Energy Drink and Alternative Beverages Essay

1. What are the strategically relevant components of the global and U. S. beverage industry macro-environment? How do the economic characteristics of the alternative beverage segment of the industry differ from that of other beverage categories? Explain. SEGMENTATION: The global market for alternative beverages was divided by product type (sports drinks, energy drinks, and vitamin-enhanced beverages) with different demands for each group. Sports drinks accounted for nearly 60% of alternative beverage sales in 2009, while vitamin-enhanced drinks and energy drinks got about 23% and 18% of 2009 alternative beverage sales, respectively, in the US. RIVALRY: The worldwide competition between three major producers (PepsiCo, Coca-Cola and Red Bull) made the industry rivalry become global. In U. S. , Pepsico has engulfed almost half or 47. 8% of the market shares last 2009. The only region where Coca-Cola beats Pepsico is in Asia-Pacific. Coca-cola has 13. 7% of the market shares while Pepsico has 12. 4%. Worldwide, Pepsico is still leading among the three with 26. 5% of market shares while Coca-Cola and Red Bull had 11. 5% and 7%, respectively. MARKET SIZE: The global beverage industry’s dollar value for beverages in 2009 was $1,581. 7 billion (458. 4 billion liters); with 48. 2% of industry sales was from carbonated soft drinks, 29. 2% from bottle water, 4. 0% from sports drinks, 1. 6% flavored or enhanced water, and 1. 2% from energy drinks. The dollar value of global market for alternative beverages in the same year was $40. 2 billion (12. 7 billion liters), while the dollar value of the U. S. market for alternative beverages stood at $17 billion (4. 2 billion liters). Meanwhile, in Asia-Pacific region, the dollar value for alternative beverages in 2009 was $12. 7 billion (6. 2 billion liters) and it was $9. 1 billion (1. 6 billion liters) in the European market. MARKET GROWTH: The dollar value of the global beverage industry had grown approximately 2. 6% annually from 2005 to 2009 and was forecasted to grow approximately 2. 3% annually from 2010 to 2014. However, this indicator for the alternative beverage industry was much higher. For example, the dollar value of the global market for alternative beverages grew at a 9. 8% annually from 2005 to 2009, but was expected to slow down to 5. 7% annually from 2010 to 2014. Based on the geographic share of the alternative beverages market, U. S. largely covers 42. 3% of it; while Asia-Pacific, Europe and Americas (excluding U. S. ) only cover 31. 5%, 22. 2% and 4% respectively. US is the country that has strongest growth internationally in terms of alternative beverage sales with a 84. 78% growth between 2005 and 2009; while Europe and Asia-Pacific are 22. 97% and 24. 51%, respectively. However, poor economic conditions in the US in 2008 and 2009 led to a 12. 3% decline in sports drink sales and a 12. 5% decline in flavored and vitamin-enhanced waters sales. It was also the reason why energy drinks sales increased just a little of 0. 2% between those years. 2. What is competition like in the alternative beverage industry? Which of the five competitive forces is strongest? Which is weakest? What competitive forces seem to have the greatest effect on industry attractiveness and the potential profitability of new entrants? In the beverage industry, competition can be extensive (large scale). There are many substitute beverages from tea,soft drinks,fruit juices, and bottled water. Provided that there is a wide range of substitute beverages, this weakens the competitive power of substitute beverages when there comes a change to consumer preference. Because there is a large purchase for wholesale clubs, grocery stores, and convenience stores ; consumers have significant influence in negotiations for pricing and slotting fees with the producers. Wholesale clubs and the likes find it difficult to represent new brands due to limited shelf space. When products become a household name such as coca cola, red bull, etc already offer the demands of consumers. Coca Cola and PepsiCo are the least vulnerable when it comes to substitute products since they offer a wide range of variety beverages. The strongest competitive force is competitive rivalry within the industry, competition grows stronger by the year. The primary focus on brand image is key to becoming a household name in the industry, Attractive packaging should be developed, New research and product development, Increase of distribution capabilities, Better taste and more variety. The Bargaining power and leverage of suppliers is the weakest competitive force, Consumers tend to buy more alternative products. The threat of new brands varies by market maturity of each alternative beverage category. Competition is strong and will continue on growing every year in the product line. Competition among all brands center mostly on brand image, attractive packaging, new product and research development, sales promotion, better access to shelf space, and strengthening distribution capabilities. Rivals expands their numbers and types of alternative beverages in their product line, the opportunity for low switch cost for consumers gets introduced and sales efforts to establish consumers brand loyalty. 