Diagnosing Malaria †Case Study

Diagnosing Malaria – Case Study Free Online Research Papers Diagnosing malaria can be missed when there is a significant time lag from exposure and negative initial tests. As clinicians we must always consider the diagnosis in the appropriate clinical setting as a missed diagnosis can potentially result in serious consequences. A 27 year old female student from Nigeria presented with a two day history of headaches, mild photophobia, sweats and fever. She arrived from Nigeria eight months previously and had not been back since. On admission she was unwell with a temperature of 38.5?C, pulse 110/min but otherwise haemodynamically stable. Examination revealed a soft ejection systolic murmur and signs of meningism, but her neurological assessment was otherwise entirely normal. Her initial investigations showed a haemoglobin level of 11.8g/dl, white cell count 3.9109/l, lymphocytes 0.5109/l, platelets 118109/l, C-reactive protein 121mg/l; urea and electrolytes and liver function tests were normal. She was commenced on ceftriaxone 2g daily with a presumptive diagnosis of meningitis. She had a normal CT head, which was followed by a normal lumbar puncture. Two sets of blood cultures and a mid-stream urine sample had no growth after 48 hours. The initial admission pyrexic thick and thin blood film and malarial antigen test (Optimal, DiaMed) were negative. She improved initially with antibiotics and intravenous fluids. 24 hours into her admission, having been reviewed by a number of senior doctors, her working diagnosis was changed to one of a viral illness and plans were made for her discharge. Malaria was felt to be unlikely given that not only was she eight months post exposure for malaria, her blood film and antigen test were negative. However, on the day of discharge she was found to spike a temperature of 38?C and remained thrombocytopenic (108109/l). It was decided that in view of her origin (Nigeria) and the fact that she remained thrombocytopenic, malaria still needed to be considered. Even though a thick and thin blood film and malarial antigen test (Optimal, DiaMed) were negative, we felt three negative blood films were needed before excluding malaria and labelling her as a patient with a viral illness. Interestingly a repeat blood film showed malarial parasitaemia of 5% Plasmodium falciparum [Figure 1]. Her haemoglobin dropped to 9g/dl and platelets dropped to 93109/l over the next two days, which then recovered. She was treated with intravenous quinine (10mg/kg) for 48hrs and converted to oral quinine for seven days followed by three tablets of oral pyrimethamine with sulfadoxine (Fansidar). She was discharged home with a negative parasitaemia. Comment The Office of National Statistics reports increasing international travel in our population with 25 million visitors to the UK and 61 million trips abroad in 2003. According to the Health Protection Agency (HPA) there were 1722 cases of malaria in the UK in 2003, 78% were Plasmodium falciparum, all of which were diagnosed within five months of arrival in the UK. Their statistics also show that 59% of malarial cases in UK are from those of African ethnicity, and patients who were infected in Nigeria contribute one third of all Plasmodium falciparum cases in UK and 2 out of 16 deaths in 2003. Immunity to malaria is acquired slowly, is incomplete and on leaving the infectious environment falls over about 1-2 years. Those who have been out of exposure for greater than 1 year or been born in UK are classed as non-immune. These individuals if exposed usually develop malaria within one month of leaving the endemic area. In contrast those who are from endemic areas and arrive in the UK as an immigrant, visitor or student (our patient) are classed as semi-immune. In these individuals and those who have taken malaria prophylaxis, incubation can be significantly prolonged, and may have milder symptoms. In those countries with high transmission rates, severe disease is usually a disease of the young (1 month to 5 years) or non-immune adults (vast majority of travellers to endemic areas). Children in areas of high transmission often show tolerability of the parasites due to constant parasitaemia without signs of disease, and paradoxically those living in low transmission areas have high clinical disease burden 1. Reviewing the HPA statistics, of the 1722 cases reported in 2003, 52% were visiting family and friends in their country of origin and probably non-immune as they had been born or lived in the UK for some time, 22% were from endemic areas (immigrants, visitors, students), and 26% were almost certainly non-immune (business travel, holiday, expatriates). Diagnosis of malaria in the 22% group, who arrive from an endemic area and are semi-immune, is often difficult because they can present late with clinical malaria, as demonstrated with our patient being in the UK for eight months prior to presentation. Our case was notable in that our patient had an initial negative microscopy and malaria antigen test. The latter is a new method for detecting malaria. It is a rapid dipstick immunoassay that detects circulating antigens of either histidine rich protein-2 of falciparum (HRP-2f) or plasmodium lactate dehydrogenase (pLDH). These are near-patient testing kits that have recently been developed to ease and speed up diagnosis, particularly in places that do not have access to microscopes or trained laboratory staff. The malarial antigen test Optimal (DiaMed) used in this case detects presence of pLDH. This assay can detect parasitaemia levels of 100-200 parasites per ?L of blood, equivalent to 0.002% 2 and has been found to have a sensitivity of 95.3% and a specificity of 100% for Plasmodium falciparum 3. However, a meta-analysis of ten popular brands showed that HRP-2 was more accurate than the pLDH tests 4. Though quick to use and easy to read they are not as accurate nor as good at dete cting species as microscopy using thick and thin films, hence why microscopy remains the method of choice. We believe most general physicians would have felt that on initial presentation our patient was unlikely to have malaria. She presented with non-specific symptoms and signs of meningism; over eight months had elapsed since her return from Nigeria and lastly initial investigations were negative for malaria. Many might have put her presentation down to a viral illness, though she had the characteristic lymphopenia and thrombocytopenia for malaria (sensitivity for thrombocytopenia in those with malaria is 60%, and specificity is 95%) 5. It is noteworthy however that a study in Nigeria found that headache, fever, chills and rigors were the commonest malaria symptoms in adults6. Further, a fact that we all forget is that the HPA advises us to consider malaria in a patient who has been potentially exposed up to 12 months. Finally if the clinical suspicion for malaria is high, three sets of malarial blood films must be taken before suggesting a negative result – easily forgotten by clinicians. In conclusion we would like to reinforce to all clinicians the advice by the Health Protection Agency that it is important to consider malaria due to Plasmodium falciparum as a differential in those who have had malaria exposure in the last 12 months and to always take three blood films if there is any clinical suspicion to make a diagnosis of malaria. Figure 1: Patients blood film showing malarial parasites References: 1. Reyburn H, Mbatia R, Drakeley C, Bruce J, Carneiro I, Olomi R, Cox J, Nkya WMMM, Lemnge M, Greenwood BM, Riley EM Association of Transmission Intensity and Age With Clinical Manifestations and Case Fatality of Severe Plasmodium falciparum Malaria Journal of American Medical Association 2005; 293:1461-1470 2. Palmer CJ, Lindo JF, Klaskala WI, Quesada JA, Kaminsky R, Baum MK, Ager AL Evaluation of the OptiMAL Test for Rapid Diagnosis of Plasmodium vivax and Plasmodium falciparum Malaria Journal of Clinical Microbiology 1998; Jan: 203-206 3. Kolaczinski J, Mohammed N, Ali I, Ali M, Khan N, Ezard N, Rowland M Comparison of the OptiMAL rapid antigen test with field microscopy for the detection of Plasmodium vivax and P. falciparum: considerations for the application of the rapid test in Afghanistan Annals of Tropical Medicine and Parasitology 2004; 98(1): 15-20 4. Marx A, Pewsner D, Egger M, Nuesch R, Bucher HC, Genton B, Hatz C, Juni P Meta-analysis: accuracy of rapid tests for malaria in travelers returning from endemic areas Annals of Internal Medicine 2005; 142(10): 836-46 5. DAcremont V, Landry P, Mueller I, Pecoud A, Genton B Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever American Journal of Tropical Medicine and Hygiene 2002, 66: 481-486 6. Harrison NE, Odunukwe NN, Ijoma CK, Mafe AG Current clinical presentation of malaria in Enugu, Nigeria Nigerian Postgraduate Medicine J. 2004; 11(4): 240-5 Research Papers on Diagnosing Malaria - Case StudyPersonal Experience with Teen PregnancyStandardized TestingResearch Process Part OneWhere Wild and West MeetLifes What IfsThe Relationship Between Delinquency and Drug UseEffects of Television Violence on ChildrenRelationship between Media Coverage and Social and19 Century Society: A Deeply Divided EraMarketing of Lifeboy Soap A Unilever Product

