Treatment for Digoxin Overdose

Treatment for Digoxin Overdose B. Trimble Digoxin Overdose Digoxin is derived from the leaves of a digitalis plant (foxglove). Some plants have chemicals that can cause symptoms similar to digoxin if eaten, such as lily of the valley and oleander. Digoxin is a substrate of P-glycoprotein. Drugs that induce or inhibit P-glycoprotein in the intestines or the kidneys have the potential to alter digoxin pharmacokinetics (Katzung, Mastes, Trevor, 2012). Digoxin increases the strength of heart contractions by inhibiting the activity of the enzyme ATPase. ATPase controls the movement of calcium, sodium, and potassium into the heart muscle. ATPase increases the amount of calcium in heart muscle, which increases the force of contractions. Digoxin slows the electrical conduction between the atrium and ventricles of the heart and slows ventricular contractions. Digoxin is eliminated through the kidneys and should be reduced in dosage in patients with kidney dysfunction (Katzung, Mastes, Trevor, 2012). Medications such as verapamil, quinidine, Amiodarone, indomethacin, spironolactone, Alprazolam and itraconazole can increase drug levels and the risk of toxicity of digoxin. Furosemide and other diuretics that reduce blood potassium or magnesium levels may predispose patients to drug induced abnormal heart rhythms. Saquinvard and ritonavir increase the amount of digoxin in the body and may cause toxicity (PubMed, 2013). Assessment of the severity of toxicity and etiology (accidental, unintentional, or deliberate overdose) altered drug metabolism due to decreased renal function or interaction with other drugs is necessary. Consideration of factors that influence treatment include age, medical history, chronicity of digoxin intoxication, severity of heart disease, and/or renal insufficiency and ECG changes (Katzung, Mastes, Trevor, 2012). Symptoms of digoxin toxicity include anorexia, nausea, vomiting, diarrhea, visual changes, cardiac arrhythmias (1st degree, 2nd degree â€Å"Wenckebach†, or 3rd degree heart block), atrial tachycardia with AV block, AV dissociation, accelerated junctional, unifocal or multifocal premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation (Patel, 2011). Toxicity is usually associated with levels greater than 2 mg/ml. Low body weight, advanced age, impaired renal function, hyperkalemia, hyper-calcemia, or hypo-magnesium may cause d igoxin toxicity. Other symptoms may include decreased consciousness, decreased urine output, difficulty breathing, and overall swelling (Brunton, Chabner, Knollman, 2011). Treatment will consist of emergency protocol if outside the hospital; this includes calling emergency medical services and CPR. Once the patient is in medical care, the treatment will depend upon the severity of symptoms and levels of digoxin in the body. Laboratory testing will include serum electrolytes, digoxin levels, and thyroid function tests. The patient will be placed on continuous cardiac monitoring with a 12 lead ECG obtained (Brunton, Chabner, Knollman, 2011). The primary focus is to correct electrolyte levels; if hypokalemic administer potassium to reach a level of 4.0 to 5.5 mmol/L. Activated charcoal will be administered either orally or per nasogastric tube in order to bind undigested digoxin. If bradycardic and symptomatic, atropine may be given intravenously. Peak cardiac effects of digoxin occur 3 to 6 hours after ingestion. Gastrointestinal symptoms precede cardiac manifestation. Neurological symptoms like fatigue and malaise are common. Visual disturbances occur with aberration in color vision, mostly yellow-green. Activated charcoal binds to the digoxin and prevents recirculation to the enterohepatic circulation. Cholestyramine may be used for chronic toxicity in patients with renal insufficiency. Continuous hemodynamic monitoring includes the ECG and 12 lead EKG (Brunton, Chabner, Knollman, 2011). Prompt measurement of electrolyte levels (potassium, calcium, digoxin, BUN, creatinine, and CMP). Sodium bicarbonate may be administered to correct metabolic acidosis along with glucose and insulin to enhance potassium uptake by the cells (Brunton, Chabner, Knollman, 2011). Magnesium may serve as a temporary antiarrthymic until digifab is available. Hypomagnesium increases myocardial digoxin uptake and decreases cellular sodium/potassium ATPase activity. Digibind (digifab or digoxin immune Fab) is an immunoglobulin fragment that binds with digoxin. In acute intentional overdose digibind (40 mg reconstituted with 4 ml sterile water) is administ ered 4 to 6 vials as a loading dose over 30 minutes as an emergent IV bolus. The bolus is followed by 0.5 mg/minute for 8 hours and then 0.1 mg/ minute for 6 hours (Patel, 2011). For patients with chronic toxicity that are dependent on digoxin, the initial dose is twice the bolus. This avoids complete reversal of clinical effects of digoxin. Response is typically within 20 to 30 minutes after infusion, elimination half- life is around 16 hours. Digoxin levels are unreliable for one to two weeks after therapy. Complications in long-term digoxin users, who receive digibind treatment administration are that it may precipitate worsening of heart failure as reversing the beneficial inotropic agent of digoxin causes hypokalemia and atrial arrhythmias with rapid ventricular response (Katzung, Mastes, Trevor, 2012). Hypokalemia has occurred in patients treated with standard therapy as well as with Fab fragments. Clinically adverse phenomena have occurs in patients with immunotherapy. Other untoward effects of Fab include anaphylaxis and serum sickness, this is because it is a sheep protein, but this is uncommon. Recrudescence of digoxin