The low-cost Airline Ryanair Essay Example | Topics and Well Written Essays - 750 words

The low-cost Airline Ryanair - Essay Example In any industry, several forces in conjunction form the success or failure of any firm that operates in it. These forces include those factors, which affect a business from outside its immediate environment, which is the macro environment. Porter’s Five Forces Model makes it easier for one to analyze these various factors in relation to any industry, as it outlines the basic factors, which one should observe to understand a company’s chances for success and market attractiveness. Ryanair, an airline in the transportation industry, forms an interesting choice of company which one can analyze using this model. To start, one needs to have a brief idea about Ryanair. It is a low-cost airline, which is the second largest airline in Europe, and belongs to the transportation sector of the tourism industry. The reason it forms such an interesting choice is that it is one of the largest in the world in terms of international passenger number and the second largest (Amason, 2010) in terms of passenger number. This success of the airline is intriguing, and leads one to wonder whether the success can be explained by the recent deregulations that happened in the aviation industry in Europe in 1997 or whether it is due to the low-cost business model that Ryanair operates under. Either way, it is an intriguing case for anyone interested in studying companies from a business management aspect (Amason, 2010). Porter’s Five Forces Model includes firms, which study the competitive environment of the firm. ... In relation to the competition it faces from other firms, Ryanair competes against several rivals. These include another low-cost Irish airline Aer Lingus, which came into direct competition with Ryanair ever since it switched to a low-cost business model. Other competitors include MyTravelLite and Go (Hoffman, 2007), both of which were at a point in time, in competition with Ryanair, although it was not long before Ryanair was able to beat them due to its low cost strategies. Aer Arann and CityJet are some more examples of competition, which Ryanair faces, while EasyJet is this airline’s largest competitor (Hoffman, 2007). The airline industry is one where no one firm can hold monopoly, because each successful firm has different strategies and different core competencies, which earn them a fair share of market share. In addition, it is a large industry, which automatically means there will be several competitors. As for the power of customers, it is not a strong force in this particular industry. The customers are more or less price takers in the airline industry, as there are dozens of airlines, which cater to customers belonging to each price category. While it is true that these airlines use low-cost strategies due to the customers only, it does not mean that the customers have the power to influence the rates of fares of these airlines. Similarly, the power of suppliers is also not very relevant to this industry. The start-up costs as well as any materials and services the airlines use for their planes or operations make a large proportion of their costs. However, their magnitude is what influences the airline’s decisions, not the wishes or demands of the suppliers, which makes the power

Core Competencies Essay Example for Free

Core Competencies Essay A business or product which generates a sturdy, dependable flow of cash. Dog- a product with low market share in a slow growing market and thus neither generates more consumes large amounts of cash. Star- products that are in high growth markets with a relatively high share of that market. They tend to generate high amounts of income. Question Mark- growing rapidly and thus consumes large amounts of cash but because they have low markets shares they do not generate much cash 2. What are core competences? Core competences are critical capabilities to a business achieving competitive advantage. The starting point for analysing core competences is recognising that competition between businesses is as much a race for competence mastery as it is for market position and market power. Senior management cannot focus on all activities of a business and the competencies required to undertake them. So the goal is for management to focus attention on competencies that really affect competitive advantage. 4 Potential sources of core competences * Distribution * Marketing * Management * Manufacturing 4 criteria used to evaluate core competences * Valuable * Rare * Costly to imitate * Non substitutable 3. What should an audit of resources include? The resources available to a business whether it be owned or obtained through partnerships, joint ventures or simply suppliers arrangement with other businesses. The assessment of the strength and weakness of an organisation in conjunction with an assessment of opportunities and threats. It should have the key success factors for the markets and industries in question and the comparable strengths and weaknesses of competitors for the same customers. 4. What are the strategic options for competing in a Mature Industry? Prune marginal products and models * Emphasize innovation in the value chain Strong focus on cost reduction * Increase sales to present customers * Purchase rivals at bargain prices * Expand internationally * Build new, more flexible competitive capabilities 5. Define the Value System The Value System is the set of interdependent situations within a business which both directly or indirectly adds value to the customer and ultimately generates a net cash inflow. This also provides a key link between competitive strategy and shareholder value. Even though the value system bears some resemblance to Porter’s value chain, the latter is perhaps less flexible and less easily tailored to the variety of the modern business.

Systematic Research

Systematic Research Introduction This report is to critical review a journal article, titled as ‘The role of management characteristics in the internationalisation of SMEs by Karise Hutchinson and Barry Quinn, School of Business, Retail and Financial Services, (university of Ulster, Colearine. UK) and Nicholas Alexander, Centre for research in Marketting, School of management and Business, (University of Whales, Aberystwyth, UK). The research was published in International Journal of Small Business and Enterprises Development, Vol. 13, No. 4, 2006. According to Saunders, Lewis and Thornhill (2003), the research is defined as â€Å"something people undertake in order to find out things in the systematic way, thereby increasing their knowledge†, Ghauri Gronhaug (2002) in addition to it ‘Systematic Research it is based on logics and not relied on just beliefs (quoted in Saunders, Lewis and Thornhill, 2003). For any type of research appropriate initial planning should be done for reaching expectation of the research objective. (Hague Jackson, 1996). So according to this research journal will be analyse in the report in orders to review that authors have conducted the research systematically by focusing on below key components: 1) Project Rationale 2) Literature Review 3) Research Paradigm Design 4) Research Methods 5) Research Results Presentation Project Rationale Research Rationale According to Saunders, Lewis and Thornhill (2003), while choosing any research topic or idea should be connected with ‘rational thinking and ‘creative thinking. In the given article the authors Hutchinson et. al (2006) have focus on internationalisation of SMEs in U.K retail sector. In this article author main focus on the evidence gathered from 9 establish international retail SMEs originating from the UK retail sector by Hutchinson et al. (2005). In this research the author have mentioned reviews of different author from different literature in relating to the internationalisation of