Toyota Motor Company Essay Example for Free

Toyota Motor Company Essay In the worldwide automotive industry, Toyota Motor Corporation is the leading player in terms of revenue, profit and net worth as of April this year (Associated Press).   The Aichi Prefecture, Japan-based automaker reported in a filing with the U.S. Securities and Exchange Commission consolidated earnings of 1.6 trillion yen or about $14.3 billion for the year ended Mar. 31, 2007. To have reached its current leadership position in the market, Toyota Motor follows a business strategy that focuses on safety, reliability, efficiency, and cost-effectiveness of its products.    The company was able to capitalize on its smaller but more fuel-efficient models to increasingly gain bigger shares in different markets worldwide. The companys key market areas are: China, Japan, North America, and Europe.   Toyota’s corporate goal is to hold on to its position as a market leader, while continuing its growth.   In order to achieve this, the automaker believes in the importance of advances in technology, production and marketing, quality control, and strengthening of its cost-efficiency model. Specifically, Toyotas strategies are focused on: a) offering of full product lineup and distinguish products through hybrid technology that includes: expansion of distribution reach for its Lexus model to reach the most number of countries, manufacturing global brands that would meet regional characteristics while  utilizing the same designs and core components. b) localization of global operations with targeted regional strategies: the company understands that having a local manufacturing, marketing, and sales offices will help it maximize that markets potential while saving on cost of shipping vehicles and parts.   The localization wil lalso protect it from currency fluctuations and help it respond better to local preferences and tastes. Toyotas biggest strength is its ability to provide markets with good alternatives to bigger and more expensive vehicles.   Its product lines are attractive and are designed to make them affordable for consumers to buy, while keeping maintenance costs minimal. I dont consider Toyota to have a weak point, but rather, I consider it to be facing challenges.   The carmakers biggest challenge, for me, is to stay competitive, not only with the American and European carmakers, but with other Asian car manufacturers that also offer quality cars at affordable costs. BIBLIOGRAPHY TOYOTA. Home Page. http://www.toyota.co.jp/en/index.html (7 November 2007) Toyota overtakes GM in global vehicle sales, The Associated Press, 24 April 2007. http://www.msnbc.msn.com/id/18286221/ (7 November 2007) Toyota Motor Corp. U.S. Securities and Exchange Commission.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://sec.gov/cgi-bin/browse-   Ã‚   edgar?action=getcompanyCIK=0001094517owner=includecount=40 (7 November 2007)

Corticosteroids and Mental Disorder

Corticosteroids and Mental Disorder Abstract Corticosteroid medication is an essential treatment in almost all medical specialties. Psychiatric side effects of corticosteroids may be both common and severe and include psychosis, mania, depression, delirium and dependence. Only a small evidence base exists about susceptibility to and epidemiology of these conditions. Corticosteroid induced psychiatric disorder typically has an acute onset and is dose related. Manic symptoms predominate acutely however long term use may be associated with depression. Steroid dependence and withdrawal syndromes have been documented. Case reports suggest that a combination of mood stabilizers and antipsychotics may be useful in management severe acute effects. This article will give psychiatrists working in a general hospital a guide to the epidemiology, clinical presentation and management of corticosteroid induced psychiatric disorder. Introduction Corticosteroids were first introduced into medical practice in the late 1940s, since when they have been used by almost all medical specialists as effective treatment for autoimmune and inflammatory conditions. Over 5 million prescriptions are written for corticosteroids in the UK each year, at a cost of over  £100 million. (NHS Health Care Statistics 2005) About 1% of the general population and as many as 7% of hospitalized patients are receiving oral corticosteroid therapy at any given point in time. (NHS Health Care Statistics 2005) Whilst being renowned for important therapeutic actions they can have many adverse effects which must be considered in long term treatment. Physical effects such as osteoporosis, central obesity and immunosuppression are frequent in patients receiving corticosteroids. Psychiatric effects include alterations in mood, delirium, dementia and psychosis. As corticosteroids have a critical place in the management of chronic disease, psychiatrists should be equipped with the knowledge to recognize and manage corticosteroid induced mental disorder. This article describes the epidemiology, clinical presentation and management of these conditions. Indications and Pharmacology There are several forms of corticosteroid medication licensed in the UK, including: betamethasone, cortisone acetate, deflazacort, hydrocortisone, methylprednisolone (prednisolone) and triamcinolone. Each of these drugs has varying degrees of mineralocorticoid and glucocorticoid activity. All of the above preparations exist in oral or intramuscular form. Inhaled steroid preparations are also will not be discussed as there is little evidence that they can induce mental disorder. The main indications for these medications are: Suppression of inflammatory and allergic bowel disease; chronic or treatment resistant Asthma and COPD; Immunosuppression in Acute Lymphoblastic Leukemia, Hodgkins and non-Hodgkins disease, and Hormone sensitive breast cancer; Palliation of symptomatic end-stage malignant disease; Organ transplant rejection; Auto-immune (Rheumatic) disease such as Systemic Lupus Erythematosis and Wegners Granulomatosis. Corticosteroids are rapidly absorbed across the Gastro Intestinal  membrane following oral administration. Peak effects can be observed after 2 hours. The circulating drugs bind extensively to the plasma proteins Corticosteroid Binding Globulin (CBG), albumin and transcortin, with only the unbound portion of a dose active. Systemic prednisolone is quickly distributed into the kidneys, intestines, skin, liver and muscle. Corticosteroids also