toxicity is possible within 7 to 14 days because Fab is eliminated more rapidly than digoxin released from tissue binary sites. Plasmapheresis may be performed or the agent reinstituted in such cases (Patel, 2011). If hemodynamically stable, bradycardia and supraventricular arrhythmias may be treated with observation and supportive measures. Ensuring hydration to optimize renal clearance, administering gastrointestinal binding agents may be used. For patients with rate related ischemia or neurological unstable digiFab is the treatment of choice (PubMed, 2013). In unstable premature ventricular contractions, lidocaine may be effective. In ventricular tachycardia the best response is to digiFab, but phenytoin and lidocaine are useful if Fab is ineffective or unavailable (Brunton, Chabner, Knollman, 2011). They depress the enhanced ventricular automaticity without significant slowing of AV conduction. Phenytoin may reverse digoxin induced prolongation of AV nodal conduction. Phenytoin has been shown to dissociate the inotropic and dysrhythmia actions of digoxin, suppressing digoxin tachycardia without diminishing the contractile affect and can terminate SVT induced by digoxin. Doses for lidocaine are 100 mg bolus with an infusion of 1 to 4 mg/minute. Phenytoin dosage is 100 mg every 5 to 10 minutes up to a loading dose of 15 mg/kg. Magnesium sulfate dosage is 2 gram over 5 minutes followed by an infusion of 1 to 2 g/hour, with magnesium levels drawn every one to two hours. Atropine may be given for bradycardia to improve sinus and AV node conduction by inhibiting vagal activity (Brunton, Chabner, Knollman, 2011). Phenytoin may reverse digoxin induced prolongation of the action potential in myocardial cells and may suspend tachycardia, prolongs effective refractory period, and depresses spontaneous depolarization in ventricular tissue. Lidocaine is a class IB antiarrthymic that increases the electrical stimulation threshold of the ventricles, suppressing the automaticity of conduction through the tissue. It combines with sodium channels and inhibits recovery after repolarization, resulting in decreased myocardial excitability and conduction velocity (Brunton, Chabner, Knol lman, 2011). Magnesium sulfate possesses properties that slow the rate of sinoatrial node impulse formation and prolong conduction times (Brunton, Chabner, Knollman, 2011). Prevention of unintentional overdose (accidental overdose, interaction with other medications, or the altered metabolism due to renal insufficiency) is mostly through patient education. Instructing the patient in the correct dosage of the medication; that blood tests will be necessary to ensure appropriate dosage; suggesting daily recording of heart rate and blood pressure. Advise the patient that many drugs interact with digoxin, and to inform the physician and pharmacist of all medications, including over the counter and herbal medications, and if started on a new prescription. Advising the patient to report any sign/symptoms associated with digoxin toxicity. Review signs and symptoms of toxicity with the patient. If the overdose were intentional, the patient would need the same consults as any other patient undergoing treatment (cardiologist, nephrologist, medical toxicologist, regional poison control center) as well as psychiatric consult. Follow up appointments with the patient to monitor drug and electrolyte levels. Reference Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans:The Pharmacological Basis of Therapeutics (12 ed.). McGraw-Hill. Katzung, B., Mastes, S., Trevor, A. (2012). Basic Clinical Pharmacology (12 ed.). McGraw-Hill. Patel, V. (2011). Digitalis toxicity. Retrieved from Medscape: http://www.emedicine.medscape.com/article/154336-overview PubMed. (2013, Janurary). Digitalis toxicity. Retrieved from PubMed.gov: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001218

The Flute Virtuosity: Johann George Tromlitz Essay -- The Gewandhaus Or

Accounts written of the late Johann George Tromlitz paint him as a bitter man; he was easily upset when writers neglected to mention his influential work on the flute. He reacts to these sentiments in the forward of one of his treatises, The Virtuoso Flute-Player (1791). Tromlitz wanted to be known as a master of the flute; he believed that his ideals were vital to the flute’s development and performance. He wrote several treatises where he speaks of the correct construction and performance of the flute, the core of his ideal. Although disputed, Tromlitz’s long-lasting impact on the flute community is absolutely indispensable: his treatises guide performers to a great extent, his compositions provide standard and well-written repertoire for the flute, and his flutes themselves mark the improvements that have been essential to the development of the modern flute. Tromlitz was born in 1725 in the small district of Reinsdorf in northern Germany. He completed his studies at the University at Leipzig in 1750, and soon after he received his degree in law, he started to build his own new set of flutes that were intended to dramatically change the construction process of flutes. He assumed the principal chair of the Große Concerte (now the Gewandhaus Orchestra) in 1754 until 1776. The Gewandhaus Orchestra was named after the concert hall in Leipzig where its main performances were and still are held. Tromlitz left the orchestra to dedicate his time to the creation of his new instruments, the teaching of new students, and the compositions he was writing for the flute repertoire. By leaving the orchestra, Tromlitz began to discover the true worth of improving the flute. The flute was being used in the orchestra on a more freque... ...r.org (accessed Jan. 24, 2014). Grove Music Online, S.v. â€Å"Tromlitz, Johann George,† by Ardal Powell. http://www. oxfordmusiconline.com (accessed Jan. 25, 2014). Powell, Ardal. The Flute. China: Yale University Press, 2002. Reilly, Edward R. â€Å"Quantz and the Transverse Flute: Some Aspects of His Practice and Thought Regarding the Instrument.† Early Music 24, no. 3 (Aug. 1997), http://www. jstor.org (accessed Jan. 24, 2014). Toff, Nancy. The Flute Book: A Complete Guide for Students and Performers. New York: Charles Scribner’s Sons, 1985. Tromlitz, Johann George. Sonata fà ¼r Flà ¶te und Cembalo in Ut majeur. Mainz, Germany: Schott Musik International, 2000. Tromlitz, Johann George, Ardal Powell, trans. The Keyed Flute. New York: Oxford University Press, 1996. ———, ———, trans. The Virtuoso Flute-Player. Cambridge, UK: Cambridge University Press, 1991.