SMEs. In supporting their literature review, author has taken the evidence of 9 established international retail SMEs companies case study within UK retail sector. In this article manager is presented as their main role because of the direct responsibility in decision making for SMEs, Also he is directly responsible for every decision. This article is highlighted the enlarging form of theor etical framework of Hutchinson et al. (2005). In the given article retailing is important for every country in between their production and consumption. If we go up in the past report from the last several years UK retail sector is keep growing and every year there is an increment of 15% from the next five years till 2011. (www.prospects.ac.uk). In the article the author states that international expansion is very important for every firm who deals in limited geographic area with their small financial base. Further study has also been recommended by many authors in internationalisation of SMEs like Iben (2003), Moini (1995). Moreover, this study is also highlighted the characteristics of founder and export relating decision in small firms Hutchinson et. al (2006). In this study multiple case approaches in argument to s single case used in their result, also the use of in-depth study can be seen in this article . For gathering the data author have used qualitative techniques in his research where the author has used face- to -face semi -structured interviews with open- ended questions from the relevant person, company reports, and archival information. For secondary data author have used important evidence, which were analysed on the basis of the study. Hutchinson et. al (2006). Research Aims and Objectives Saunders, Lewis Thornhill (2003) for every research researcher aim and objective should be clear at the same time it should provide purpose and direction of the research without setting aim and objective will divert the researcher from their study. The authors however showed the research aims and objectives in the research journal that can be summarised by the following: Aim: The aim of this study is to specifically explore the role of management characteristics in the internationalisation of SMEs Hutchinson et. al (2006). In order to reach his aim author have set the following objective: To investigate the importance and impact of objective and subjective factor in decision making in the internationalisation of SMEs. To explore the business skill, positive attitude to risk and the vision of the entrepreneur, ability to network can be useful valid indicators for the internationalisation of SMEs or not. To explain how the importance of decision maker in internationalisation of SMEs. . LITERATURE REVIEW : In this article author have conducted the literature review mostly from â€Å"secondary literature sources† i.e books, journals, article also ‘primary literature source from face-to-face interviews with relevant person, open-ended semi-structured approach, analysing their company report. Author has used all the relevant data, which is derived from the evidence of case study in UK retail sector. Author has done beautifully research, which is directly link up with their key words. This article clearly present the different reviews of many writers for internationalisation of SMEs. Also author has taken the help of previous research by Hutchinson et al(2005) and present their result in finding the role of objective and subjective factors in the internationalisation of SMEs. This article has presented some example [(such as The Body Shop (Anita Roddick), Virgin (Richard Branson), Laure Ashley (Laura and Bernard Ashley)] of people who have positive risk taking attitude which is important factor in globalisation of SMEs Hutchinson et. al (2006). Critical Literature Review Literature Review is important because it helps the researcher itself to make his research more clear and understandable in better way. For this purpose the researcher first needs to justify to himself that the study is worth conducting. Review of existing body of literature does precisely that. In addition to it, the researchers should have a clear cut idea what he wants to do achieve in his research (Remenyi, Williams, Money Swartz, 1998). By the term ‘critically analyse the literature review, Dee (2000) suggests that researcher should refer to work by 1) accepted experts or literature in that field, 2) select both supportive and unsupportive literature in a logical manner to the research area, 3) judge the importance of the literature by differentiating clearly between fact and opinion (quoted in Saunders, Lewis Thornhill, 2003). Strong Points By Critical Literature Review: By using different literature from different variety of sources, which make this research more understandable and clear towards the aim of the study. By indication of the key word in introduction parts is fruitful and helpful in exploring the same topic also at the same time study make it clear that the author has doing his research with in their related topic. By using the strong points of case study that the importance of manager in decision making in the internationalisation of SMEs Hutchinson et. al (2006). Weak points: In the given article literature used by the author is not up-to date most of the time article referred for the research are old. In the given article author for his research has used previous research of the different authors, old journals, articles are very limited source in supporting their research. He could have come up with more authors views for attaining their objective or make this study more effective. The author have selected for his research 17 different international retail SMEs out of which he has taken only the evidence of 9 international SMEs in his research Hutchinson et. al (2006). Research Paradigm Design Research Paradigm According to Remenyi, Williams, Money Swartz (1998) Research Paradigm it is of 4 types categories. First is Epistemology which focuses on the relationship between enquirer and known, second is Ontology which focuses on humanity and social reality. Third is Human Nature which focuses on human nature and environmental and last is Methodology which focuses on approaches to evidence collection. According to the article author have used Epistemology as research paradigm for his research. The reason behind is author has put focus on how does the decision of manager important in globalisation of SMEs. Moreover, to this by conduction face-to-face interviews, open-ended questions with relevant person is fully link in between the enquirer and known from this points research is interpretive (Eisenhardt, 1989; Yin, 1989). Research Design A research design is a framework for conducting a research project as it contains the step-by-step procedure for obtaining important information to structure research problem. (Malhotra and brisks, 2007). Research design it contained many components like case study, experiments, survey, cross sectional studies, longitudinal studies, explanatory studies, descriptive studies, action research, ethnography, and grounded theory (Saunders, Lewis and Thornhill, 2003). In the referred article author collected the data mainly from secondary source of strong points of evidence of case study, also from books, journals and expertise in order to find out the importance of 5 factors in the success and development of internationalisation of SMEs. Moreover, to reaching his aims he applied ‘Exploratory, Descriptive and Explanatory Studies in research design. According to SaundersLewis and Thornhill (2003) ‘Exploratory Studies is useful for clarifying and exploring the perception in that research from the way of different literature, by taking advices and help form experts. For attaining the aim of this research author identifies the role of manager in decision-making in development also refer different books of many authors. ‘Explanatory