3. How is the market for energy drinks, sports drinks and vitamin-enhanced beverages changing? What are the underlying drivers of change and how might those forces individually or collectively make the industry more or less attractive? The market for energy drinks, sports drinks and vitamin-enhanced beverages is now changing due to the change in the long-term industry growth rate. Because of the US recession on the entire beverage industry the demand for the alternative beverages was expected to grow worldwide as the purchasing power of the consumers increased. The volume of the alternative beverages offered higher profit margin than those of other beverages. Product innovation, in terms of flavors and formulation, was the most important competitive feature of the alternative beverages. They competed on the basis of differentiation from traditional drinks. This made the industry attractive because of the enhanced look and flavors that the company made. The modernization in marketing and distribution system changed the industry in the way that the beverages may be bought from convenience stores, restaurants, sporting events, delis, concerts, festivals, carnivals and vending machines. The industry was made more attractive because of the famous artists that the companies hire for advertisements. There was also an expansion of target markets, and an increase in new entrants, which made the industry seem appealing to others. The regulations and policies that the government implemented made the industry less attractive due to the products’ faults being exposed to the public. The growing concern of people about health associated with their consumption also made the industry less attractive. For example, caffeine in energy drinks, mixture of alcohol and energy drinks, melatonine hormone in relaxation drinks, and use of Kava and unapproved valerian roots as food additives. The drivers of change, however, will unlikely alter the attractiveness of the alternative beverages for the next years because large producers of this industry would rely on product innovations and acquisitions to increase sales and market shares. But individual and collective effect of industry drivers of change will likely affect the attractiveness of the industry. 4. What does your strategic group map of the energy drinks, sports drink, and vitamin-enhanced beverage industry look like? Which strategic groups do you think are in the best positions? The worst positions? PepsiCo, Coca-Cola, Red Bull GmbH, and Hansen Natural Corporation are strategic groups that are in the best positions because they have already established a market position and they hold most of the market share in the alternative beverage industry. They also account for most of the sales in the industry and they have conquered not just US but also Europe and some parts of Asia and America. Living Essentials, Vacation in a Bottle, Dream Water or Drank are strategic groups that are in the worst positions. This is due to the small number of consumers that they have and policies implemented by the government hinder their expansion. Though Living Essentials lead the development of energy drinks, they did not expanded their market thus other companies took advantage of the opportunity. 5. What key factors determine the success of alternative beverage producers? The four key factors that determine the success of alternative beverage producers: (1) access to distribution, (2) innovating product skills, (3) image, and (4) sufficient sales volume. The first one is access to distribution, which is regarded as the most important industry success factor due to the fact that most brands of energy drinks/alternative beverages cannot achieve good sales volumes and market shares unless they are widely available in stores, and there are also far too many brands for all to be included on store shelves. Popular brands that enjoyed first mover advantages such as Red Bull and 5-Hour Energy and brands offered by Coca-Cola and PepsiCo were assured of consistent access to distribution. The second factor is innovating product skills. By definition, alternative beverages were different from traditional beverages based upon product innovation. Moreover, continuing product innovations were essential to developing additional volume gains from line extensions and the entry into new categories like energy shots. The third one is image, which was also a critical factor in choosing a brand of customers. The image presented by the product’s name and emphasized in advertisements, endorsements, and promotions created demand for one brand over another. Brand image was also a result of labels and packaging that alternative beverage consumer found appealing. Small producers with poor image building capabilities found it difficult to compete in the industry unless the product enjoyed a first-mover advantage similar to that achieved by 5-Hour Energy. Finally, sufficient sales volume to achieve scale economies in marketing expenditures is also an important driver. Successful alternative beverage producers were required to have sufficient sales volumes to keep marketing expenses at an acceptable cost per unit basis. 6. What recommendations would you make to Coca-Cola to improve its competitiveness in the global alternative beverage industry? to PepsiCo? to Red Bull GmbH? Coca Cola * Increase alternative beverage drink brand awareness in Europe and capture its market * Grow infrastructure in Africa * Continue to budget and implement their â€Å"2020 vision† corporate strategy * Enhance product line and innovation PepsiCo * Focus on current energy drink line * Continue to promote their tea and juice-energy lines * Offer different sized cans for current energy drink lines of No fear and Amp * Proceed to distribute Rockstar energy drinks and strengthen their alliance with them RedBull * Expand product line while focusing on market penetration in South America * Branch out with additional lines of alternative beverages * Continue to promote brand