The Negative Impact of Internet and Television on our Youth Essay examp

The Negative Impact of Internet and Television on our Youth Meet Jane Doe. Jane is sixteen years old and is "down" with all of the most popular trends. In the morning, Jane washes her hair with Fructise Fortifying shampoo and conditioner. Under her massage therapy showerhead, she rinses away the sweet smell of plumeria from her Bath and Body Works body wash. She hops out of the shower and straps on her cream Victoria Secrets bra and matching panties. As she slides on her dark brown Abercrombie and Fitch sweater, she sways to "Hey Ya" by Outkast blaring out of her Sony 5 disc CD player. She runs to her PC, starts the Internet and quickly finishes her weekend homework from her online literature class. She hears the ring of her Nokia cell phone and quickly answers it. Her friends ask her to come and hang with them. She immediately answers yes and rushes through the door to her new Mercedes Benz to meet them. Jane watches T.V., surfs the Internet, and uses the telephone to find all of the best tidbits to become a cool, fashionable young women. Her so-called perfect world revolves around these communication tools. Little does Jane know that all of these tools may cause her character harm in the future. One rainy day, Jane was sitting on her couch surfing through the channels on her T.V. Naturally, there was nothing to watch, so she quickly flipped through the channels until something caught her eye. A man's face covered the middle of the screen. This face was drenched in water and had two small cuts purposely placed to the right of his right eye. His lips slowly cracked a deceitful smirk. Intense, deranged hatred seemed to have swallowed his deep green eyes that sat under a continuous downcast brow, which made him seem almos... ...s eyes open wide as she realizes what she had just said. Just then it seemed like the reality of the whole day had set in. Her mind had been mutated by the massacre she had seen on her television. Sex had just become an everyday thing that everyone does. Offensive words are now used in everyday language without considering the people who are present. The communication tools in her everyday life had not only shaped the way that she lived but also her character. Jane stopped realizing who she was becoming. She didn't want to become that kind of person. Slowly Jane saunters up the stairs to her room. Passing by the mirror, she pauses for a moment and examines herself. She what kind of person she wanted to be. Grabbing one of her cherished book, she flops on to her bed and starts reading forgetting everything that had happened that day. However, tomorrow is another day. The Negative Impact of Internet and Television on our Youth Essay examp The Negative Impact of Internet and Television on our Youth Meet Jane Doe. Jane is sixteen years old and is "down" with all of the most popular trends. In the morning, Jane washes her hair with Fructise Fortifying shampoo and conditioner. Under her massage therapy showerhead, she rinses away the sweet smell of plumeria from her Bath and Body Works body wash. She hops out of the shower and straps on her cream Victoria Secrets bra and matching panties. As she slides on her dark brown Abercrombie and Fitch sweater, she sways to "Hey Ya" by Outkast blaring out of her Sony 5 disc CD player. She runs to her PC, starts the Internet and quickly finishes her weekend homework from her online literature class. She hears the ring of her Nokia cell phone and quickly answers it. Her friends ask her to come and hang with them. She immediately answers yes and rushes through the door to her new Mercedes Benz to meet them. Jane watches T.V., surfs the Internet, and uses the telephone to find all of the best tidbits to become a cool, fashionable young women. Her so-called perfect world revolves around these communication tools. Little does Jane know that all of these tools may cause her character harm in the future. One rainy day, Jane was sitting on her couch surfing through the channels on her T.V. Naturally, there was nothing to watch, so she quickly flipped through the channels until something caught her eye. A man's face covered the middle of the screen. This face was drenched in water and had two small cuts purposely placed to the right of his right eye. His lips slowly cracked a deceitful smirk. Intense, deranged hatred seemed to have swallowed his deep green eyes that sat under a continuous downcast brow, which made him seem almos... ...s eyes open wide as she realizes what she had just said. Just then it seemed like the reality of the whole day had set in. Her mind had been mutated by the massacre she had seen on her television. Sex had just become an everyday thing that everyone does. Offensive words are now used in everyday language without considering the people who are present. The communication tools in her everyday life had not only shaped the way that she lived but also her character. Jane stopped realizing who she was becoming. She didn't want to become that kind of person. Slowly Jane saunters up the stairs to her room. Passing by the mirror, she pauses for a moment and examines herself. She what kind of person she wanted to be. Grabbing one of her cherished book, she flops on to her bed and starts reading forgetting everything that had happened that day. However, tomorrow is another day.

