Gastroesophageal Reflux Disease Essay Example | Topics and Well Written Essays - 4500 words

Gastroesophageal Reflux Disease - Essay Example The superficial layer of the esophagus is known as adventitia. The adventitia attaches the esophagus to surrounding structures. The esophagus secretes mucus and transports food into the stomach but it does not produce digestive enzymes. The stomach contents can reflux (back up) into the inferior portion of the esophagus when the lower esophageal sphincter fails to close adequately after food has entered the stomach; the condition which is known as gastroesophageal reflux disease (GERD). In GERD, the basal layer of of the epithelium is is thickened, and the papillae of the lamina propria are elongated and extend toward the surface. Abnormalities of the lower esophageal sphincter, Hiatus hernia, Delayed esophageal clearance, Gastric contents, Defective gastric emptying, Increased intra-abdominal pressure, and Dietary and environmental factors may be the factors involved in GERD. Clinically, GERD may be diagnosed by radiographic examinations using dyes, endoscopy, and esophageal pH-metr y. PPI trial is also an accepted method of first line diagnostic test. Treatment involves both non-pharmacological treatment measures as well as pharmacotherapy. Non-pharmacological treatment include avoidance of foods and medications that exacerbate GERD, smoking secession, weight reduction, taking a small meal at a time, avoidance of alcohol and elevation of the head of the bed. Drugs for treating GERD include H2 receptor antagonists like cimetidine, ranitidine, famotidine or nizatidine. Proton pump inhibitors such as omeprazole, pantoprazole, lansoprazole and rebeprazole are found to be very effective to reduce acid reflux and hence inflammation. H2 blockers were found to heal ulcers and erosions but the typical reflux changes of the squamous epithelium of the esophageal mucosa are not recovered. Studies confirmed that PPIs not only heal ulcers and erosions but also cures basal cell hyperplasia and elongation of the papillae. The percentage of normal epithelium were also reported to increase significantly after PPI administration in patients with GERD. Two commonly employed treatment alternatives for GERD are antirefluctive surgery and Endoscopic Treatments. Surgery is preferred only when the patient fails to respond to pharmacological treatment, when the patient prefers surgery, in those patients who have complications of GERD like barrett's esophagitis, or if the patient has atypical symptoms and reflux documented on 24-hour ambulatory pH monitoring. Several randomized controlled trials have confirmed that open fundoplication and medical treatment have similar long-term effects for GERD. Laparoscopic antireflux surgery is also reported to have similar outcomes to the open procedures. Endoscopic Treatments for GERD include plicating gastric folds methods (Endoscopic Gastroplication, ELGP method, thermal tissue remodeling /neurolysis method, and bulking injection method. These endoluminal treatments augment the reflux barrier. Section I: Organ system structure and Function. Explain the accepted normal healthy structure of parts and function of organ system; How it works The esophagus is a collapsible muscular tube, about 25 cm (10 in.) long that lies posterior to the trachea. The esophagus begins at the inferior end of the laryngopharynx and passes through the mediastinum anterior to vertebral column. Then it pierces the diaphragm through an opening called the

Ethics in Negotiation Essay Example | Topics and Well Written Essays - 500 words

Ethics in Negotiation - Essay Example It is usually an ‘anything that sells’ approach that is adopted by such sellers. Sellers tend to arbitrarily decide on prices since merchandise is acquired from a plethora of sources with no objective means of deciding on price (Kugel, 2013). They thus pitch a price according to the profile of the customer who visits, based on personal discernments about their willingness and ability to pay for the items. Most customers are however aware of this fact, and the more affluent ones quickly reject the initial price as it borders on exploitation. Hence, bargaining becomes necessary to avoid being taken advantage of by crafty retailers practicing price discrimination to maximize profits. With stalls set up very close to one another, a customer can look through the catalog of a number of vendors whilst standing in one of them. He can thus be aware of the quality of items offered by other vendors, which if greater, can be used as leverage against the current one. Vendors are typically reluctant to let go of customers once they start negotiations, and threats about opting to visit other stalls are extremely effective in getting them to reduce their asking price. They are aware that customers benefit from choice and selection, and if they do not comply with their reasonable wishes, another vendor will. A major factor behind the existence and prevalence of bargaining in flea markets is that of information asymmetry. In a normal market, a customer is aware about the details of merchandise such as the manufacturer, area of production, quality etc. This is not the case with flea markets, where customers are aware that they may be getting anything from a good quality reject of a top notch brand to a used up, ready for scrap item. Sellers in most cases know more about the products origins etc., and can thus often fool customers in believing that the product may be of higher quality than what

Strategies of communication Essay Example | Topics and Well Written Essays - 1750 words