Ageism: How Children and Teens Are Unfairly Stereotyped

Ageism: How Children and Teens are Unfairly Stereotyped Jazzie Collins Pacific High School Abstract Over the years, children and teens have been portrayed as immature and sometimes even stupid. Many adults think that they are incapable of many things and deserve no respect. However, young people have made many accomplishments in history. They have invented things and some have even become emperors. Kids and teens deserve more respect than they are getting. Children and teens are constantly being degraded as â€Å"stupid† and immature†. They are put down and disrespected just for their age and adults often see them as incapable, weak and silly. In some cases they could be considered right but believing that all children are foolish is completely wrong. â€Å"Children should be seen, not heard,† a phrase often heard in olden times and even sometimes today, is a prime example of ageism. It is degrading to them as human beings. The law enabling citizens in America to have freedom of speech does not exclude children and teenagers. If it did, there would be many things today that we would be without. Many inventions we have now came from the minds of young ones. For example, the earmuffs, a popular and stylish way to protect your ears from the bitter cold of winter, were invented by a 15 year old boy from Maine. The protective winter gear called Wristies was created by a 10 year old girl in the year 1994. There are numerous inventions from the minds of teens and children. Chester Greenwood, living in Farmington, Maine, invented earmuffs at the age of 15. While testing out a new pair of ice skates, he became frustrated with trying to protect his ears from the harsh cold. Feeling very bulky, itchy and, overall uncomfortable, his scarf did no help. So instead, he made two ear-shaped loops from wire and had fur sewn into them by his grandmother. Chester then improved them by adding a steel bar to the top of the separate ear muffs, helping to hold them in place on a person’s head. Afterwards, he had the new and enhanced version of his invention patented. Then, with Greenwood’s Champion Ear Protectors, he established Greenwood’s Ear Protector Factory and made a large fortune supplying ear muffs to U. S. soldiers during World War I. Chester then went on to patent many more inventions. In 1977, Maine’s legislative declared December 21 as â€Å"Chester Greenwood Day† to honor Chester Greenwood as a great contributor to cold weather protection. Another form of winter gear coming from the mind of a child was something called a Wristie. Wristies resemble wrist bands and are designed to worn under a coat and gloves to block out the wind, snow and cold from entering any unprotected gaps. The brain behind these was a 10 year old from Bedford, Massachusetts named Kathryn Gregory. Kathryn invented and trademarked Wristies and, also while a kid inventor, started Wristies Inc. , a company that manufactured and sold Wristies. The young entrepreneur has made deals with the Girl Scouts, Federal Express and McDonalds and in 1997, Kathryn Gregory became the youngest person ever to sell on QVC, the television shopping show. Kathryn Gregory may have been the youngest person to ever appear on QVC, but King tut was the youngest Egyptian pharaoh to ever rule over Egypt in ancient times. When Tutankhamun’s father died, coincidentally right after being forced to step down from his throne, Tutankhamun was made pharaoh at the young age of 9. In that same year, he married his half sister Ankhesenpaaten. King Tut, as he was later known as, then became the youngest ruling Egyptian pharaoh. He is still famous today due mainly to his great wealth and young age of ruling. Adults aren’t always wiser than children and teens. In many households, the child has to take care of their parent or guardians whether it be financially, mentally, physically or sometimes all three. Usually, when the cold or teen is taking care of their parent or guardian financially, it is because the adult either blows all of their money on drugs and alcohol, the adult was laid off their job and has yet to find another or sometimes, the adult is simply incapable of working. In any case, the responsibility is left up to the minor to pay bills and put food on the table. Another kind of situation that is quite common is in households where the parents or single parent has undergone an injury or has acquired some sort of mental disability and are unable to really take care of themselves. It is also present in households where something has happened in the parent or guardian’s life and they’ve slipped into such a depression that they no longer care for anything, leaving their kids to take on the responsibility of caring for not only the adult in the house but also for themselves and each other. They then must make sure things get done such as putting food on the table and making sure the bills are paid. In the movie/novel â€Å"What’s Eating Gilbert Grape†, a young man named Gilbert Grape must take on the responsibility of taking care of his morbidly obese mother and brother, Annie, who is mentally handicapped. Gilbert Grape must also repair their old farmhouse all on his own because of his father’s death. Ever since his father’s death, Gilbert’s mom has been able to do nothing else but eat, leaving her unable to care of neither her children nor herself. A real-life example of a situation of the child having to care for their parent is that of a girl named Rebekah Knerr. Ever since Rebekah Knerr was very a young (around the age of 2), her father has had a mental illness causing him to disappear off to somewhere for long periods of time without telling anyone where he is whenever he gets too stressed. Because of this illness, he will disappear for a few days up to, at the most, 2 weeks. Ever since Rebekah was young, she has had to take care of her dad by going along with him everywhere he goes and making sure he doesn’t wander off. It is a very stressful and aggravating job and requires a great amount of maturity and patience. An amount of maturity and patience teens and children are often underestimated of. When it comes to teens and children, credit it almost never given to the ones who truly deserve and have earned it. It is almost non-existent. But those who look down upon them are fools themselves, because children and teens everywhere show more strength and maturity the adults in their lives. Some kids are young inventors and others are entrepreneurs and created many of the wonderful and handy inventions we have today. There is definitely more to children and teens that meets the adult eye. References Life of King Tut. (2009). Retrieved January 6, 2010, from http://www. king-tut. org. uk/life-of-king-tut/index. htm

Global water crisis Research Paper Example | Topics and Well Written Essays - 2000 words

Global water crisis - Research Paper Example For purposes of this particular study, the author will seek to discuss some of the triggers of the global water crisis that is currently taking place, the means by which this crisis impacts upon the economically disadvantaged, sick, and poverty stricken to a disproportional degree, and some of the most promising solutions as they exists within the modern technologically developing world. As such, certain cases will be analyzed under the lens of two possible scenarios for leveraging water resources within areas around the globe within the next 50 years. In such a way, by analyzing the two means by which a high level of fresh water resources can be procured, it is the hope of this student that such a recommendation and approach can help to both inform policy makers within the government, society, and industry with the ways that current changes to extant realities can positively impact upon the future of these regions. Although it may seem convenient to approach the water resource short age from purely a regional perspective, the fact of the matter is that water shortages, as well as the overall purity of these water resources, is an issue that globally effects 780 million people (Ellis, 2011). As has briefly been discussed within the introduction and regional information overview, two factors that continue to have a profound and noticeable effect on the existence of water shortage issues is the growth of the world’s population in tandem with the changes to precipitation that global climate change have affected. Due to the fact that many previously populated regions of the world have experienced a great degree of desertification, the extent to which the natural environment can continue to provide the ever increasing demands of the native population comes into question (Kishore, 2013). Environmentalists and researchers are in agreement that unless fundamental changes are made with regards to the way the world’s water resources are utilized, within the next few decades the access to water will become a far greater issue than it is currently. Besides the rapid growth in human population, the rise in industrialization and the means by which the developing world is rapidly seeking to integrate with the global economy by supplying consumer goods to the developed world can be seen as one of the primary issues that trigger some of the global water shortages that are exhibited within the current time (Hull, 2009). Ultimately, industrialization is not only a polluting process but one that utilizes high levels of steam or water power as both a means to cool the process and machinery of production and as a type of power to drive it. Moreover, in poorer regions of the developing world, non-technologically advanced farming methods see millions of gallons of irrigation water squandered while entire regions go without basic potable water needs. Similarly, the actual size of most water supplies around the world has shrunk as a result of climate change and the ones that are remaining have oftentimes been tainted by pollution; so much so that entire populations that had previously had ready access to potable and sustainable levels of drinking water find themselves in a water shortage and/or water crisis within the current time. Due to the fact that the resource of water is the very fundamental building block of all forms of biological life on planet earth, it is of vital and daily importance to

