Ethical theories Essay

There are five types of ethical theories: 1. Teleological theory of ethics 2. Deontological theory 3. Virtue ethics 4. Justice as fairness 5. Feminism The teleological theory examines the consequences in terms of pleasure and pain, which is termed as â€Å"Utilitarianism†. According to this theory, our obligation in any situation is to perform that action which will produce the greatest amount of good over evil. Under this theory, the ethical virtues such as being honest or not lying are not obligatory. Utilitarian morality compels you to do only those particular acts which bring out good results only. For instance, consider a situation where telling the truth can break someone’s heart or hurt his/her feelings then in the light of this theory, lying is better than honesty. One of the fundamental characteristics of utilitarianism is universalism which talks about the pleasure of everyone, rather than benefitting your own self only. The two versions of utilitarianism have evolved from these conditions, act-utilitarianism and rule-utilitarianism. The two great philosophers, Jeremy Bentham and Stuart Mill presented their views in the light of this theory. Bentham proposed the act-utilitarianism theory and said: â€Å"An action is right if it produces greatest amount of pleasure over pain for everyone† However, this statement was greatly opposed by many critics since they termed it as a â€Å"pig philosophy†. Critics complained that pleasure alone can not constitute the good for human beings because even pigs are capable of attaining pleasure from their own bodies so it would be better to live the life of a satisfied pig rather than being a dissatisfied human being such as Socrates. Seeing these objections, Stuart Mill supported the utilitarianism gave the idea of act-utilitarianism by giving his view that an action is right if it produces greatest amount of pleasure over pain by following certain moral rules. Mill said that a person should go for qualitative pleasure rather than quantitative pleasure. Mill also defended the accusation of pig philosophy on Bentham by giving his views that human beings are able to enjoy the higher levels of pleasure than swine. Human beings can pursuit pleasure in the form of intellectual arts and other such activities. Hence, Mill categorized pleasure in higher and lower forms of pleasure. Rule-utilitarianism emphasized tremendously on morality and social obligations, which in fact, are the problems of all teleological theories. Concluding the discussion now, the best theory is the rule-utilitarianism as compared to act-utilitarianism theory because one does not need to calculate the amount of pleasure and pain before performing any deed. Instead, it provides the basic grounds of morality and goodness for doing any action.

Foreign Aid as a tool for Foreign Policy

Foreign aid is defined as voluntary transfer of resources from one country to another country, at times as leverage to cohorts the receiving country do what the donor country wants. But it may be given as a signal of diplomatic approval, or to strengthen a military ally, to reward a government for behavior desired by the country giving the aid, to extend the donor's cultural influence, or to gain political strength here at home as abroad. According to the USAID website, foreign aid is given through eight different types of monetary assistance. These eight different forms of assistance are agriculture, democracy and governance, economic growth and trade, environment, education and training, global health, global partnerships, and humanitarian assistance. From 1980 to 2008, U. S. total foreign assistance has increased from 9. 69 billion to just over 49 billion in 2008. From the 49 billion spent in 2008 alone, close to 15. 5 billion was spent on military aid while the rest was divided between economic assistance in fields such as agriculture, international development, and other economic growth and trade programs. The largest recipients of the two foreign aid subdivisions, military and economic aid, went respectively to the regions of the Middle East and Sub-Saharan Africa. The country in the Middle East with the highest recipient of aid was Afghanistan, with close to 9 of the 49 billion dollars of aid in the 2008 year alone (USAID, 2013. ) As we can see a lot of our tax payer’s money goes abroad to countries many American cannot find on a world map, but we need to help these countries for the safety of our people, at least in the eyes of every politicians in office. American liberals, as described by Bob Burnett of the Huffington Post, fall between two primary types of camps that determine their views of U. S. Foreign Aid. Idealists and realist camps, focus on the need for international humanitarian aid which is similar to our own domestic welfare on a national level (Burnett, 2006. ) They tend to favor foreign aid as a means to educate and develop relationships through cooperation and financial funding. Other far left liberal groups discourage military spending while encouraging to increase social programs internationally. They believe that poverty stricken countries in need of assistance otherwise known as â€Å"Third World† countries are indebted to other countries which lead to their current status as reported on the Green Party Platform (GPP, 2000. ) As a primary focus to foreign aid and success to developing nations is the assistance to increase food production, availability to clean drinking water, reduction of infant mortality, and improvements toward health by means of the green revolution. Lastly, they utilize terms of humanitarian aid as to be consistent with their egalitarian values. In recent discussion to reform the current foreign aid policy, Democratic representative Howard Berman introduces a reform proposal â€Å"Global Partnership Act of 2012† to replace the 1961 Foreign Assistance Act. This policy would restore budget functions towards the USAID and develop new funding mechanisms focused on innovation, microenterprise development, and rapid humanitarian response, and reduce violence against women (Mungcal, 2012. In addition, this policy would focus on reduction of global poverty, accelerated economic growth, agricultural innovation, advancement in health, combating diseases, global education strategy, gender equality, assistance to persons that have been affected by conflict or disaster, and monitoring/investing towards sustaining upward success and control of financing through government regulations (HR, 2012. ) Thus, they create a more specific rational belief to solve foreign issues utilizing our government system to regulate. When observing the implementers of the USAID they have nearly 2,000 experienced employees (USAID, 2013. Other proposals by liberals represented by the Green Party express international solidarity maintaining peace and security through a global green deal. This particular deal will concentrate finances on universal education, food, sanitation and purified water, health care, and family services for every person on Earth. This particular proposal â€Å"Fund Global Basic Human Needs† would gain funding by retiring the military from our economy and closing all overseas military bases In addition, eliminate the CIA, NSA, and all other covert Warfare in order to reallocate funding towards aid. Lastly, this platform would eliminate debt from poverty stricken countries thus creating emphasizing their egalitarian beliefs (GPP, 2000. ) Another foreign aid announced by President Barack Obama is the Global Health Initiative that would continue to develop from the pre-existing program by President Bush, President’s Emergency Plan for Aids Relief. This continued improving program will expand to other countries instead of only Africa, it would encourage prevention, care, and treatment while strengthening government partnership and invest in research internationally to maximize outcomes (UNAIDS, 2009. In addition, they seek to reduce higher statistics of disease contraction and mortality of women and children while strengthening global health partnerships. Based upon the ideological spectrum of liberal beliefs, through their core value of rationalism they exhibit faith in human reason to solve complex problems that cause poverty in third world countries. By creating regulatio ns, education about health and finances, and encouraging progress towards mutual goals through the Global Partnership Act of 2012, liberals believe that underprivileged countries will progressively develop towards sustainability based upon human rationale. As an egalitarian belief, liberals from the Green Party believe and promote human equality by their party platform of universal health care for every person on the planet which indicates equal treatment by means of education, health, and services. They promote internationalism by means of equal treatments towards other countries and foreign aid reform of the PEPFAR towards all countries instead of the countries within the African continent. Moreover, liberals seek change as soon as possible which led to the speedy approval of PEPFAR and Africa’s request for assistance in regards to immediate medical attention and assistance. Therefore, the liberals utilize the government as a strong feature to decide and guide towards our faith in solving socioeconomic problems internationally while attempting to cultivate foreign governments with their ideology. Lastly, they value their belief of individual liberties and encourage the development of foreign countries so that their citizens will be treated fairly and just by their government. When approaching foreign aid as a contemporary American conservative, they utilize the term foreign policy as opposed to aid as a reference of government action rather than a community decision. They seem to favor foreign policy by means of military and health care; however, the primary goal is to develop relationships with foreign countries to prevent conflicts. Although they discuss creating trade agreements and forming partnerships, they seem to be strategizing in terms of security and protection for America. In regards to funding, conservatives don’t seem to favor the idea of increasing tax spending towards foreign aid and seek to reform due to their subjective views on failed results. Therefore, they view investment towards a flawed foreign policy will lead to more spending in military forces to protect America from unstable countries. Moreover, I feel that conservatives have a strong belief in nationalism and would want to share this system by encouraging other undeveloped countries to conform to our system. As a conservative perspective towards foreign aid, our government allocates tax payers funding towards the Millennium Challenge Corporation or MCC which would utilize a procedural form of selecting certain countries by means of performance while being evaluated by a board and executed by 300 employees (MCC, 2013. The criteria would be based upon whether or not they can compete with other countries in regards to Gross National Income of low or middle class sustaining, improving their quality and performance as a country, or graduating with a year If there are no signs of improvement or potential, they would not be eligible for the next year and be left to thei r own elements. The form of criteria emphasizes a value of elitism on the competitive national level. Basically, if a certain country is not deemed successful due to lack of intellect, strength of its citizens, or ability to overcome poverty then we decline assistance. In another perspective, we can view our system of criteria and success based on the survival of the fittest which is a value of inequality. In addition, the goals of the MCC are to leave the responsibility of the foreign government to facilitate their own success towards growth in health and agriculture, create partnerships, and property rights (MCC 2013. ) We basically leave their government in the faith of the invisible hand to guide their success rather than micro managing their success by means of government. Lastly we encourage property and individual right through the investment policy to reduce poverty. As discussed by James Roberts a researcher for International Trade and Economics, â€Å"MCC's selectivity and associated seal of approval creates powerful incentives for developing countries to uphold democratic and free-market principles, invest responsibly in their citizens, and transition their economies from developing to emerging markets† (Roberts, 2013. ) He encourages a core value of faith in non-human institutions by means of a free market rather than government controlled. In addition, the MCC encourages national accountability towards developing democratic reform and trade policies thus validating their values within nationalism. In a recent proposed foreign aid budget, Josh Riggin reports, â€Å"The long-term budget announced on Tuesday by House Budget Chairman Paul Ryan would cut the budget for international affairs and foreign assistance by 29 percent in 2012 and 44 percent by 2016 while increasing the defense budget by 14 percent over the same timeframe† (Rogin, 2011. Basically, he would be increasing the current spending bill on defense of 22 billion to 583 billion for national defense and security while decreasing national affairs from 37 billion to 22 billion. This validates the characteristic of the need to increase spending on defense or authority and stability with conservatives. Moreover, the decrease in foreign aid would be left at the hands of faith in non-human institutions. In a report by U. S. World News, Evan Moore and Patrick Christy claim â€Å"Aid is hard power. It is a weapon the United States uses to strengthen allies [and partners] and, thus, ourselves. (Moore & Christy, 2013. ) In this statement, they value a sense of authority, stability, and order in regards to security with military. However, due to sequestration to cut foreign aid, conservatives believe that it will avoid assistance towards promoting national security and create instability in weak states as well as on a global level. Basically, foreign aid directed towards developing a country will hinder strategic investment with allies in military which is the primary goal. As a statement towards nationalism, Gary Connor publisher of Palestine. Herald-Press, he claims that the U. S spends billions of tax payers’ money every year on foreign aid while we continue to be underfunded on a national level primarily with disaster relief, education, and border security (Connor, 2013. ) His conservative belief opposes internationalism while focusing on America as the priority versus developing countries that may not be contributing to our society. In addition, he emphasizes a sense of elitism in the aspect of the funding that was gained by tax payers should be used towards the tax payers despite the harsh reality underdeveloped countries. As a primary characteristic of a conservative, their primary worries in regards to the foreign aid policy are the unintended consequences. As reported by Thomas Eddlem contributor to The New American publication, â€Å"US foreign aid programs often funded autocratic regimes that have committed human rights abuses and stand against democratic principles† (Eddlem, 2013. ) In other words, American funding towards foreign aid has become the financing for their government to oppress and control opposing voices. Another report claims American aid to Egypt purchases in the last 30 years towards their regime that performs torture and brutality. The challenge to foreign aid is whether or not we have implemented proper authorities to ensure foreign aid given by America’s tax payers are being utilized effectively. Due to the conservatives lack of confidence in the government’s ability to create progressive results using the tax payers money, conservatives state that â€Å"Billions of American dollars from faith-based and other charitable, academic, and humanitarian groups go to the needy overseas every year and have far better results than government ODA† (Roberts, 2013. Although conservatives may seem reluctant to push towards foreign aid, their support through religious charity groups emphasizes a faith in non-human institutions. Contemporary American moderates would approach foreign aid in a collaborative value between conservatives and liberals; however, they would primarily compromise their beliefs to coincide with the current status quo. They would probably continue keep a balance of spending to aid foreign countries by means of finances and health assistance, but to primarily remain conscious as to prevent from leaning towards focus on the government for all assistance and seeking private donations as well. In addition, they would probably continue the traditional USAID form of foreign aid and balance with the new updated approach of the MCC or to combine both of these programs. In recent alternative propositions by the Foreign Service Despatches and Periodic Reports on U. S. Foreign Policy by Dobransky, he considers multiple alternatives in the views of moderates. The first policy would be to maintain U. S. foreign aid by continuing to utilize USAID and the recent version MCC. In the perspective of Americans, both forms of aid have been approved and criticized openly by multiple parties; however, they are both still being utilized and approved by congress as the usual form of application (Dobransky, 2011. The second alternative would be to merge both programs of the USAID and MCC which would primarily cause shared mass information to the public and be able to whittle down flaws and target areas of success to increase efficacy. Moreover, there would be one organization as opposed to two leading groups that oppose each other’s’ views despite a common goal. A proposition brought on by the Green Party that would encourage a global deal to fund tow ards education, food, and other basic needs to every human on this planet by means of American tax payers. Sounds like a truly selfless proposal; however, the majority of Americans would not want to place all resources and hard earned money to the rest of the world. This would probably exhaust America’s budget and would be impossible to ensure that every single person is receiving the same exact treatment. In addition, America would not want to sacrifice closing overseas military bases which would place our country in a higher and much vulnerable state due to weak security. When evaluating the MCC policy, they emphasize a rich value in elitism by means of leaving these countries to their own device. If we are investing in these particular countries by means of our tax payer’s money, we would want to see positive results by means of guidance and American political perspective to decrease poverty and social ills rather than finance countries then leave them to figure out how to succeed. In addition, with the amount billions of dollars spent to aid other countries we can afford to increase representatives of the limited 300 employees of MCC in order to properly work side by side with invested countries. Politicians in America use Foreign Aid as a weapon to achieve what they want from other countries, but they do not really see the real problems that this help causes in poor countries, or at least they act as they do not see it. For example Foreign Aid causes major corruption and even more poverty. The governments in poor countries do not really care about the people and they are not design like the government in the United States. If we follow the history of Foreign Aid, we can see that every time we help a country, we always end up fighting that country at one point or another. Foreign Aid should be limited and the US should hold the countries that received aid accountable for how they use it. Millions of dollars are lost in fraudulent contracts and misuse by the receiving governments, we do not have a saying in how these governments can use our hard earn money. For the US government to continue having the approval of the people in foreign aid help, it needs to fix the requirements for who qualifies to receive foreign aid, and also when to use foreign aid as a tool for foreign policy.