Strategies of communication - Essay Example The aforementioned points are important in all communicating situations whether one is transmitting persuasive, positive or negative messages. However, it must be noted that communication can be misinterpreted even if there is nothing wrong with the message due to a number of reasons. The research shows that implicit personality, logical error, the halo effect, stereotyping, differences in perception, incorrect filtering, language problems, poor listening, differing emotional states, differing backgrounds, information overload, message complexity, lack of trust, differing status, and closed communication climate can influence the process of decoding. I have been working, most of the time, in Marketing and Sales departments in different companies after completing my education. Marketing and Sales are generally considered a key department for all organizations as it generates revenues for the organization, which is vital for the survival of the organizations. Working in this department means that a person should have high communication and analytic skills because not only he holds meetings with external clients but also spends considerable time in holding meetings with various departments of the company. Almost six months ago, I changed my company and joined the current firm as General Manager where I have a team of 30 people. The climate of the organization was antagonistic and morale of the employees of the department was not very high when I joined the company.

President Obama's Speech in Cairo Essay Example | Topics and Well Written Essays - 1500 words

President Obama's Speech in Cairo - Essay Example Throughout his speech, the radical idea was that of respect for the Muslim and Arab world. He believed that this was an issue that those who had been in power had omitted. His speech addresses six issues that cause tension between the two divides, including violent extremists, the situation between Israelis, Palestinians, and Arabs, responsibilities and rights of nations on nuclear weapons, democracy, religious freedom, and women’s rights (Huff Post). Personally, the second issue of the situation between Israelis, Palestinians, and Arabs. Question Two The situation between Israeli, Palestine, and the Arab world is the greatest source of crisis in the Middle East. The conflict in the Middle East, which began in the early 1990s, has been the source of serious economic downturn in the world. Despite countries endeavors to heal the prevailing state of economy, this conflict has remained an obstacle. The Middle East region exports the largest quantities of oil products to the US, E urope, and other parts of the world. The persistent conflicts between the Israelis and the Palestinians often result to surging of oil prices, driving the global economy into a recession. At a recession, every plan by the government in power stops progressing. Worst of all, business, which earn governments revenue get to a point of shut down. Moreover, a majority of the Arab states take advantage of the crisis to achieve their own gains and misgivings (Huff Post). Question Three President Obama downplays Tehran by highlighting the diplomatic recognition of Israel by Saudi Arabia, with attempts to hasten the two-state solution for the Israeli-Palestine conflict. President Obama addresses the Middle East conflict beginning with the Palestinian suffering from 1967 (Huff Post). On what Palestinians refer to as the nakba catastrophe; President Obama expresses his acknowledgment of the issue than any other American president, urging for the cease of Israeli settlement. However, he also de fends the Israeli, referring to US ties with Israeli as unbreakable, and proceeding to condemn Muslim Holocaust and anti-Semitism denials as hateful, ignorant, and baseless. Moreover, he urged Hamas (which has majority of support from Palestinians) to stop acts of violence, recognize the rights of Israeli existence and recognize past agreements, promising America’s alignment policies with countries that promote peace. In his speech, the president preaches for peace among settlers. His main emphasis was violence against children and old women by Hamas, stating that their actions surrender moral authority rather than claiming it. Any form of violence, precisely violence against children and old women to him, is an inhuman act that should be shunned. He gives an example of American struggle for civil rights against slavery and apartheid, asking Hamas to follow a similar non-violent path of resistance (Huff Post). Considering the fact that president Obama is an African American, this statement has significant weight attached. In summary, president Obama exhibits the American devotion to Israel and Palestine. In this, he advocates for a secure and safe state for both nations through the two-state solution. His conditions are that Israeli must stop settlement and the Hamas (supported by Palestinians) must stop terror and violence

PTLLS prepare to teach in The Life Long Learning Sector Level4 Assignment

PTLLS prepare to teach in The Life Long Learning Sector Level4 - Assignment Example This outlines the key aspects of teaching legislation and requirements. It is my duty to maintain the professional integrity and uphold are all cost the reputational of my professionalism. It is therefore very crucial to identify the needs of my learners. For this reason it is therefore important to meet the professional requirements that are valued by the institute that I serve, and be responsible for the scheme of work that I am going to teach my learners (LLUK 45). In order for teachers to protect themselves and the best way to do it is to follow the rules of the code of practice. Being a teacher I automatically become a role model to my students and for this reason am not going to discriminate, abuse (physically or verbally), dress in a good manner and avoid tardiness. The code of professional practice comes in support of all teachers as guidance to how to be a good teacher. This society is very dynamic, and teaching as a profession is becoming more and more complicated. In order to keep up with the changes, I need to ensure that I meet the highest possible standard. Due to this reasons I should be committed to my own professional learning, seeking to expand my skills and to deepen my knowledge as a professional teacher (Gravells 78). There are a few legislations that a teacher should comply with. There are some generic legislation that includes code of professional practice (2008), which was developed by the institute for learning (IfL 30) and covers aspects such as professional integrity, respect, reasonable care, professional practice, disclosure and responsibility. The other one is the children act that comprises of five fundamental aspects; each child should be kept healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well-being. It will also be helpful to be guided by the Equality act (2010), which covers aspects such as age, disability, gender, gender