How Google motivate their employees Essay Example | Topics and Well Written Essays - 1500 words

How Google motivate their employees - Essay Example The culture of the organization has been made conducive to its employees. The next aspect that promotes employee motivation concerns product innovation. The company has been a leader in providing conditions necessary for employee’s participation in innovation. The company further focus on employee passion on performing of tasks rather than on pay. It is also imperative to state that Google management team has been able to encourage creativity while enhance organizational control. It is also one of the goals of the organization to utilization of data in providing employee with rewards and in motivating (Wood, 2015).The other motivational aspects of the organization relates to its pay rewards. Employees in the organization receive various innovative pay benefits that motivate them towards organization success. The management teams of the organization provides employee with room to promote their own ideas. These provide employees with various bases for creating their own products (Wood, 2015). In return, to such strategies, Google is able to recruit employees with very high skills. They further construct innovative ways of retaining employees. The other motivating aspect of the organization is the provision of challenging and inspiring activities for its employees.Modern organizations need to utilize innovative ways in motivating its employees. Motivating of employees ensures that organizations are able to maximize on their efforts. Modern organizations are able to streamline employees’ ideas towards innovating products.

Personal Definition of Innovation Essay Example | Topics and Well Written Essays - 1250 words

Personal Definition of Innovation - Essay Example In this regard, the essay aims to propose a personal definition of innovation taking into consideration a comparative analysis of the concepts of innovation, invention, and creativity. Likewise, a description of the relationship between technical or traditional problem solving and creative or intuitive problem solving would be proffered. An explanation of the importance of innovation to the success of individuals, organizational leaders, organizations, and nations would also be presented. Finally, a determination of the importance of management systems and styles to creating an organization where innovation is enabled would be discussed. Innovation is a process of creative change with a clearly defined purpose of improving a current system or operating process to attain maximized potentials of resources towards a higher level of growth. As a process, innovation needs the application of effective strategies for improved performance. It accurately defines specific aspects to be addressed: a weakness, a threat, a gap in an organization’s current operating system or structure and outlines alternative courses of action that presents possible and viable solutions to the identified dilemma. Innovation, as a change process, is designed with the vision to increase the satisfaction of the organizations’ target market and thereby contribute to the maximization of organizational goals. Innovation is the â€Å"process by which an idea or invention is translated into a good or service for which people will pay. In business, innovation results often from the application of a scientific or technical idea in decreasing the gap between the needs or expectations of the customers and the performance of a firms products† (Business Dictionary, 1). vaccine against market slowdowns and an elixir that rejuvenates growth† (Rigby, et.al, 79). The authors compared innovation to evolving changes in a fashion industry requiring continuous reinvention of product line,

Rainbows, Mirages, and the Green Flash Essay Example | Topics and Well Written Essays - 250 words - 2

Rainbows, Mirages, and the Green Flash - Essay Example On that point rainbows are formed when white light from the sun travels through the raindrops. Apparently, dispersion occurs, which is the separation of white light into its constituent colors as a result of the refraction. Notably, if one needs to see the rainbow, one must look towards the sun. Essentially, the level of the sky does not matter, however, the colours appears at different parts of the sky for instance red appears on the high sky an violet on the lower. On that point, the secondary rainbow occurs when the colours in the raindrop after being refracted are reflected twice and it appears above the primary rainbow. On the contrary, supernumerary arcs can be defined as the shades of pink and green observed under the primary rainbow. Mirage can be defined as the phenomenon of bending light travelling into the warmer low density medium to the ground. Evidently, the inferior medium is commonly observed in the desert and this form of refraction makes hot, dry surfaces appear wet. In addition, superior mirage occurs when the air next to the ground is cold and thus rays are bent away from the ground. Incidentally, we can distinguish superior and inferior mirages by their effect, for instance, inferior mirages, cause an inverted image of the object on the ground while in superior, the image appears upright, in other words makes mountains appear longer. Lastly, green flash occurs when the sun is setting and it involves the bending of light in the upper atmosphere. Notably, the bending is usually exaggerated. It is worth noting that the occurrence is hard to spot. Notably, I have never seen the phenomenon. To this end, refraction has vast application in nature, thus an interesting topic to study. The formation of rainbows, mirages, and the green flash. (2005, September 14). The formation of rainbows, mirages, and the green flash. Retrieved April 28, 2014, from

FOUNDATIONS FOR RESEARCH 2 Essay Example | Topics and Well Written Essays - 3500 words