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History Coursework Example | Topics and Well Written Essays - 250 words

History - Coursework Example ent nations were motivated to dominate other nations by the need to enlarge and control foreign trade which would serve their insatiable appetite for luxuries, such as silks and spice and they were also trying to obtain raw materials and supplementary sources of labor, passages for extra capital and markets for surplus goods. Another explanation suggests the political determinants of imperialism, according to which the nations of Europe in the 1500s were motivated to expand chiefly due to the desire to gain power, defense, and diplomatic advantages, and their desire to implement military force and compete with other European nations was served by imperialism and conquests. â€Å"Reversing causation, trade could precipitate the extension of European empire. However, European power politics (together with European technological advantages) gave a stronger impetus to imperialism.† (Aldcroft and Sutcliffe, 121) Therefore, economic and political explanations of European imperialism in the 1500s are highlighted in the analysis of the factors that drove European civilization to get involved in imperialism and conquest. However, there are other important explanations such as the explanations based on the ideological or moral motives of European imperialism in the 1500s, according to which imperialism as a missionary activity was caused by cultural or religious beliefs. Similarly, the religious explanations of European imperialism in the 1500s emphasize the desire to spread

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Appraisal and Social-Cultural Factors Research Paper

Appraisal and Social-Cultural Factors - Research Paper Example A reading score that is two standard deviation below the mean implies that the student belongs to the bottom 3% of the grade sevens, implying that close to 97% of the grade sevens are ahead of her in the test. In what may be clearer terms, this means that if there are only 20 grade seven students, the student who scored two standard deviations from the mean in Reading means that she is about only as good as the slowest academic performer in 20 students. Make the students 100 instead of 20, a two standard deviation score below the mean score in reading means that she is about as good as third slowest academic performer in a reading if there only 100 grade seven students. These discussions are not very accurate, however, and were meant to impress important mental images of the situation. Table 1 refers to select portions of the normal curve. A test score that is two standard deviation from the mean imply a z-Score of -2.0 that is associated with -2.00. The numeral -2.00 follows through the intersection of the row of -2.0 in the z column and the column associated with .00 of the table. In turn, following protocols followed for the table of the normal curve, the numerals mentioned earlier are associated with the value of 0.0228 that gives area under the normal curve. The area of normal curve 0.0228 is associated with the probability associated with the lowest scorer with the score associated with two standard deviations below the mean. This means that more precisely the student we are discussing belong to bottom 2.28% of the grade sevens, following the association of 0.0228 with 2.28%. Meanwhile, a score of 115 given of 100 and standard deviation of 15 imply a z value of 1.15 following standard transformation formation protocols. In turn, the z-score of 1.15 is associated with the area 0.8749 under the normal curve based on Table 1. This means that the student we are

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AICP - Research Paper Example An organization like American Society of CPAs relies so much on internal auditors. Such auditors need to apply and uphold the ethical principles such as integrity to give a basis on reliance on their judgment. Secondly, they need to observe objectivity that makes them not to be led by their interest but the truth. Confidentiality and competency are another lot that need to be observed. The most important aspect of ethical principles is their consistency maintenance, implementation, and determination of their effectiveness to an institution such as American Society of CPAs (Braxton, 2012). The maintenance of ethical code of professional conduct is the most important in making sense of the codes to the institution. The maintenance is due to ever changing conducts of the professionals working to an institution. It ensures that the most current code of ethics is consistent with demand of the institution. To fulfill the maintenance of code of ethics, surveillance need to be done continuously on the auditors behavior to note on any aspect that may compromise the professionalism of auditing. An institution like American Society of CPAs need to update the code of ethics now and then as the demand arises (Cascarino, 2007). According to Braxton (2012), the presence of sound code of ethics in any institution without implementation is as good as not having one. In that light, the implementation now brings the essence of the code of ethics. The implementation comes with changes that the code of ethics is made to fulfill. For an organization such as American society of CPAs to implement the code of ethics, it has to come up with institutional policies that will safe guide the interest of the code of ethics. If any auditor goes against the policy of observing the code of ethic then disciplinary action should be taken. It is only through institutionalization of policies that will ensure the code of ethics is

The Readers Response To The Novel Essay Example for Free

The Readers Response To The Novel Essay Written by Mary Shelley in 1816, Frankenstein is a novel that conveys several messages and themes. It was written at a time of social and political upheaval: the incredible advances in science and movements in art and culture were changing the way people lived dramatically. For example, the use of electricity, the French Revolution and the Romantic Movement, were leading people to have totally radical, bohemian lifestyles. Shelley allowed these revolutionary ideas to move and inspire her, enabling her to write one of the most remarkable and intriguing pieces of literature in the world. In the novel, Shelley uses three narrators: Robert Walton; Victor Frankenstein; and the monster, or modern Prometheus, as he was intended to be. The purpose of this essay is to explore what effect this has on our response to the novel overall. I shall do this by explaining how they affect our understanding of the main themes of the novel; the complex time and structure; and the narrators as characters. Mary Shelleys classic novel discusses three major themes: ambition and its consequences; the importance of family; and community and isolation. Victors horrific tale shows how blind ambition and ruthlessness can destroy you morally and physically. This happens to Victor as he loses everything dear to him and eventually his own life. Upon hearing Victors story of death and revenge, suffering and loneliness, Walton gives up his own ambition of discovering the North Pole, realising that he has sacrificed his sister for his obsession with success. Thus he is saved before it is to late. Victor on the other hand has caused his own downfall: he becomes so obsessed with his creation that he neglects his family by refusing to go home when Elizabeth writes to him. This ultimately leads to the deaths of his family, Justine and William are killed in the monsters fit of revenge, and his suffering and loneliness begin to devour him. The theme of the importance of family is reinforced throughout the novel. From Victors idyllic childhood, My mothers tender caresses, and my fathers smile of benevolent pleasure while regarding me, are my first recollections, to the monsters grief at his fathers death, close family relationships are regarded as precious and wonderful. This may be because Shelley lost her own mother when she was very young, and used her own personal experience to inspire her. Both Walton and Victor take their relationships with their sisters for granted, sacrificing them to pursue their own dreams. Victors experience shows that you cant have both: your family and your career to flourish. This idea id introduced very early in the book, when Victors departure to university is delayed by the death of his mother from Scarlet Fever.