Studies means a situation to indentify the relationship between their variables. In this regard author has mentioned a meaning full title to their work, which shows that research in done in international S MEs in retail sector Hutchinson et. al (2006). Research Approach Deductive and Inductive are two types of approaches. According to Carson et al. (2005) deductive approach is based on the theoretical structure development for testing with statistical methods. This approach allows to the researcher to test the theory by observation or survey. While inductive approach focus on the shift of theory to data observation which sufficient sample size and validity of data. (Saunders, Lewis and Thornhill (2003). In this study author has used deductive approach because researchers has beautifully research with in their keyword also on the basis of evidence case study, by using exploratory study to connect with literature review in searching the data whether the business skills, positive risk attitude, ability to network, vision of the entrepreneur are factors in globalisations of SMEs. In addition to it author has clearly present different views of many authors thats makes this research more sensible Hutchinson et. al (2006). Research Methodology Research Strategy According to Creswell (2003) research strategy is of three types; Qualitative Approach, Quantitative Approach and Mixed Methods Approach, as all these approaches are different from each other for collecting data, for getting results and data analysis. In this article the researcher for reaching their objectives employed Mixed Methods Approach as research strategy as the researcher collected both quantitative and qualitative data. For Qualitative approach author have used several authors opinions, previous research report, face-to face interviews, open-ended semi-structured questionnaire in drawing their conclusion. For Quantitative approach researcher has taken 9 establish international SMEs case study Hutchinson et. al (2006). Data Collection Methods: According to the McDaniel and Gate (2001) there are two ways of collecting the data; 1) Primary Data: In this data is collected for the first time for the research such as observations, experimentation and survey research. 2) Secondary Data: It is the previously researched data collected from different types of sources such as, journals, internet database, company report or website or any researcher report etc. In this author has mainly use secondary data for gathering information from books, journals, previously and report on the same topic. Author also used evidence of establish international SMEs case study. Strength Weakness of Research Methodology: In the article the researcher for doing the research used Deductive approach as the research approach, for research design used Exploratory, Descriptive and Explanatory Studies, Qualitative research as research strategy and for collection of the data used secondary data for conducting the research. There are some strength and weakness in the research, which are as follows: Strong points: By using in-depth case study, multiple case approach make more understandable in achieving their aim and objectives of this research. Moreover, this study is in the context of small and medium size firm SMEs, which focus on aim of the study. Beautifully present the domestic and international activities of all 9 companies by dividing into 4 different retail sectors also put emphasis on formal contact because to avoid small size firm with in strange market. In the given article author have clearly mentioned the expand work of Hutichinson et al. (2005). In addition to it author has beautifully identify the gap in the study. Given study clears that both formal and informal contact is necessary for internationalisation of SMEs by using this contact he could have done it better or very easy in setting up firm branch overseas Hutchinson et. al (2006). Weak points: By using less quantitative and objective technique can be seen in this article. So we can say that there is lack of real information. In secondary research he could have done something more to add the data in his research to make his research relevant in terms of if someone read this article then he can easily understand the result derive from secondary data is relevant by using proper data. From the sample of 17 companies choosing only 9 established international retail SMEs whose sale turnover is less then 25 millions that make this research more difficult in drawing their result or not realistic. By using uneven samples categories in conducting their research such as small, medium and large, if he want to do research in my viewpoint he could have to choose one categories with one sector thats makes easy or clearer in understanding. None of the sample is similar to anyone, so on this basis it clears that the result arrive from research is not so relevant. If the make the sample of 17 internationalised companies then study prove to be more relevant. Also in primary research author he could have come up with more face-to face interviews, with more questioners so that the conclusion can draw easily Hutchinson et. al (2006). RESULT AND PRESENTATION Relative Value and Context result In this article authors research result has appropriate link to the key words of the topic that has been mentioned in the literature review by researcher. In the result author has successfully proposed their study in different section from their domestic turnover wise which provides total description for both domestic and international activities of all 9 companies and it is fully interpretive in nature. In addition to it author has clearly relate to objective managerial characteristics to decision maker ability, global experience and business skills, also choices of choosing foreign market defers from case to case in the expansion of internationalisation of SMEs. This study proves that the pivotal role of manager in the internationalisation of SMEs in UK retail sector. In this study author has also clear the importance role of both formal and informal contact are important factors in the early expansion and development of business overseas. Also author has taken uneven sample of com panies that some company has only two branches in overseas and some having more then 30 branch worldwide. All the 9 companies taken by author are in the favour of positive decision in the overall business performance. This research successfully proves the close relationship between characteristics of decision maker and inclination to initiate and develop international activity Moreover, after reaching the result author has also given implication for manger for both public and private support organisation. By giving importance to customer service which proves the importance of business skill in retailing and branding this asserts the importance of management knowledge of the international retail business environment Hutchinson et. al (2006). Presentation Structures In the referred article author presented very beautifully structure to his article so that it is easy to clear the main aim and objective of this research and after that he presented step-by-step link up with research topic and his key words that already clearly mentioned by researcher in the abstract part. In presenting all reviews of different authors turn his study in more realistic way then moved to explaining the objective and subjective factors in decision making in internationalisation of SMEs then gave their conclusion. For making his research more effective and authentic author has taken the help of good examples and with good arguments. In the given article researcher has used the strong points of evidence of case study that makes study more effective and easy to understand Hutchinson et. al (2006). CONCLUSION After completed critically analysis in this research, in my viewpoint this research gave us a lot of knowledge about the importance of decision maters in internationalisation of SMEs. Moreover, author has also given the implication for manager in both public and private support companies. He has also mentioned at what certain both formal and informal contact matters when company initially opening their firm in overseas. Moreover, to this results are very general. By making his research more effective he could have compare more then one sector but still this study is interesting and need a lot to do in further research. Author has beautifully identified the gap of the study. By adding regression analysis, graphs or charts or some other useful tool attached to he appendix in finding the result to get the idea easily and clearly Hutchinson et. al (2006). Bibliography Carson, D et.al (2005) Qualitative Marketing Research. London, SAGE Publications Ltd. Creswell, J., W. (2003), ‘Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 2nd ed., California: SAGE Publications Ltd. Malhotra, N. and Birks, D. (2007), ‘Marketing Research: An applied approach. 