distribute into the breast milk and cross the placenta. Corticosteroids are predominantly metabolized by the liver to active metabolites then further metabolized to inactive compounds. These inactive metabolites, as well as a small portion of unchanged drug, undergo urinary excretion. The plasma elimination half-life is 1 hour whereas the biological half-life of prednisone is 18-36 hours. Corticosteroids act as glucocorticoid receptor agonists. On binding, the corticoreceptor-ligand complex translocates itself into the cell nucleus, where it binds to Glucocorticoid Response Elements (GRE) in the promoter region of target genes. Insert Figure 1 about here The DNA bound receptor then interacts with basic transcription factors, altering gene expression. There are high concentrations of CBG in specific brain areas such as the hippocampus and pre-frontal cortex and these can therefore be thought of as a potential mediator of corticosteroid induced psychiatric disorder. Chronic disease and corticosteroids In parallel to the psychiatric side effects of corticosteroid therapy, most chronic medical conditions may be associated with considerable psychiatric morbidity. A primary objective of the psychiatrist is to distinguish between the psychiatric effects of chronic illness and corticosteroids. The 1-year prevalence for ICD-10 depressive episode alone is 3 ·2% (95% CI 3 ·0-3 ·5) and an average of between about 9% and 23% of patients with one or more chronic physical diseases have co-morbid depression. In an international meta-analysis, patients with a variety of chronic physical diseases and co-morbid depression had significantly worse health scores than those with chronic disease alone. (Moussavi et al 2007) There are many potential reasons for this, including physical symptoms such as pain and secondary disability leading to loss of function. Studies of depression amongst the medically ill almost always fail however to account for possible corticosteroid effects. In patients with severe COPD given 30 mg of prednisolone for 14 days, when lung spirometry and mood state were measured, no changes in spirometry were detected until 7 days of active therapy. However, small but significant reductions in anxiety and depression were measured after 3 days of prednisolone and before any measurable improvement in lung function. This single study is a major part of a small evidence base suggesting that corticosteroids produce a mild sense of wellbeing rather than the wellbeing necessarily being a consequence of physical improvement. (Swinburn et al 1988) Classification, Epidemiology and Clinical Features Psychiatric side effects were first described and classified by Rome and Braceland in 1952 shortly after the initial introduction of corticosteroids into the pharmacopoeia. As can be noted in Table 1, the descriptions of symptoms in 1952 have an implicit hierarchy which places psychosis above ego disturbance of a neurotic nature and places these above euphoria. (Rome and Braceland 1952) Insert Table 1 about here Epidemiology The proportion of patients developing psychiatric symptoms during corticosteroid therapy has been reported to range from 3 to 75 percent, with a weighted average of about 28 percent. (Lewis and Smith 1983) Amongst the larger studies, the Boston Collaborative Drug Surveillance Program (Boston Collaborative Drug Surveillance Program 1972) monitored 718 hospitalized medical patients who received prednisolone, of whom just 21 (3%)had acute psychiatric reactions: in 6 of 463 (1%) patients receiving 40mg prednisolone, 8 of 175 (5%) patients receiving 41-80mg and 7 of those receiving above 80mg (18%). The dose-response trend was significant, but the study was conducted in 1972 and deals with relatively small numbers of affected subjects who underwent only a basic psychiatric screening. In terms of speed of onset, symptoms appear to develop rapidly. In groups of both patients and healthy subjects, psychiatric symptoms occurred between 3 days and one week. (Lewis and Smith 1983, Hall 1979, Naber 1996) Evidence shows that significantly more women than men (P =0.009) develop psychiatric symptoms as a function of corticosteroid treatment. (Nielsen et al 1963) Prednisolone is the medication most cited to cause psychiatric side effects. In case reports, prednisolone was responsible for 37 cases followed by methylprednisolone, dexamethasone betamethasone, and hydrocortisone. (Lewis and Smith 1983) When dose equivalences were calculated, ranging from 5 to 200mg prednisolone per day, a mean dose of 58.3mg per day or more was cited as substantially raising the risk of a psychiatric reaction. This does not mean that psychiatric reactions only occur at higher dosages. While dosage is not related to the risk of developing mental disturbances, dosage nor duration of treatment seems to impact upon the time of onset, duration, severity, or type of mental disturbances and it is unclear whether patients with a history of psychiatric disorder are predisposed to such disturbances. (Ling 1981) Affective Symptoms The most common psychiatric reaction during glucocorticoid therapy is mood change, which accounts for almost 90 percent of the psychiatric reactions (Hall 1979, Stiefel 1989) In a review of 56 case studies of psychiatric reactions to steroids, of those reporting mood symptoms (45 cases), mania was observed in 48%, depression in 25%, and a mixed state in 9%. (Flores and Kenna) Reversible mood change can be seen in healthy control subjects after administration of prednisone and dexamethasone. One study showed that 8/12 healthy controls experienced this, with manic symptoms predominating. (Brown 1998) A further study which looked at methylprednisone in ophthalmology patients, all of whom were free of psychiatric disorder, found that 36% developed mania or depression during high dose steroid treatment. (Naber 1996) Studies examining the consequences of low dose steroid treatment have found little or no affective symptomatology (Swinburn 1988). With regard to steroid induced mania, patients typically report sudden euphoric mood, excessive energy, indefatigability and some grandiosity. In addition to the rapid development of mood symptoms, suicidality can be associated with steroid treatment. (Flores and Kenna). In addition to mood symptoms patients have been reported to experience sleep disturbances and weight gain. Recurrent affective disorder A further important consideration is whether any such affective disturbance