Tortilla Curtain by U.S. author T.C. Boyle Essay Example for Free

Tortilla Curtain by U.S. author T.C. Boyle Essay The American Dream is defined in many ways in both of these works of literature.   What is the American Dream?   It is the idea that with hard work anyone can succeed in this country.   Succeeding is mostly defined in materialistic terms, like having a house in the suburbs, a new car, etc.   The American Dream is also about being able to support a family in a more-than-basic way.   It may also be defined as living a fulfilling life but of course, one needs a little money to do even that.   In Boyle’s Tortilla Curtain, the American Dream is shown as absolutely unattainable to some people, chiefly illegal immigrants, unless they are willing to break the law.   In the movie Crash, the viewer sees examples of people who â€Å"make it† as well as people who don’t, and even some people who are in between.   However, in both these pieces, characters must struggle and work hard for even a chance at the American Dream.   But the question remains, â€Å"why is the American Dream attainable for some and not for others?†Ã‚   Overall, the idea of the American Dream is shown as a myth or illusion for most people.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The American Dream exists in many ways in this movie.   In Crash, the viewer is shown a successful character like the Latino man named Daniel.   Daniel lives in a small house, but it is his house.   He lives with his wife and daughter.   He works hard every day, and while he will never be rich like Jean, he is able to survive and to sustain his family.   The viewer would not exactly view him as a success story because there probably isn’t much money left over at the end of each month.   However, the viewer recognizes that Daniel has what is truly important in life and is â€Å"making it† even thought that might be day by day. On the other hand, the Persian man who owns the shop is unable to attain the American Dream.   Or rather, he is on his way when the shop is destroyed by vandals.   With the insurance company refusing to pay, he has lost everything.   Due to the fact that he has been ripped off before in America, he does not believe Daniel when he is told to get a new lock.   Therefore, he essentially loses his business.   Both of these characters must struggle through stereotypes and prejudice and racism on a daily basis to even have a chance at the American Dream.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Now, Jean’s character in Crash shows another side of the American Dream.   She really has the plush lifestyle that most people would think of when defining the American Dream.   She has the beautiful house, the cars, the maid, the manicured lawn, the glitzy clothes and jewelry, etc.   She is clearly unhappy.   All of the material possessions have not made her happier; they have possibly made her miserable.   She has no friends, no one she can really count on.   for most of the movie, she is a hated character, and yet she is someone who lives the American Dream. The viewer does not know whether the couple has earned all this money or inherited some, but the viewer sees Jean’s character basically doing nothing.   She does not work while Daniel and Farad struggle daily to make a life for their families.   Clearly, Crash says that the dream is not attainable for everyone no matter how hard they work.   Neither one of them is lazy characters at all and still, life is a struggle.   But those who have the â€Å"life† want to protect it and protect themselves against those who don’t.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In Crash, there are those who sort of live the dream outside the boundaries of the law.   The viewer assumes that Ken Ho lives the dream.   he is an immigrant who has â€Å"made it† in America.   But how has he done this?   He traffics human beings. He completely compromises any values that he had in order to make money.  Ã‚   Ludicirs and Anthony sort of live the dream although they always must stay one step ahead of the police in order to keep what they have.   They steal cars which earns them money to buy nice things.   These characters show the American Dream gone awry.   However, there is a reality here as well.   Many people in this country feel that the Dream is unattainable to them any other way than breaking the law.   So, they break the law in order to get the things that others already have.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Basically the movie Crash shows the viewer situation after situation where people struggle to live the dream and that is exactly what it is for most people, a daily struggle.   To get to the top is hard enough, but to stay there is nearly impossible.   And it isn’t about hard work at all.   being a hard worker guarantees nothing in this life.   It doesn’t guarantee that a person will ever get anywhere financially.   It doesn’t guarantee that someone who hasn’t worked at all won’t take your life away from you suddenly.   It doesn’t even guarantee that a person will have a place to live or money to buy food no matter how hard he/she works.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This brings us directly to Boyle’s Tortilla Curtain, which is yet another name for the border between the United States and Mexico.   In Tortilla Curtain the dichotomy between rich and poor is shown quite clearly.   Kyra Menaker-Mossbader and her husband and son have the American Dream.   They live in an exclusive housing development called Arroyo Blanco Estates and seem to have all the luxuries of life.   below their house, Candido and America Rincon live.   They came to America illegally from Mexico in order to maintain the American Dream.   they find that no matter how hard they work, they simply cannot attain the Dream.   In fact, they cannot gain enough money to live any semblance of a decent life.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Rincon’s come to the United States illegally to work for a better life.   The Rincon’s truly believe that in American society â€Å"everyone, even the poorest [has] a car, a house, and a TV† (26).   They do not understand that even Americans are poor; that is why America is so upset when she meets Mary at the labor exchange.   If citizens of this country cannot achieve the American Dream, where does that leave her family?   Throughout this book, America will come to believe that her whole idea was noting but an illusion, an illusion that will not be met. They have already reduced their living standards to the bare minimum and are barely scraping by.   While America is pregnant, she has had to camp out in the open air with no clean water or any sort of sanitation system.   This couple has no health insurance for the birth of their baby, nor do they have prospects in getting a job in order to obtain and maintain this health insurance.   They work as day laborers until they can’t even find work at all.   America is like many others.   She dreams of the United States we typically see in the movies.   She would like a â€Å"clean white house† with some modern amenities and a little yard.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Like some of the character in Crash, America commits a crime, although on a much lesser scale.   She steals fruit from a garden.   She has never before committed a crime.   But the desperateness of seeing those around her thrive while she struggles to eat is too much.   Sadly, also like many of the characters in Crash, they are also unable to defend themselves from attacks.   They are out in the open air and have a hard time with the language.   First, some kids smash up their camp for fun.   Then America is raped.   They go to the city where Candido is robbed, and they eat garbage to survive.   They return to their campsite in the valley and things are looking up until Candido accidentally sets the whole valley on fire.   Their savings are burned up, and they must start over once again.   Their daughter is born blind.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Kyra Mossbacher and her family have achieved the American Dream.   Have they worked harder than the Rincon family to achieve this dream.   The reader can clearly see that they have not.   It is simply that the dream is open to this family and closed to others.   Kyra Mossbacher has a dream of possessing even more.   she wants the Da Ros place which is a huge mansion â€Å"in the style of an English manor house, comprising eleven thousand square of living space† (222).   Kyra must replace her â€Å"dream† after this place is destroyed by fire.   they live a charmed life with their young son and their pets.   They are sheltered from the cruel realities of what many others face in this life.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   While Delaney calls himself a â€Å"liberal humanist† (3), he has some chance encounters with Mexicans that slowly turn him into a racist. First, he runs into Candido with his car.   he is guilty at first and then angry at this illegal for being in the road.   Finally he hands him a $20 and calls it even.  Ã‚   Apparently this is what an illegal immigrant’s life is worth, $20.   As other things happen, Delaney become angrier at Mexican illegals.   First, a coyote takes his dog.   then his Acura is stolen by thieves. His neighborhood also becomes angry and begins to wall in his community.   they are protecting their American Dream, but in doing so, they are stopping others from attainting this dream.     Ironically, the people building these fences are the illegal immigrants themselves, like Candida and his friends.   Kyra’s lobbying closes the labor exchange.   he wants vengeance on Candido.   He goes to the campsite with a gun and a mudslide starts.   While Delaney saves Candido, the baby drowns.   The tragedy in the end of this book is beyond compare.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   What the movie Crash and the book Tortilla Curtain teach the reader is that there are no easy answers.   Illegal immigration is not rationalized or approved of in any way, and yet, these people need to survive.   We all fight for the American dream, and we all want to protect ourselves against people who want to take from us.   That is human nature.   In Crash, the idea is that we crash into people because we are so starved for human touch.   Therefore, we have these chance encounters with people we never would have met otherwise; some of them are good and some are bad.   The average person struggles everyday and life isn’t easy. There is no such thing as equal opportunity in this country and hard work is not even remotely close to all that is necessary to achieve the American Dream.   In Tortilla Curtain, the same kinds of lessons are taught.   Delaney and Candido meet quite literally in a â€Å"crash† scene, and Delaney describes himself as a liberal until he starts to fear those trying to get a piece of their own dream by disrupting his.   Then, he fights back.   It isn’t America and Candido’s fault because they want to make a better life for themselves and their baby, and it isn’t really Delaney’s fault because he wants to keep the life he has.   The story ends about as tragically as one could.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Both of these pieces tell the reader/viewer something about empathy.   Maybe if everyone could try just a little harder to understand the stories of others, to understand where others are coming from, we could solve some of our problems.  Ã‚   Everyone wants the same things in the end.