3rd ed., Prentice Hall, Financial times. McDaniel, C. Gate, R. (2001), ‘Marketing Research Essentials, 3rd ed., Ohio: South-Western College Publishing. Remenyi, D., Williams, B., Money, A. Swartz, E. (1998), ‘Doing Research in Business and Management: An Introduction to Process and Method, London: SAGE Publications Ltd. Saunders, M., Lewis, P. Thornhill, A. (2003), ‘Research Methods for Business Students, 3rd ed., Essex: Pearson Education Limited. http://www.prospects.ac.uk/cms/ShowPage/Home_page/Explore_job_sectors/Retail/overview/p!egiLLL http://books.google.co.uk/books?id=6TUuXQifwxoCpg=PA280lpg=PA280dq=any+books+on+internationalisation+of+sMEssource=blots=brYSpAWGAJsig=kh5oVONN4DAFAKze7rSioizjbnchl=enei=zj5wSuTZOMKZjAeLx7GSBQsa=Xoi=book_resultct=resultresnum=9 Quinn, B., Hutchinson, K. and Alexander, N. (1998), ‘The role of management characteristics in the internationalisation of SMEs :Journal of Small Business and Enterprise Development Vol. 13 No. 4

Patient with Congestive Heart Failure

Patient with Congestive Heart Failure Patient S.V. is a 54 years old female. She is a postmenopausal housewife and her family history is not being recorded. She is a non-smoker and does not drink alcohol at all. She has no-known drug allergic. The past medical history showed us that Madam S.V. is having, rheumatoid arthritis (RA), hypertension (HPT) for 10 years and diabetes mellitus (DM) for 7 years. She was admitted to the hospital on few weeks ago due to congestive heart failure. Madam S.V.s drugs history include: T. furosemide 40mg od Oedema HF T. perindopril 4mg od HF HPT T. spironolactone 25mg od HF T. Losec (Omeprazole) 20mg bd Duodenal ulceration P. Calcium lactate 1 puff od Calcium supplement T. Rocatriol 0.25mg bd Vitamin D supplement T. Metformin 500mg bd DM T. folate 5mg od Folate deficiency T. Methotrexate 20mg/week RA Clinical data The abnormal result of FBC may due to folate deficiency that caused by side effect of methotrexate. Besides that, patient was having high neutrophil number for his differential count which is 8.7 k/ µL (normal range 1.9-8.7 k/ µL). This may due to the long-term use of corticorsteroid. Patients total carbon dioxide in the blood was two times higher than normal range (23-27 Vol%). Prothrombin time and INR of the patient was low: PT =11.1 sec (normal range = 11.9-14.5 sec), INR = 0.82 (normal range 2-4). However, the reason is unknown. Diagnosis ECG and chest X-ray were carried out and the results showed that patient was having sinus tachycardia and cardiomegaly. Cardiovascular system of patient also had been checked. It found that the patient was having a 3rd heart sound. Hence, the patient was diagnosed with congestive heart failure (CHF). Clinical progress DAY 1 Patient is admitted to the hospital at 10.30am by ambulance. She is weak but conscious and alert. The patient complains that she is shortness of breath (SOB) and her sleep has been interrupted due to SOB. It can also be considered as paroxysmal nocturnal dyspnoea (PND) which is sudden, severe SOB at night that awakes a person from sleep, often coughing and wheezing. At the same time, she also experiences from chest discomfort and swelling leg. Besides that, the patient also shows the symptoms of cushings syndrome such as moonface and hirstuism. The blood pressure (BP) and pulse rate (PR) of Madam S.V. are found to be quite high as well, which is 118/87mm/Hg and 146b/min respectively. Test ordered include FBC, RP, LFT, ABG, Coagulation test, UE, CXR, ECG and random glucose test. Nebulizer is given to patient once she is admitted. She is also on high flow mask oxygen 15L/min at the same time to ease the problem of SOB. Salfasalazine 1g bd is added to patient. The management plan is to carry out lung function test, continue to on the face mask for oxygen supply, revise all test results, restrict fluid and continue with old medications. DAY 2 Patient still complain of minimal SOB and minimal chest pain. Another new complain, headache, has been recorded. Her BP and PR have been slowly decreased but they are still not within the normal range. T. bisoprolol 2.5mg od is added for a better control of HPT and HF. Management plan include restrict fluid DAY 3 Patient is no longer complaining for anything. She has no chest pain and SOB anymore. Her PR has back to normal range. However her BP is still slightly higher than normal range. Management plan is same as day 2. Sulphasalazine since the condition of RA is improved. DAY 4 Patient is feeling well, comfortable and tolerating orally. Her BP and PR are within the normal range. The management plan is to perform a CRX report, patient can be discharged if normal result is obtained and continue old medications. Pharmaceutical care issues There are few things need to be taken care of in this case. Firstly, the patient is having the problem of nausea and vomiting and no action is taken to solve this problem. Antiemetic drug (H1 receptor antagonist, cyclizine; D2 receptor antagonist, halopiridol) should be given. At the same time, underlying cause of nausea and vomiting has to be identified if possible. This may caused by side effect of perindopril. Secondly, patient is having cushings syndrome due to long-term usage of steroids for her rheumatoid arthritis. However, there is no any record about the steroids intake for patient in clinical notes. Hence, we have to ask GP or patient to make sure that whether she has stopped taking steroids or still continue with it. According to CSM, long-term corticosteroids therapy should be withdrew gradually. Abrupt discontinuation of corticosteroids therapy may cause severe symptoms because normal production of steroids by the body has been affected. The dose may be reduced rapidly down to physiological doses (prednisolone 7.5mg daily). Then, the progress of dose reducing can be slowed down. The patient is hirudism which is one of the symptoms of cushings syndrome. This problem can be overcome by local measures such as shaving, or depilation such as using wax or cream (eg: eflornithine). The dose of T.folate for patient which is 5mg once daily is indicated for treatment of megaloblastic anemia. However, the FBC test result does not show any symptoms of megaloblastic anemia. The dose of T.folate should be 5mg once daily if it is indicated for folate deficiency induced by mehtotrexate. Blood film should be carried out to make sure that whether the patient is having megaloblastic anemia or not. FBC, serum folate and serum B12 are reliable indicator of folate status. Real indication of T.folate has to be clarified with doctor before dispense the drug. Oedema problem never been improved since the day patient been admitted into the hospital. Restrict fluid intake and strict I/O charting is carried out. However, patient is not compliance to it. Some simple self-care techniques can be taught to