consultations with treating physicians. In the suspected cases, past medical/medication history of patients were collected. In addition to patients medication history, information on co-morbidities was also collected. We used the WHO criteria for defining ADRs.[4] For every identified patient with ADR, two patients without ADRs were enrolled as matched controls. The information pertaining to the suspected ADRs was collected and documented in a specially designed ADR computerized documentation database for further assessment.[23] An ADR alert card was distributed to those patients who experienced severe adverse reactions to prevent further re-exposure of the suspected drug. All ADRs were reviewed and assessed by the research team. The documented ADRs were evaluated and characterized respect to patient demographics, nature of the reactions, drugs and organ system involved and outcome of the reactions. Using standard approach, the Causality, severity, preventability and the presences of predisposing factors of the reactions were assessed and reported. Patients age and sex were considered for the analysis. ADRs were classified as either Type A or Type B according to the system introduced by Rawlins and Thompson.[24] The suspected drugs were classified according to Anatomical Therapeutic Chemical (ATC) classification based on WHO-ATC Index 2009.[25]Using WHO Adverse Reaction Terminology documented ADRs were further classified into various organ system classes.[26] Management strategies employed for the ADRs were categorized as drug withdrawal, dose reduction, additional treatment for ADR and no change in a regimen without any additional treatment. Patient outcomes were reported as fatal, fully recovered, recovering and unknown. The causality of suspected ADRs was assessed using Naranjos ADR probability scale and classified into certain, probable, possible and unlikely to be drug induced depending upon the level of association.[27] The preventability of ADRs was analyzed and categorized into definitely preventable, probably preventable and not preventable using the modified criteria of Schumock and Thornton by Lau et al.[28]Using the criterion developed by Hartwig et al., for severity assessment, we assessed the suspected ADRs and classified into mild, moderate and severe reactions.[29] The onset of ADRs was assessed and classified into sub-acute, latent and acute groups.[4] Predisposing/risk factors Many patient-related factors predispose the occurrence of ADRs. The patient related factors like age, gender, multiple and inter-current disease states, and polypharmacy are considered as significant risk factor for developing ADR.[30] Patients age was categorized into 6 groups (less than 20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, more than 60 years). Polypharmacy was categorized as minor (2-3 drugs), moderate (4-5 drugs) or major (5 drugs) based on the classification by Veehof et al.[31] Gender of the patient was also considered as a one of the predispose factor for the development of ADRs. Multiple disease state ( > 2 coded diseases) of the patient at the time of reaction also include in the analysis. The overall incidence of ADRs was calculated using the total number of in-patient episodes which resulted in ADRs in relation to the total number of in-patients followed during the study period. The length of hospital stay for each patient was collected from Hospital Patient Administrative System (HPAS) and used to compare the Length of Stay (LOS) between patients with and without ADRs. Additional hospital stay due to ADRs was assessed using the nature and clinical features of ADRs, discussion with treating medical staffs and assessment of patients medical records. Statistical analysis Descriptive statistics was used summarize the patient demographic and clinical characteristics like gender, diagnosis, a number of drug dispensed, the frequency of ADR, drugs involved, organ system involved and severity of ADRs. Mean with 95% confidence interval was used to summarize age and LOS. Chi-square test was used to find the association between age group, gender, the LOS with and without ADRs. Relative risk was used to measure the strength of association. The data were hierarchically arranged, to count the multiple ADR episodes which can occur with multiple admissions. Population averaged Poisson regression (GEE) was used to estimate the adjusted relative risk of each covariate associated with ADR.[32,33] Further compound symmetry was used to account for the within-subject correlation. All analysis was performed using SPSS for window 15 (SPSS Inc., South Asia, Bangalore). The significance level was set at P Results: A total of 757 patients (431 men and 326 women) using cardiovascular medications were intensively monitored. The mean age of the study population was 57.21  ± 14.22 years (18 -92 years). The average length of hospital stay was 10.6  ± 5.8 days. Overall, the incidence of ADRs was 31.84%. Two hundred and fourteen patients including 122 females and 119 males reported at least one ADR. Maximum of six ADRs were reported from one patient. Compared to males, females developed more of ADRs was observed more in females when (p 0.0001). The length of stay was increased due to ADR for a minimum of 3 days and a maximum of 28 days. The frequency of different age groups in patients with and without ADRs is presented in table-1. The main diagnosis of the study population is listed in table-1. Age group of less than 20 years is excluded because of lower sample size. Age group of more than 60 years had more ADRs compared to other age groups. Cardiovascular risk factors of a patient with