Perfect Custom Essays

Perfect Custom Essays Nowadays, paper writing for college students has proved to be rather a difficult task for most of them. Consequently, this has pushed them to seek essay writing services from various agencies that offer such services. Various factors have contributed to the students turning to custom essay writing companies for help. These factors include lack of adequate material to complete the assignments, others may be non-natives and the English language appears to be difficult to comprehend. Most college students prefer English essay writing from English native speaking individuals. This is because English is their second language, and they would want their work immaculately done. This may seem unethical to some, but it is quite helpful to many as these companies offer templates that assist students in composing their original work. Additionally, these companies offer various services such as thesis writing, research papers, dissertation chapters, course work and reports among others. Proofread ing and editing of previously done work are also services offered by these companies. Subsequently, such services help in avoiding common grammatical errors such as run-on sentences, punctuation mistakes, spelling mistakes, subject verb agreements and other common typos. It also helps in eliminating plagiarism by correct citations where work has been borrowed and paraphrased to represent originality. These companies accomplish all these by employing expert writers who offer excellent and professional English essay writing skills. Some of these professional writers are English language natives while others have English as their second language but still offer excellent services to the clients available.

Defense Intelligence Agency Essay Example | Topics and Well Written Essays - 250 words

Defense Intelligence Agency - Essay Example The decision that DIA delivers concerning intelligence information is an advantage to war fighters, policy makers and defense planners (DIA, 2015). The collected intelligence information is an advantage because it is usable by the military and other states security officers to be alert of any kind of attack especially from terror. The new base contribute to a new mission of applying interpersonal skills, high level training and professional talents that provide the necessary human intelligence (HUMINT). The agency collects and analyses key intelligence information data using a variety of sophisticated tools and technology before coming up with the decision (DIA, 2015). The DIA then makes a decision concerning the information analyzed on how to deploy security personnel globally in order to be on top of the matter in case of any abnormalities. During the security deployment activity, the DIA takes a long war fighter and interagency partners to be on watch out in order to manage and contain the security. Therefore, the work of DIA is to coordinate with all the security personnel and share with them intelligence information with an intention to defend America’s national security interest (DIA,