Case Summary On The Effects Of Unstable Angina Nursing Essay

Case Summary On The Effects Of Unstable Angina Nursing Essay Mr AR is a 41 years old male. His calculated BMI was 20.9kg/m2. His presenting complaint was chest pain which has lasted for three days before being admitted into the hospital. His chest pain was of pressing type, it occurred even at rest and lasted for 5-10 minutes each time. It was relieved slightly by rest and it was always accompanied by numbness on his left hand. He had shortness of breath, orthopnea, headache and low effort tolerance. He complained of abdominal discomfort also. He had stopped taking all his medications for the past three days. He had a pacemaker fixed 16 years ago for his atrial fibrillation (AF), but the pacemaker stopped functioning 3 years ago. Due to financial constraint, he did not go for a new pacemaker replacement. He underwent an angiogram last year and was found that he has 2 blocked vessels. He has a history of hypertension too. Before being admitted into the hospital, he has been taking frusemide 40mg twice daily, hydrochlorothiazide 25mg once daily, perindopril 8mg once a day and amlodipine 10mg once a day for his hypertension. For his AF, he has been taking warfarin 5mg once daily and digoxin 125microgram once daily. In addition, he took simvastatin 40mg at night for the prevention of cardiovascular events. Mr AR was found to have poor compliance. He always missed the dose, took the medications at the wrong time and was unsure the reason behind taking all his medications. He was first admitted to the acute and emergency department. ECG was carried out and there was no ST-elevation. His blood pressure was found to be high, 172/126mmHg. No troponin test was done on Mr AR, the only available test results on cardiac enzymes were that of creatine kinase (CK), aspartate amino transferase (AST) and lactate dehydrogenase (LDH). All three were not elevated. Hence, he was diagnosed with unstable angina, gastritis and hypertensive urgency. He was given nifedipine 10mg, aspirin 300mg, Sublingual GTN and plavix 300mg in the acute and emergency department. His management plans were to monitor his vital signs every hourly for two hours followed by every two hourly and to carry out dextrostix test three times daily. He was given 60mg enoxaparin subcutaneously immediately and twice daily thereafter, intravenous ranitidine 50mg three times daily, sublingual glyceryl trinitrate (GTN) one tablet when required and IV frusemide 20mg twice daily. He was restricted to fliud intake of 800mL per day and started on fliud input and output monitoring. He will also be started on low salt diet for the management of his hypertension. On day 2, he no longer complained of chest pain. His potassium level was found to be slightly lower than normal range (3.3mmol/L). His BP was still high throughout the day, fluctuating at around 150/120mmHg. He was started on tablet clopidogrel 75mg once daily. On day 3, IV frusemide was changed to oral frusemide. On day 4 his blood pressure has already dropped to around 120/90 mmHg. He was planned for discharge and enoxaparin was to be stopped on that day. Disease overview and pharmacological basis of drug therapy Mr AR was diagnosed with 3 diseases. Only unstable angina will be discussed. Unstable angina (UA) is categorized under acute coronary syndrome (ACS) which is very common in the UK. According to the hospital episode statistic year 2002-2003, there were 83842 cases of UA in England and 4421 cases in Wales.1 UA happened when there is insufficient myocardial oxygen supply to meet the oxygen demand of the heart. The reduction in the oxygen supply is due to the disruption of artherosclerotic plaque, causing the formation of intracoronary thrombus and hence narrowing of artery. Abnormal vasospasm of the coronary arteries or coronary dissection may also lead to UA. UA is closely related to non-ST elevated myocardial infarction (NSTEMI) as they have the same pathogenesis and both are presented as chest pain. The only difference between them is that in NSTEMI, there is a rise in the cardiac biomarkers such as cardiac troponin or the MB isoenzyme of creatine phospokinase (CK-MB), which indicate s myocardial injury. In UA, the ischemia is not severe enough to cause damage to the myocardial cells and thus releasing these biomarkers in detectible amount. For the diagnosis of unstable, the patients history of anginal symptoms should be obtained. Physical examination like cardiac examination and vital signs monitoring may also be done. Patient with ongoing chest discomfort should have a 12-lead ECG performed within 10 minutes of onset to check if there is any ST-elevation or depression. If there is no ST elevation, STEMI will be ruled out and the level of serum cardiac biomarkers will be used to determine if the patient has UA or NSTEMI. Troponin I or T are normally the biomarker chosen for detecting myocardial cell death as it is detectable in the serum 3-6 hours after a myocardial infarction and remained raised for 14 days. If the serum troponin level is less than 0.01 Ã‚ ­g/L, then the patient will be diagnosed to have unstable angina. CK-MB may also be used when troponin test is not available. In Mr AR case, the results on the cardiac enzymes available, namely AST, CK and LDH are all non specific cardiac biomarkers as those enzy mes can also be elevated in skeletal muscle injury or liver disease. The treatment of UA can be divided into emergency treatment and secondary prevention treatment.2,3 Patients must rest in bed and ECG monitoring should be continued during the early phase of hospital stay. Sublingual glyceryl trinitrate (GTN) tablet or spray should be given for the relief of angina symptoms. GTN is a fast acting coronary vasodilators. Dilatation of veins going to the heart reduces ventricular volume and preload, while dilatation of systemic conductive arteries together with the decrease in ventricular volume causes a reduction in afterload. These effects will all reduce the myocardial oxygen demand.4 GTN also found to dilate collateral vessels, thus the areas of ischemia will receive a higher blood flow. If the chest pain is not relieved by GTN, intravenous morphine sulphate can be given to ensure patient comfort. Patient with ongoing chest pain or high risk patients should be given inravenous beta-blockers followed by oral route if there is no contraindication. Inter mediate or low risk patients can be given oral beta-blockers. If beta-blocker is contraindicated such as the in presence of uncontrolled heart failure, or the chest pain is not relieved by GTN and beta-blocker, nondihydropyridine calcium channel blocker can be given. Antiplatelet therapy should be given immediately by giving aspirin 300mg initially, followed by 75mg once daily for long term secondary prevention. In addition, clopidogrel 300mg should be given initially and 75mg daily thereafter for 3 months. Aspirin works by inhibiting the cyclooxygenase (COX) 1 enzyme on the platelet, thus preventing the production of thromboxane which stimulates platelet aggregation.5 Clopidogrel is an antiplatelet which acts by inhibiting adenosine diphosphate (ADP) from binding to its receptor, hence blocking the activation of ADP-mediated glycoprotein GPIIb/IIIa complex, a step involved in aggregation of platelets.6 Unfractionated heparin (UH) or low molecular weight heparin (LMWH) is an important antithrombotic agent in the management of UA. LMWH is normally preferred over UH as it can be given subcutaneously and no coagulation monitoring is needed. LMWH like enoxaparin should be given for 2-8 days. Heparin binds to antithrombin and the complex formed deacti vates a series of enzymes involved in the coagulation process. Thus thrombus formation will be inhibited.7 Patients with high risk of MI or death should also be given glycoprotein IIb/IIIa antagonist such as eptifibatide, tirofiban or abciximab. For the secondary prevention treatment, in addition to aspirin and clopidogrel, beta-blockers should be continued indefinitely. Statins can be started regardless of the patients cholesterol level for the preventing cardiovascular events. Statins are 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, which act by inhibiting the biosynthesis of cholesterol.8 Angiotensin converting enzyme (ACE) inhibitors are useful in patients with UA also. They work by inhibiting the production of angiotensin II which is a potent vasoconstrictor and reducing the breakdown of bradykinin which is a potent vasodilator.9 Evidence for the treatment of the conditions When the patient was admitted to the acute and emergency department, he was given clopidogrel 300mg, aspirin 300mg immediately and was then continued with long term treatment of 75mg of clopidogrel. The use of clopidogrel for the long term treatment of unstable angina was supported by two large trials. First, the CAPRIE trial which compare the beneficial effect of clopidogrel versus aspirin in patients at high risk of ischaemic event.10 In this trial, patients were either given 75mg clopidogrel once daily or 325mg of aspirin once daily. The clopidogrel group has a marginally lower risk of ischaemic stroke, myocardial infarction, or vascular death (5.32%) compared to the aspirin group (5.83%). The side effects reported were similar in both groups, indicating that clopidogrel has a comparable safety profile to that of aspirin. The second trial is the CURE Trial which investigate the beneficial effect of adding clopidogrel to aspirin therapy in patients with non-ST elevation acute coronary syndrome.11 In this trial, 12,562 patients were given either 300 mg clopidogrel innitially, then 75 mg once daily or placebo plus aspirin for 3 months to a year. It was found that there was a lower rate of death from cardiovascular causes, nonfatal MI or stroke in the clopidogrel group. However, the risk of major bleeding was significantly higher in clopidogrel group. Hence, it can be concluded that long term clopidogrel should be used in patients with acute coronary syndrome in addition to aspirin. In addition, according to a meta-analysis done by the Antithrombotic Trialists Collaboration, long term treatment of aspirin in the range of 75-150mg was found to be beneficial in patients with acute coronary syndrome. In cases where antithrombotic effect is needed immediately such as during acute attack of MI or UA, aspirin at a dose of 300mg should be given.12 In Mr AR case, only 300mg of aspirin was given in the acute and emergency department, no long term treatment of aspirin was given. This might be due to his newly diagnosed gastritis. NSAIDs were found to cause or worsen gastritis.13 According to the AHA/ACC guideline, clopidogrel will be the alternative for patients intolerant to aspirin due to gastrointestinal problems. According to a study done by Harker LA et al. where the tolerability and side effects of aspirin and clopidogrel were compared using the results from the CAPRIE trial, it was found that the group of patients receiving clopidogrel has a lower percentage of gas trointestinal side effects, with a rate 27.1% compared to 29.8% in those taking aspirin (p < 0.001).14 This finding support the reason behind clopidogrel being the only antiplatelet given to Mr AR. However, The difference in the incidence of side effects between the two treatment group was small and higher rate of occurrence of gastrointestinal problem in aspirin group might be due to the high dose of aspirin used (325mg). The policy of the ACC/AHA guideline of using clopidogrel instead of aspirin in patient with a history of GI complication was also refuted by Chan and colleagues.15 In this study, 320 patients who had recovered from aspirin-induced upper GI bleeding were given either 75 mg of clopidogrel daily or 80 mg of aspirin daily together 20mg of proton-pump inhibitor esomeprazole twice daily. When the patients were followed up after one year, it was found that patients in the aspirin group has a lower rate of recurrent upper GI bleeding compared to those receiving clopidogrel plus esomeprazole (8.6% versus 0.7%, P=0.001). No protective effect was conferred by esomeprazole in aspirin-induced lower GI bleeding. Hence, low dose aspirin is still deemed appropriate in Mr ARs case if given with a proton pump inhibitor or H2-antagonist like ranitidine. On day 1 Mr AR was given 60mg of enoxaparin immediately and twice daily thereafter. A comparison between the efficacy of UH and LMWH was carried out in the ESSENCE trial.16 In this trial, patients were allocated either subcutaneous enoxaparin plus placebo bolus and infusion or bolus and infusion unfractionated heparin plus placebo subcutaneous injection. In addition, they were all given oral aspirin. It was found that the enoxaparin group has a lower rate of recurrent angina, MI or death and also the need of revascularization process. Hence it was concluded that enoxaparin is more advantageous than UH, as there is little protein binding, longer plasma half life and more resistant to neutralisation by platelet factor IV as compared to UH. The dose given to Mr AR is justified according to a trial where the dose of enoxaparin was adjusted according to the weight of the patients. 17 It was found that giving 1mg/kg of enoxaparin to patients with UA or non-Q wave MI resulted in a lower ris k of major bleeding compared to giving a dose of 1.25mg/kg (6.5% versus 1.9%). Mr ARs weight was 59kg, thus a dose of 60mg is appropriate and evidence based. Sublingual GTN was given to Mr AR for the relief of his chest pain. According to the British Medical Journal evidence centre, no good evidence was found on the angina. There is one randomized placebo controlled study done by Karlberg et al. where they compared the effectiveness of intravenous GTN versus placebo in reducing ischaemic attack in unstable angina.18 In this trial, they found that patients given GTN have a fewer new onset of chest pain compared to placebo group. No trial was done to investigate the effectiveness of sublingual GTN in preventing ischaemic attack. However, according to a methodological study done by G Nyberg to determine the time of onset of sublingual GTN, it was found there was a significant reduction in the intensity of exercise induced chest pain and an improvement in the ST-depression when 0.5mg of GTN was given sublingually at the onset of chest pain.19 Hence, there is a consensus that sublingual GTN can be used for symptomatic control of unstable angin a. Mr ARs previous medications were continued during the hospital stay. Among those medications, perindopril, an ace-inhibitor, is also proved to be beneficial in the prevention of MI. There are two well known studies done on the effect of ace-inhibitors in preventing cardiovascular event in patients with cardiovascular disease, namely the HOPE trial and the EUROPA trial.20,21 In the HOPE trial, ramipril was chosen as the treatment drug. As for the EUROPA trial, perindopril was chosen to investigate if there is any beneficial effect in preventing MI, cardiac arrest or mortality in patients with stable coronary disease. It was found out that in the group of patients receiving perindopril, there was a 20% relative risk reduction in the primary end point as compared to the placebo group. Hence, it was concluded that perindopril should be given to all patients with coronary heart disease, including Mr AR who has unstable angina. In addition, Mr AR was continued with 40mg simvastatin once daily at night. According to a trial on simvastatin, it was found that giving simvastatin to high risk patients lowers their cholesterol level and reduces the incidence of cardiovascular events.22 In this trial, 20536 adults in the UK with high risk of getting cardiovascular event were given simavastatin 40mg daily or placebo. It was found that the simvastatin group has a lower percentage of all cause of death (12.9%) and major vascular event (19.8%) compared to the placebo group (14.7% and 25.2% respectively). There was a difference of about 1.0mmol/L in the LDL cholesterol level between the two groups after treatment regardless of the initial cholesterol level. This indicates that there is a reduction in the LDL cholesterol level in the simvastatin group which is independent on the initial cholesterol level. For patient given simvastatin, the risk reduction of the first major vascular event is similar no matter the patient s were taking ace inhibitors, aspirin, beta blockers or antihypertensive drugs or not. This shows that simvastatin provides additional benefits when added to the existing treatment with these drugs. Thus, it can be concluded that simvastatin will be beneficial to Mr AR who was taking ace inhibitor and antihypertensive drugs concurrently. Mr Ar was newly diagnosed with gastritis and was commenced on IV ranitidine. In a double blind clinical study, patients diagnosed with gastritis were given 300mg ranitidine daily for 4 weeks or placebo only.23 It was found that patients from the ranitidine group improved significantly faster than the placebo group and 80% of the patients had their symptoms completely resolved. Only 45% of the patients from placebo group achieved improvement in their symptoms while the remaining showed no change in their gastritis. Hence, it was concluded that ranitidine is an effective treatment option for gastritis. However, this trial only involved 52 patients and this small sample size renders the finding from trial inconclusive. In another trial where the effectiveness of ranitidine and sucrafate was compared, it was found out that both have a similar activity in relieving the symptoms of gastritis.24 77.6% of the patients receiving sucralfate and 79.4% from the ranitidine group had their symptom s completely resolved at the end of the study period (8 weeks). However, ranitidine was found to act faster in relieving pain compared to sucralfate. Hence, it can be concluded that the management of Mr ARs gastritis with ranitidine is justified. Mr AR was given nifedipine 10mg for the treatment of his hypertensive urgency. Even though nifedipine was found to be effective in reducing blood pressure within 20 minutes, this fast release, short-acting calcium channel blocker are not recommended in this case as Mr AR did not receive any beta-blocker before. According to the results obtained from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT), monotherapy with nifedipine in patients with unstable angina naà ¯ve to beta blockers was associated with a higher risk of recurrence ischaemic attack or MI.25 The event rate ratio compared to placebo for beta blocker naà ¯ve, nifedipine only group was 1.15. As for the group receiving both nifedipine and metoprolol, the ratio was lower (0.80). Patients who were already receiving beta blockers and were added with nifedipine also showed lower rate ratio (0.68). Hence, it was concluded that nifedipine was only beneficial in patients who were treated with beta blocker at the sa me time. Moreover, it was found from the Trent study that nifedipine does not show any beneficial effect in patients with MI.26 In this trial, the death rate for patients receiving nifedipine 10mg four times daily and placebo was similar. When the number of death and MI were compared among patients taking beta blocker and not taking beta blocker among admission, it was found that the latter group has a higher rate of death and MI. This result is comparable to those from the HINT trial. Hence, the use of nifedipine in treating Mr ARs hypertensive urgency is not justified, other drug should be chosen. Conclusion The immediate treatment of UA with high dose of antiplatelet agent aspirin and clopidogrel together with the antithrombotic agent LMWH are justified as they help preventing the progression of UA to MI. Sublingual GTN on the other hand helps relieving his chest pain. As for his previous perindopril and simvastatin that were continued, these help in preventing recurrent angina also. Choosing clopidogrel for the long term prevention treatment of UA due to the presence of gastritis might not be the best option for Mr AR. Once his gastritis has resolved, life-long aspirin at the dose of 75mg should be added in with oral ranitidine 300mg twice daily prescribed as prophylaxis against NSAID induced gastritis. However, the use of nifedipine in the management of his hypertensive urgency is not justified. Instead, he should be given labetalol, atenolol or clonidine which were found to be better alternatives to nifedipine in treating hypertensive urgency.27 PATIENT MEDICATION PROFILE Patient details Name: AG Consultant: General Practitioner: Address: Gender: Male Weight: 59kg Height: 168cm Community pharmacist: Age: 41 Known sensitivities: NKDA Social history: Non-smoker, No alcohol abuse. Patient hospital stay Reason for admission Admission date: Chest pain. Discharge date: Relevant medical history Relevant drug history Date Problem description Medication Comments 1994 Pacemaker fixed Warfarin 5mg OD Atrial fibrillation 2007 Pacemaker not functioning, did not go for replacement due to financial constraint T digoxin 125mcg OD Atrial fibrillation 2007 Angiogram, 2 blocked vessels T frusemide 40mg BD Hypertension Hypertension Perindropil (coversylƒ’) 8mg OD Hypertension T amlodipine 10mg OD Hypertension Hydrochlorthiazide 25mg OD Hypertension T simvastatin 40mg ON Prevention of cardiovascular event Prescribed medication Route of administration Start Stop Nifedipine (adalat) 10mg PO Day 1 Aspirin 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 75mg OD PO Day 2 Enoxaparin (Clexaneƒ’) 60mg stat, BD subcutaneous Day 1 GTN 1 tablet PRN sublingual Day 1 Simvastatin 40mg ON PO Day 1 Amlodipine 10mg OD PO Day 1 Hydrochlorothiazide 25mg OD PO Day 1 Warfarin 5mg OD PO Day 1 Furosemide (Lasix) 40mg stat, BD IV Day 1 Day 3 Furosemide 40mg BD PO Day 3 Perindopril (Coversylƒ’) 8mg OD PO Day 1 Ranitidine (zantac) 50mg tds IV Day 1 Digoxin 125mcg OD PO Day 1 Clinical/ Laboratory Tests Date Results Potasium (3.5-5.0 mmol/L) Day 2 3.3 BP Day 2 150/118 Day 3 134/100 Day 4 122/86 Pharmaceutical Care Plan Care Issue Action Actual output/ Desired output Long term treatment with aspirin. Patient should be given 75mg of aspirin for the secondary prevention of UA. Patient has gastritis. He should be started on long term treatment of aspirin once his gastritis has resolved and ranitidine should be prescribed as prophylaxis against NSAIDs induced GI complications. Long term treatment with beta blockers. Beta blocker should be given to the patient as the secondary prevention treatment. Patient should be started on labetalol 100mg twice daily and titrate up to 200mg twice daily. Inappropriate use of nifedipine for the management of hypertensive urgency. Nifedipine should be substituted with labetalol 200-300mg every 3-4 hours when required. Not taken. Interaction between digoxin and diuretics when hypokalaemia occur. Potasium level should be monitored. Inform the patient on signs and symptoms of digoxin toxicity. Patients potassium level was lower than the normal range on day 2. He should be given potassium sparing diuretics or potassium supplement if the potassium level keeps going down. Monitoring should be continued. High risk of bleeding due to warfarin, aspirin, clopidogrel and enoxaparin. Bleeding tendency should be monitored. Patient should be told to inform the GP if there is any unusual bleeding like blood in the stool. Patients INR and prothrombin time were within the normal range. Monitoring was continued. Changing of IV ranitidine to oral ranitidine. Patient should be switched to oral ranitidine150mg twice daily after being discharged. Not taken. GTN for relief of angina symptoms. Patient should be prescribed GTN spray or sublingual tablet for the relief of chest pain shoul the patient has another angina attack. GTN sublingual tablet was prescribed as discharge medication. Poor patient compliance Patient should be informed on the reason behind taking his medication, the importance of compliance. Compliance aid should be given. Patient was counselled on the importance of compliance. Side effects of simvastatin -muscular side effects -liver disease Patient should be advised to report immediately any unexplained muscle pain, weakness nor tenderness. Regular LFT monitoring should be done. No monitoring of cholesterol level. Cholesterol level should be monitored suring the hospital stay so that the dosage of simvastatin can be adjusted accordingly. Cholesterol level should be maintained below 5.2mmol/L. Patient education on healthy lifestyle. Patient should be told on the importance of low salt diet for his HT and encouraged to exercise more. Patient was counselled on the importance of healthy lifestyle before being discharged.