FOUNDATIONS FOR RESEARCH 2 - Essay Example (2009), reducing anxiety in adults though the relaxation-breathing techniques has been used severally and proved through clinical trials as being effective in the production of good asthma outcomes. It is true that all research works aims at bridging a certain gap in information in less researched areas. In this case, more evidence will prove the importance of using such interventions in asthmatic children. The article was properly titled while the contents are in line with the title. This is proved by performing a search on the article using the key words like relaxation, breathing, asthma, trial, controlled etc. The research report abstract has enough information and readers can determine if the research has enough evidence to qualify it as being relevant. It is an overview which is visible since it is concise and brief and has all key findings articulated by the researcher. The abstract captures all key elements of the research work. In brief, the research abstract gives the resea rchers objectives which include evaluation of the effectiveness of combined self-management and relaxation breathing training for children with moderate-to-severe asthma compared to self-management-only training (Li-Chi Chiang et al. 2009), the research background, the methodology, the design, the sample and the results. A good abstract has to contain all the above as it summarizes the researchers assertions in a nutshell and makes it easier for many to understand the research work without flipping each page as Alasuutari, P. et al. (2008) puts it. An important part included here is the background part. This is key in any research work as it gives the information gap which forms a justification for the research. The authors start by first explaining Self-management programs, there use, when they have been used and their successes. Further, it gives perceptions towards their use and gives an indication that if used on children, then successes can be realized. At the end of the abstra ct, the researchers gives a summary of the findings from the analyzed data concluding that a combination of self-management and relaxation-breathing training can reduce anxiety, thus improving asthmatic children’s health. These results can serve as an evidence base for psychological nursing practice with asthmatic children (Li-Chi Chiang et al. 2009). In addition, the authors further gives the addition knowledge contributed to by the paper and the gap it attempts to fill, its relevance and its application and integration into the existing knowledge base. In the research study report, the independent variable were combined self-management and relaxation-breathing training for children and self-management-only training while the dependent variable was severity of asthma and are specified in the report abstract. In the study report, the researchers report that data on anxiety levels, self-perceived health status, asthma signs/symptoms, peak expiratory flow rate, and medication u se was collected. Here the independent variables are anxiety levels, self-perceived health status, peak expiratory flow rate, and medication use while the dependent variable is asthma signs/symptoms. Other important considerations made on the data included interaction effects among the two groups and research timelines. The impact of interactions at times is enormous such that its omission leads to un-biased results. It is always important to tell in

The Significant Level of Success of Marks and Spencer Stores Research Paper

The Significant Level of Success of Marks and Spencer Stores - Research Paper Example In viewing the resources of the company, it is important to determine the assets that Marks and Spencer have at present. Although the data only provides consolidated assets, it is sufficient to define the capacity of the company to improve its performance. Overall, the assets of the company are higher than the total liabilities. The net assets of the company have increased from 2005 to 2006. This shows that the company continues to acquire resources that are vital for the company. The figures may its entirety, but the impact in the food retail sector is expected to be felt (Marks and Spencer, 2006). One significant observation that can be made is that the company has a wide range of quality food sources. This is in references to the responsible food sourcing that the company adopts. The supplies of the company are considered as one of its valuable resources. Because of its outstanding food production materials, the quality of the finished products has improved. Boosting the food with the finest inputs allow the company to effectively satisfy the needs of the consumers. Subsequently, quality sources also make the company more cost-effective. Another important resource of the company is its identity. This is established through the brand name of Marks and Spencer. Despite some criticisms, the brand has gained the distinction of being the most trusted retailer in the UK. Over the years, the brand name has been embraced in different areas of the world. The credibility of the company is one of its intangible resources that deserved to be recognised.

Probability in Healthcare Assignment Example | Topics and Well Written Essays - 250 words

Probability in Healthcare - Assignment Example Treating variation for time spent on Physical Education is evident that it offers health benefits to elementary schooling going children. The experiment was done to 300 elementary school going children from different schools. The probability of P.E reducing obese was 0.8. This was considered a positive significance and the probability was close to one. Thus, it was depicted that Physical education plays a significant role in reducing the rate of obesity among children. The researchers also identified a gender difference: additional Physical education reduces weight three times more than to girls of the same age. The explanation behind these results is that PE among other physical activities is complements for boy child (Increased PE makes boys to be more active), but substitutes for girls. The researcher further stated that the challenge was to ensure more girls take part in physical activities in order to reduce their obese rates. Thus, elementary schools should consider adding more time to Physical education classes to increases the probability of curbing obesity amongst school going

Molarity and Percent Solution Lab Essay Example for Free

Molarity and Percent Solution Lab Essay Objective: The objective of this lab was to determine the molarity and percent solution of a solution with an unknown concentration. Background: Molarity is the number of moles of a solute per liter of a solution. Percent solution is the percentage of a solute in a specific mass or volume of a solvent. A solute is a solid that gets dissolved in a solvent or a liquid that is a smaller amount than the solvent. A solvent is a liquid that dissolves the solute and it always is a larger amount. Solvation is when solute particles are surrounded by solvent molecules. A lab technique that was used during the lab was to boil the solution in order to separate the solute from the solvent. Materials List: 10mL graduated cylinder Solution with unknown concentration Hot plate Pipette Hot grip Scale 100mL beaker Procedure: 1. Obtain the solution with the unknown concentration from Mrs. Magdaleno. 2. Measure the volume of the solution by pouring it in the 10mL graduated cylinder. Use the pipette to take out solution in the graduated cylinder until the volume was at 6mL. Record it in the data table. 3. Measure the empty 100mL beaker using the scale. Record it in the data table. 4. Pour the solution in the 100mL beaker. 5. Find the mass of the beaker and solution using the scale. Make sure to subtract original beaker mass from the mass of the beaker and solution. 6. Boil the solution to separate the solute from the solvent by using the hot plate set to nine. 7. Once all the water has evaporated use the hot grips to remove the beaker from the hot plate and let cool. Find the mass of the beaker and solute using the scale. Make sure to subtract beaker mass from the beaker and solute mass. 8. Use the data from the data table to solve for molarity and percent solution. Observations: The water started to boil and evaporate when it was on the hot plate. It smelt like the salt was burning. Some salt spilled out on the lab station when the water completely evaporated. Data Table: |Volume of solution (L) |6mL=0.006L | |Mass of beaker (g) |68.95g | |Mass of solution and beaker(g) |75.06g | |Mass of solution(g) |6.12g | |Mass of solute and beaker(g) |69.41g | |Mass of solute(g) |0.46g | Results: A: Molarity B: Percent Solution Conclusion: The molarity that was calculated for the unknown solution was 1.31M. The percent solution that was calculated for the unknown solution was 7.52%. A procedural that would have led to a lower concentration value was when some salt spilled out onto the lab station after all of the water had evaporated from the beaker. Another error that would result in a higher concentration would be if the beaker was not dry when the mass was measured with the scale. Something that could be done differently to lead to a more accurate concentration would be to take the beaker off the hot plate sooner and not let the salt sit and burn or come out of the beaker.