From the business idea (will upload the file), create a hybrid of Assignment

From the business idea (will upload the file), create a hybrid of ideas or compile a new idea then, document how the business mo - Assignment Example What makes the company success The sinner party company being a brand new service within the area of location, many people above eighteen years would be attracted to the services offered by the company. Many of the customers would be looking for a bar with lighting and logo placement which would help in overcoming the competitions by the other companies. Additionally, the Sinner Party Company has been strategically placed where the population is high hence more customers. The process layout of the company is very convenient to the customers hence their attraction to the company (Anderson, Narus & Van Rossum, 2006 pp. 90). Target customer The Sinner Party Company has no discrimination to customers. The company targets all kinds of customers at all age above 18 which is authorized by the law. The customer consideration by the company is the ability to make the payment of the services provided by the company. Additionally, they consider the customers attitudes and their behaviors during the party. For instance, the customers should be able to adhere to the company’s rules and regulations where they should not carry anything illegal to the party station (Winer, 2001n.p). In that case, the sinner party company gets attached well to their customer hence good relationship. The company’s relationship to the customers is pleasing and strong. For instant, the company offers the customers with two options; to provide private bar service for the customers at their own homes, to provide the customer with both the destination and the private bar services (Payne & Frow, 2005 pp. 168). Additionally, the company places the parties near to the customers where they are able to access the places at the right time. They also have the freedom offered by the company to choose the product they would wish to have during their function. In that case, the company’s relationship to the customers is strong enough (Payne & Frow, 2005 pp. 170). Macro environment The Sinn er Party Company has been net working economically, politically, socially, and technologically. Due to their social relationship with the Sydney people, they have been allowed to use the offices and the suburbs for their functioning. On the other hand, politically, Sinner Party has strictly adhered to the laws (Kirschbaum, 2005). They do not allow any customer who might bring illegal things in their company. In that case, the company has flourished without any government complains. On the side of economic, the sinner party company is a government revenue generating company. They consider the customers ability to make the payment according their charges. In that case, they make adjustments of their charges to equalize each customer and make everyone fit in to their rank (Kirschbaum, 2005). Due to the technology advancement in the company, the operations have been ease. The record keeping has become computerized where the company is able to record more than one thousand customers with their dates of functioning. Additionally, company has been able to bank their money hence safety. The sinner party company operates both daytime and night. In that case, the advancement of the technology has highly benefited the company. They have employed security maintainers who have been using technological tools to keep and ensure the customers safe both during the two sessions. Distribution channel The use of

The story develops Essay Example for Free

The story develops Essay The author of Frankenstein is Mary Shelley. She was born on August 30th 1797 in London. Then later died on February 1st 1851 when she was 53. Her father was William Godwin, he was a radical philosopher and a novelist. Her mother was Mary Wollstonecraft, she is still known today as a feminist. Her mother died in September 10th 1797 of a disease called puerperal fever. Mary Shelley was married to Percy Shelley. She eloped with Percy Shelley at the early age of 16, the reason for this is that Percy Shelley was already married. They eloped to France. Percy Shelley was an important figure in his own right because he was a poet and good friends of her parents. Mary Shelley and Percy Shelley had four children, but sadly only one survived. Shortly after the death of Mary Shelleys first child she had a dream about her dead child being held before a fire and then being restored to life by someone breathing into her. Mary Shelleys husband Percy Shelley drowned when he was 29 years old on a boat trip. The book was written because of a ghost challenge set by Lord Byron. At the time Mary Shelley was only 19, which made her the youngest in the challenge. There were other people who were set the challenge as well but when Lord Byron saw Mary Shelleys book he was deadly serious about trying to get it published. Mary Shelleys life is the key thing that influenced her in writing the novel. One influence in her life was her mother dying when Mary Shelley was only 10 days old. Also three of Mary Shelleys children died in infancy. When one of her children died, shortly after she had a dream of breathing life back into the child. This is said to have been influential towards the novel. The time when Mary Shelley wrote the novel, in the early 19th century, was a very exciting time for scientific and industrial development. It was known as the age of endless possibilities, simply because they thought they could do anything and nothing could stop them. This is thought of to have been another reason why Mary Shelley wrote about Frankenstein because it would appeal to a lot of people at the time it was written.