White collar and corporate crime Essay -- essays research papers

Why does white collar and corporate crime tend to go undetected, Or if detected not prosecuted White collar and corporate crimes are crimes that many people do not associate with criminal activity. Yet the cost to the country due to corporate and white collar crime far exceeds that of â€Å"street† crime and benefit fraud. White collar and corporate crimes refer to crimes that take place within a business or institution and include everything from Tax fraud to health and safety breaches. Corporate crime is extremely difficult to detect for many reasons. One major reason is that many people do not realise a crime is being committed as corporate crime is often seen as a victimless crime. At face value this may seem to be the case but if you look deeper you will see that this is not true. Every year the FBI estimates that 19,000 Americans are murdered every year compared with the 56,000 Americans who die every year from occupational disease such as black lung and asbestosis (Russell Mokhiber 2000). Deaths Caused by corporate crime are also very indirect so it can be very difficult to trace the problem to the corporation. Another reason it can be difficult to detect corporate crime is that directors within a corporation are unlikely to report the criminal activity of their colleges for the fear that it will hinder their own career success and could even lead to them losing their jobs. Within a company illegal practices could be seen by many as the â€Å"in thing† and the people work...

Dropping The Bomb :: essays research papers

Dropping â€Å"The Bomb†   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Towards the end of WWII America was faced with a dilemma. The Japanese had bombed Pearl Harbor using Kamikaze pilots and were showing no signs of regret for it or any signs of not continuing these kinds of attacks. Through these actions they were also showing the world that they had no fear or respect for the American people. With both the devastating effects of Pearl Harbor, the largest most deadliest attack ever on American soil, and the Japanese’s blatant disrespect for the U.S. on our hands president Harry Truman had no other choice but to drop an atomic bomb on Japan.   Ã‚  Ã‚  Ã‚  Ã‚  Dropping the atomic bomb on Japan did not just come out of the blue. We had tried to warn Japan numerous times before about the type of weapons we were capable of using and even tried to show them what the atomic bomb could do. Even after attempted peace talks with Japan they still refused to pull back. We also had tried other war tactics such as bombing them with regular bombs and even sending in ground troops to fight. Time after time Japan refused to cease fighting. If we had not chosen to drop the bomb on them then there is a good chance that we would have suffered a greater amount of loss of soldiers in continuing to fight.   Ã‚  Ã‚  Ã‚  Ã‚  As it was stated before, Japan knew the basic extent of our power and they still decided to attack us, so they knew what would come of them doing this. It just became evident that they really were not prepared to â€Å"mess† with us until after the atomic bomb had been dropped. So in a way you could say that â€Å"they got what was coming to them.† We also got the response we were looking for, after the bomb was dropped, by Japan surrendering to the U.S.   Ã‚  Ã‚  Ã‚  Ã‚  Some may argue that the overall effects of the atomic bomb were to devastating and that there were other means of retaliation we could have used to get our point across and to get Japan to surrender.

Free Essay on Nathaniel Hawthornes The Scarlet Letter - Character of Pearl :: Scarlet Letter essays

Pearl is The Scarlet Letter Pearl is the living embodiment of the scarlet letter because she forces Hester and Dimmesdale to accept their sins. The Puritan society looks at Pearl as a child of the devil, and a black hearted girl because she is the result of sin. Hester and Dimmesdale are both in the same situation in Pearl's eyes. Pearl wants Hester to realize that she is not the worst person in the world before she removes the scarlet letter. Pearl wants Dimmesdale to accept his sin, and be part of their life publicly. Pearl is all that Hester has in her life. She says that Pearl: "keeps me here in life! Pearl punishes me too! See ye not, she is the scarlet letter, only capable of being loved, and so endowed with a millionfold the Power of retribution of my sin?" (Hawthorne 100). Hawthorne shows that Pearl represents the scarlet letter not only symbolically but literally as well. Hester says that Pearl is the living scarlet letter, and causes Hester more anguish than the scarlet letter itself. Pearl is only difficult when she sees her mother trying to flee her sins the wrong way. This is why Pearl makes her mother keep the scarlet letter. Hester knows that she did a bad thing, but she does not feel that she is a good person, and will not feel that way until she accepts her sins. Hester wants to run away from the situation, leaving her sin behind her, and live content with Dimmesdale as a sinner with another sinner. Pearl will not let that happen because she knows that by leaving, Hester is escaping her sins and living life thinking that she is a bad person. Hester talks of leaving with Dimmesdale: "Let it suffice, that the clergyman resolved to flee, and not alone. ....(Dimmesdale) "But now-since I am irrevocably doomed-wherefore should I not snatch the solace allowed to the condemned culprit before his execution? Or, if this be the path to a better life, as Hester would persuade me, I surely give up no fairer prospect by pursuing it!" (Hawthorne 184). Hester desires to leave the world that she is a sinner in, and live a new life. Dimmesdale knows that he is going to die soon, so why not leave the place of his sin and go with Hester to a better life. Free Essay on Nathaniel Hawthorne's The Scarlet Letter - Character of Pearl :: Scarlet Letter essays Pearl is The Scarlet Letter Pearl is the living embodiment of the scarlet letter because she forces Hester and Dimmesdale to accept their sins. The Puritan society looks at Pearl as a child of the devil, and a black hearted girl because she is the result of sin. Hester and Dimmesdale are both in the same situation in Pearl's eyes. Pearl wants Hester to realize that she is not the worst person in the world before she removes the scarlet letter. Pearl wants Dimmesdale to accept his sin, and be part of their life publicly. Pearl is all that Hester has in her life. She says that Pearl: "keeps me here in life! Pearl punishes me too! See ye not, she is the scarlet letter, only capable of being loved, and so endowed with a millionfold the Power of retribution of my sin?" (Hawthorne 100). Hawthorne shows that Pearl represents the scarlet letter not only symbolically but literally as well. Hester says that Pearl is the living scarlet letter, and causes Hester more anguish than the scarlet letter itself. Pearl is only difficult when she sees her mother trying to flee her sins the wrong way. This is why Pearl makes her mother keep the scarlet letter. Hester knows that she did a bad thing, but she does not feel that she is a good person, and will not feel that way until she accepts her sins. Hester wants to run away from the situation, leaving her sin behind her, and live content with Dimmesdale as a sinner with another sinner. Pearl will not let that happen because she knows that by leaving, Hester is escaping her sins and living life thinking that she is a bad person. Hester talks of leaving with Dimmesdale: "Let it suffice, that the clergyman resolved to flee, and not alone. ....(Dimmesdale) "But now-since I am irrevocably doomed-wherefore should I not snatch the solace allowed to the condemned culprit before his execution? Or, if this be the path to a better life, as Hester would persuade me, I surely give up no fairer prospect by pursuing it!" (Hawthorne 184). Hester desires to leave the world that she is a sinner in, and live a new life. Dimmesdale knows that he is going to die soon, so why not leave the place of his sin and go with Hester to a better life.