Examining Benefits of Free International Trade

Examining Benefits of Free International Trade Naveen Prabhu Kamalasekaran 2 (a) Explain why free international trade can be good for countries’ economies and examine the attempts to reduce trade barriers in the past decade To start with, let us find what international trade is all about then we will figure out how this could be good for economies and what are the attempts that were made in the last decade to bring down those trade barriers. Free trade is purchase of goods or services between two countries without any restrictions like tariff, duties or quotas. There are two theories related to free trade and the first of that kind was by Adam smith who postulated that trade between two nations happens on ‘absolute advantage’ . Law of absolute advantage states that when one nation is more efficient than the other trading nation in producing commodity one but less efficient in producing commodity two, then both nation should specialize on the product that gives them absolute advantage and export that to their trading partner (Salvatore 2004). However, it doesn’t highlight on the opportunity cost that it incurs in taking absolute advantage. Later, ‘Comparative advantage on opportunity cost theory’ was proposed by Gottfried Haberler which states that a country has comparative advantage over the other in production of goods if it can produce at lower opportunity cost (Sloman 2007). The law can be better explained with the below table. Hours to make one unit Opportunity Cost EU Cars 30 6 TVs TVs 5 1/6 car UK Cars 60 10 TVs TVs 6 1/10 car Source: Begg and Ward (2009) The above tabe clearly shows that the UK has comparative advantage over EU in TV as it has got 1/10 th of car as oppurtunity cost compared to 1/6th in EU . Similarly, EU has advantage over UK in Cars and its oppurtunity cost is 6 TVs comparted to 10 TVs in UK. As EU is ready to trade above 6 TVs and UK ready to buy anything less than 10 TV then there should be an equlibrium for international prices for car (Begg and Ward 2009). Graph 1 Source: Begg and Ward (2009) International trade is propelled by comparative advantage but what is the source behind that? Differences in climate, geography and natural resources, difference in factor endowment and difference in technology are the few sources behind that (Krugman and Wells 2005). The key advantages of free trade are explained below Decrease in cost: Specializing in an industry helps to gain the economies of scale which results in comparative cost benefit. For example, Boeing is able to produce aircrafts more effectively and cheaply because it could sell large portion of it to other countries. The importing countries get benefited as they could get the product cheaply than it was produced domestically. Increase in competition: As a result of trade, imported goods enter the market which triggers competition against domestic players and it increases efficiency and innovation of home products. Consumers on the other hand get benefited by the variety of products available to them. Trade as engine of growth: When the exports have high income elasticity of demand, it provides economic stimulus to exporting country. For example, most developed countries experienced huge growth and trade has been the engine for this. India which has achieved which experienced growth from 38% in 1995 to 52% in 2005 (Department of State n.d). Trade raises income: Reduction in trade barriers results in increase in incomes, both personal and national. Recently economists estimated that cutting trade barriers in agriculture, services and manufacturing by 1/3rd would boost world economy by $613 billion (WTO n.d, a) . Non-economic advantage: Trade helps to resolve disputes and promotes peace. Trade war of 1930 which resulted in high trade barriers to protect domestic economy leads to Great depression and played a role in World War 2 (WTO n.d, b). In order to embrace the benefits of free international trade, world countries decided to drop their trade barriers like custom duties, quotas, subsidies on local products, etc.,. The advent of free trade materialized post Second World War and in the year 1947, 23 countries together formed General Agreement on Tariffs and Trade (GATT) which was later replaced by WTO (World Trade Organization) on 1955 with 159 members till date. Following WTO numerous trade blocs were formed based on regional groupings and they are NAFTA, APEC, EU and G20.Following paragraphs will detail about the bilateral, regional and multilateral trade attempts made to reduce the trade barriers. Multilateral trade agreements are made between many countries at a same time. Example of that is DDA (Doha Development Agenda). It is the latest round of trade negation with the WTO members. It was officially launched in November, 2011 with an objective of achieving major reforms on global trades by reduction in trade barriers and revised trade rules (WTO, n.d c). The talks were primarily centered on opening of agricultural markets as trade barriers for agricultural products are higher than other products. Developing countries apply high tariffs to protect their local farmers. After numerous rounds of talk, DDA collapsed on July 2008 as developed countries failed to agree the developing countries access to each other market (BBC 2011). Bilateral trade enables exchange of goods and services between two countries and enables preference of tariff and quota free trading. An example for that is, in November 2007, Japan signs bilateral trade agreement with ASEAN (The Association of South East) which was totaled more than 160 billion a year. It was said, trade barriers will be removed within 10 years for six richest members of ASEAN and up to 18 years for four poorest countries. This pact excludes export of agricultural products like beef, rice and other dairy products to Japan due to powerful farm lobby (Burton 2011). World’s largest free trade agreement which is yet to materialize between US and EU, started 12 years back. Issue here is the farm trade, as EU imposes high sanitary barriers to American beef exporters and banned hormone-fuelled beef and pork. In response, US banned EU beef on the ground of mad cow disease scare a decade ago. Many businesses on both the sides of Atlantic are looking forward for the success of this pact to reduce the tariff and to smooth the regulatory regimes (Chaffin and Politi 2013). 