patient to reduce the build up of fluid. Counsel the patient about the importance of following Strict I/O chart. Dose of furosemide can be increased if oedema doesnt improve. The blood pressure of patient is still not stable yet. Patient has to be counseled to improve her diet and lifestyle. It is also necessary to monitor BP of patient regularly. Increasing dose of ÃŽÂ ²-blocker can be considered if BP is not reducing. However, due to its negative inotropic effect, ÃŽÂ ²-blocker should be started in very low dose and increase gradually. Lastly, upon discharge, ensure all appropriate medications are prescribed and patient is counseled appropriately. We have to tell patient that Perindopril is added in and ensure patients compliance with medication. Patient should be told to avoid alcohol and cranberry juice and consult GP if anything goes wrong. Disease overview Incidence Heart failure (HF) affects 0.3-2% of general population. In 2001, officially there are 11500 deaths are recorded in the UK due to HF. The incidence rate increase by double each decade from age 45. It affects 3-5% of those over 65 years and 8-16% of those over 75 years. The Rotterdam study shows that prevalence is higher in men compared to women. Pathophysiology Heart failure can be defined as inability of the heart to supply sufficient blood flow to meet the bodys needs. HF can result from any disorder that reduces ventricular filling (diastolic dysfunction) and myocardial contractility (systolic dysfunction). The leading causes of HF are coronary artery disease and HPT. As cardiac function decreases after myocardiac injury, the heart relies on few compensatory mechanisms. Although those compensatory mechanisms can initially maintain the cardiac function, they are responsible for HF symptoms and contribute to disease progression. An initiating event such as acute MI can cause the HF state becomes a systemic disease whose progression is largely mediated by neurohormones and autocrine/paracrine factors such as agiotensin II, norepinephrine, aldosterone, natriuretic peptides, and so on. Some drugs may exacerbate HF due to their inotropic, cardiotoxic and sodium-/water- retention properties. Diagnosis A complete history, physical examination and appropriate lab testing are essential in initial evaluation of patients suspected from having HF. The signs and symptoms are the key for early detection. Breathlessness, angina, fatigue and wheeze are common signs and symptoms. Patient complains that she is having SOB and PND. Electrocardiogram (ECG) and B-type natriuretic peptides (BNP) are essential tests for every patient with suspected HF. ECG is carried out once the patient is admitted into the hospital. Madam S.V. was detected to have sinus tachycardia by ECG which is one for the common ECG abnormalities in HF. Others common ECG abnormalities include sinus bradycardia, atrial fibrillation, ventricular arrhythmias and so on. Plasma BNP is not measured in this case. Chest X-ray (CXR) is also an essential component of diagnostic work-out in HF. It is very useful for detection of cardiomegaly, pulmonary congestion and pleural fluid accumulation. It also demonstrates the presence of any pulmonary disease or infection that will lead to dyspnoea. Via CXR, patient is detected from having cardiomegaly which is also one of the abnormalities for HF. Echocardiography (ECHO) should be performed shortly if one or both ECG and BNP get an abnormal result. ECHO is widely available and safe and provides essential information on aetiology of HF. However, ECHO is not carried out in this case. Some other tests such as FBC, RP, LFT, ABG, UE and random glucose test have been carried out to exclude others possible conditions. Pharmacology basis of drug therapy Diuretics The most important function of diuretic drug is to act by decreasing Na+ reabsorption. Diuretic drugs can inhibit Na+ reabsorption by actions on different transport mechanism, which are located at different sites in nephron. All diuretics are acting on the luminal surface of the nephron. They are protein bound in blood and reach the tubular fluid by secretion into proximal convoluted tubule utilizing the organic acid transport mechanism. They are mostly used to control symptoms of breathlessness and fluid retention. However, they do not alter disease progression or prolong survival. Thus they are not considered mandatory therapy for patients without fluid retention. Loop diuretics for example furosemide is most widely used if compared to other thiazide. It produces diuresis with NaCl loss. It also has vasodilator action which is partly mediated via prostaglandin. This will increase blood flow in the medulla and hence contributes to their natriuretic effect. Unlike thiazides, loop diuretics maintain their effectiveness in the presence of impaired renal function, although higher doses may be necessary. Thizide diuretics are relatively weak diuretics and used alone infrequently in HF. However, thiazide like metolazone can be used in the combination with loop diuretic to promote effective diuresis. Angiotensin-Converting Enzyme Inhibitors (ACEIs) ACE is binding to the plasma membrane and can also exist as a soluble enzyme. The ACEIs act by substrate competition by binding in the Leu-His binding pocket on ACE. Thus, action of angiotensin-I is inhibited. They also decrease the concentration of angiotensin II and aldosterone and attenuating many of their deleterious effects, including reducing ventricular remodelling, myocardial fibrosis, vasoconstriction and sodium and water retention. In addition, they also very helpful in reducing blood pressure due to arterial vasodilation. However, they will inhibit the breakdown of bradykinin which contributes to strong hypotensive action and cough. There are currently 11 ACEIs available for clinical use with similar structure and properties, including captopril, enalapril, lisinopril and others. ACEIs are indicated in all grades I to IV of heart failure which stated in NYHA. Potassium sparing diuretics should be stopped before starting ACEI. ACEIs may increase the risk of renal failure in patient with high dose diuretics, elderly, those with existing renal dysfunction and patients with grade IV HF. Hence regular renal function monitoring is required once patient has stabilized on drug. ÃŽÂ ²-blockers ÃŽÂ ²-blockers can be either selective for ÃŽÂ ²1-adrenoceptor which is cardioselective such as atenolol, bisoprolol and metoprolol or non-selective which can act on both ÃŽÂ ²1-and ÃŽÂ ²2-adrenocepors such as propranolol and timolol. Blockade of ÃŽÂ ²1-receptors will decrease rate and force of contraction of heart. Meanwhile, ÃŽÂ ²2-adrnoceptor blockade inhibits adrenaline-induced vasodilatation mediated by these receptors. Via these mechanisms, heart rate and cardiac output can be reduced. Beneficial effects of ÃŽÂ ²-blockers may result from antiarrhythmic effects, slowing ventricular remodelling, decrease myocyte death, improving LV systolic function, decreasing heart rate, and ventricular wall stress. The use of ÃŽÂ ²-blockers is not suitable for patients who have unstable HF. Patients should receive a ÃŽÂ ²-blocker even if symptoms are mild or well controlled with ACEI and diuretic therapy. Because of negative inotropic effects of ÃŽÂ ²-blockers, they should be started in very low doses with slow upward dose titration to avoid any symptomatic worsening. ÃŽÂ ²-blockers may worsen HF in the short term, but if use with caution they may be very useful in preventing long-term deterioration. Aldosterone antagonists Aldosterone antagonists such as spironolactone and eplerenone also can be called as potassium sparing diuretics. They act on aldosterone-sensitive portion of nephron (last part of distal convoluted tubule and first part of collecting tubule. They block the mineralcorticoid receptor and inhibit Na+ reabsoption and K+ excretion. Spironolactone can be added to ACEI, diuretic