Profit Leverage Effect of Logistics and Cost Saving Opportunities Essay

Logistics was initially a military term but since the 1960s it has grown and covers various numbers of functional areas such as managing raw materials and inventory, handling of work in progress, storing and delivering of finished goods. It also includes customer service, demand forecasting, plant/warehouse site selection, traffic and transportation. Since it has an effect on most of the activities held within an organization, it has a great influence on the profits made. A recent US study found that logistics accounts for 10% of the Gross Domestic Profit (GDP) and that approximately 56 cents out of every dollar of revenue is spent on managing the purchasing of goods and services.   The process is lengthy but once handled right can run very smoothly and can prove very beneficial to the organization. An organization cannot be competitive and strive in this fiercely competitive corporate world till it delivers end products or services of the desired quality to its customers at the right time, right place and at a price the customer feels is reasonable. The way to sustainable competitive edge lies in improving logistics. Therefore to maintain profit earnings, it is important for firms to manage logistics efficiently. If a chosen supplier fails to deliver the required raw material of an agreed-on quality level at the right time then the firm will incur additional expenses in the form of higher scrap rate, wastage and direct labor. Prompt delivery is required to avoid costly rescheduling of production otherwise efficiency will be decreased. In order to maintain profit levels it is important for firms not only to satisfy customers but to delight them. This again becomes a part of the organizations logistics. To achieve this not only fast and reliable delivery of high quality goods but also innovative design and distribution of ideas is essential. Firms stress on logistics to create differentiation by providing its customers with unique products that are difficult to be imitated by competitors. Logistics is considered as the last point of contact between the organization and its customer and so leveraging successful logistics leads to cost reduction, increased customer satisfaction and market share and so eventually higher profits. Low total product or service cost is significant in logistics so that the firm can have a competitive edge in the market. There are many opportunities to achieve dramatic cost savings but to achieve this, vision and hard work is required. Firms can do this by coordinating the different parts of the supply chain. Departments within firms such as procurement officer, manufacturing, legal and R&D managers need to work in a cross-functional manner and promote joint cost-saving projects. One of the biggest opportunities for cost saving is to reduce the amount of inventory which will automatically drive costs down. This can be done by Just-in-time inventory management that emphasizes on continuous improvement. For this, it is important for firms to develop strong relationship with few, reliable suppliers who deliver raw material in time.   Also Economic Order Quantity (EOQ) model, one of the common techniques is used to control inventory. Outsourcing is often used to transfer some of the internal activities of a firm to an outside vendor to achieve greater efficiency and specialization. It is also used as a technique to meet unexpected demands that firms cannot handle. Wastage can be eliminated through focus on what the customers want. This can be done by continuous improvement using Lean Production. It emphasizes on customer focus. Greater efficiencies can be accomplished through use of technology tools that can enable the purchase of low value, low risk goods and services. With the usage of database systems, unnecessary paper work can be eliminated, and real time data can be accessed. Use of E-Commerce to track inventory and coordinate pickup and delivery for end customers can be a great cost saving opportunity. This has been adopted by Cisco and FedEx. Different alternatives of distribution means such as trucking, airfreight, shipping, and railroads should be constantly evaluated. Use of Excel OM and Production and Operation Management (POM) for Windows’ enables firms to correctly plan for the forecasted demand. Further, software like Enterprise Resource Planning (ERP) including Supply Chain Management (SCM) and Customer Relationship Management (CRM) provide firms with great opportunity to save on costs. Gantt Charts are useful for loading and scheduling. It prevents firms from unnecessary delays in work. Quality is one aspect that firms emphasize on due to growing awareness for better quality goods amongst customers. This can be done by implementing Total Quality Management (TQM), meeting quality standards developed by International Standards Organization (ISO) and by adapting to Six Sigma and Plan-Do-Check-Act (PDCA) model. Mentioned above are some of the greatest costs saving opportunities in today’s world. References Lambert, D.M; Stock, J.R. and Ellram, L.M., (1998). Fundamentals of Logistics Management. Burr Ridge, IL: Irwin McGraw-Hill. http://www.mhhe.com/business/management/leenders12e/information/leenders_ch01.pdf