Research Paper on the Year 1969 -- American History

"First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to the Earth."- John F. Kennedy. On a warm July night in 1969, this dream came true. Millions of people sat captivated in front of their TVs witnessing one of the most monumental events in history, Neil Armstrong walking gracefully on the moon. This event in US history changed the way we look at space forever. Political issues such as the Vietnam War and foreign affairs were on the forefront of American's minds. Thousands of people came peacefully together in a historical concert event called Woodstock. Children were introduced to a place called "Sesame Street" and Heavy Metal meant more than just an old car. The year 1969 impacted American's lives today in politics, science, sports, art, entertainment and daily living. Politics On January 20, 1969 our 37th president, Richard Milhous Nixon, was sworn into Presidency. His main focus as president was to pull forces out of Vietnam in order to end the War that began in 1961. Nixon began this process by pulling 75,000 troops out of Vietnam in the first year he was president. Nixon also worked to improve US relations with China as well as with the Soviet Union. He was the first president to visit China. He also imposed a wage price freeze to combat inflation that was replaced by a system of wage price controls, to be later removed. Nixon?s term as President will forever be remembered due to his resignation from presidency over the Watergate scandal. One of the most important political issues of 1969 was the Vietnam War. Throughout this year many demonstrations took place to protest the war. For example, in... ...as ?nifty? if you drove a Firebird Trans Am or Dodge charger. Today, people restore these cars to drive a piece of automotive history. The population of the US in 1969 was 202,677,000. Many people from Hollywood and sports were born this year. Some people born this year are Bobby Brown, Renee Zellweger, Steffi Graf, Ice Cube, and Brett Favre. Some people who died this year were Dwight D Eisenhower, Rocky Marciano, and Brian Jones. Conclusion The events in 1969 brought the beginning of many things to our country. Sports made multiple historical moments and a new genre of music was created and made unforgettable. Neil Armstrong was the first man to set foot onto the moon and it was a moment that will never be forgotten. The Boeing 747 first took flight and can be seen in our skies today. What better way to end the 1960's with an amazing year like 1969.

Analyse the ways that the director builds suspense and scares the audience in the film JAWS