involves one isolated episode or leads on to recurrent disorder. Nine patients whose initial clinical presentation met DSM-IV criteria for a steroid-induced mood disorder were shown in the long term to have a clinical course of bipolar disorder. (Wada 2001) Seven patients initially developed a manic or hypomanic state with sub-acute onset ranging from 1 to 3 months and six patients had manic episodes accompanied by psychotic features. The proportion of manic episodes relative to total mood episodes of the 9 patients was 66%, suggesting manic predominance. Seven patients had future mood episodes that had no direct relationship to corticosteroid therapy and were preceded by various psychosocial stressors. Four of 5 patients who received future steroids rapidly became manic or hypomanic. Recurrent cases of corticosteroid-induced mood disorder therefore appear to have clinical features such as sub-acute onset, fr equent accompanying psychotic features, and similar recurrent episodes in association with psychosocial stressors and corticosteroid use. Psychotic Symptoms In a review of 55 case reports of steroid induced psychiatric disorder, 58% of cases demonstrated psychotic symptoms. (Ling 1981) In 72% of the cases with psychotic symptoms, they were combined with an affective disorder. Similarly, in a review of 79 case reports there was a 71% incidence of psychotic symptoms with affective symptoms reported in over 75% of these. Hallucinations occurred in 58% of the cases and delusions in 74% .(Lewis and Smith 1983) In a more recent review of 56 case reports, psychotic symptoms were reported in 65% of cases. In eight of these, the development of psychotic symptoms was more clearly associated with the withdrawal, rather than with the administration, of steroids. (Flores and Kenna) Interestingly, but perhaps coincidentally, seven of these eight cases occurred in female patients. All eight cases included mood disturbance; 2 with depression, 4 with mania, and 2 with a mixed state. Cognitive effects The cognitive effects of corticosteroid therapy have been seen in patients receiving short term or long-term corticosteroids, and relate primarily to declarative or verbal memory. (Flores and Kenna) In one study, patients on corticosteroids had poorer performance on the Rey Auditory Verbal Learning Test (RAVLT), (a measure of declarative memory), the Stroop Color Word Test (a measure of working memory) performance, smaller hippocampal volumes and lower levels of N-acetyl aspartate (a putative marker of neuronal viability in the temporal lobe region). (Brown 2001) Deficits in declarative memory have been observed in subjects receiving as low as 4 to 5 days of dexamethasone or prednisone. (Newcomer 1999) A dose-dependent impairment in declarative memory has been reported with high dose (160 mg/day), but not low dose (40 mg/day) hydrocortisone. It appears that these cognitive impairments may be reversed with the reduction or withdrawal of corticosteroids. Similar results for declarative memory deficits are found in persons with Cushings disease. Such findings are consistent with reductions in hippocampal volume which are correlated with cortisol levels. (Starkman 1992) Steroid Dependence and withdrawal Several case reports suggest that corticosteroids may be abused for their euphoric effects. (34) Typically this will involve higher doses of oral systemic steroids although there is one report of dependence secondary to a nasal spray. (35) In a case review, 8 patients out of 11 cases of steroid dependency had a previous psychiatric history (predominantly depressive symptomatology), and 4 had a history of drug or alcohol mis-use or dependence. It has been suggested that patients who may request higher steroid doses or who resist dose reduction despite their improving health should be carefully monitored. (Stoudemire 1994) In the more recent review of case studies (Flores and Kenna), the development of psychiatric symptoms was also associated with the withdrawal of steroids. Corticosteroid withdrawal symptoms generally include depression and fatigue but mania and delirium have also been reported during dose reduction or discontinuation. Psychiatric symptoms during steroid withdrawal generally improve or resolve when corticosteroids are re introduced. Cushings disease and psychiatric disorder Cushings syndrome relates to the multi-organ over exposure of iatrogenic or endogenous corticosteroid and is associated with a variety of psychiatric and psychological disturbances. In one study examining 43 patients before and after treatment for Cushings psychopathology was observed in a considerable number. Only 8 patients of 43 with active Cushings syndrome (19%) were without psychiatric symptoms. Psychiatric diagnoses included: neurotic depression in 20 (46%), possible neurotic depression in 1 (2%), reactive depression in 6 (14%), and non-specific neurotic symptoms in 8 (19%). Psychoses were suspected in 3 of the patients who were depressed, but none of the 43 patients with active Cushings syndrome had a definite diagnosis of Schizophrenia, Mania, Obsessive Compulsive Disorder or Generalised Anxiety Disorder. After treatment in 25 patients, when cortisol levels had been substantially reduced (to within normal limits in 88% of them), the percentage rated as psychiatrically asymptomatic increased from 19% to 68%. Scores for depression and anxiety showed significant improvements after treatment for Cushings syndrome and Eysenck Personality Inventory assessments showed a significant improvement in neuroticism score. (Kelly 1996) Treatment of Corticosteroid induced psychiatric disorder There is a very limited literature on the treatment of corticosteroid induced mental disorder, although it can be noted from the forgoing that psychiatric symptoms generally resolve with discontinuation of the medication. In one review of the literature, tapering the dose of steroids alone appears to be effective up to 90% cases. (Flores and Kenna) Case studies also suggest that switching steroids may be of value. (Okishiro et al 2009) The primary objective in managing these conditions is to balance the relative risk of psychiatric disturbance against the medical consequences of withdrawing the steroid. The management of corticosteroid induced psychiatric disorder can otherwise be largely divided into managing an acute psychotic/manic episode versus managing long term depressive symptoms and dependency. Although little evidence exists either way, it