Six Steps to Learning How to Overcome Challenges in Your Life

There are six steps to learning how to overcome challenges in your life. Each of these steps identifying the challenge or problem, defining the challenge or problem, analyzing the cause of the challenge or problem, exploring solutions to the challenge or problem, deciding to solve the challenge or problem, and taking action to overcome the challenge or problem will require your total involvement (Pokras, 1989). While no one is an expert on your particular challenge, there are strategies that can be used as tools to help you overcome these challenges. The first tool involves identifying the challenge. Successfully overcoming challenges require knowing exactly what the challenge involves. Many times when we first encounter a challenge we feel threatened and react defensively before knowing what we are up against. When we step back from the problem or challenge and take time to examine it we find the problem has other contributing factors that were not clearly in focus in the outset. During this phase take time to collect data about your problem or challenge such as when it began, what were the symptoms that a problem existed, and how long has this been going on (Pokras, 1989). Upon identifying the factors or underlying causes of the problem you can then move onto step two defining the challenge. In this step it is a good idea to write down the possible causes for the challenge that you are now facing. This will require analyzing the data you have collected, thinking about what this data means, deciding what it is you want and what you do not want, and narrowing down the challenge or problem to single points of causation (Pokras, 1989). Once you have narrowed the scope of the challenge or problem down to a manageable level you are now ready for step three-analyzing the cause of the problem. Really what takes place in step three is taking the time to analyze actions that were taken that resulted in there being a challenge or problem that you are now facing. This is can be accomplished by doing some type of cause and effect diagram that will give you the ability to visually comprehend what happened. Usually when we can clearly see where we went wrong we have that aha moment. Now that you have identified, defined, and analyzed the challenge or problem, what do you do now? Here is where the real work begins because many people can tell you what their problem is but they have a hard time doing something to change their situation. Step four requires you to make a decision to do something by exploring possible solutions to the challenge. Niven (2005) suggest developing a strategy or plan that allows you to decide what you need to change to overcome the challenge or the problem. This step is an important step because it takes a desire to succeed to overcome the challenge or problem and no one can instill in you the desire to change. This desire must come from within but will not happen until you make up in your mind what you want out of life, how you want your life to be, what you need to survive, and what it is you need to change to overcome your challenge or problem. Making the decision that you must change and that you have the power to make that change is difficult but can be the most rewarding thing you can do. In step five you will discover that after the decision is made that you want to change you can now actually decide to solve your problem. This step will require deciding on your criteria for success, deciding what your goals will be, establishing priorities, defining objectives, and taking responsibility for improving your own life (Cohen, Jacobs, Quintessenza, Chai, and Ungerleider, 2007). The most important tool in this step is writing an action plan including the aforementioned elements along with your vision for your life, your mission in life, and your personal philosophy or strategy for living your life (Niven, 2005). This plan must be written in a manner that allows you to measure your progress toward overcoming your challenge or problem. Part of your plan, for example, may involve getting a mentor, a person to serve as a role model, or setting up a support system (Cohen et al, 2007) by a certain date to fully implement your plan. Once you have established your plan you are ready to move onto the final step. The last step to overcoming challenges involves taking action . Implementation of your action plan will be the most critical part of you being successful in overcoming your challenge. This will require your total commitment, dedication, involvement and perseverance to achieve success. You ust remember that the best laid plans will not solve your problems if you do not do something to put them into motion, prepare yourself to deal with the unexpected, and be ready to make the little changes necessary to your plan to reach your goals. If you carry out the six steps of identifying the challenge or problem, defining the problem, analyzing the cause of the problem, exploring solutions to the problem, deciding to solve the problem, and taking action to overcome the problem (Pokras, 1989) you will begin to make progress to overcoming your challenges.