and without ADR are shown in table-2. The most frequent system-organ class affected by ADRs was Platelet, bleeding clotting disorders (188, 48.89%), followed by metabolic and nutritional disorders (53, 13.66%) and gastrointestinal system disorders (50, 12.89%) (Table-3). The most common strategy for management of ADRs was drug withdrawal (94.3%) and dose alteration (5.4%) (Table-4). The mean length of hospital stay was 13.3 and 6.5 days for patients with and without ADR respectively. The length of stay was found to be longer in patients with ADR. Aspirin produced the highest number of reactions (150; 38.7%) followed by heparin (45; 11.6%), Atorvastatin (24; 6.2%) and Ramipril (24; 6.2%) (Table -3) with Platelet, bleeding clotting disorders (188, 48.89%). The most frequently reported reaction was bleeding (186; 47.9%) followed by gastric ulcer (52, 13.4%) (Table-3). The causality assessment of ADRs revealed that 85.31% of ADRs were classified as probable, followed by 7.99% as definite and 6.7% as possible. 64.4 % patients recovered from the ADRs and 35.6 % were recovering at the time of discharge (Table-4). The GEE analysis shows that the female, alcoholics, smokers and patients those taking more than 7 drugs had a higher risk for developing an ADR. (Table-2). Statistical analyses also revealed that patient taking Heparin (RR 2.90, 95% CI 2.22-3.80, Enalapril (RR 1.95, 95% CI 1.34-2.83), warfarin (RR 1.69, 95% CI 1.33-2.54) had a significantly increased probability of developing of ADRs (Table-5). Discussion: ADRs can significantly increase patients mortality or morbidity and consequently higher healthcare expenditure.[34] The study findings reveal that developing an ADRs in hospitalized patients substantially contribute to patients morbidity, further increasing the disease burden and cost of managing ADRs. The incidence of ADRs (31.8%) found in this study was twice higher than a previously reported systematic review of international studies (15.1%).[2] The present study showed that females experienced a higher incidence of ADRs (9.87%) when compared to males (7.23%) which are similar to the findings of previously published studies.[1,35-37]Several reasons have been put forth for this observed difference. Men and women have a different pharmacodynamic response to various drugs; which may consider as one of the factors for women to develop more number of ADRs. But in a study reported by Jose., on comparable Indian population male patients were found to have more ADRs than female population .[38] The incidence of ADRs was higher in the elderly patients (31.19%; age > 60 Years) compare to other age groups. (à Ã¢â‚¬ ¡2= 23.03, df-5, p 0.0001); this finding is similar to the results of Mohebbi et al.[19] Studies have shown that the incidence of ADRs may increase with increasing age. Again, due to multiple comorbid conditions and receive multiple drug therapy the elderly patients tend to have a higher risk for developing an ADR. In addition, older individuals undergo changes in drug responsiveness and disposition.[39] It appears that elderly patients need more attention to prevent the occurrence of ADRs. In this study, the incidence of Aspirin-induced ADRs was 38.7% (n=150); which was the highest rate compared to other cardiovascular drugs in this study. However, High rates of ADRs with streptokinase have been reported previously.[40]Studies reported a rate of amiodarone-induced ADRs as 16%, whereas in the current study it was too low at 0.5%.[41] This might be due to the lower use of amiodarone in the current study subjects. In a study conducted by Wiffen et al., investigating ADRs induced by all groups of drugs, warfarin was among the top three drugs causing ADRs.[42] In our study, the rate of ADRs attributed to warfarin was just 3.6%, whereas heparin-induced bleeding was the second highest ADR in this study population (45, 11.6%). In this study, we found central nervous and gastrointestinal systems are the most frequently affected organ system classes by ADRs. These findings were similar to the findings of a study conducted in Iran.[13]The incidence of preventable ADRs in this study (6.9%) is comparably lower than those detected in other studies.[34]This might be probably due to intensive monitoring of CCU patients in our study. The rate of serious ADRs (22.2%) detected in this study tend to be higher than other studies.[14] Population averaged Poisson regression (GEE) model showed that factors like gender and age of more than 60 years, multiple drug therapy and the presence of co-morbidity were risk factors for experiencing ADRs. The average duration of drug usage was found to be longer in patients without ADR. It appears that most of the ADRs have been noted shortly after initiating cardiovascular drugs and the incidence of ADRs in this study population was not related to the duration of usage. Similar to findings of many other studies, increasing the number of drugs led to increased frequency of ADRs. Conclusion The finding of this study indicates that cardiovascular drugs cause serious and frequent adverse reactions. The incidence of cardiovascular ADRs was 31.84%. The most common drugs causing ADRs were the anti-platelet and anticoagulant class of drugs. Female gender, age more than 60 years and use of more than 7 drugs was found to be the risk factors for developing ADRs. The identified incidence was higher than many reported studies. The current study identified the common ADRs and their predictors. Patients with identified predictors for adverse drug reactions can be intensively monitored and necessary preventive measures can be initiated if signs of reactions are observed.