can be assumed that severe behavioral disturbance should be managed as it usually is symptomatically with appropriate doses of benzodiazepines and antipsychotics. In terms of managing acute psychotic/manic episodes one study found that of 27 patients treated with lithium carbonate prophylactically none developed severe mood symptoms while receiving corticosteroids. However, six out of 44 patients (14%) not receiving lithium developed mania or depression. (Falk 1979) Antipsychotics, specifically haloperidol, risperidone and olanzapine, are noted from case reports to be useful in mania, mixed affective states, psychosis and delirium. A further case report suggested the successful use of low-dose olanzapine (2.5 mg/day) for severe mood swings and suicidal ideation in a patient with asthma on chronic prednisolone therapy. With regard to depressive symptoms, several case reports have demonstrated some evidence with lithium following the onset of depressive symptoms. Carbemazepine has been reported to be useful in managing both manic and depressive symptoms secondary to corticosteroids. (Wada 2001) There appears to be little benefit from the use of tricyclic antidepressants and in fact, a worsening of neuropsychiatric symptoms has been reported. (Hall 1978) Case reports have been published describing the successful treatment of steroid-induced depression with sertraline, fluvoxamine, and fluoxetine. One such report supports the use of a combination of an antidepressant and antipsychotic in the treatment of steroid-induced psychotic depression (Ismail 2002). Case reports are noted to suggest the effectiveness of benzodiazepines, in the management of specific steroid-induced symptoms as insomnia and anxiety Conclusions Above all, it is clear that the literature on the psychiatric adverse effects of corticosteroids is limited and larger studies on medically ill populations need to be carried out. Clinical practice continues to be informed by case reports despite over 50 years of awareness of these problems. There exists a great opportunity for future research to find predictors of steroid response including their genetic and neuroimaging antecedents and it is clear that the literature could be enhanced with prospective studies and clinical trials. The ICD 10 codes steroid induced psychiatric disorder under F55.5 Abuse of non-dependence-producing substances Steroids or Hormones. No distinction is made about type or chronicity of symptoms. Arguably it may be more useful to classify steroids induced psychiatric disorder under F19.-Mental and behavioral disorders due to multiple drug use and use of other psychoactive substances. Corticosteroid induced psychiatric disorder can pragmatically be classified at present as described in table 2. Insert Table 2 about here With regard to the acute corticosteroid syndrome, the clinical presentation can be diverse but the severity of the symptoms appears to be dose dependent and they tend to occur within the first week of steroid administration. Affective symptoms are most common and a hypomanic/manic presentation is most likely. Some patients appear to have sub clinical hypomanic symptoms which they do not report. Symptoms resolve in most cases on discontinuation of the steroid. Cases are best treated with a mixture of a mood stabilizer (possibly prophylactically) and antipsychotic. With regards to chronic steroid syndrome, the merits of continuation of the steroid must be considered and a small literature suggests that depression in this group can be managed with an SSRI and not a tricyclic antidepressant. In patients who are on long term steroids, a dependence and withdrawal syndrome may be seen. No evidence exists as to how this should be managed but again negotiation should occur between the clinicians and the patient on the need for steroids and a gradual tapering of dose should be considered. Presently it is not known whether individuals have idiosyncratic reaction to steroids or that, given a high enough dose everyone would suffer some mental disturbance. There is a suggestion that those with a previous affective disorder or a family history may be more susceptible to the adverse effects of steroids. If as many as 27% of those on high dose steroids suffer psychiatric symptoms, it is surprising that millions of patients do not present to psychiatric services. Case vignette: Steroid-induced psychosis A 40-year-old woman was admitted to a GI ward for corticosteroid treatment as a result of a flare-up of her inflammatory bowel disease (IBD). Her previous psychiatric history included recurrent depression, for which she had been successfully prescribed fluoxetine by her GP for several years. She was treated for 5 days with prednisolone 40mg IV which was then switched to oral prednisolone prior to her discharge home. Over the next week she progressively became increasingly irritable, experiencing hyperacusis, preferring to stay up all night doing housework and decorating, and suffered from marked lability of mood, fluctuating from euphoria to extreme despair and tearfulness, and anxiety. She began to experience command hallucinations of her late father, who had suffered from schizophrenia, telling her to kill herself, as he had in fact done a number of years earlier. She experienced delusions of being unclean and malodorous. She was visibly seen to be responding to unseen stimuli. She was unable to leave her home for fear that people wished to harm her. On day 5 post-discharge her family sought help from her GP who recommended that she stop her steroids, after noting that 18 years earlier she had experienced a similar episode in response to steroid treatment for her Crohns disease. Her GP prescribed Chlorpromazine but unfortunately the patient developed a marked pill-rolling tremor and akathisia. Next day the patient attended a GI outpatient clinic and due to her distress and anxiety a psychiatric opinion was immediately sought. She was informally admitted and commenced on olanzepine and diazepam with a significant diminution of her psychosis and anxiety such that after a few days she was able to be discharged home. Over the next several weeks she was closely followed-up by liaison psychiatry as an outpatient. Her psychotic symptoms had completely resolved with olanzapine treatment. She did, however, continued to experience low mood and anxiety as a result of on going stress associated with her IBD and required further treatment with antidepressant medications.