After the horrifying release of Steven Spielberg's classic ‘Jaws', the word has since then been associated with the monstrous killer in the ocean, the 20 foot great white, teeth covered in the flesh of an unsuspecting victim, swimming in a pool of blood. Steven Spielberg uses a variety of tricks and techniques to build suspense. Different camera angles, zooms, music and many other ways are used by Spielberg to create the tense atmosphere that is Jaws. These tricks and techniques all helped steady the bricks of Spielberg's masterpiece. Without these techniques, the impact that Jaws had imprinted upon the audience would not have been present. These tricks and techniques will be critically analysed to see how they had been used so efficiently to create an unwavering tower of suspense and drama. Jaws is set in the beautiful tranquil island of Amity. The air is calm and peaceful. Kids can be seen in the distant, splashing up and down in the deep blue ocean. You can see the tension relax as people lie in the hot summer sand, eyes drifting into their own world. Amity Island: the perfect holiday. However, the serene atmosphere is twisted apart when the ‘jaws' of a Great White appears. After the merciless deaths of four people, our protagonist, Chief Brody, must take action to stop the murderous beast from feeding once more upon the people of amity. Teamed with the marine biologist Matt Hooper and the crazed fisherman, Quint, they must set off to hunt down the Great White. Jaws is set on Independence Day, a national American holiday on the 4th of July. This was the day that the US formally adopted the Declaration of Independence from the UK. This would make the perfect scenario for Jaws. Teamed with the hot summer weather typical of July and the bustling holiday, the beach created the perfect scene for a Great White shark to attack. People would gather at the beach, the mood would be joyful. One Great White shark and the chaos that would form would be uncontrollable Music plays an important role in Jaws. Without the music, the suspense would all break down. Steven Spielberg uses music in a special way. He links a certain piece of music to the shark, which essentially becomes the sharks theme. Whenever this theme is played, the audience's first thoughts would be of the shark. The audience is in constant caution of the shark's presence, not knowing when or if it actually will attack. This not only creates suspense, but also creates the fear of knowing that the shark is most likely present. However, with this, Spielberg can also create false alarms. Due to the fact that the music is affiliated to the shark, the music can be used to create the illusion of an attack when there is nothing. This creates doubts in the audience's mind, who were sure that there would have been an attack. This also creates tension because of the fact that Spielberg can then surprise the audience with an actual shark attack. The main theme is also really simple; just two notes, forming something similar to a ‘duh dah' sound. With this simple rhythm, Spielberg can increase the speed of the two notes creating a faster sense of suspense and danger. Spielberg makes the notes fade into the scene as a ‘non-diegetic' sound. This means that the sound is present outside of the scene, only detectable by the audience and not the characters. Because it is non diegetic, only the audience will hear the theme, thus making them more nervous/tensed due to the fact that the characters remain clueless of the fate that may await them. The music starts of slow. It speeds up as the action gets more intense and it halts suddenly. The audience will have no idea what is going to happen. At this stage, Spielberg does two things. Create a false alarm, and nothing happens or he makes an attack. The audience will not know whether it will be an attack or a feint, which is why the music is so effective. What is also effective is the lack of music. Or any sounds at all. This creates a sense of emptiness. The lack of any non-diegetic sounds mixed with diegetic sounds such as the screaming of a victim creates a sense of fear. We hear it not as an audience, but from the ears of the victim, which is what scares us the most. Diegetic sounds are also used by Spielberg. Diegetic sounds are sounds outside the scene. These could include many things such as the waves crashing, the chatter of the characters or the music playing in the scene such as an instrument or radio. With this, we can feel the emotions/feelings of the character in more depth, because we are hearing what they hear, not something created outside the scene. But what may also be effective are camera techniques. These can be camera shots that are moving, still, from a certain angle or even from the perspective of someone/thing in the scene. Camera techniques are used most efficiently in an action scene, such as in the first attack with the young girl called Chrissy. This scene starts off with the camera focusing on the whole group of teenagers. We can hear the Diegetic sounds such as guitars, the waves and even the crackling of the fire. The young girl, Chrissy, and a young boy move away from the scene. The camera follows them. Soon, they arrive at the oceans end. The camera isn't clear and the scene is dark. This creates a relaxed but mysterious atmosphere. The young girl goes into the ocean as the boy is getting ready to go in. The camera then focuses on the young girl in the ocean. As we see her swimming, suddenly, a certain theme appears causing tension. This theme is the theme that symbolizes the shark. It starts off lightly, as the girl is still swimming, unwary of any dangers. Soon, the music becomes faster and louder. The camera angle then changes. It appears under the water. We see the view from the camera from under the water to above, as if it were from the perspective of something. Soon, the audience realizes that there is something in the water, which is the shark. We see from the shark's POV as it gets closer to the young girl, the tempo of the music gets louder and faster. And soon, the shark is near attacking distance of the girl. Suddenly, the camera goes above water and points at the lone girl, swimming. All non-diegetic sounds stop, as we hear only the waves and the girl. And then, all of a sudden, we see the girl pulled down. We hear just the screams, which causes a greater sense of fear. The girl struggles, only to show and flatter the strength of the shark. The girl is then pulled under the water and all of a sudden, the screams disappear. All we can hear are the waves. The camera then becomes still, pointing at the distance in the ocean. All is silent apart from the waves. All this is to emphasize what had just happened, as all we can think about is the scene that had just occurred, as the camera movement is still, pointing to ‘nothingness'; just the plain ocean. The sun then rises, symbolizing the time passing. What we need to realize is not once was the attacker, the shark, shown in clear view. All we saw was the view from the eyes of the shark, and the view of the young girl being attacked from something cloaked by the ocean. This is to create more fear in the shark and create more tension. The second attack is against a young child called Alex. In this scene, we are at a lively beach. There is a happy atmosphere. We can hear children playing, water splashing, waves crashing. It's a fast pace. However, we know something is going to go wrong. We see chief Brody on the beach. His worried face and constant suspicions create fear and tension in our minds, thinking about the shark. Chief Brody's fear deeply contrasts with the whole beach's excitement, creating unwariness in the scene, due to the main focus being on Brody and the outside focus being on the beach. Brody, being on the constant lookout, is being cautious of every single detail, causing great exaggeration in small details. This creates suspense, as we don't know what will happen due to all the false alarms that go on in this scene. We see a wide shot on all of the people in the ocean. Chief Brody is paranoid, causing the smallest things to seem as if they have a large effect. The first example of this is the girl screaming. This scream causes the audience to become paranoid due to the contrast in Brody and the atmosphere. Brody is distracted, causing him to become more anxious to see what was going on. However, the scream was meaningless, which was the first false alarm. The second false alarm was the old man and woman. The old man swam underneath the water and slowly rose, causing Chief Brody to think it was a shark, only to be relieved and slightly frustrated at the fact that it was just a person. This all creates a sense of unpreparedness to the actual attack due to the false alarms. The false alarms create a feeling of reassurance. Chief Brody's wife starts to relax him, allowing him to ease his paranoia of the shark. Then suddenly, the atmosphere changes. The familiar music plays. The disappearance of a dog into the water highly implies that something is there. The audience is now aware of something being there, however, Brody is unfocused and the whole beach has now idea what was going to happen. And all of a sudden, as the theme gradually becomes louder and faster, the camera shot goes underneath. The POV is now from the sharks. We see several vulnerable children from under the ocean, their legs sticking out. However, the shark goes closer and closer to a single person. As the shark goes closer, the music speeds up and tension rises. And soon, the shark attacks. The people on the beach have no idea what's going on, and the sudden atmosphere change causes a chaos. Brody notices too late. Soon, everyone evacuates, however, one person is still searching desperately for someone. As the scene ends, a young boy's life jacket appears on the shore and the camera focuses on it completely, torn and slightly covered in red. The audience realizes that whoever owned that jacket was the victim. The shark is the main object of fear in Jaws. It appears out of nowhere, shocking the audience. The fact that it doesn't show the shark directly creates uneasiness and a feeling of defencelessness. It makes it seem menacing that it attacks, creeping through where no one can see it. The unusual size and the intimidating pictures that are shown to study the shark creates a scary image, due to the fact that the actual shark itself isn't shown until later. And the music, it creates a sort of stealth for the shark. If the music is on, the shark is assumed to be there. If the music is not on, the shark is not assumed to be there. The false alarms were all created for one purpose, the real attack. The false alarms led to the audience easing up, but then to be surprised by the actual attack. Near the end of the film, the jetty used to capture the shark is small and unstable. Compared to the shark, it is miniscule. The phrase ‘we're going to need a bigger boat' said by Brody shows that it's in vulnerable to the shark's giant size. It isn't sufficient enough. The feeling of breaking down and falling into the ocean, where you are practically food for the shark creates suspense. It could break down any time. Overall, Jaws was an excellent film and the techniques by Steven Spielberg completed it. The scariest parts were no doubt, the unpredictable shock. They came out of nowhere and broke apart the suspense with no warning. The film was a big success and appealed to me greatly.