Chilean Copper Mine Collapse Essay

This paper will discuss in how important it’s to know your audience. When having to communicate a disaster like the Chilean copper mine that occur in South America it’s one example of where knowing your audience was a very important issue. This disaster in the Chilean copper mine, a disastrous downfall in one of the shafts of the mine has left 33 miners trapped 310 meters below the ground. The outcomes of the company and their reaction to the disaster would eventually define how the world, their audience, would see them. It turns out to be very crucial that the spokesperson of the company who issues updates and information to the public is careful and sensitive to the families. The audience the company would be reporting to would be made up of the news correspondence, the victim’s families, and the media. Not only would the company spokesperson have to keep the reputation and point of view of the mining company in one piece, they would have to issue specific and straightforward information that would not always be in the greatest interest of the company’s position. All though in the beginning the company may not have a great extent of information, it’s necessary for them to inform the families with as much information as soon as possible. This would consist of any information as to what is taking place in the mine while the miners are still trapped. When communicating we need to have some emotion and sympathy than just  the facts of what is going on inside the mine. With all the families wanting to be inform that everything is okay and everyone is doing his or her best to get the situation under control. When speaking to any type of media they are concerned only about the facts. They do not care about emotions or sympathy of the friends or families. If there are no facts to give to the media than nothing should be assumed to those until there are facts to share. The collapse would not only have emotional impact on the 33 miners trapped underground, the family members of those miners would be distressed as well. The family members of those 33 men would have to wait in suffering before they would receive word of their family member’s fate. When a disaster of this extent occurs, the company has the obligation to keep the family members well-informed every step of the rescue progression, above the news bulletin and media. Furthermore informing the families right away in regards to what’s being done to rescue the miners is very important. For instance the families should be inform that while the miners remain in the trapped mines the government is taking steps from getting doses of anti-depressants for the men. Also they’re sending down fresh clothes and games to help keep them physically and mentally fit. In addition the families need to know that the government and rescue team is guiding the miners to a secure area. The secure area is where they can establish various places one for resting and sleeping. The families of the miners need to be informed that the rescue team is doing everything possible to keep the miners in good spirits. Also asking the families to get involve by writing positive encouraging letters for their love ones it’s encouraged. When communicating to the families that the government has contacted NASA to help with the rescue it will give them a little piece of mind. Let them know the rescue team will be able to utilize all the new technology of NASA‘s and their resources to rescue the miners. NASA who has sent people to the moon and outer space has many tools and resources for a situation like this. Therefore the most appropriate channel to communicate with the media, families in a situation like this one of the trapped miners is face to face. The reason to announce the incident face to face is because it shows your compassion, truthfulness and braveness. I would say for the employees of the company I would use email and face to face. The email would be sent out first to the employees followed up with a face to face is case they had any questions or concerns. In conclusion it’s important to remember that timeliness is of the utmost importance when dealing with situations of this magnitude. When taking families into consideration, the company must deliver the information of the mine collapse with an extreme level of discretion, clarity, and encouragement and compassion. References http://web.ebscohost.com.ezproxy.apollolibray.com http://www.msnbc.com.world_news-americas/t/trapped-chilean-mines

The School s Grading System - 1479 Words