T.S.Eliot Murder in the Cathedral

T. S. Eliot's Murder in the Cathedral tells the story of Thomas Beckett, a man who reigned as Archbishop of Canterbury during the 12th century in England until his death in 1170. In order to tell Beckett's story, Eliot creates a series of equally interesting characters that each play a crucial role thought the play. The most unique rolefound within the play is the Women ofCanterbury, or the Chorus. Throughout the piece, the Chorus delivers seven choral odes. These choral odes, when looked at as a collective work tell a story. They begin with brief foreshadowing of events that will occur later in the play, but then quickly jump into necessary storyline; one which summarizes the events of the pasts, and then immerses the audience into the common man's view of the events in the present. The first choral ode begins with heavy foreshadowing. The Women of Canterbury are drawn towards the Cathedral, but they do not know why. At first, there is confusion. They question, â€Å"Are we drawn by danger? Is it the knowledge of safety that that draws our feet towards the Cathedral? As they reach the cathedral however, they come upon a realization. â€Å"There is not danger for us, and there is no safety in the cathedral. Some presage of an act, which our eyes are compelled to witness, has forced our feet towards the cathedral. † They recognize that it is not their own personal danger that draws them closerto the cathedral, but instead the foreshadowing of a horrifying act in which they will be forced to bear wi tness. It will be an act so terrible, that safety can not even be found within the hallowed halls of the cathedral. After the period of foreshadowing, themood of the first choral ode drasticallyshifts away from the dark and mysterious presage of an act to a description of the concrete past. The remainder of the choral ode serves as away to bring the audience up to speed on the last seven years of Canterbury'shistory. While they convey the events of the past, the women of Canterbury express a constant lurking fear for the safety of their Archbishop. A perfect example of this common theme found within the first choral ode is in the following stanza, in which the Chorus states: â€Å"Seven years and the summer is over, Seven years since the Archbishop left us, He who was always so kind to his people. But it would not be well if should return. † These lines are typical of the first choral ode, for not only do they explain to the audience that the Archbishop Thomas Beckett has been gone for seven years now, but they fear for his well being and for the wellbeing of Canterbury if he were to return. As the choral ode draws to a close, the Women of Canterbury give off a sense of unavoidable waiting. They say: â€Å"Come happy December, who shall observe you, who shall preserve you? Shall the Son of Man be born again in the litter of scorn? For us, the poor, there is no action, But only to wait and to witness† They welcome the month of December,but then question how it could possibly be a joyous time. Who would be able to celebrate the Christmas and Advent season with the terrible events that are about to occur? Could Jesus bereborn into such scorn? The Women ofCanterbury know that there is little they can do at this time. They must wait, and then witness the act that they fear. With the commencement of the secondchoral ode, the general mood shifts from confusion and waiting to fear. The Women of Canterbury have been informed that Beckett is returning to Canterbury. Such an announcement stirs great anxiety amongst them. They fear that their way of life will be disrupted and endangered. They plea to a Thomas who has not yet arrived to: â€Å"Return. Quickly. Quietly. Leave us to perish in quiet. You come with applause, you come with rejoicing, but You come bringing death into Canterbury: A doom on the house, a doom on yourself, a doom on the world. † The women say that though they will be rejoicing on the outside, their deep insides will be dominated by fear, for they believe that his coming will come hand in hand with his own death. The idea of fear is the general theme in thesecond choral ode, as it constantly recurs throughout the lines. Later in the choral ode, the women say, â€Å"We are afraid in a fear which we cannot know, which we cannot face, which none understands. † This illustrates thedepth and complexity of the fear which they are facing, for they know not how to neither combat it nor completely comprehend it. All the people know is that with Thomas comes death upon their home of Canterbury, so the beg him to â€Å"leave us, leave us, leave us sullen Dover, andset sail for France. † The fear of the second choral ode becomes a reality in the third. The Women of Canterbury know what decision Beckett has made. They tell him, â€Å"We have not been happy, my Lord, we have not been too happy. We are not ignorant women, we know what we must expect and not expect. † By saying this, the Women of Canterbury mean that they understandthe consequences that Thomas has chosen by staying in Canterbury. They know that he will perish if he stays. Then the women begin to despair. They cry, â€Å"God gave us always some reason, some hope; but now a new terror has soiled us, which none can avert,† and, â€Å"God is leaving us, God is leaving us, more pang, more pain than birth or death. The Women of Canterbury, who always took faith in the idea the God was protecting their Archbishop, believe that Thomas has turned away from the Lord's protection by deciding to remain at Canterbury, for