The Construction Of The Great Wall

The Construction Of The Great Wall The construction of the great wall arose throughout the Warring States Period (403 to 221 BC). The Great Wall is a fortification alongside the northern and northwestern boundary of China, running from Shanhaiguan on the Gulf of Bohai on the east to the vicinity of Gaodai, Gansu Province, on the west, with an inner wall consecutively southward from the vicinity of Beijing almost to Handan. Shi Huangdi, first emperor of the Chin dynasty founded the biggest portion of the wall as a defense against raids by nomadic peoples. Organized work on the wall was begun about 221 BC, after Shi Huangdi had united China under his rule, and it was completed about 204 BC. Small segments of the wall were probably already in existence, but Shi Huangdi is thought to have had some nearly 1,200 miles of the wall erected during his reign. 300,000 men several of them political prisoners whose bodies are thought to be buried in the wall (not essentially true) were put to work joining the segments into one h uge rampart of stone and earth. In later times, chiefly during the period of the Ming dynasty (AD 1368-1644), the Great Wall was fixed and extended by reinforcing it with cement and stone. The fortification finally reached a length of about 1,500 miles, ensuing the course of rivers instead of bridging them and conforming to the contours of the mountains and valleys in its path. The wall is built of earth and stone, faced with brick in the eastern parts. It is from 15 to 30 feet thick at the base (about 20 feet on the average) and tapers to some 12 feet at the top. The height averages 25 feet exclusive of the crenellated parapets. Watchtowers about 40 feet in height are placed at intervals of approximately 200 yards. Several hundred kilometers of the Great Wall remain intact in the eastern reaches. The amount of brick and stone working to construct the Great Wall might limit the earth with a barrier eight feet high. From the 6th to the 14th centuries, the wall proved to be an effective barrier against strong-minded invaders, who revealed that bribing the lookouts was their most effective weapon. The Chinese Emperors aided in this cause by failing to pay there army troops, usually a bad mistake. If you dont pay your army, someone else will. Scholars guess that the Great Wall with all its divisions once stretched for 6,200 miles, from the Yalu River in the northern east to Xinjiang in the northwest. Today it measures 6,000 miles. The Great Wall has suffered serious damage from wind and water erosion, as well as man-made destruction. In the past it has been a treasure store of stone for many a poor farmer. Between 1870 and 1974, the 8th Route Army stationed at Gubeikou destroyed 9,840 feet of the wall to use the stone to erect some barracks. Later in 1979, the State ordered the same army group to tea r down their barracks and rebuild the wall. In 226 the armies of the Chu Dynasty and the Qin dynasty met in a great final battle. The victor would get the prize of the richest and most technologically advanced nation of the world. The Qin Emperor needed to defend the country from the marauding bands of nomadic horsemen of the north. These bands of horsemen who raided the rich farmland came from the barren land of the north and were forced to become marauding nomads. It was a clash of farmers against warriors. The group would be difficult to defeat. The strength, stability and prosperity of the new empire were threatened by these marauding hordes. To preserve Chinas borders the Qin set about building a huge defensive barrier in 221 BC. Wall building became the chief defensive strategy to repel the enemy from the north. This was in the age before gunpowder and cannons. The first Great Wall was a massive undertaking. It was the equivalent of building 30 of the great pyramids of Egypt. To build this great wall of 3,000 miles the Qin Emperor chose his most able general Ling Qia. He was given an army of over 300,000 men. They had to build roads, and the infrastructure as well as the wall. Much of the wall was built of beaten clay. Rock was not always available, so tamped earth became the first choice. Dirt was designated from at least four inches below the surface so seeds and grasses could not germinate and thus undermine the strength of the wall. Consuming first a form made of wood, earth was piled and was pounded into a layer of four inches thick. Following layers of this would produce a wall twenty feet high that would still be standing some 2,000 years later. The wall stretched from the borders of North Korea across the northern border to the far reaches in western China. In ten years they built a wall across the entire northern border of China in lands that included marshes, quicksand, deserts, and altitudes of 8,000 feet. They built twenty-five miles a month that is almost a mile a day. One section is across 60 miles of a mountain range. This section was built entirely of native stone with the flat face placed on the outside to face the enemy. This dry stonewall was built 20 feet high with 26-foot high beacon towers. The Qin army invented new weapons to exploit thei r advantage of their new wall. The most deadly of these was the crossbow that could hurl an arrow 250 yards with amazing accuracy. Other weapons included iron casting techniques to produce double edged swords which would not be known in the west for some 1,300 years later. The soft bronze swords of the enemy were no match for the double-edged iron swords of the Qin army. All of this was achieved at great economic and human costs. The emperor thought the wall would bring peace to the nation but the nation was weakened by the heavy cost of the construction. Ditches along the wall were filled with the corpses of workers who died building the wall. Deaths of wall workers are estimated to exceed one million. Some have claimed that the dead workers were entombed in the wall itself. Later investigations proved this untrue. Also decaying bodies would have weakened the structure and would not have been allowed. No society could sustain such a terrible burden. Taxation became heavier and heav ier. Some 3,500,000 people were involved in the building of the Great Wall. That was 70% of the total