Since 1983, grades have been steadily rising which might seem like a good improvement, but instead, it has been negatively impacting students’ education and the world around them, leaving people to question the school’s grading system. According to Vikram Mansharamani and Peter Jacobs, one of the main reasons for grade inflation was that during the Vietnam War, students were given â€Å"higher grades to ensure that students wouldn’t fail out or be drafted†. Although this may be true, even after the Vietnam War, grades were above average. In the early 2000s, Wellesley College and Princeton both tried to combat the inflation and got two different results. Despite Wellesley’s â€Å"average GPA falling from 3.55 to 2.28, it’s been slowly drifting back†¦show more content†¦One simple error from them and I could be dead or in a coma forever. Or in the instance of a surgeon, if they didn’t put in enough hours in the skill lab, or ve ry minimal, and didn’t even master their techniques, I wouldn’t allow them to perform on me. In this sense, if students graduate without the necessary skills and knowledge that they should have learned, they can ultimately begin to destroy the population. With the inflation of grades, their value drops to the point where some people suggest not even using grades. Mark Oppenheimer suggests in his article, There’s nothing wrong with grade inflation, that instead of grades, the professors essentially write feedback and tell the students what they did correctly and what they need to improve on. If we think of grade inflation as currency, we can easily see how it would lose its value. As grades lose their value, professors lose their credibility. They are hired for the sole purpose of educating their students, not to give them good grades. Although passing their students is one of the main goals as an educator, they should ensure that their students are learning the material and not taking the easy route out. Professor Rebecca Schuman exclaimed that â€Å"as a professor, there is little worse than spending an entire semester attempting to connectShow MoreRelatedGrading System807 Words   |  4 PagesThe grading system of UH is a problem. For sure, students care about the grades. Some of them worried about it if they didn t make A in classes. Some of them afraid of failing the courses. Parents want their kids to make good grades, also. The grading system of UH make the students working hard if they want to get good grades. Grading system is a problem, to solve this problem we should vote for it. Let the student and parents tell the school whether they want to change it or not. At UH, weRead MoreHigh Family s University Grading System975 Words   |  4 Pagesand commitment is insufficient to do well in school. 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Are we all satisfied with the education we received? The answer is amp;#8220;no.; It is apparent that todayamp;#8217;s education system in the United States is not satisfying the needs of all people. nbsp;nbsp;nbsp;nbsp;nbsp;OneRead MoreEducation And Society And The American Dream1449 Words   |  6 PagesEducation can be defined as the process of receiving or giving systematic instruction, especially at a school or University. For many education is seen as an enlightening experience and one they can grow from. For others it is seen as a necessity or something they are obligated to have. It can be seen as It has always been stated that a nation’s brilliance and ability to prosper is directly dependent upon its people’s educations. 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The Contribution Of Karl Marx Essay - 1337 Words

This essay considers the contribution of Karl Marx to the study of sociology, throughout this essay I will be discussing what Marxism is, how Marxism has affected today’s society as well as academics that did not agree with Marx’s theories. Marxism is the social and economic system based on the theories of Karl Marx and Freidrich Engels. Karl Marx was born in Trier, Germany in 1818, Marx studied law and Berlin University but later changed to philosophy until finally perusing his interest in journalism. When Marx finished his studies he began writing for a left-winged newspaper, the Rhensig Gazette (Rheinishe Zeitung) where they would publish his articles almost every week. Marx soon became the editor in 1942 however the newspaper closed soon after due to new censorship laws in Germany. In 1983 Marx and his wife Jenny moved to Paris where Marx thought he would be able to express himself more freely without the fear of being judged or censored, like he was back in Germany. However, this was not the case as he ended up in London due to being chased out of several countries due to people thinking he was a dangerous man due to his political views and writings Marx met his lifetime best friend in Germany, Freidrich Engels, who would soon go on to assist Marx with his writings. They would both soon become increasingly influ ential with sociologists. â€Å"Marx’s impact can only be compared with that of religious figures like Jesus or Muhammad† (1). Marxism was discovered after theShow MoreRelatedThe Contribution to Economics of Each of the Following: †¢ Adam Smith †¢ Thomas Malthus †¢ David Ricardo †¢ Karl Marx †¢ Alfred Marshall †¢ John Maynard Keynes †¢ Milton Friedman2179 Words   |  9 PagesWrite an essay describing the contribution to economics of each of the following: †¢ Adam Smith †¢ Thomas Malthus †¢ David Ricardo †¢ Karl Marx †¢ Alfred Marshall †¢ John Maynard Keynes †¢ Milton Friedman â€Å"Many Economists have tried to establish why the economy performs as it does and want to have a basis for predicting how the economy will perform when circumstances change†. (Nagel, S pg 1 1999) Economists are just people after all, who have lived through different times and experiences in theirRead MoreKarl Marx And Max Weber1324 Words   |  6 PagesKarl Marx and Max Weber were influential sociologists that paved the way for modern sociological school of thought. 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A Common Problem Faced By Immigrants Essay - 1809 Words