and digoxin to improve morbidity and mortality in patient with severe HF. Eplerenone is more specific compared to spirinolactone as inhibitor of aldosterone receptors and has been shown to reduce morbidity and mortality in patient with left ventricular dysfunction post-MI. However, the diuretic effects of aldosterone antagonists are minimal. Combination of aldosterone antagonist with thiazide or loop diuretics will potentiate the effect of thiazide or loop diuretics. This is a more effective alternative compared to potassium supplement. Angiotensin receptor blockers (ARBs) and Digoxin ARBs may be used as an alternative to ACEIs (eg: losartan) when patient is intolerant to ACEIs or may be used as adjunct therapy (eg: valsartan and cadesartan) in patient who remains symptomatic despite the dose of ACE and ÃŽÂ ²-blockers have been optimised. However, ARB is not given to the patient since she is well tolerated to ACEIs. Digoxin is one of the main drugs for HF treatment. However, digoxin is not recommended in this case. Digoxin can only been given if patients HF is worsening or patient is having atrial fibrillation at the same time. Hence, it is reasonable to exclude digoxin from treatment in this case. Evidence for treatment of the conditions Diuretics Diuretic is a very important drug for heart failure treatment especially for symptoms of fluid retention. A meta-analysis which includes 18 randomised controlled trials (RCT), n=982, had been carried out to study the role of diuretics (loop diuretics and thiazides) in patient with congestive heart failure (CHF). 8 trials were placebo-controlled and another 10 were comparison between diuretics and other drugs such as ACEIs, digoxin and ibopamine. The results had shown that diuretics reduce the risk of deterioration of disease and mortality compared to placebo group. When compared to active controls, diuretics also showed significant improvement in patients exercise capacity. The beneficial effects of diuretics are further supported by Cochrane database which also indicated that diuretics cause significant reduction rate and improvement in patients morbidity. Another study also proved that the withdrawal of furosemide will cause increase in volume load and right ventricular pressure. There will lead to deterioration of CHF which include impaired quality of life, weight gain and walking distance reduced. Higher dose of furosemide will have more desirable effects such as increasing general well-being and reducing symptoms of disease. However, the inappropriate high dose of furosemide will lead to hypotension. The risk of hypotension will be increased if patient on ACEIs or vasodilators at the same time with diuretics. According to NICE guidelines, low dose should be prescribed for the initiation of therapy and titrated up according to patients condition. Furosemide is the most commonly used loop diuretic. However, some patients are more responsive to other loop diuretic such as torasemide. This may due to its longer duration of action and high absorption. Some pharmacoeconomic analyses also proved that torsemide reduces hospitalisation for patient with CHF. Hence, overall treatment costs are reduced although torasemide is more expensive than furosemide. Patients that treated with torasemide have improved their quality of life. The data also suggest torasemide to be used as first-line treatment for patients with CHF and for those who are not response to furosemide. Besides that, according to a double-blind study, n= 1663, additional of aldosterone antagonist, spironolactone with furosemide had significantly reduced mortality and morbidity rate of patients with severe HF Hence from the evidences above, we can conclude that furosemide 40mg od is rationale to be given to patient to treat the symptoms of her CHF. Angiotensin-Converting Enzyme Inhibitors (ACEIs) The patient is taking perindopril 4mg od for her HF. A clinical trial has been carried out to compare the effectiveness between ACEIs and placebo in patients with symptomatic CHF. The overall results showed the significant reduction in total rate of mortality and risk hospitalisation. The benefits of ACEIs are further supported by five long-term randomised trials which had recruited 12763 patients with heart failure or left-ventricular systolic dysfunction (LVSD) to compare the effectiveness between ACEIs and placebo. Results showed that mortality rate has been reduced by 23%, readmission rate of heart failure reduced by 35% and re-infarction rate had been reduced by 26% for the patients who assessed ACEIs compared to placebo group. The benefits of ACEIs were observed at the beginning of therapy and it persisted long term. In SOLVD investigation, n=4228, ACEIs (enalapril) reduced the rate of hospitalisations and also incidence of heart failure in patients with reduced left ventricular ejection fractions compared to placebo group. Some randomised controlled trials proved that ACEIs also improve the exercise capacity and quality of life in majority of the patients. Not all the patients with heart failure due to left-ventricular systolic dysfunction experienced the improvement of exercise capacity. However, ACEIs alone is not enough for the treatment of heart failure with pulmonary oedema. Diuretic is needed to maintain sodium balance and prevent any fluid retention. ACEIs are more often to be prescribed compared to vasodilators and angiotensin receptor blockers due to more evidence supports. ACEIs will cause hyperkalaemia, cough and deterioration of renal function. Hence, renal function and serum potassium level need to be checked before the treatment is initiated. The SOLVD data, a randomised, double-blind and placebo controlled trial with 3379 patients, proved that enalapril caused 33% increased in deterioration of renal function compared to control group (P = 0.03). There is another study (n=191) showed that 44% of patients taking ACEIs suffered from persistent cough compared to controls which is only 11.1% (P The studies above showed that ACEIs are rationale to be used as first-line treatment HF. ÃŽÂ ²-blockers ÃŽÂ ²-blockers should be included in the treatment of HF even though the patient is already well controlled by diuretics and ACEIs. The European Journal of Heart Failure suggested that ÃŽÂ ²-blockers should be prescribed to all patients with stable HF and when left-ventricular ejection fraction à ¢Ã¢â‚¬ °Ã‚ ¤ 40%. A lot of meta-analyses showed that ÃŽÂ ²-blockers play a role in increasing life expectancy in patients with HF due to LVSD. In a meta-analysis which includes 21 trials (n= 5894), ÃŽÂ ²-blockers showed a significantly reduction of overall and cardiovascular mortality by 34-39%in patients with severe HF. Another meta-analysis of 16 clinical studies also showed the reduction of 24% for patients who were taking ÃŽÂ ²-blockers for their HF treatment rather than placebo. An interesting meta-analysis had been carried out to test the efficacy of ÃŽÂ ²-blockers in the patients with diabetes mellitus (DM) and CHF. The result of this meta-analysis showed that ÃŽÂ ²-blockers had reduced the mortality rate of patient with DM and CHF. However, the reduction was not significant (P=0.11) compared to CHF patients without DM. Most of the survival benefits for patient with NYHA class II and III are well documented. There is a meta-analysis had proven that ÃŽÂ ²-blockers are having the same improvement of survival rate among the patients with severe HF compared to patients with NYHA class II and III. However, further studies need to be carried out to evaluate overall benefits versus risks of treatment in NYHA class IV. There are three main studies, nà ¢Ã¢â‚¬ °Ã‹â€ 9000, had been carried out to compare the efficacy between ÃŽÂ ²-blockers (bisoprolol, metoprolol succinate CR, carvedilol) and placebo. Almost 90% of patients involve in there three randomised trials were on ACEIs or ARB. Most of them also took