population of China at that time. For each worker working on the wall, six were required to feed and support them. Construction of the Qin wall became the most loathed imperial plan in Chinese history. In 209 BC, Only a year after the death of the Qin Emperor, millions of laborers rose up and ended the tyranny and bloodshed of wall building. The Qin Dynasty had fallen, brought down by the building of the great wall. Within ten years much of the wall was a neglected ruin. Once again the northern border was at the mercy of the northern invaders. After three years of civil war in 206 BC the first Han Dynasty was formed under the Gao Di Emperor, Liu Bang. At first he attempted to appease the northern invaders with gifts and increased trade but peace was sporadic. A massive force of the Han army attacked the invaders and forced them back across the northern borders. To consolidate their victories they began to mark out their new extended borders. In many areas they simply restored the old Qin wall. In order to build walls in the desert of the west, new methods of construction had to be devised. Here the soil consists of a gravel of sand and small stones. They used alternating layers of red willows and the gravel and lots of tamping. This produced a wall that has survived for some 2,000 years. Using these techniques and hundreds of thousands of people, the Han were able to build the wall far into the Gobi desert. And where clay was used as a skin or coating it made the wall difficult to scale and protected it against the erosion of the weather. The Han leadership knew to have a strong frontier they not only needed to build a strong wall but they also needed crack troops to defend it. They developed a force of light cavalry that could foray into the enemy territory to check on the enemy movements in his own grounds. They had many victories against the Xiongnu. They then employed renegade Xiongnu horse masters to set up horse breeding stables and to train their troops in horsemanship. By the time of the sixth Han Emperor Wu Di some 66 years later, they had crushed the Xiongnu and the wall was extended some 300 miles into the Gobi Desert. The wall now extended across the principle trading routes and if you wished to trade with the Chinese you needed to enter through the gates in the wall. Around these gates towns were established and became the trade centers of the area. At most gates foreigners were not allowed to go past the gates so these became the portals of trade into China. One flawless example is the stunningly preserved Jade Gate. Built in 101 BC, it is 28 feet high and 66 feet square. Close by they built a fort for the Han soldiers defending the wall. This piece of the wall is 453 feet long, 115 feet wide and 23 feet high. The wall became more than a trade route and a barrier to keep out the enemy, it turned out to be vital for communications. Along its ramparts messages can be sent at incredible speeds from one end of the empire to the other. All along the northern border beacon towers were built every 15 to 30 miles. They formed a communication network, which ran from outposts deep into enemy territory to the ancient capital in the east. From these towers the Han troops used smoke by day and torches by night to send messages along the length of the wall. They burnt wood, and straw mixed with wolf dung, which produced rich black columns of smoke. Statutes firmly governed the code of these signals. One column of smoke indicated a n impending attack by a force of less than 500. Two columns showed an attack by a force less than 3,000 and four columns indicated an attack by a force of up to 10,000.China would wait another 1,300 years before embarking on its greatest period of wall building. The Ming Dynasty built much of what remains today. They were driven by desperation to build the ultimate defense and lock the northern frontier once and for all. The Ming renovated the old Qin and Han walls and extended them. The Ming wall stretched some 4,500 miles from the Korean border at Dandong to the city of Jayuguan in the western desert. Today that fort is one of the most impressive, ornate, and sophisticated military constructions in the history of China. The Ming Dynasty came into power in 1368 inheriting a nation crushed by 100 years of rule by the Mongols. The mighty Genghis Khan had united these tribes in 1206 and had pushed their way through China. Ultimately they fell from within. A peasant revolt spelled the defeat of the Mongol empire. The leader of this revolt was Zhu Yangzhong who was installed as the first Ming Emperor. He immediately took up the challenge to begin building the great defense again. The enthusiasm in which the Ming emperors embraced this ambition was staggering. They built more wall than any other dynasty. The Ming wall was typically built with a stone facing over tamped inner clay. This wall was almost indestructible. The Ming bricks were a marvel of engineering holding up to a pressure of over 1000 pounds per square inch. The mortar was of super strength. The mortar was stronger than the bricks themselves. The puzzle of this super strength has now been solved. The mystery ingredient was rice flour. With innovations like these, the Ming was able to build spectacular monuments. A feature of the wall was water drainage systems that channeled the water to the Chinese side and withheld the water to the enemy side and thus inhibited plant growth and so denied cover to the attackers. Warning towers were built in enemy territory. These spurs were built out from the main wall and permitted the Chinese to attack the marauders from two sides. The armies were controlled from watchtowers that were built every 200 yards along the Ming walls. Locks and bolts secured the doors and windows from within creating a formidable fortress. From these towers the defenders could unleash arrows and spears from heavily protected slits. Later cannon were used. Having discovered gunpowder, the Ming was also the first to use hand grenades and mines. Stones were also pushed through special openings to create man made avalanches to crush the enemy. If the attackers succeeded in scaling the wall, the defenders could retreat to the guard towers. These guard towers were only accessible by retractable ladders.