Recent happenings around the world have brought the subject of migration to the forefront of everyday conversation. However, the â€Å"migration phenomenon† is not a new one but can be traced as far back as human history itself. In some way, migration can be seen as an innate part of animal behavior and the human experience. Historically, several push and pull factors have forced several groups to move across the globe in the hopes of improving their situations. However, the circumstances surrounding one’s migration to a new place differs for each individual. Apart from the political and economic strife of migration to a different country, immigrants and refugees are left with the added struggle of maintaining their social identity, culture, and kinship when acclimating to a new environment. In order to properly explain this topic, I draw on the information from several articles, lectures, films, and interviews I have conducted with close family and friends. A common problem faced by immigrants is social identity. Social identity refers to the need to identify as a member of a group and not merely as an individual. Man is a social being and being able to identify with a group helps in giving a sense of belonging, developing self-esteem and a sense of pride. Social identity and sense of self are therefore important to an individual’s well-being. As a member of a group, every individual performs the role(s) and expectations of that group. However, intersectional identities existShow MoreRelatedProblems by Farmers and Immigrants in 1800s861 Words   |  4 PagesHistory Essay 11/3/09 There were many problems faced by both farmers and immigrants in the late 1800’s. The economy was very shaky, the government was not stepping up to help, and the immigrants faced harsh times in their coming to America. Eventually many groups were formed to help with these issues. Farmers faced many issues in the 1800’s. First off, debt was a huge issue for farmers. Falling crop prices, unpaid loans, and crashing banks all led to the huge debt of farmers. Because theRead MoreThe Problem Of Illegal Immigrants1179 Words   |  5 PagesMany immigrants who decide to leave their countries do so for either economic, political, or familial reasons. Poverty and limited resources are also problems that arise when it comes to deciding whether to leave their country or not. One of the biggest issues that comes with these immigrants is that they go through without documentation, therefore, becoming labeled as illegal immigrants. While couple of the people I interviewed received education back in their own countries, the economic situationsRead More Italian Immigrants in America Essay1350 Words   |  6 PagesItalian Immigrants in America   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Ever since the United States was founded, immigrants have been arriving on its soil.   The first white inhabitants of the U.S. were immigrants from Europe.   They came for many reasons, such as religion and opportunity.   As the country grew and became more prosperous, it became more enticing to foreigners looking for opportunity.   This continued into the 20th century and finally during the 1920’s, the United States began to restrict immigrants from comingRead MoreEssay about Out of This Furnace Analysis892 Words   |  4 PagesSteel Mill Immigrants Of Industrial America For many Americans, the late nineteenth century was a time of big business, marked by economic and social evolution. In the period between the 1880 and 1920, the American economy was growing at a rapid pace. Many European immigrants without industrial skills flooded into American factories and steel mills. These new comers came in search of better economic opportunity, which paved the way for Heavy, low paying labor that became the job description ofRead MoreSteel Mill Immigrants of Industrial America Essay619 Words   |  3 PagesSteel Mill Immigrants of Industrial America For many Americans, the late nineteenth century was a time of big business, marked by economic and social evolution. In the period between the 1880 and 1920, the American economy was growing at a rapid pace. Many European immigrants without industrial skills flooded into American factories and steel mills. These new comers came in search of better economic opportunity, which paved the way for Heavy, low paying labor that became the job descriptionRead MoreItalian Immigration to America1113 Words   |  4 Pagesarrived in the United States. Majority being from 1900 to 1914. Once they arrived in America, immigrants faced difficult challenges. Most of the time not even knowing the English language and also having very little education. Many of the new immigrants were forced to accept the lowest paying and hellish jobs. Sometimes were often forced by the average man who acted like they were slaves. Most of the immigrants found homes in the