2 (b). What negative effects might free international trade have upon countries’ economies, and why countries adopt protectionist policies? Countries exhibit protectionist measures though there are advantages in the international free trade. The arguments behind restriction of trade are as follow – to protect infant industries, to reduce dependency on goods with little potential, to protect industry of national interest, to prevent dumping of imported goods, international cartels, to eliminate monopolize of foreign products, to avoid global fluctuations , to prevent harmful imports , to safeguard environment (Sloman 2007 , Begg and Ward 2009). As part of trade protection, countries raise barriers by imposing tariff, quotas, subsidies and embargoes to name a few .The brief descriptions of all the above mentioned arguments against international trade are explained in the following paragraphs with suitable examples. Infant-industry argument: If a country feels for any particular product it produces has potential competitive advantage but it’s still at the initial stage of development, it tries to protect that by trade barriers. Protection from foreign competition will help these companies to grow and to become efficient (Salvatore 2004). An example to support this argument would be, Ghana which has immense natural wealth but suffers from poverty and unemployment due to influence of international policies and lack of protection for its infant industries. It was highlighted that lot of developed countries earlier had higher tariff’s to protect their infant industries which made them grow stronger (Spy Ghana 2013). Reduce dependency of material with less dynamic potential: Developing countries generally export raw materials and food stuff which are primaries and experience inelastic price changes. It leads to slow growth and it doesn’t drive growth as promised by international trading. Outcome of this would be they are handicapped from exploiting the advantage of manufacturing the product out of those raw materials and exporting it which has higher price elastic demand (Sloman 2007). European countries try to deprive Nigeria to develop value addition sector of Cocoa by imposing high import taxes on products of cocoa whereas raw cocoa are encouraged at zero import duties (This Day Live 2013). Protecting industries of national interests: A country might support one particular industry as it feels that to be very important for its economy and it doesn’t want to be dependent on any other country for the same at the later stages. Government patronages those industries by providing incentives and make them efficient (Begg and Ward 2009). Example: Japan patronages its agriculture industries from trading though it was pressurized by America to drop off the tariff on its agricultural products as part of Trans-Pacific-Partnership (TPP) agreement which Japan about to sign. Currently Japan imposes 800% tariff on imported rice and the agriculture industry receives the state patronage of 1.1 % of GDP (Harner 2011). Dumping of Goods: Dumping is the export of commodities at very low cost compared to its cost domestically. It results in driving out the foreign producers out of business abroad and establishes monopoly power. There are two types of dumping and they are ‘Predatory dumping’ in which prices are lowered in abroad for a temporary period until it drives out the competitors and achieves monopoly. The other type is called ‘Sporadic dumping’ in which sale is occasional to unload the unforeseen or temporary surplus. Normally countries counter-attack this practice by imposing antidumping duties to offset the price difference (Salvatore 2004). Recently, Vietnam imposed antidumping duty of 14.38 % on one of the Malaysian cold-rolled stainless steel coils exporter following the POSCO VST’s claim of reducing their domestic business (FMT 2014). International Cartels: They are the group of suppliers of a product who are located in different countries and agreed to restrict output and export of commodities in order to increase their total profits. Practicing these cartels is illegal domestically in most of the countries (Salvatore 2004). Recently 21 Japanese auto suppliers caught in a price-fixing and bid-rigging scandal as they conspired to fix prices of instrument panel clusters sold to US from April 2008 to February 2010. These companies involved in this scandal were charged with ransom of $4.56 million to consumers and executives of those firms were sentenced to prison ranging from 14 to 19 months (Shepardson 2014). Monopoly of imported goods: Tough competition by imported goods drives domestic players out of the market and gives monopoly. This results in increase in prices resulted due to misallocation of resources. Governments try to protect country from such occurrences by adoption of strategic trade policy by which it provides comparative advantage through trade protection, subsidies and government-industry programs in the high technology fields or industries that are crucial for future success. Classical example for the strategic trade policy would be, Japan’s semi-conductor breakthrough in mid-1980‘s which was earlier dominated by US in the 1970’s. Japan’s ministry of trade and industry targeted this industry, financed in research and development and fostered government-company cooperation to protect it from foreign completion (Salvatore 2004). In-line with the above arguments on protectionism, tariff, quotas and subsidies are methods for government to collect revenues, protect jobs in the domestic market and to increase production. Of the three methods, tariff is the most important type of trade restriction. It’s generally expressed as fixed percentage of value of the traded commodities and called as ad valorem tariff. Find below graph that details the impact of tariff on imported goods and producer, consumer surpluses. Graph 2: Source: Economicsonline n.d Table2 Without any trading, price and quantity of a product were P and Q. If country opens up its market, the global price of the product will be at P1 which is lower than the equilibrium and the output