My Philosophy of Education Essay -- Philosophy on Teaching Statement

Philosophy of Education Norms and values are a reflection of society’s standards of behavior. Since society evolves from each generational perspective, the â€Å"norm† is continuously changing. As a result, the rising adults have a grave influence on how the world will evolve into the next generation. What we teach our students today will reflect the success of our future. How we, as teachers, get our messages across will definitely influence the student’s ability to apply that knowledge. From my experiences and what I have encountered I intend to incorporate the Pragmatic and Idealistic philosophies into my classroom, based on my predictions on how to be a successful teacher. The Pragmatic approach to education involves placing the students as a number one priority. This type of classroom environment would give the child an opportunity to make decisions, which is a crucial part of living a successful life in today’s societies. I would provide a classroom with a helpful and productive atmosphere. This would transform the classroom into a community of learners. This would give the children hands on experience with a project that needed solutions and the idea of how important â€Å"team work† can help in solving difficult situations. Students in my eyes will absorb a greater amount of material if they are actively involved in its processes. I concede with the theories of social reconstructionism in that I truly feel that in order to make a group successful, each individual that is apart of that group must be successful. This idea promotes human growth and development with the incorporation of flexibility in a student’s educatio n. This flexibility will help the student deal with and be able to overcome conflicts within t... ...cation pole, and I believe that the Idealism approach should also be incorporated into the classroom. There is no right or definite way to do anything; this should be kept in mind while performing any task. I feel like focusing on children and being a positive influence does nothing but benefit the child and the future of our world. That after all is what teaching is about, providing the tools to keep the world running. I think sometimes the foundation of teaching is repressed in the minds of teachers, do to the overload of stipulations placed on them daily. Whom are we really hurting here? The children are the ones who suffer. If the children stay as the focus in each classroom and are positively influenced by the teacher then education, what it truly means, will be reached. I plan to incorporate all of this into my everyday classroom. I hope others do to.

Cannibalism as a Sexual Disorder :: Anthropology Essays Paleontology Papers

Cannibalism as a Sexual Disorder Cannibalism occurs prevalently in both Tarzan and Heart of Darkness, and is a controversial topic with which the public is largely unfamiliar. Although cannibalism is generally thought of in a primitive animal sense, experts have revealed that cannibalism can be identified as a sexual disorder (O’Connor). A cannibal is scientifically classified as an anthropophagus (â€Å"Anthropophagus†), which falls under the category of Anthropophagy. Anthropophagy by definition is the sexual gratification by consumption of human flesh or blood. Although rather disturbing, sexual cannibalism is now accepted as the more common variety of cannibalism (O’Connor). Because sexual cannibalism is considered to be a social taboo both today, and during the times of Tarzan and Marlow, the creation of entertainment based on it has been limited, though the urges to expand on this topic may have been far more prevalent. There have been many films and novels created which depict the anthropophagy related to animals, most specifically, spiders. For example, films such as â€Å"Invasion of the Body Snatchers† and â€Å"Little Shop of Horrors† develop the similarities among human and insect anthropophagy (O’Connor). Due to the use of Anthropophagy for leisure purposes, it is evident that cannibalism is a topic of much interest among humans, aside from its label as a social taboo. Technically, a human’s eating of another human has a chemical effect on the blood. Too much human meat causes a build up of vitamin A and amino acids such as homocysteine in the bloodstream, which could cause congenital defects in future offspring. However, if human organs which are rich in B vitamins and folic acid are eaten along with the human meat, homocysteine is not able to metabolize in the bloodstream. This means that cannibalism could hypothetically be the basis of a healthy diet (â€Å"Natural Food†). Contrary to human meat and organs actually being healthy to a human diet, cannibalism is also said to cause madness and addiction based on sexual urges and gratification. Kate Rix depicts that sexual cannibalism in its truest sense may in fact lead to the development of necrophilia tendencies. Disturbing behavior, such as that of cannibalism as well as necrophilism, is a result of chemical imbalances in the brain.

Intercultural Communications Essay

* This chapter offers six reasons or imperatives for studying intercultural communications * Economics * The workplace * Businesses must be more attentive to diversity issues * As the workforce becomes more diverse, their will be more problems * Benefits * Speaking different languages * Seeing new business markets * Marketing products to different cultures * Learn about different cultures * Global economy * Globalization * Bring money to the poor areas by opening up businesses * Wal-mart, they open one in china, but takes away jobs from Americans * Mom and pop stores out of business * Pollution in other countries because they don’t have regulations * To bridge the cultural gap, many companies employ cross-cultural trainers who assist people abroad by giving them information and strategies from dealing with cultural differences * American’s tend to say that they are the best and won’t open up * Technology * GLOBAL VILLAGE to discribe a world in which communication technology (tv, radeo, news services) brings new and information to the most remote parts of the world * Today people are connected via e-mail, instant message, bulletin boards, and the internet to people they have never met face-to-face. * Complex relationships can develop through technology * Technology and Human Communication * Kenneth gergen describes the changes that occur as technology alters patterns of communication * Relationships were described on how far a person could walk * What does it have to do with intercultural communication * Easier to talk to people * Faster * Convenient * Too reliable, forget your phone at home and you get anxiety * Effects face-to-face communication * Limits what you are trying to say * Miscommunication, taking a text the wrong way * DIGITAL DIVIDE exists between those who have access to technologies like the internet and those who do not * Older Americans, those with low incomes and less education, and people with physical disabilities lag behind. * 22% of Americans have never been online and are categories as the â€Å"truly disconnected† * Demographics * Changes come from two sources, either changing demographics within the United States or changing immigration patterns * Changing us demographics * DEMOGRAPHICS refers to the general characteristics of a given population * Population will change drastically by 2050 * Changing immigration patterns * There is a contradiction when discussing immigration in the United States * â€Å"nation of immigrants† * patters of immigration are having a significant effect on the social landscape of the United States * these demographic changes present many opportunities and challenges for students of intercultural communication and for society * Learn about other cultures * Meet men and women from around the world * Tolerance of other cultures * Miscommunication * Different work habits * Intercultural conflict is not necessarily a consequence of diversity * Expands our linguistics, politics, etc. * Historical overview: we have to look at the history of immigrants in the u.s. to get a better sense of the sociocultureal situation * MELTING POT- the cultures all get together and melt together and make one cultur e * College classroom * SALAD BOWL- when cultures are distinctly different * My big fat Greek wedding * Economic conditions affect attitudes toward foreign workers and immigration policies * They sent all of the Americans back to free up jobs for White Americans * 10 years later they told them all to come back for cheap labor and they can be in the country * The current situation * Always going to have conflict and diversities * â€Å"Crash† the movie shows all the diversities between cultures in LA * Class structure * Usually the one they are born into * Economic disparity among these groups * Peace * The key issue is whether or not individuals of different sexes, ages, ethnicities, races, languages, and cultural backgrounds coexist on the planet * Not realistic because we are not all on the same page * Contact among different cultural groups often leads to disharmony * Conflict is also tied to economic disparities and economic colonialism * Some are extremely poor, and don’t have natural resources * Going somewhere and nobody likes American’s * Media influences us a lot and they don’t like that * It will be naà ¯ve to assume that knowing intercultural communications would end the wars * Self-awareness * One of the most important (but less obvious) reasons for studying intercultural communication is to gain an awareness of one’s own cultural identity and background * Peter Adler observes that the study of intercultural communication begins as a journey into another * If you are white and middle class, intercultural learning may mean an enhancing awareness of your privilege * Ethics * Ethics are the principles of conduct which help to govern the behavior of individuals and groups * Ethical judgments and cultural values: * Ethical judgments focus more on the degrees of rightness and wrongness in human behavior than do cultural values * Cultural values tell us what is â€Å"good† and what â€Å"ought† to be. * â€Å"killing for the name of god† * Universally ethical * This book stresses the relativity of cultural * According to the UNIVERSALIST position, we need to identify those rules that apply across cultures * By contrast, the RELATIVIST position holds that any cultural behavior can be judged only within the cultural context in which it occurs. This means that only community can truly judge the ethics of its member

Cash and Working Capital Essay

1. What are four general phases of the working capital cycle? Four general phases of working cycle are: a. Purchasing of resources: relates to the acquisition of supplies and labor, such as the level of inventory necessary to maintain realistic production schedules and the staff required to ensure adequate provision of services. b. Production/sale of service: healthcare services, no inventory. c. Billing: refers to the release or discharge of a patient and the generation of a bill. d. Collection: the generation of a bill and the actual collection of the cash from the patient or the patient’s third-party payer. 2. What are the three primary sources of short-term funds? Three primary sources of short-term funds are: a. Single-payment loan: a loan that requires the payment repaid at the end of its duration instead of in monthly installments. b. Line of credit: agreement that permits a firm to borrow up to a specified limit during a defined loan period. c. Revolving credit agreement: similar to a line of credit except that it is usually for a period longer than 1 year. Look more:  non normal cash flows essay 3. An organization’s short-term investment options for idle cash include what four areas? List and provide their characteristics a. Short-term working capital needs: a business needs funds to handle the standard and usual expenses associated with the operation of the company. It is safe to assume that most healthcare firms should carry approximately 20 days of expected cash transactions at any point in time to meet normal short-term working capital needs for cash. However, it is not safe to say that a not-for-profit healthcare firm would need only 20 days of cash. b. Capital investment needs: a non-profit healthcare organization needs funds to finance replacement and renovation of existing capital assets as well as investment in new product and service line areas. Different from taxable firm and investor-owned healthcare firm, the organization must routinely set aside funds for replacement and the amount of money reserved depends on percentage  of debt financing to be used and projected future levels of capital expenditures. c. Contingencies: a business needs funds to handle unexpected demands for cash flow, also called contingency funds. The amount of money reserved reflects the company’s tolerance of risk. d. Supplement Operating Earnings: non-profit healthcare organization needs funds to provide a dependable flow of investment earnings that can be used to supplement expected weaknesses in operating earnings. This helps to prevent significant deterioration and weak operating margin in operating earnings. 4. Discuss the term float. Float is a brief moment in the banking system where money is counted twice due to delays in processing checks. When a check is deposited, the bank credits a customer’s account and that is when float is created. However, it could take a couple of days for the check to be received and clear by the payer’s bank. During this floating time, the amount on the check appears in both the payee and payer’s account. Also, float can be available shares in a company for trading. These shares are making available to the general public for trading and the company is not liable for how the shares are being traded. References Cleverley, W.O., Cleverley, J.O., Song, H.S. (2011). Essentials of Healthcare Finance (7th Edition). Sudbury, MA: Jones & Bartlett Learning. (n.d.). Retrieved from http://www.investopedia.com/terms/w/workingcapital.asp (n.d.). Retrieved from http://www.investopedia.com/terms/c/capital-investment.asp Tatum, M. (2003). What is short-term working capital?. In B. Harris (Ed.), Copyright Protected: 2003-2014 Conjecture Corporation.