older sections of the big northeastern coast al cities. Later became knownRead MoreEssay on Ellis Island1698 Words   |  7 Pageswith the opening of Ellis Island as an immigration depo. This attracted many immigrants to the United Stated because of more job opportunities and as means to start a new life. As more immigrants came to America, it began to be known as the land of opportunities. Immigrants coming in filled work spaces in industries with the hopes of someday becoming successful. These immigrants helped prove to other future immigrants that if you moved to America then you could start a better life for yourselfRead MoreThe Immigration Act Of 17901304 Words   |  6 Pageshow labor legislation was used. The year 1970 is often known to be the largest turning point in the history of US immigration. The law limited naturalization to immigrants who were free white persons of good moral character. That being said, The Naturalization act of The United States who granted citizenship to immigrants that faced many barri ers are restrictions to the American Law and the many cultural difference caused many challenges throughout the journey process after the NaturalizationRead MoreEssay on An Analysis of the Jungle by Upton Sinclair1396 Words   |  6 PagesIn the early 1900s life for Americas new Chicago immigrant workers in the meat packing industry was explored by Upton Sinclairs novel The Jungle. Originally published in 1904 as a serial piece in the socialist newspaper Appeal to Reason, Sinclairs novel was initially found too graphic and shocking by publishing firms and therefore was not published in its complete form until 1906. In this paper, I will focus on the challenges faced by a newly immigrated worker and on what I feel SinclairsRead MoreThe Impact Of Immigration On The United States1148 Words   |  5 Pagesplethora of cultural variation and ethical treasure as well as a place that gives great opportunities to attain wealth. Waves of immigrants came crashing down upon the United State s in search of this wealth, all seeking the American Dream that they heard of from their respective homelands. Even still, the quest to realize this dream draws in many from afar and as a result; immigrants are still drawn to the United States. Entwined with the topic of immigration is the continuing process of industrialization

Harvard Referencing Guide Free Essays

Harvard System Referencing Guide 1. INTRODUCTION This guide sets out the Harvard system of referencing to be used in the Thesis and other major essays submitted as part of the course taught through out the MBA program. It is important to reference published material that you wish to use in your essay. We will write a custom essay sample on Harvard Referencing Guide or any similar topic only for you Order Now While referencing is a standard that is used to avoid plagiarism it also supports a strong scientific method. To build arguments and provide evidence you must reference any published resources you use. The spirit of referencing is embodied in Newton’s famous 1676 quote, ‘If I have seen further it is by standing on the shoulders of giants’. It means that Newton’s great discoveries were made by building on the previous work of scientists. This reference guide sets out how to reference other authors’ work properly. For each type of material you are referencing (e. g. books, journal articles, newspapers, internet sites), this guide presents two parts, how to write the reference in the text of your essay and how to write the full reference at the end of the essay. The section at the end of the essay should be called a reference section and only include those references cited in the essay. For the purposes of this guide these two sections will be called in-text referencing and the reference list format. A note on paraphrasing and quoting: Quotes are direct transcriptions of text from other sources while paraphrasing uses your own words to express others’ ideas. You should attempt to paraphrase where possible and only use quotes sparingly and strategically. Both paraphrasing and quoting require referencing, and quotes must refer to the page number from which they were taken (see Books). 2. GENERIC FORMAT The Harvard system has a generic format for in-text referencing and the reference list. While this guide provides a range of examples for books, articles, Internet sources etc, the generic format below should be used where adaptation is necessary. In-text (Author, year) or Author (year) e. g. Sillince (1996) or (Sillince, 1999) Reference List Books Author, (Year) Title. Place Published: Publisher. e. g. Sillince, J. A. A. (1996) Business Expert Systems. Hitchin: Technical Publications. Articles Author, (Year) ‘Article title’. Journal Title, volume (number): pages. e. g. Sillince, J. A. A. (1999) ‘The role of political language forms and language coherence in the organizational change process’. Organization Studies, 20 (3): 485-518. 