diuretics and digoxin. All trials showed the improvement of mortality rate (RRR= 34%), risk of hospitalisation (RRR= 28-36%) and self-reported well being. So far, there are no significant differences between selective and non-selective ÃŽÂ ²-blockers and those with or without vasodilating propert ies. In one randomised controlled trial (COMET), n=3029, carvedilol was used to compared with the efficacy and clinical outcome of metoprolol tartate. The result has shown that carvedilol reduced the mortality rate significantly among the patients compared to short-acting metoprolol tartate (P=0.0017). However, there is no any clinical trial about comparison between carvedilol and long-acting metoprolol succinate. There is little economic evidence can be found for ÃŽÂ ²-blockers. NICE guidelines suggested that ÃŽÂ ²-blockers are cost effective due to reduction of hospitalisation rate. Bisoprolol 2.5mg od had been added to the patient on second day since patient was admitted. The evidences above do support that the usage of ÃŽÂ ²-blocker should be included in patient with HF. Aldosterone antagonists Spironolactone is the most common aldosterone antagonist used in treatment of HF. In a double-blind study (RALES), 1663 patients with severe HF (NYHA class III and IV), left ventricular ejection fraction à ¢Ã¢â‚¬ °Ã‚ ¤ 35% and being treated with diuretics, ACEIs or digoxin were recruited to test the effectiveness of spironolactone on their morbidity and mortality. The result showed 30% reduction in mortality rate and 35% reduction of frequency of hospitalisation compared to placebo group. Addition of spironolactone to ACEIs, diuretics or digoxin had reduced the mortality rate in patients with severe HF. Additional of spironolactone may lead to hyperkalaemia. However the problem of hyperkalaemia can be solved by closing monitoring the potassium level of patients. Another study also showed that spironolactone reduced 30% mortality rate in patients with HF when it has been added to ÃŽÂ ²-blockers and digoxin. A selective aldosterone antagonist, eplerenone, has fewer side effects compared to spironolactone. A randomised controlled trial (EPHESUS), n=6633, proved that morbidity and mortality rate among patients with left ventricular dysfunction after acute myocardial infarction had been reduced with the addition of eplerenone compared to placebo group. There is no relevant economic evidence of aldosterone antagonist. Eplerenone is mostly used when patients cannot tolerate with spironolactone. Hence, spironolactone 25mg od is appropriate to used as adjunct to diuretics, ACEIs or maybe ÃŽÂ ²-blockers for patient in this case. Since the patient does not suffer any side-effects from spironolactone, it is not necessary to change to eplerenone. Conclusion As a conclusion, patients CHF has been appropriately treated by following the guidelines and also supported by numerous of clinical studies. From the clinical process, we can see that the condition of patient was gradually improved day by day. A ÃŽÂ ²-blocker, bisoprolol was added in the second day in order to achieve a better control of patients HF and also HPT. According to guidelines, the dose of bisoprolol should be initiated with 1.25mg, not 2.5mg. The potassium levels need to be monitored regularly due to the concomitant use of perindopril and spironolactone which may cause hyperkalaemia. ARB and digoxin are not prescribed to the patient because she is well tolerated with ACEIs and she does not have AF. Other treatment for HF such as vasodilators (hydrazine and ISDN) will only be considered when all of the treatment options above have failed to this patient. Non pharmacological treatment such as life-style modification, healthy diet, restrict fluid intake and salt intake als o play a very important in controlling patients HF and HPT for long-term.

The Storm :: essays research papers

â€Å"The Storm† may be interpreted as a condemnation of societal constraints upon feminine sexuality. As Calixta â€Å"unfastened her white sacque at the throat† she was taking off chains of oppression of her sexuality. When Calixta â€Å"nervously began to gather up from the floor the lengths of a cotton sheet which she had been sewing† she is putting her duties away for pleasure and is finally going to fulfill her birthright for passionate sex. In â€Å"The Storm† Calixta is a shameless married woman who â€Å"lifted her pretty chin in the air and laughed aloud† after committing an adulteress act. Kate Chopin had a unique style of writing for her time.   Ã‚  Ã‚  Ã‚  Ã‚  In Calixta’s time, showing of the neck and chest was inappropriate and forbidden. So when â€Å"she unfastened her white sacque at the throat† she is expressing that she is a sexual being and is defying against restraints on feminine sexuality. Kate Chopin was a daring writer. In the time of the composition of the storm women were considered property and expected to accept their housewife duties. Women could not freely express their sexuality and Kate was out to change that.   Ã‚  Ã‚  Ã‚  Ã‚  As Calixta â€Å"nervously began to gather up from the floor the lengths of a cotton sheet which she had been sewing† she is rebelling against traditional 1890’s womanhood. Women were not permitted to feel sexual. By putting it away she was lowering the priority of her duties for sex. Sex was something she was unfamiliar to and not something married women did for pleasure. Calixta is going all out!   Ã‚  Ã‚  Ã‚  Ã‚  When Alcee rides off, he smiles and Calixta â€Å"lifted her pretty chin in the air and laughed aloud.† This action was a proclamation of her freedom from sexual oppression. Calixta was prepared for sex and embraced it. She is not ashamed of her act and she fulfilled her birthright for passionate sex. Calixta is a loose woman?

Things They Carried Essay: Rebirth of a Spirit :: Things They Carried Essays

Rebirth of a Spirit in The Things They Carried Speaking of courage is a story found in Tim O ' Brien's The Things They Carried about a solider named Norman Bowker who has returned home from the Vietnam War. As Bowker circles the town's "source of pride" he comes to realize that the town that he left so many years ago will never be the same. While his life was paused by the war, theirs weren't. He also comes to understand that while the people he once knew have changed that he has also changed. He has been consumed by a war and it will forever alter his being. When Norman Bowker returns to his hometown after the war things seem to have moved on without him. It seems that while his life was put on pause, his friends and family had moved on to their lives. His simple wish is for the past to be the present once again. He speaks of his friends Max Arnold and Sally Kramer. Now, Max was dead and Bowker refers to him as an idea. He talks of how things would be different if Max was around to listen to all his stories and how Max would have enjoyed them. The irony is that Max is gone. At one time Bowker had carried a picture of Sally in his wallet. He talked of how he would stop and talk to her when he saw her while driving. He decided that he might impress her with his knowledge that he had acquired during the war such as his ability to predict the time at any point during the day within 10 minutes. He repeatedly said "if she was to listen". Just like the others she did not want to think about the war, it was in the past. Page 143 makes a clear po int that "The town could not talk, and would not listen.. It (the town) did not know shit about shit, and did not care to know". As Bowker continues what seems to be a trip back to what is reality he circles the town lake nearly 13 times. This lake is the life of the town and is very symbolic in itself. On one side of the lake the houses are "modern, with big porches and picture windows facing the water" on the opposite side the houses were described as "handsome, though less expensive and on a smaller scale".