not even God could protect him from the wrath of what was yet to come. The fourth choral ode that opens up the second act heads in a completely dif ferent direction than the intense despair of the third choral ode. Instead, this choral ode is more accepting, for the chorus knows that the death of Beckett is coming. Nature is used throughout this choral ode to foreshadow his death. At one point theWomen of Canterbury say, â€Å"The starved crow sits in the field, attentive;and in the wood the owl rehearses the hallow note of death. † The starved crow that they speak of symbolizes the Four Knights, who arrive in Canterburyshortly after the choral ode is delivered. The owl symbolizes the result of their visit to Canterbury: a death, a death that they fear will be brought upon Thomas. Though they have accepted the situation, the Women of Canterbury feel helpless, for all they can do between that moment and Thomas's death is wait. Asthere is nothing they can do, they say,†We wait, and the time is short, but the waiting is long. † As the fifth choral ode begins, the helplessness from the fourth choral ode carries over, but this time it is coupled with an air of guilt. The Women of Canterbury are stuck in an in between zone. They grieve: â€Å"Now is too late for action, too soon for contrition. Nothing is possible but the shamed swoon Of those consenting to the last humiliation. I have consented, Lord Archbishop, have consented. † The women realize that the wheel is turning and the eternal action leading to Beckett's doom is in motion. They are in despair, for it is too late for them to try and aid their Archbishop, but too soon for them to seek forgiveness for allowing Beckett to be killed. The murder of their Archbishop is a matter that they are taking personal responsibility for, and they view it as a humiliation to them all. Their final cry of â€Å"I have consented, Lord Archbishop† truly isolates and illustrates the immense guilt that they have brought upon themselves. The Women of Canterbury believe that by standing aside and allowing the Knights to threaten Thomas, they have consented to his murder. All they have left is helplessness, guilt, and like always, waiting. The sixth choral ode is met with a shiftfrom helplessness to intense distress. Archbishop Thomas Beckett has just been murdered, and the Women of Canterbury feel as if they, along with all of Canterbury, have been stained with their Archbishop's blood. The chorus screams: â€Å"Clear the air! Clean the sky! Wash thewind! Take the Stone from the stone, take the skin from the arm, Take the muscle from the bone, and wash them. Wash the stone, wash the bone, wash the brain, Wash the soul, wash them wash them! † As shown, the Women of Canterbury become obsessed with trying to wash themselves clean of Beckett's blood. Such words confirm that the Women of Canterbury see not only the Four Knights as Thomas Beckett's killer, but themselves as well. They feel severe regret, proclaiming: â€Å"We did not wish anything to happen We understood the private catastrophe, The personal loss, the general misery, Living and partly living† These lines show that, though they believe that they were a part of the murder, they were unintentionally involved. They did not mean for any illwill to come upon their Archbishop, but through their lack of action, their living and partly living, they allowed Beckett to face a tragedy, a tragedy that they were completely aware of, alone. The Women of Canterbury abandoned their Lord, and they do notknow how to deal with their despair The final choral ode begins not with despair, but instead with grateful praise to an all powerful God. The entire choral ode reads like one long prayer of praise, thanks, and then contrition to a merciful God. At points,the Women of Canterbury even go as far as to compare their deceased Archbishop to Jesus Christ. In it's beginning, they say, â€Å"We praise Thee, O God, for Thy glory displayed in all the creatures† The Women of Canterbury then go on to on to show their gratitude to God by respectfully praying, â€Å"We thank Thee for Thy mercies of blood, for Thy redemption by blood. For the blood of Thy martyrs and saints. † By these words, the Women of Canterbury are thanking God for redeeming their souls with theblood of Thomas, their Archbishop. Through these lines, Eliot is comparingthe murder of Thomas Beckett to the death of Jesus Christ on the cross, saying that both died to save the souls of those around them. Finally, the Woman of Canterbury seek contrition, pleading, â€Å"Forgive us, O Lord, we acknowledge ourselves as type of the common man, of the men and women who shut the door and sit by the fire. â€Å"On one level, they ask forgiveness for standing by and doing nothing to prevent Beckett's death, for they are just common men. If read more deeply however, they return to the Christ like image of Beckett. The common men askfor forgiveness, for like Peter, they†sat by the fire† and denied their Lord. Just as Peter allowed Christ to die, so the Women of Canterbury allowed Thomas Beckett to die. The seven choral odes in T. S. Eliot's Murder in the Cathedral tell the story of the common man's view of the events that occurred during that fateful December of 1170 in Canterbury. Through foreshadowing and interesting use of language, T. S. Eliot crafts the Chorus to be one of, if not the most fascinating character found within the whole play. Their unique perspective on Thomas Beckett's murder truly makes Murder in the Cathedral one of the greatest plays of the 20th Century.