Cmr Enterprises Essay

CMR, originally Mike’s Cabinets, is an architectural millwork business that competes in two different market segments: commercial and residential. In order to effectively compete in both markets, the nature of CMR’s business varies slightly between them. Commercial business provides two-thirds of the company’s projects as well as 80% of its sales. Due to the higher volume in demand, the commercial sales force is larger than the residential sales team, which relies heavily on CMR’s showroom. The market for commercial business is larger than residential market with projections of its value at upwards of $5 billion. Commercial contracts are also harder to secure than their residential counterparts. They must be bid on and won. Due to the heavy competition for these larger commercial contracts, the â€Å"got rate† for them is around 32%, whereas the residential â€Å"got rate† is around 69%. CMR’s residential department has to operate some what differently than the commercial facet of the company. First of all, project management requires a different degree of flexibility in order to meet ever-changing customer requests. Cash flow cycles are about four to six weeks, which is significantly shorter than the 6 months or more it takes for a commercial cycle. With less indirect labor and lower material costs, residential work actually boasts a higher net margin as well. The main difference between CMR’s nature of business between segments is the customer relationship factor. Residential customers require a softer approach with more face-to-face exposure. Commercial customers are primarily concerned with finding the lowest bid. However, CMR is building relationships with many contractors in attempt to make their jobs easier and potentially work with them in the future. Although CMR treats every customer as equally important, the commercial customers are arguably more valuable. 35 of the top 50 contractor prospects for 1999 were commercial contractors. Furthermore, commercial business typically achieves higher revenues and is likely the only means of meeting CMR’s aggressive growth goals. When Sam Marcus and William Walters bought Mike’s Cabinets in early 1997 they knew they were going to need to change some things abou t the way their business operated. Mike’s Cabinets was running very well as a small town cabinet shop that worked on projects for homeowners as well as large commercial buildings, and had a very good reputation with the people of Lincoln,Nebraska. Although things were running smoothly with the business, Sam and William wanted to produce more profits, and increase cash flows. Blackstone Homes was a homebuilding company that started only two years before Marcus bought Mike’s Cabinets. By the time Marcus was in charge of CMR, Blackstone was one of the largest homebuilders in the area. The president of Blackstone Homes approached Marcus in the fall of 1997, with the idea of starting a partnership. Blackstone was having problems with their current supplier because they couldn’t seem to deliver the cabinets when promised. Marcus was initially intrigued by the sheer volume of work they would be doing with Blackstone, but he thought it would be a great fit with where he was planning for his company to go, and seemed like a great way to make progress towards his profit and cash flow goals. Marcus had to work with his employees and overall business plan, but decided that the residential side of the business was worth expan ding, so he signed a contract with Blackstone Homes. Marcus’s decision to sign with Blackstone Homes was a very good idea for CMR Enterprises. Blackstone had great potential to become one of CMR’s largest accounts, and promised to have continual yearly growth. Blackstone agreed to specify only CMR’s cabinets in all their homes, and CMR assigned a project manager to work exclusively with their new partner. Both companies could see that they would both be benefiting from this partnership from the very beginning, and they were correct. Throughout the first year, Blackstone contributed heavily to CMR’s success, and eventually grew to be about 25% of the residential side of the business. Marcus saw that the residential side of the business had great potential for future growth, and he knew that this was a great way to get his company involved. The additional emphasis on residential work used more of the company’s resources, but it proved to be worth it with the increased revenue and cash flows. CMR Enterprises is confronting an issue with one of its most valuable clients, Blackstone. Blackstone as one of the biggest customers in the area, giving CMR an opportunity for immediate market share and his volume supported its goals to standardize its processes into flexible cells. They approached CMR looking for a new partner to work on a business that represented 25% of CMR’s residential business during the first year of this relationship. Sam Marcus was counting on further growth with his customer to pay his debt and fund expansion efforts. But relationshipswith Blackstone had become increasingly intense on residential construction. Marcus had aggressive goals of reaching $70 million in sales by 2007 by creating a scalable and replicable business model. Moreover, build close relationship with the Blackstone will gave CMR an opportunity to standardize its business processes to be able to benefit from improved operational efficiencies that comes because of scale of operations. However, the relationship between two companies had evolved unpleasantly over time. When Blackstone sells a house, it does come with a pre-finished and installed kitchen, which is included in the price. But if customers want to check CMR’s showroom, they would build these w oodworks according to their new specifications. So the added cost will then be charged to the contractor. After an increase in CMR prices, Blackstone transferred this increase to subcontractors, so impacting considerably their margins and making CMR looked as a too expensive product. This issue to some extent contributed to the clash with Blackstone. Also, internal miscommunication had played a part in this episode. Marcus had implemented a software system for the company, called InfoCentral, and insisted that the residential team use InfoCentral for all internal communications. But it did not work out the way he expected. The system is not frequently updated as required by the employees. The business relations between the two companies started well and was fulfilling for both part. Revenues from Blackstone represent a significant part of revenue growth of the year. However, when the business expended, so did the problems. What was more disappointing was that CMR had shown a weak ma nagement of its relationship with this big client and several operational failures that need to be controlled. Within CMR Enterprises, revenue is generated at different rates in the different segments. Commercial business is responsible for 82% of the revenues generated by the firm, leaving just 18% to residential. Not only do they generate revenue at different rates, but profit is generated at different rates as well. According to the CMR Enterprises Factsheet, SG&A Costs were $2,900,000. If we distribute these costs according to percent of revenue generated across the CMR’s business segments, we see that the commercial segment provided a Net Profit of $1,124,152 for a Net Margin of 15.5%, while the residential segment provided a Net Profit of $87,632 for a Net Margin of 5.4%. Blackstone’s Net margin of 5.7% is actually greater than the Net Margin for the residentialsegment without Blackstone. Net Profit from Blackstone for the year was $17,235. In the second scenario, SG&A costs were assigned in a different way. Indirect labor was assigned to the corresponding segment. SG&A expenses besides indirect labor were then distributed to the segments according to percent of revenue generated. This tells a different story. Whereas in the first scenario the commercial segment was responsible for almost 10% more Net Margin; in the second scenario, residential Net Profit was $274,632 for a Net Margin of 17.2%, while commercial Net Profit was $937,152 for a Net Margin of 13.9%. In this scenario Net Margin from Blackstone is only 13.3% of revenue, which is below the average for residential. The cause of the difference between the scenarios is the high number of administrative personnel assigned to commercial work. From the CMR Enterprises Factsheet, we see that there are 43 administrative personnel, of which only 4 are dedicated to residential work. This leaves 39 employees working on commercial work at an average of $50,000 per year, a total of $1.9 million dollars. Scenario 2 captures this more fully, placing a more realistic percentage of SG&A costs onto the commercial segment. Blackstone’s profitability is slightly less than that of the commercial business, and nearly 4% less than the residential business. Terminating the relationship with Blackstone would be a good choice in the situation for CMR Enterprises. It is obvious that Blackstone provides a significant amount of residential business, which means a substantial cash contribution to support CMR’s other business like commercial work. Especially in the initial partnership, CMR first grabbed residential market share and earned 25% more of its residential business and Blackstone benefited from CMR’s expertise and correction. However, some potential loss shows the general trend that CMR benefit less and less in the partnership with Blackstone. First, CMR acquires more profit per shop hour in commercial business than residential work. According to Exhibit 7b, the highest residential revenue per shop hour of $48.13 is less profitable than the lowest commercial revenue per shop hour. Even though we recommend letting Blackstone go as a client, the residential business on a whole is profitable and should be kept. It is integral to the companies’ core values, and provides a valuable link to the community. Moving forward with franchising efforts, however, we would advise sticking to commercial business. If CMR is to attempt to make headway into new markets, it would be advantageous to proceed with a strategy that is more singular in focus. CMR has had success implementing their InfoCentral tool in their commercial business, and it seems that they have a good business model going forward. Trying to replicate the success that they’ve had with the residential business would add unwanted complexity to their business model. CMR’s current residential customer base is there as a result of years of loyalty and good service from Mike’s Cabinets. This loyalty would not exist in a new market.