The Theories of Creationism and Evolution

Creationism is the belief that all life and matter on this planet was created by a god or supreme being. It states that a god is the creator of all, and that he (or she) created everything out of nothing. This is a strong belief of many, and seriously contradicts scientific thinking. One can not mention creationism and not say something about the Bible s creation story. It takes place over seven days in which God creates the universe out of nothing. And the earth was without shape and void (genesis 1:1) The breakdown of creation is as follows: Day 1 God made light and separated it from the dark, making day and night. Day 2 God created the water below and the sky above. Day 3 God made earth and made plants grow on it in abundance. Day 4 God created the moon, the sun, the stars and the planets. Day 5 God made the birds of the sky and the creatures of the deep seas. Day 6 God created the animals and the human beings of earth. Day 7 God rested after work. This explanation of creation is preached in Christianity, Judaism, and Islam. Ever since the idea of evolution came about, (see Part II) creation scientist, have been trying to prove their theory over evolution. They cite these major issues: 1. There are no transitional links and intermediate forms in either the fossil record or the modern world, which means, there is no actual evidence that evolution has occurred either in the past or the present. 2. Natural selection (the supposed evolution mechanism, along with mutations) is incapable of advancing an organism to a â€Å"higher-order. 3. Although evolutionists state that life resulted from non-life, matter resulted from nothing, and humans resulted from animals, each of these is an impossibility of science and the natural world. 4. The supposed hominids (creatures in-between ape and human that evolutionists believe used to exist) bones and skull record used by evolutionists often consists of `findsÙŽ which are thoroughly unrevealing and inconsistent. They are neither clear nor conclusive even though evolutionists present them as if they were. 5. Nine of the twelve popularly supposed hominids are actually extinct apes/ monkeys and not part human at all. 6. The final three supposed hominids put forth by evolutionists are actually modern human beings and not part monkey/ ape at all. Therefore, all twelve of the supposed hominids can be explained as being either fully monkey/ ape or fully modern human but not as something in between. 7. The rock strata finds (layers of buried fossils) are better explained by a universal flood than by evolution. Using these and other arguments, Creationists (those who believe in creationism) have fought for what they believe and so far have made some interesting impacts in the nation and around the world. For instance, recently in Kansas, the school board decreed that evolution was to be taken off the science curriculum. It was not to be taught. At all. Part II Evolution: The belief that all life evolved, or mutated into what it is today. Charles Darwin started off the whole evolution revolution after studying creatures in the Galapagos Islands. He published his controversial book, The Origin of Species by Means of Natural Selection, which appeared in 1859. Darwin is hailed as the father of modern theories of evolution. Common usage of the word â€Å"evolution† is the idea that living things in our world have come into being through unguided natural processes starting from a primeval soup of subatomic particles and radiation, over approximately 20 billion years. The idea of evolution that was stated above can be infinitely explained using a combination of the following four studies: 1. Cosmology is the branch of astronomy that deals with the origin and formation of the general structure of the universe. 2. Abiogenesis refers to first life, which is the production of living things from inanimate matter. 3. Macro-evolution or general evolution refers the progression to more complex forms of life. The way of macro-evolution, including whether or not micro-evolution over a long enough time leads to macro-evolution, can be regarded as a â€Å"research topic.† 4. Micro-evolution or speciation refers to population and species change throughout time. There are many examples of speciation, if by the development of a new â€Å"species† we are referring to development of a new population of creatures which will not breed with the original population to produce viable offspring. Micro-evolution is a scientific fact which no one, including creationists, can dispute. The accepted ways if explaining micro-evolution are â€Å"mutation† and â€Å"natural selection.† Mutations are â€Å"mistakes† in the genetic material used for reproduction, which can occur for many reasons (example: as a result of exposure to radiation.) Naturally occurring mutations are very rare, and it is understood that the ones that do occur, almost all have a bad effect. The occasional positive mutation, giving some benefit to the organism, provides the â€Å"new material† for natural selection to work with. Natural selection is based on the thought that there is variation among creatures in a population. Natural selection says that those individuals who have some advantage in their environment (such as being a faster runner, having a better camouflage, etc.) are more likely to have more offspring, which makes the probability of passing the advantage on to future generations. The Peppered Moth (Biston betularia) is typically a whitish moth covered with black spots. This coloring gives an effective camouflage for the moths as they sit on some kinds of birch trees. Like people, however, these moths can be found in a range of colors from very black to very white and all the shades in between. In a famous study in England it was found that when the white trees, on which the moths sat, became dirty (dark) from pollution, birds ate more of the lighter moths, apparently missing the darker ones because of their blending in with the trees. It was no surprise that the population of darker moths increased while the lighter ones decreased. Later on, when the city got together some better pollution laws the trees returned to a lighter color. Along with this, the lighter moths proliferated and the darker ones dwindled in numbers. This is clearly natural selection in action, but is it evolution? Not really, unless natural variation within species that happens in all plants and animals is called â€Å"evolution.† The problem with calling this type of variation evolution is that it is very limited. There are, for example, over 150 breeds of dogs recognized by the AKC and more are added each year, but they are all dogs. You can select for dogs with long ears or short ears, go for big dogs or small dogs, but you can’t select for dogs with flippers. The reason is obvious, there are no genes for wings in the gene pool of the dog. Because of this, dogs will be remain dogs and Peppered Moths will be Peppered Moths. Part III Let the party begin: The fight and contrast of creationist ideas and those of evolutionists. The problem between the creationist and the evolutionists is that they have no common ground. Their theories are based on an all-or-nothing concept. If one is accepted, the other is discarded. That is just the way they are set up. Because of this, the battle rages on. Each side has had their triumphs and disappointments. Some of the best minds in the world are working to prove to all people that their ideas are better. For instance, some creationist argue there is not a single known case of a truly good mutation, one having no negative side effects. This can be easily argued with using the is not response that everybody remembers from early childhood. Unfortunately for the creationists, there is scientific evidence all science is based on theory. Theory can easily be debunked, depending on how the data is looked at. The war continues. In another instance creationists say that natural selection can only select: among already existing traits-it cannot create something new, such as dogs with wings. While this idea has not been proven false, it has not been proven true either. Evolutionists can dismiss this statement by saying that normal genetic changes take place and natural selection helps out. The spiral of argument is never ending. The reason that the two sides can never see eye to eye on anything goes beyond beliefs into semantics. Each side uses the word theory differently. Evolutionists see theory as a scientifically provable and repeatable series of circumstances. Creationists use the word theory as what someone thinks or supposes will happen. And so creationism can be called a theory equal to the theory of evolution. As far as anybody can see this struggle between these two camps has no finish. As long as there is no distinct evidence to prove one way or another, people will argue over these two theories and brainpower will be spent. Even if there were a conclusion to this battle, there would still be some who wouldn t believe, and so there would still be controversy. Who knows? Nothing can be proven.