R – 7 Scandal – Boston Post Magazine

The breakthrough of the century could have been the Respiratory Syncytial Virus (RSV) or more commonly termed as R – 7. With two and a half years of research, Dr. Cliff Bannaker has worked on this virus from its very conception up to its ‘coming out’ at Glass-Mendelssohn laboratory. This particular drug is banked on as the possible cure to cancer. The Glass-Mendelssohn laboratory is at the heart of Harvard University’s Philpott Institute. The Director is Dr. Sandy Glass, whose given name is Sam Glazeroff, who is a descendant of Eastern European Jews. On the other hand, his co- director Marrion Mendelssohn, is a product of Franz Applebaum at Columbia. This is also where she met her husband Jacob, who in turn was a researcher – turned professor, now teaching microbiology at a local college. Dr. Cliff Bannaker is one of the most promising young doctors from Stanford. He was under the mentoring of the deceased Professor Oppenheimer. He is a son of Los Angeles store owners, who are both are college degree holders. He has been in the laboratory for three years being hired under the recommendations of Professor Oppenheimer. The laboratory is staffed with a few post – doctorate degree holders and two laboratory technicians. The doctor’s are Dr. Robin Drecker, Dr. Xiang Feng, Dr. Prithwish and the man who created the virus Dr. Cliff Bannaker. Their qualified laboratory technicians are Aidan and Natalya. The RVS was first introduced by Bannaker during his entry in the laboratory. He was given the opportunity to do his research. Such project initially showcased high potential for turning cancer cells into normal ones but it is worthy to note that this was not the only research done within the laboratory. However, even if this one has the highest prospect, there was a failure on the initial experiment with live subjects. With such, the directors had advised Bannaker to stop his experiment on RSV and work with fellow doctor Drecker, who is also Bannaker’s girlfriend. However, with intractable spirit (or frankly insubordination), Bannaker continued to inject live subjects, in this case- mice, with the virus. The RSV’s second attempt found several nude mice, which are those that do not have hair due to some disorder, that did not have the cancerous tumors after the injection of RSV. This was found by Dr. Feng who is the laboratory’s record keeper and the co-director Mendelssohn. The initial reaction is to ‘hide’ this from the director Glass. Nevertheless, this was also subsequently revealed. The restless but close to unproductive laboratory, with contagious glee probably from their director, eagerly proceeded with an announcement. With whirlwind speed, the research findings were published in a scientific journal, Nature. The laboratory gained publicity and funding for the venture. Consequently, the laboratory started its own quandary. The doctors who tried to replicate the results were unsuccessful. Thus, suspicion ignited in each in every doctor who tried unsuccessfully. The suspicions of the issue went into a full-blown investigation complete with Congressional hearing, wherein one of the doctors of the same laboratory became, so to speak, the whistle-blower of the whole charade. Drecker was also accused of holding professional jealousy against the people who strongly (though baselessly) believed in the work of Bannaker. At the same manner, such actions of the laboratory elicited commentary from the whole medical field. Not to mention, those in politics, in business as well as all people connected with what happened and the general public. How the ‘R – 7 Scandal’ violated Ethics in Research The whole ‘R – 7 scandal’ is composed of ethical and moral violations that deserve to be scrutinized both from the researchers’ ethical standards and from the perspective of the general public. Researchers have ethical standards that are built as a two way shield, as a protection for the general public and as flight leverage for the researchers. When researchers conduct certain studies, there are sets of ethical guidelines that should be followed. Although different field of studies have different sets of guidelines, there are still parallelism in such that every research should follow. Bannaker is probably an honest researcher who did not have the heart for a failed research. Honesty is a major ethical issue with the ‘R – 7 Scandal’ where the truth about the whole issue may never be entirely given light, or perhaps there will still be doubts as to the real occurrence of the whole fiasco. Not only did Bannaker twisted honestly but it also has something to do with the directors, Mendelssohn and Glass. Mendelssohn and Glass are the directors of the laboratory and their honesty is a very crucial for the integrity of the researches done under their leadership. They have the bestowed responsibility to make sure that the results are not manipulated in a dishonest way. Such actions have compromised not only themselves, but all the past and current researches done by the staff under their command. This leads to yet another issue of carefulness. Whether the scandal is a product of carelessness or dishonesty, all that are responsible have still forgotten to take into consideration this ethical virtue. As a result, irresponsible publication is observed. Responsible publication should be in line with the researchers’ openness to the results of their studies, as well as, to gear towards advancement of the field. Bannaker have apparently underestimated Drecker where some reports have said that prior to the deemed termination of Bannaker’s RSV, he was already asked to help Drecker in her research. However, Bannaker refused for unconfirmed reason where he thinks of her research as not ambitious enough. That alone is a breach of research ethics in terms of respecting one’s colleague in terms of their work. Responsible mentoring, that should also been practiced by Mendelssohn and Glass, have also failed miserably. They have forgotten to follow procedures like replicating the study just to make sure that the results are both conclusive and reliable. Apparently, key