Free Essays on Ultima

Antonio’s Religious Doubts The most important aspect in the second half of the novel Bless me Ultima is the gradual loss of faith in Antonio. He is at a very young age (3rd grade) but his friends and family look up to him as the priest of the household. It is apparent that Antonio has dreams of being a great priest which would bring honor to his family and make him a well-respected man. Unfortunately it is not as easy as Antonio would think because he is doubting the Catholic God because of the people who believe in the catholic God but who have so many troubles going on in their lives. He is secretly question why a powerful catholic God would constantly punish his own people. Antonio could not find an answer to why evil exists in the Catholic religion, instead he finds peace in a spiritual relationship with the land and nature. He owes this appreciation of the land and new life from the influences of his mother, his father, and Ultima. Antonio has finally attained almost a harmony regarding his different heritages. He is able to peacefully enjoy the beauty of his land without having to question immorality. Antonio's last dream addresses his crisis of religious faith. The three figures of people he tried to save state that Antonio prayed for them in his innocence. He tried to save Narcisco, Florence, and then Ultima. Ultima’s death really made Antonio question the faith is practicing. He feels as though now God is punishing him and for what, is not Antonio a priest? The dream hints at Antonio's understanding that people often disobey the rules of their own religions. His dream also foreshadows how Ultima will die. Seeing the failure of all three people he loved, Antonio asks God why he has forsaken him. Thus questioning his own religion.... Free Essays on Ultima Free Essays on Ultima Antonio’s Religious Doubts The most important aspect in the second half of the novel Bless me Ultima is the gradual loss of faith in Antonio. He is at a very young age (3rd grade) but his friends and family look up to him as the priest of the household. It is apparent that Antonio has dreams of being a great priest which would bring honor to his family and make him a well-respected man. Unfortunately it is not as easy as Antonio would think because he is doubting the Catholic God because of the people who believe in the catholic God but who have so many troubles going on in their lives. He is secretly question why a powerful catholic God would constantly punish his own people. Antonio could not find an answer to why evil exists in the Catholic religion, instead he finds peace in a spiritual relationship with the land and nature. He owes this appreciation of the land and new life from the influences of his mother, his father, and Ultima. Antonio has finally attained almost a harmony regarding his different heritages. He is able to peacefully enjoy the beauty of his land without having to question immorality. Antonio's last dream addresses his crisis of religious faith. The three figures of people he tried to save state that Antonio prayed for them in his innocence. He tried to save Narcisco, Florence, and then Ultima. Ultima’s death really made Antonio question the faith is practicing. He feels as though now God is punishing him and for what, is not Antonio a priest? The dream hints at Antonio's understanding that people often disobey the rules of their own religions. His dream also foreshadows how Ultima will die. Seeing the failure of all three people he loved, Antonio asks God why he has forsaken him. Thus questioning his own religion....