Arizona Tewa Kiva Speech as a Manifestation of Linguistic Ideology Essay

Arizona Tewa Kiva Speech as a Manifestation of Linguistic Ideology - Essay Example (298) He reports that Tewa were a Pueblo Indian group â€Å"which removed itself from Spanish influence in 1700 by migrating to the eastern most of the Hope Mesas† (298) In order to maintain their distinct culture they 1) resisted linguistic borrowing from other languages and 2) were the only out migrating group to retain its’ language into the present. The language preservation has been achieved through the Tewa control of â€Å"kiva† speech which is the religious ceremonial speech common to all Pueblo societies. The instruments of control are 1) regulation by convention 2) indigenous purity 3) strict compartmentalization and 4) linguistic indexing of identity. Regulation by Convention Ritual performances rely on fixed prayer and song texts with no tolerance for innovation. This is also manifested in everyday speech preferences, for example by greeting formulae. Also in traditional stories â€Å"audience members and performers alike have a tradition which emplo ys stylized non-verbal accompaniment and uses familiar story telling conventions,† for example the repeated use of â€Å"ba† as a genre making equivalent to our â€Å"so they say†. Such conventions must be followed even if narrators chose to contextualize their stories for specific audiences, or the content and narrator are non traditional in order for audience acceptance Indigenous Purity and Strict Compartmentalization. The author reports that the Tewa have a strict prohibition against the inclusion of foreign words and non kiva Tewa words in kiva ceremonies. This he contends is prompted by the â€Å"need for stylized consistency â€Å" in a conventional liturgical speech level, rather than indicating xenophobia against foreign languages. (302) By a trickle down effect the prohibition against foreign words prevails in everyday speech patterns as well. There is also a strict compartmentalization in Tewa linguistic ideology with â€Å"kiva talk† strictly segregated from both foreign influence and everyday Tewa language in order to preserve its’ sanctity. While examination of linguistic data supports the conclusion that few foreign words have been incorporated into Tewa language, there is evidence of grammatical convergence. Linguistic Indexing of Identity The author states that in Tewa society â€Å"a person’s speech behavior expresses important information the speaker’s identity†. This relates to his or her positional rather than personal identity. For example, â€Å"a conventional component of public announcements is the explicit announcement by the chanter of his mediating status as spokesman.† (306) Conclusion Kroskrity concludes by claiming â€Å"linguistic ideology presents an account which captures the cultural unity of otherwise disparate linguistic norms† and justifies the opening quote of this summary.(311) Since in Tewa society both religious and political leadership is concentra ted in kiva ceremonies, their linguistic ideology provides an insight into how power and social control are exercised. The â€Å"Father Knows Best† Dynamic in Dinnertime Narratives Introduction This article â€Å"addresses gender asymmetry in middle class European American families through an examination of a simple social activity narrating ( a story or a report) over family dinner† on the basis of the Father Knows Best dynamic where father is typically set up to be primary audience, judge, and center of family members actions, conditions, thoughts, and feelings as was the case for this well known 1950s ( 101 )TV sitcom. In spite of more recent feminist ideology, this family power dynamic appears to still prevail. Methodology The author’s study focuses on dinnertime communication patterns of 7 two-parent families earning under $40.000 per annum between 1987 and 1989.( 102 ) Each family had a 5 year old child who

EMBA 560 Executive Position week 2 exercise 2 Research Paper - 1

EMBA 560 Executive Position week 2 exercise 2 - Research Paper Example He/she also must possess honesty, integrity, character, trustworthiness, and all the personal virtues I would need my VP to have to be able to command the respect of others and for me to repose trust in him/her. Having made this wish list, I shall then analyze the needs of the organization. Where is the organization at this time? What are the more serious challenges that it faces now, and will face in the medium to long-term? How about the engineering department itself, what are its current and medium to long-term requirements? Some organizations have problems dealing with revenues; that is a marketing problem. Others have challenges in controlling costs; that is an operations problem. Still other may have union issues or skills obsolescence, or demotivation; these are HR problems. Several of these may occur simultaneously, so it will be necessary to prioritize and rank them in order of importance to the firm. It is only at this point that one may begin to consider the candidates. Do they all possess the basic attributes? If so, how does hiring each one match the organization’s needs? For instance, if motivation is an issue, prefer to hire from within, and maybe prefer seniority, because the younger candidate can wait a few more years to be hired. To add inputs to my decision, I will probably invite each one of them to a cordial lunch to discover their own personal disposition and inclination about the position, without necessarily informing them that they are being considered. This may be unethical in the case of Ms Hernandez since she is still connected with the competitor, so in her case the fact finding may be done through a third person. In any case, it is important to know how each would feel about the position, particularly John Adams who is the successor apparent. In making my consideration, I should be aware that since John Adams is the one everyone