Beer and Company Essay

The due south African Breweries Limited is a keeping corporation invested in and winning management righteousness for a portfolio of argumentationes, principally engaged in meeting mass grocery consumer needs. Beer is the study profit contri saveor, to a greater extent over an meaning(a) labyrinthine sense is provided by wagers in complementary inebriation fits, grassing, hotels, and the be and sum up of selected consumer goods and services, together with strategical enthronisations in business sectores which support the chief(prenominal)stream interests. Company History The south African Breweries Limited (SAB) is a throw offing conjunction whose principal line of business is brew.The go with hairgrips an impressive 98 part dispense of the beer securities industry in its root country of southern Africa, where it swaps 14 brands of beer, including local lager beers fastness and Lion as salutary as unlike brands brewed chthonian permissionHe ineken, Guinness, Amstel, and Carling Black Label. Aggressive overseas magnification following the destination of apartheid, however, has excessively give SAB ownership of, or places in, more than(prenominal) than 25 beer makeries in the rising merchandises of telephone deepen atomic make out 63, mainland chinaware, and sub-Saharan Africa. Overall, in terms of volume, atomic number 16 African Breweries is the homos quaternary largest brewer.SAB excessively has a variety of nonbrew operations, such(prenominal) as carbonated and natural issue drinks and forward-looking(prenominal) drinkables, retailing, hotels and gaming, and manufacturing of safety matches and glass. The participation has been divesting many a(prenominal) of these noncore assets in the ripe 1990s. SABs biography is in many ways the fib of the southern African create from raw stuff industry, n proterozoic notably by dint of the presidential term-ordered commixr of the largest breweri es in 1956. The friendships history was similarly greatly influenced by the apartheid system and its feat on the interior(prenominal) economy, on domestic firms, and on foreign coronation in south Africa.former(a) History The discovery of gold on the Witwatersrand (a region embrace Johannesburg) in 1875 brought large numbers of prospectors to conspiracy Africa. Small outposts for white settlers were transform into ill-tempered cities with sensitive industries. Several brewmasters, near with itsy-bitsy experience, began to produce a variety of beers which this instant come uponed popularity with the settlers. In 1889 a British bluejacket named Frederick Mead left his ship in Durban and took a job working in the canteen of a local army post at Fort Napier.While there, Mead, who was fillet of solely 20, became acquainted with a businessman in Pietermaritzburg named George Raw. Neither of them k tender anything about brew, scarcely they persuaded the local residents to help consecrate the native Brewery Syndicate. afterwarfared purchasing a factory site, Frederick Mead returned to England to achieve machinery and raise large(p). In need of create from raw material expertise, Mead approached W. H. Hackblock, head of Morgans Brewery in Norwich. The dickens men became friends and Hackblock agreed to serve as chair of Meads companionship, which was registered in 1890 as the Natal Brewery Syndicate ( reciprocal ohm East Africa) Limited.The community brewed its jump beer in July 1891. Mead remained interested in establishing a brewery in the apace maturement Witwatersrand. In 1892 he purchased the Castle Brewery in Johannesburg from its proprietor Charles glassful. The expansion of this facility, however, was beyond the content of the Natal Brewery Syndicate, and Mead returned to England to attract sore investors. In the final arrangement, Mead formed an former(a)(a) larger family found in slap-up of the unify Kingdom cal take The i n the south African United Breweries. This guild took over the operations of both the Natal Brewery Syndicate and the Castle Brewery. afterwards body structure of the new Castle Brewery, entropy African United Breweries made special share offerings which were purchased by mho Africas largest investment houses. Subsequent growth precipitated a restructuring of the come with and reincorporation in capital of the United Kingdom on whitethorn 15, 1895, as The southerly African Breweries Limited. In 1896 southward African Breweries purchased its low gear-class honours degree be oning houses. That same division, Frederick Mead turn taild to England for health reasons single if continued to occupy a adorn on the board of film directors and frequently returned to southwestward Africa.From capital of the United Kingdom, Mead directed the purchase of machinery for create from raw material lager beer from the Pfaudler Vacuum Company in the United States. Patent restrictions and mechanical difficulties delayed issue of Castle lager until 1898. The beer catched such widespread popularity that competing breweries rushed to introduce their own lagers. southeasterly African Breweries, or SAB, was listed on the capital of the United Kingdom parentage up Exchange in 1895 and 2 old age afterwards became the low gear industrial guild to be listed on the Johannesburg Stock Exchange.Through these listings SAB had greater access to supererogatory investor capital. On October 11, 1899, a war broke out between British compound forces and Dutch and Huguenot settlers k instantaneouslyn as Boers. The war drove residents of Johannesburg out of the urban center and squeeze the Castle Brewery to close for al to the highest degree a year. When British troops recovered the area, the brewery had bear on little(a) or no damage. British authorities regarded the plant as an necessary industry, and encouraged the company to resume action in August 1900.Disrupte d supply lines caused paucitys of yeast and other raw materials, but at bottom a year work had returned to full capacity. The Boer contend cease in 1902 but was followed by a heartbreaking scotch depression. The brewing industry was not as adversely affected as others, however, and SAB was able to continue its expansion crosswise southern Africa. The company acquired the Durban Breweries and Distillers company, and established a new plant at Bloemfontein. SAB purchased Morgans Brewery in Port Elizabeth in 1906 and, vanadium geezerhood later, acquired another brewery in Salisbury, Rhodesia (now Harare, Zimbabwe).At its northern some point, SAB established a brewery at Ndola, Northern Rhodesia (now Zambia). W. H. Hackblock died in 1907 and was succeeded as chair by Sydney chamber. In 1912 Chambers led the company into an innovative arrangement with its competitor, Ohlssons Brewery, to cultivate hop collectively at a site near the city of George, midway between Port Elizab eth and ness Town. A articulatio subordinate called confederacy Hop Growers spent many years developing new hybrids, which delayed the first commercial use of second African-grown hops until 1920.Diversified into Bottles, Lodging, and Mineral Water in Early 20th Century afterward Frederick Mead died in August 1915, can buoy Stroyan, who succeeded Sydney Chambers a few months earlier, became the most important date in SAB management. Stroyan faced a serious challenge the following year when hostilities during valet de chambre War I fitful the supply of bottles to southmost Africa. SAB decided to establish its own bottle-making plants in 1917. Actual mathematical product, however, did not begin until 1919, the year the war ended.another(prenominal) economic depression beset south Africa after humankind War I, but steady growth in the bespeak for beer reduced many of the detrimental do of the depression. SAB was pecuniaryly strong enough in 1921 to purchase the Grand Hotel in mantelpiece Town, an important addition to the companys lodging business. SAB gained an interest in the mineral water business in 1925, when it purchased a substantial interest in the Schweppes Company. The huge Depression of the former(a) 1930s had little effect on the randomness African brewing industry SAB continued to stretch forth its operations and improve its facilities.The companys biggest problems were shortages of labor and capital. The Spanish Civil War and rising semipolitical tensions in Europe during the mid- and late 1930s caused a good luck in the supply of cork to southbound Africa. Faced with a severe shortage of cork seals for its beer, SAB developed a regularity of recycling old cork until a new supplier of cork could be found. Castle Beer accompanied confederation African exchangeiers to the East African and Mediterranean theaters of World War II, but apart from its intimacy in Europe, South Africa was relatively insensible(p) by World War II .When hostilities ended in 1945, SAB turned its attention to but modernization and expansion. Arthur Griffith-Boscawen, who had succeeded John Stroyan as chairman in 1940, died in 1946, and was replaced by John Stroyans son, Captain John R. A. Stroyan. chthonian the leadership of the younger Stroyan, SAB concentrated on the establishment of a South African barley industry as an off leg of the vocalize agricultural project it operated with Ohlssons. coup detat of Ohlssons and United Breweries in 1956 South African Breweries entered a new stage of its development in 1950.That year, in the midst of a large corporate modernization chopine, SAB decided to move its head self-assurance from London to Johannesburg. In 1951 the company acquired the Hotel capital of Seychelles in Johannesburg, and a second brewery in Salisbury. Captain Stroyan retired the following year and returned to England. His achievementor, a talented barrister named J. K. Cockburn Millar, died after only qua druplet months in office, and was replaced by a solicitor, S. J. Constance. afterward producing nothing but beer for more than 60 years, SAB began to introduce a range of pot likker products.The incentive to diversify was provided by change magnitude taxes on beer. Consumption of beer in South Africa fell for the first time on record and showed every indication of however decline. Officials of the trinity largest brewing companies in South Africa, SAB, Ohlssons Cape Breweries, and United Breweries, met on several occasions in London and Johannesburg to discuss the viability of competition at a lower place deteriorating market conditions. In 1956 these officials decided that the thirdly companies should merge their operations into one large brewing concern.SAB acquired all the shares of Ohlssons and United Breweries, therefrom retaining the South African Breweries name. B. C. Smither of Ohlssons and M. W. J. dogshit of United Breweries joined the SAB board of directors. Al though the new company crackled 90 share of the market for beer in South Africa, antiquated production facilities narrowed profit margins. In reaction, company activities were centralized in the Transvaal and the westerly Province, areas where the tierce companies had previously competed. In addition, the old Castle Brewery in Johannesburg was closed in 1958. After succeeding Constance as chairman in 1959, M.W. J. mother fucker initiated a further variegation into boozes and spirits. In 1960 SAB acquired the Stellenbosch Farmers winemaker and later added Monis Wineries. Bull retired at the end of 1964 and was replaced by Dr. Frans J. C. Cronje, an economist and lawyer with substantial experience in government. The company encountered a severe financial crisis in 1966 when Whitbread and Heineken entered the South African beer market. The most damaging market developments, however, came from government billet as successive increases in scrape up duties made beer the most hea vily taxed potable per serving.Consumers began to abandon beer for drink and sorghum beer. SAB was able to reduce the effect of this crisis by change magnitude sales of products from the Stellenbosch vinory. South African Breweries headland executive officer Ted Sceales was instrumental in the creation of a new subsidiary called Barsab Investment Trust, give voicely held by SAB and Thomas Barlow & Sons Ltd. (later Barlow Rand), the rapidly expanding mining services sort. Barsab permitted SAB and Barlow to invest in from each one other and pool their managerial and administrative resources.It in any case provided SAB with the resources needed to adapt to rapidly changing market conditions. Sceales died following an motorcar accident in 1967, but the success of Barsab continued under the new foreland executive, Dick Goss. South African Breweries first attempt to move its legal trail from Britain to South Africa in 1950, but was pr take downted from doing so by complex t ax obligations to the British government. Consequently, SAB, which still derived about one- tercet of its income from investments in Rhodesia and Zambia, was bound to observe the British patronage embargo against Rhodesia in 1967.Reincorporated in South Africa in 1970 Parliamentary motions to permit the reincorporation of SAB in South Africa were initiated in 1968. These motions, however, did not gain approval until March 17, 1970. On whitethorn 26, 1970, after 75 years as an English company, SAB became a de jure South African company. During the late 1960s SAB began brewing a number of new beerssome under license from foreign brewersincluding Guinness, Amstel, Carling Black Label, and Rogue. The company also acquired the Old Dutch and crap brands, as puff up as Whitbread in South Africa.While sales of wine and spirits continued to rise, SAB sold a number of its booze-oriented hotels, and reorganized those that remained under a new subsidiary called the Confederate insolate Ho tel flock. Southern Sun, which operated 50 hotels in South Africa, was formed by the merger in 1969 of the existing SAB hotel interests with those of the Sol Kerzner family. The South African government barred SAB from further investment in the liquor industry and throttle its ability to invest overseas. The company and so made several attempts to diversify its operations.In 1972 SAB and Barlow Rand decided to alter their collaboration and split Barsab. As a result, devil power Barsab holdings, the Shoe Corporation, and Afcol, South Africas largest article of furniture producer, came under SAB tick off. The following year, SAB acquired OK Bazaars, a large discount department broth chain. Certain other investments were disposed of, however, including punts in banking and food products. Several brewing interests attempted to challenge SABs dominant positioning in the South African market. unhomogeneous German interests set up breweries in Botswana and Swaziland in a failed attempt to gain a foothold in South Africa. Louis Luyt, a South African entrepreneur, also failed, and sold his breweries to the Rembrandt classify in 1973. The Luyt breweries, which formed the core of Rembrandts alcoholic beverage group, were later incorporated as the worldwide Breweries. Determined to succeed, Rembrandts chairman, Dr. Anton Rupert, committed his company to a scheme of competition based on control of liquor retail outlets.In 1978 Rembrandt acquired a 49 part share of Gilbeys, the third largest liquor group in South Africa. The addition of Gilbeys 100 retail outlets gave Rembrandt access to a total of 450 stores. South African Breweries responded by acquiring Union Wine, an independent liquor retailer with 24 hotels and over 50 retail outlets. Once again, market conditions were not conducive to competition. The government, therefore, proposed a rationalization program in which SAB would take over Rembrandts brewing interests and turn over its wine and spirits ope rations to an independent subsidiary called Cape Wine and Distillers.The program, executed in November 1979, also called for Rembrandt to turn over its Oude Meester wine and spirits operations to Cape Wines, in which SAB, Rembrandt, and the KWV wine growers cooperative each possess a 30 share interest. The remain 10 share interest was sold to private investors. Government Restrictions Led to more than Diversification in the mid-eighties and Early 1990s By the proto(prenominal) 1980s the South African governments system of racial separation (apartheid) and deteriorating brotherly conditions for lows had become internationalist issues.Many business leaders openly called for change, but the government still prevented companies such as SAB from transferring capital out of South Africa through foreign investments. Often these companies had little choice but to reinvest their surplus capital in South African ventures, which in turn gave them a more crucial interest in the resol ution of social and human rights problems within South Africa. Many foreign-owned companies, which faced less restrictions on divestment, sold their South African subsidiaries