How To Make Spanish Crossword Puzzles

How To Make Spanish Crossword Puzzles Are you a Spanish teacher who is tired of giving routine fill-in-the-blank and multiple-choice vocabulary tests? If so, you can bet your students are wearier of them then you are. The answer may be a fun variation of fill-in-the-blank - crossword puzzles, known as crucigramas in Spanish. With software available for only the bother of a download, you can quickly create Spanish-language crossword puzzles with your own choice of words. Free Crossword Puzzle Software The free software, EclipseCrossword from Green Eclipse Software, lets you readily make your own word lists and definitions, so puzzles can be custom-designed for what youre trying to teach. One nice feature of EclipseCrossword that makes it particularly suitable for teaching Spanish and many other foreign languages is that it supports diacritical marks, so you can include words with the à ± as well as accent marks on the vowels. The software, which uses Windows, is free, so you cant expect it to have the capability of professional software that will let you develop crosswords with the density and symmetry of the puzzles youll find in top newspapers and magazines. But it is otherwise quite versatile, letting you specify the desired size (go too small, and the program will leave words out) and output format. You can print the puzzles directly, or you can save them to a Web page.

Moral testimony Article Example | Topics and Well Written Essays - 2000 words

Moral testimony - Article Example "Moral experts have no need to seek out others' moral expertise, but moral non-experts lack sufficient knowledge to determine whether the advice provided by a putative moral expert in response to complex moral situations is correct and hence whether an individual is a bone fide expert."1 The acceptance of moral testimony has been challenged on the basis that it does not make knowledge available to the recipient and therefore the use of such a knowledge is illegitimate.Before the reasons for this objection are discussed it is worth noting that little academic attention has actually been paid to the idea of whether or not testimony can be a legitimate source of moral beliefs.2 "we should be open to being persuaded by others, responsive to moral argument; but we should not take their word on moral issues, not allow ourselves to be influenced by the fact that they hold a certain view''.if, on the other hand, reliance on moral testimony is legitimate, there will still be questions about the conditions under which it is so". 3 This means that even though it is hard for us as humans to reject or accept moral judgements and considerations subconsciously , we cannot let these considerations to become a part of our analyses in real life. For example my idea that a certain person is "racist" or a "liar" is based on my own perceptions and experiences. When dealing with this person my prejudices will inevitably suffice (even though in a very subtle manner).However any action by a third party based on my views or "moral testimony" should not be relied upon. Even if my moral testimony does form the basis of another party's reaction or action and it is subsequently accepted Hopkins(2007) believes that there should be a more "solid" reason for doing so rather than my own value judgements. It has been further suggested that "moral discourse, for some reason or other, cannot meet the conditions necessary for learning from the word of others. Since the epistemology is wrong, there is no knowledge to be had from testimonial transactions on moral matters."(Hopkins 2007). It is for this reason that it is believed that it would be rather "illegitimate" to let other's claims guide one's moral belief. For example as an employer of a person I might be faced with the moral testimony of the hiring committee that this person has "moral shortcomings" but I cannot base my judgement on these moral shortcomings. Firstly because morality is largely a matter of perception and the evidence offered in this regard will also be based on "feelings" or the personal experiences of the moral expert, and not actual evidence of their shortcoming like theft or irresponsibility on the job. Of course the contrary view in this regards is that in the right circumstances, moral dialogue may meet and fulfil all the criteria of testimonies in general (Hopkins 2007). The problem however remains that moral testimony lies in a standard that only relates to morals and since knowledge is right, testimony does make moral knowledge available. (Hopkins 2007) For a more profound analysis of this issue it is necessary to delve deeper into what the words "moral" and "testimony" entail in

Weekly Assignment No. 12 & Weekly Assignment No. 13 Essay

Weekly Assignment No. 12 & Weekly Assignment No. 13 - Essay Example We are reviewing the performance of big contractor companies on the recent projects to select the one we would like to contract with. A business proposal is a kind of business plan when the business is in the conceptual stage. The scope of work, the resources and other business essentials have not yet been finalized. On the other hand, a business plan is the actual plan of a business once everything has been finalized. It has scenario details and is usually made for a period of five years. The business plan includes but is not limited to the products, the cost and benefit analysis, objectives and the marketing plan. Entrepreneurs need a business plan in order to concoct the management and leadership strategies. The business plan suggests the resources that the entrepreneur should arrange as well as the milestones that the entrepreneur has to achieve. The business plan provides the entrepreneur with a firm basis for his/her future decisions and an objective understanding of the business as a