3. BOOKS The following exemplifies several in-text references for books with one, two, more than two authors, and authors cited by another author. When citing more than two authors, list all authors’ surnames the first time, then use et al. (see example). Note the different formats for the in-text referencing of paraphrasing and quotes (with page number) and the complete references in the reference list. In-Text One Author The development of bureaucratization in the UK was fundamentally different from that of the US. The Taylorist efficiency movement occurred in the US during an expansionary period while the same movement occurred in the UK during one of the worst ever recessions (Littler, 1982). Littler (1982) concludes that for these reasons the labor movements in the UK are fundamentally different from those in the US. These differences in capitalist development had important consequences, ‘This affected the pattern of resistance, and British capitalism still carries the scars of this historical conjuncture’ (Littler, 1982: 195). Two Authors Managerial skills are a key focus for Whetton and Cameron’s (1991) introductory text. How to cite Harvard Referencing Guide, Papers

Low Self Esteem Essay Example For Students

Low Self Esteem Essay Languages, colors, cultures and also the way one behaves may differ from one nation to another. Yet, each and every one of us living on the surface of this planet have several things in common. One of these similarities is that we all have a way of regarding our own self. It is believed that a large amount of individuals feel very good about themselves. Nevertheless, from time to time even the best of us get a dose of negative emotions. Very heartbreaking stories about self dislike were told by many depressed teenagers and older people. What are the causes of this kind of Low Self Esteem Essay and how can one person get solutions to outcome them? Self Esteem is defined as confidence in your own merit as an individual#. Such concepts as self-esteem and self-image have been regarded by some social psychologists as useful, while others have regarded them as unnecessary. There is a considerable amount of research on such topics but it would be very difficult to find the exact definition because volumes have been written about self esteem. Definitions given in self esteem literature run a yard long. But after cutting through all the scientific words, the question of self-esteem really centers down to something quite simple: How do a person feels about his/herself? If the person feels good about him/herself, they have a high self-esteem. If they feel bad about him/herself, they have a low self esteem. Since low self esteem is a worst problem than the higher one, lets examine it to find some solution by investigating a number of low self esteem causes and personal cases. Individuals with truly high self esteem feel good about themselves and continue believing in themselves regardless of what others think of them. Some people feel good about themselves only as long as others support them and approve them. The moment another person criticizes them, or withdraws her or his support from them, they not only feel bad about themselves, they may even hate themselves. That would be the first step into low self-esteem. When a person acts like that, life can be hurtful for most of the time and they might find themselves at the mercy of others. When these kind of persons dont have the emotional freedom and independence from the criticism and approval of others, their choice of action is limited. There may be options far superior and promising but they may be too apprehensive to choose them because they primarily depend too much on other peoples immediate approval. Thinking that it would be impossible for them to do things right they end-up being incapable to do things accurately. People who are unsure of themselves have trouble sustaining their relationships because their feelings get easily hurt. They are too quick to read insult and ridicule in the innocent remarks of others. Since they feel insulted, hurt, embarrassed, and ashamed without due cause, their reactions baffle and pushes others away. They ride an emotional roller coaster and some of them resort to alcohol and drugs.# This problem occurs most likely among teenagers or older young people. This is due because of the limitations that might frustrate them. They are growing up, and often there is a period of awkwardness in which dropping things or bumping into them is a daily embarrassment. Then, too, they simply dont have an adults experience in bouncing back from disappointments. And because their perceptive powers havent been sufficiently trained through use, they may not always make the wisest decisions.# At times they may feel that they cant do anything right. Amelia Earhart (898 words) EssayFailure to meet ones parents expectations can be another cause of low self-esteem. If I make an A minus in school, one youth says, my folks want to know why it wasnt an A and forget about appreciating my hard work. After that they even start comparing me unfairly with my older brother. Such kind of unjust comparisons are a good reason for a teenager to develop a low self-esteem. At this level a youth should try to develop a better self-respect. But how is this possible? First, teens should take an honest look at their assets and liabilities. This should also include an investigation .