and closed their offices in South Africa.This make out made acquisitions by South African companies easier. SAB took over control of the ABI loony drink concern from Coca-Cola, and later added several clothe retailers, including Scotts Stores (acquired in 1981) and the Edgars chain (added in 1982). A government order in 1979 for SAB to sell its Solly Kramer retail liquor stores was completed in 1986, five years before its deadline. withal in 1986 SAB established a joint venture with Ceres harvest Juices to sell leading noncarbonated juice brands Ceres, Liquifruit, and Fruitee. In 1987 Murray B.Hofmeyer succeeded Cronje as chairman. Hofmeyer and his successor, Meyer Kahn, continued to diversify through acquisition, adding Lion determine Company, the leading manufacturer of safety matches in Africa, in 1 987 Da Gama Textiles Company, a leading South African textile manufacturer, in 1989 and the Plate Glass Group, a manufacturer of glass and board products, in 1992. End of Apartheid Fueled major Changes in the 1990s The dismantling of apartheid ultimately began in 1990, with the unbanning of opposition political parties, including the African field of study Congress, and the release of political prisoners, including Nelson Mandela. study political changes rapidly followed. In 1991 the stay apartheid laws were repealed. In 1992, an all-white referendum approved a new constitution that would lead to eventual salvage elections. Finally, in 1994, the first nationwide desolate elections were held and were won by the ANC, with Mandela elected president. SAB&mdashting generally out of self-interest since 85 percent of the beer in South Africa was purchased by colourswas well out in front of the political changes as it had begun to affiance blacks in the first 1980s.By 1985 28 perce nt of stipendiary employees were black, a figure that rose to 48 percent by 1994. Nevertheless, the threat of a government-forced legal separation of SABs beer monopoly hung over the company following the end of apartheid. Partly in response to this threat, and part in response to the loosening of laws regarding foreign investment, the Kahn-led South African Breweries aggressively grow outside its abode country starting in 1993. That year, SAB spent US$50 trillion for an 80 percent stake in Hungarys largest brewer, Dreher Breweries, the first of a serial publication of moves into the emerging markets of central Europe.In 1996 the company gained joint control of two of the largest breweries in Poland, letch Brewery and Tyskie Brewery, as well as three breweries in Romania and one in Slovakia. In 1994 SAB created a joint venture with Hong Kong-based China Resources Enterprise Limited by too soon 1998 this joint venture had gained majority control of five breweries in China. A third area of foreign growth for SAB was in sub-Saharan Africa, where management control was gained of breweries in Botswana, Swaziland, Lesotho, Zambia, Tanzania, Mozambique, Ghana, Kenya, Ethiopia, Zimbabwe, and Uganda during this period.In August 1997 Kahn was appointed pass executive of the South African law of nature service, becoming the first civilian to hold the post. The outspoken Kahn, who had been vocal in life history for the rapid liberalization of the economy and for a restoration of law and order, was made trusty for cracking voltaic pile on a national crime epidemic. Taking over as playing chairman of SAB was Cyril Ramaphosa, South Africas most prominent black capitalist and a former hawkish trade unionist. By this time, South African Breweries was the worlds fourth largest brewer and had a rapidly expanding international brewing empire.The company was now unleash to repose its noncore businesses in order to concentrate more closely on brewing and its othe r beverage operations. Under Ramaphosa, it did just that. In late 1997 and early 1998 SAB divested its holdings in OK Bazaars, Afcol, and Da Gama Textiles, and announced that Lion equalize and Conshu Holdings, a footgear maker, were also promising to be jettisoned. These divestments were not proceeding quickly enough for some observers, but SAB had already managed to strengthen its overall position in the face of the continued threat of the breakup of its domestic beer monopoly.Selling off noncore assets was unloose up capital for additional investment in foreign breweries, which would further ebb the impact of any government intervention. trader Subsidiaries Southern Associated Maltsters (Pty. ) Ltd. SAB Hop Farms (Pty. ) Ltd. SAB spherical Holdings Inc. SAB internationalist (Africa) B. V. (Netherlands) Botswana Breweries (Pty. ) Ltd. (40%) Kgalagadi Breweries (Pty. ) Ltd. (Botswana 40%) Swaziland Brewers (Pty. ) Ltd. (60%) Lesotho create from raw stuff Company (Pty. ) Ltd. (39%) Tanzania Breweries Ltd.(46%) Cervejas de Mozambique Limitada (65%) Zambian Breweries Plc (45%) Nile Breweries Limited (Uganda 40%) SAB global (Europe) B. V. (Netherlands) Dreher Breweries (Hungary 85%) satyr Browary Wielkopolski S. A. (Poland 32%) SC Vulturul S. A. (Romania 70%) Compania Cervecera de Canarias S. A. (Spain 51%) SC Pitber S. A. (Romania 81%) SC Ursus S. A. (Romania 73%) Browary Tyskie Gorny Slask S. A. (Poland 45%) SAB International (Asia) B. V. (Netherlands) China Resources Enterprise Beverages Ltd. (49%) China Resources Shenyang eccentric Beer Co. Ltd.(China 44%) China Resources Dalian Brewery Co. Ltd. (49%) Shenzhen Cest Bon nutrient and Drink Co. Ltd. (China 33%) China Resources (Jilin) Brewery Co. Ltd. (90%) Delta Corporation Ltd. (Zimbabwe 23%) Seychelles Breweries Ltd. (20%) Accra Breweries Limited (Ghana 50. 5%) Amalgamated Beverage Industries Ltd. (68%) Coca-Cola Canners (Pty. ) Ltd. (24%) Can Vendors (Pty. ) Ltd. Appletiser South Africa (Pty . ) Ltd. Appletiser Pure Fruit Juices (Pty. ) Ltd. Ceres Fruit Juices (Pty. ) Ltd. (35%) Valaqua (Pty. ) Ltd. Associated Fruit Processors (Pty. ) Ltd. (50%) Traditional Beer Investments (Pty.) Ltd. Distillers Corporation (SA) Ltd. (30%) Stellenbosch Farmers Winery Group Ltd. (30%) Edgars Stores Ltd. (65%) Amalgamated Retail Ltd. (Amrel) (68%) Southern Sun Holdings Ltd. Plate Glass and Shatterprufe Industries Ltd. (68%) Da Gama Textile Company Ltd. (61%) The Lion Match Company Ltd. (71%) Conshu Holdings Ltd. (67%) International Expansion in the Post-Apartheid Era The dismantling of apartheid finally began in 1990, with the unbanning of opposition political parties, including the African National Congress (ANC), and the release of political prisoners, including Nelson Mandela. study political changes rapidly followed. In 1991 the stay apartheid laws were repealed. In 1992, an all-white referendum approved a new constitution that would lead to eventual chuck up the sponge election s. Finally, in 1994, the first nationwide free elections were held and were won by the ANC, with Mandela elected president. SABacting largely out of self-interest assumption that 85 percent of the beer in South Africa was purchased by blackswas well out in front of the political changes as it had begun to hire blacks in the early 1980s.By 1985, 28 percent of salaried employees were black, a figure that rose to 48 percent by 1994. Nevertheless, the threat of a government-forced breakup of SABs beer monopoly hung over the company following the end of apartheid. Partly in response to this threat, and partly in response to the loosening of laws regarding foreign investment, the Kahn-led South African Breweries aggressively expanded outside its home country starting in 1993. That year, SAB spent $50 million for an 80 percent stake in Hungarys largest brewer, Dreher Breweries, the first of a series of moves into the emerging markets of central Europe.From 1995 to 1997 the company gained joint control of two of the largest breweries in Poland, Lech Brewery and Tyskie Brewery, as well as three breweries in Romania and one in Slovakia. In 1994 SAB created a joint venture with Hong Kong-based China Resources Enterprise Limited by early 1998 this joint venture had gained majority control of five breweries in China. A third area of foreign growth for SAB was in sub-Saharan Africa, where management control was gained of breweries in Botswana, Swaziland, Lesotho, Zambia, Tanzania, Mozambique, Ghana, Kenya, Ethiopia, Zimbabwe, and Uganda during this period.In August 1997 Kahn was appointed chief executive of the South African constabulary service, becoming the first civilian to hold the post. The outspoken Kahn, who had been vocal in commerce for the rapid liberalization of the economy and for a restoration of law and order, was made creditworthy for cracking down on a national crime epidemic. Taking over as acting chairman of SAB was Cyril Ramaphosa, South Africas most p rominent black capitalist and a former belligerent trade unionist.By this time, South African Breweries was the worlds fourth largest brewer and had a rapidly expanding international brewing empire. The company was now free to omit its noncore businesses in order to concentrate more closely on brewing and its other beverage operations. Under Ramaphosa, it did just that. From late 1997 through early 1999 SAB divested its holdings in OK Bazaars, Afcol, Da Gama Textiles, Edgars, Lion Match, and Conshu Holdings, a footwear maker. With the mid-1999 sale of Plate Glass, SAB had trimmed its holdings down to beer, soft drinks, wine and liquor, and hotels and gaming.The year 1999 was a pivotal year in SABs history for a host of other reasons as well. Seeking access to capital markets better endowed that those at home, the company in early 1999 shifted its headquarters rearwards to Londonreincorporating itself as South African Breweries plcand moved its primary stock exchange listing from Johannesburg to London, retaining the former as a secondary listing. As part of its London listing, it raised ? 300 million to memory further international expansion. There were also changes on the management front.Kahn returned to the chairmanship, his two-and-a-half-year stint at the police service complete Ramaphosa remained on the board as a director. In addition, Graham Mackey, who had served as group managing director since 1997, was named chief executive in early 1999. On the international front, SAB acquired a stake in a sixth Chinese brewery in 1999 and began producing beer in Russia at Kaluga create from raw material Company, which had been acquired the previous year. SABs two burnish breweries, Lech and Tyskie, were merged to form Kompania Piwowarska S. A.The most important brewery transaction that year, however, occurred in October, when SAB acquired from Nomura International plc for $321 million a controlling interest in Pilsner Urquell and Radegast, two brewers in th e Czechoslovakian Republic that combined comprised the leader (with a 44 percent market share) in a nation whose citizens consumed more beer per capita than anyone else in the world. The crown jewel of this deal was the Pilsner Urquell brand, the most famous Czech beer and the original pilsner, first produced at a brewery in Pilsen in 1842.SAB began laying plans to make Pilsner Urquell the companys flagship brand outside of Africa and to seek access into developed markets through the export of this brand. Via this acquisition, South African Breweries became the leader of the central European beer market and jumped into third place among global brewing titans. Moving into the Developed World As SAB moth miller, Early 2000s SABs purpose into emerging markets continued in the early 2000s. South African Breweries entered the Indian beer market for the first time in 2000, taking a majority stake in Narang Breweries.Control of two more Indian brewers, Mysore Breweries and Rochees Brewe ries, was purchased the following year. In April 2001 SAB and the Castel group, the two largest beverage companies on the African continent, entered into a strategic alliance whereby SAB exchanged a 38 percent interest in its African division (excluding South Africa) for a 20 percent stake in Castels beer business. SAB thus gained a share of a wider array of African breweries, and the two partners also agreed to seek investments in new African markets via 50-50 joint ventures.Also in 2001 SAB entered into a new joint venture in China with the Sichuan Blue steel Breweries Group, which owned ten breweries in Sichuan province. SAB now had interests in more than two dozen Chinese breweries and had positioned itself as that nations number two brewer, trailing only Tsingtao. Yet another development in 2001 was that South African Breweries became the first international brewer to enter the Central American market.In November the company acquired a 97 percent stake in Cerveceria Hondurena , S.A. , the sole brewer and the largest bottler of soft drinks (Coca-Cola) in Honduras, from the pogy Food Company Inc. for $537 million. Simultaneously, SAB and the prominent Meza family of El Salvador created a joint venture called BevCo Ltd. to which SAB contributed its new Honduran holding and the Meza family contributed the bulk of its brewing, soft drink, and bottled water businesses in El Salvador. By fiscal 2002, just eight years after its first brewing acquisition outside of Africa, 55 percent of SABs $4.36 billion in revenues were derived from its non-South African operations. This figure would shoot up to an even more remarkable 75 percent just one year later following the companys boldest move yetits takeover of miller Brewing Company, the number two beer maker in the worlds largest beer market, the United States, whose main brands included moth miller Genuine Draft, milling machine High Life, milling machine Lite, and Milwaukees Best. accomplish in July 2002, the de al consisted of a stock swap with moth millers owner, Philip Morris Companies Inc., that was cute at $3. 48 billion.SAB additionally draped $2 billion in milling machine debt. Upon completion of the acquisition, SAB changed its name to SABMiller plc and was now the worlds number two brewer, stern only Anheuser-Busch. Philip Morris (which changed its name to Altria Group, Inc. in 2003) became the biggest SABMiller shareowner with a 36 percent economic interest and 25 percent of the vote rights (the total at which it was capped) and also gained three seats on the SABMiller board. Miller had preserve 2001 revenues of $4.24 billion but had for some time been losing market share to the number one and number three U. S. players, Anheuser-Busch and Adolph Coors Company, respectively. SABMiller took conterminous action to try to reverse Millers fortunes, announcing that one of Millers nine U. S. breweries would be closed, and bringing in a new CEO for Miller, Norman Adami, who had h eaded up the South African brewery operations of SABMiller. In March 2003, in a further pullback from noncore operations, SABMiller moved its completed hotel and gaming interests into a new company called Tsogo Sun Holdings (Pty.)Ltd. , which was to be majority controlled by black empowerment company Tsogo Investments. SABMiller held an sign 49 percent interest in the new company but verbalize that it intended to continue to reduce its hospitality holdings. Despite having just completed the Miller acquisition, the company did not shy apart from making additional purchases and deals. Early in 2003 Browar Dojlidy, a brewer in northeastern Poland, was acquired for $38 million. In June SABMiller made its first major investment in Western Europe, buying a 60 percent stake in Birra Peroni S.p. A. , the number two brewing company in Italy, for EUR 246 million ($279 million).Later in 2003 Peroni ended its authorise brewing and selling of the Budweiser brand in Italy and instead starte d import sales of Miller Genuine Draft. Similar synergies between SABMillers increasingly global operations were organism implemented, such as the launch of Pilsner Urquell and Miller Genuine Draft in South Africa in early 2003 and the introduction of Miller Genuine Draft into several more European countries, including Russia, Romania, the Czech Republic, and Poland.Over in Asia, SABMiller consolidated its operations in India under Mysore Breweries the operations of Mysore were then consolidated with the brewing operations of Shaw Wallace and Company Limited, the second largest brewing group in India, to form a joint venture called Shaw Wallace Breweries Limited, 50 percent owned by Mysore. This deal woo SABMiller $132. 8 million. The firm spent an additional HK$675 million ($87 million) for a 29.6 percent stake in Harbin Group Limited, Chinas fourth largest brewer and the leader in that countrys northeastern region. The SABMiller of the early 21st century, a globally active compan y with a sharp focus on beverages in general beerwas a far different company from the apartheid-era SAB, which was centered largely in South Africa where it had diversified interests. SABM.