players of the scandal have all been seduced by the fame, honor and the seemingly ‘infinite’ grants for the laboratory. At the same time, Drecker, whether her intentions are due to integrity or to professional jealousy, her respect for the truth is ambiguous. In addition to this, researches now also possess legal values. Remember that anything anyone does is under laws and regulations. Consequently, such actions should be appended with legality. The same is true for those who are soliciting for grants or funding from various institutions. How the general public is mislead The public who had high hopes of finding the cure for cancer has been disappointed. In UK alone, there are approximately 289,000 people who are diagnosed with cancer every year, according to Cancer Research UK. Furthermore, there are 150,000 cancer deaths each year which actually boil down to an estimated one death every four minutes. Imagine how many people became disheartened by the revelation that the RSV is a hoax. Social responsibility is a research ethic that should have been treated with respect. Lives are being played at as well as emotions, not only of the people with cancer but the families and friends as well. Thus, nobody have the right to have been as irresponsible as what have happened in the research failure. Clearly, people have expected more ethics from doctors. Generally, people do not condemn any doctor who are ‘not producing’ any results for their studies. Most are even understanding of such, and in turn are more conscious, respectful and appreciative of those trying to come up with advances especially in the medical field. The general public has such high respect of people who have dedicated their lives for the advancement of our lives. Without such people, the conveniences that are enjoyed today may never have come into being. Nevertheless, with such trust, the doctors – researchers should always take into consideration the people, patients and families alike, they serve and not their personal gains. The actions of the individuals from the Glass-Mendelssohn laboratory have affected the lives of many around the world. The gain only belonged to those who have received the fame, grants and all other benefits associated with it, but the suffering is left to those who had tried to hold on for the sake of the ray of hope shed by the results of the failed study. Indeed, such actions have left more scars of frustrations for the people suffering from cancer as well as their families. Lesson Learned Doctors are also human beings that have rooms for mistakes. The ‘R- 7 Scandal’ is a result of carelessness, hasty decisions and hidden agendas. The whole mess serves as a wake up call both for researchers, politicians, grant agencies and the general public. The world of research should be focused on ethical and moral bases. Grant agencies, on the other hand, should be able to create a reliable system of negotiating with research organization on how these organizations can achieve support from them. Politicians should also be able to find more ways for some research laboratories to have funding so that such laboratories would not depend on grants. Thus, less pressure on ‘producing’ results just to acquire funds for continuing research. The general public should also carry at least an ounce of skepticism to avoid the disappointment brought about by failed researches. Looking into the bright side, the study only reached global fame in terms of the research scandals. However, it has not sickened the otherwise, already sick patients, or worse killed them. Far more damage and responsibility could have been the result of such. Therefore, the whole ‘R – 7 Scandal’ should be a reminder of how every single agency and group of individuals should, at least, carry common honesty, careful planning, untainted agenda and uncorrupted social responsibility in making conclusions. Probably, the next time researchers have discovered a cure for cancer or anything resembling such, they would be more responsible and critical.

How Big Global Businesses Compare Research Paper

How Big Global Businesses Compare - Research Paper Example Such results buoyed by strong growth in sales in North America. Thus, the revenue grew to three point eight billion euros. Due to the last year of the considerable change and reinvention, it enabled the company to expect the upcoming 2015 year to be a year of execution with expects annual sales to grow in all sectors, networks, mapping services, technologies and patents (Huuhtanen, 2015). While Nokia holds thirty-nine percent of the world market, it still faces severe competition from such companies as Apple and Google, which entered the market with their high-end products in 2007. Organizational culture is an important factor that influences companies in various contexts. Thus, it is important for establishing competitive advantages and it also impacts on organizational performance. The interest in culture has led to the development of different models, which aim is to explain organizational culture and its relevance for organizations (Dauber, Fink & Yolles, 2012). It is assumed that there are three models of culture within organization, which are the artifacts, the values and the assumed values. Schein believes that artifacts of the company are its dress code, work process and organizational structure. Business goals and strategies as well as company’s philosophies are the espoused values, which should be supported by the way company performs its activities and how these activities are managed. All shared values within the organization constitute assumptions of the company. While using Scheins model, business are able to understand cultural elements o f their organization and be  able to analyze the relationship between assumptions and common business practices. Using models gives possibility to change the basic assumptions of a given culture and hence improve the effectiveness of the company as well (Madu, 2011). Thus, for Apple, the main competitor of Nokia Company, the model of culture includes people with their innovative approach to the development of