increases from Q to Q2. This increases the consumer surplus and decreases the domestic supplier surplus. Government imposition of tariff lifts the world supply curve to shift upwards at a new price of P2. The import falls between Q3 to Q4 and domestic supply increases from Q1 to Q4. This condition results in fall of consumer surplus and increase in domestic supplier surplus and makes consumers to pay higher price which benefits both the supplier and the government by increased producer surplus and tariff revenue respectively. (Economicsonline n.d) Quotas: It’s the non-tariff based barrier which restricts the imports quantitatively. It’s mainly used to protect agriculture and to stimulate import substitution of manufactured products. An example for quota is , China allows 894,000 tons of cotton imports with a duty of 1% and currently it has increased its sliding scale tariff from 14,000 yuan to 15,000 yuan per ton to clear its fiber stockpiled in domestic reserves (Economic Times 2013). Subsidies: It is the benefit given by the government to particular industry in the form of cash or tax reduction to make production cheaper for the domestic industry. To fund subsidy for an industry, government spreads taxation across the tax payers. Graph 3: Source: Begg and Ward 2009 Table 3 Introduction of subsidy pushes the supply curve to the right from UKS1 to UKs2. The price to the consumers remains the same but the import falls from QD to QD1 where the domestic supply increase from QS to QS1. (Begg and Ward 2009) Thus, negative effects of free trade have been discussed with a highlight of different trade barriers that countries impose to save domestic industries from import. References BBC (2011).World trade talks end in collapse. [online] Available at http://news.bbc.co.uk/1/hi/7531099.stm [Accessed: 7/1/14]. Begg, D. Ward, D. (2009).Economics for business. 3rd edition. London: McGraw-Hill. Burton, J. (2011). Japan agrees bilateral trade pact with ASEAN.Financial Times.22 November 2006. [Online] via Proquest Available at http://search.proquest.com/docview/250051960?accountid=17193 [Accessed 6/1/14] Chaffin, J. Politi, J. (2013). Cuts both ways. Financial Times. 18 April 2013 [online] via Proquest Available at http://search.proquest.com/docview/1328470674?accountid=17193 [Accessed: 13/1/2014]. Department of State (n.d).International trade as an engine of growth for development. [online] Available at http://2001-2009.state.gov/e/eeb/rls/othr/2008/106389.htm [Accessed: 7/1/14]. Economicsonline (2014).Trade protectionism. [online] Available at http://www.economicsonline.co.uk/Global_economics/Trade_protectionism.html [Accessed: 7/1/14]. FMT: Free Malaysia Today (2014). Viets impose anti-dumping steel tariff. 7 January 2014 [online] Available at http://www.freemalaysiatoday.com/category/business/2014/01/07/viets-impose-anti-dumping-steel-tariff/ [7/1/2014]. Harner, S. (2011).WTO critique of Japanese agriculture. Forbes. 17 February 2011 [online] Available at http://www.forbes.com/sites/stephenharner/2011/02/17/wto-criticique-of-japanese-agriculture/ [Accessed: 6/1/14] Salvatore, D. (2004).International economics. 8th Edition. Crawfordsville: John Wiley Sons, Inc. Shepardson, D. (2014). Japanese auto supplier agrees to settle price-fixing civil suit. Detroit News. 7 January 2014 [online] Available at: http://www.detroitnews.com/article/20140107/AUTO01/301070060/Japanese-auto-supplier-agrees-settle-price-fixing-civil-suit?odyssey=mod|newswell|text|FRONTPAGE|p [Accessed: 7/1/14] Sloman, J., and Hinde, K. (2007). Economics for Business. 4th Edition. Harlow: Pearson Education Limited. Spy Ghana (2013).What ghana needs now is an economic revolution. 19 December 2013 [online] . Available at http://www.spyghana.com/what-ghana-needs-now-is-an-economic-revolution/ [Accessed: 7/1/2014]. The Economic Times (2013).China cotton import costs to rise under adjusted tariffs. 16 December 2013. [online] Available at http://economictimes.indiatimes.com/news/international/business/china-cotton-import-costs-to-rise-under-adjusted-tariffs/articleshow/27469107.cms [Accessed: 13/1/14]. This Day Live (2013). The Case for Cocoa Value Addition in Nigeria. 3 September 2013 [online]. Available at http://www.thisdaylive.com/articles/the-case-for-cocoa-value-addition-in-nigeria/157985/ [Accessed: 6/1/14]. WTO (n. d.a).Trade raises Incomes. [online] Available at http://www.wto.org/english/thewto_e/whatis_e/10ben_e/10b06_e.htm [Accessed: 13/1/14]. WTO (n. d.b).The system helps to keep the peace. [online] Available at http://www.wto.org/english/thewto_e/whatis_e/10ben_e/10b01_e.htm [Accessed: 13/1/14]. WTO (n. d. c). The Doha Round. [online] Available at http://www.wto.org/english/tratop_e/dda_e/dda_e.htm [Accessed: 7/1/14]

First and Second Language Acquisition Essay -- Biology Essays Research

First and Second Language Acquisition In our everyday lives, the origin of our ability to communicate is usually not often taken into consideration. One doesn't think about how every person has, or rather had at one time, an innate ability to learn a language to total fluency without a conscious effort – a feat that is seen by the scientific community "as one of the many utterly unexplainable mysteries that beset us in our daily lives" (3).. Other such mysteries include our body's ability to pump blood and take in oxygen constantly seemingly without thought, and a new mother's ability to unconsciously raise her body temperature when her infant is placed on her chest. But a child's first language acquisition is different from these phenomena; different because it cannot be repeated. No matter how many languages are learned later in life, the rapidity and accuracy of the first acquisition can simply not be repeated. This mystery is most definitely why first language acquisition, and subsequently second language acqu isition, is such a highly researched topic. On the surface one would look at child first language acquisition and adult second language acquisition and see similarities. In each case the learner first learns how to make basic sounds, then words, phrases and sentences; and as this learning continues the sentences become more and more complex. However, when one looks at the outcomes of these two types of acquisition, the differences are dramatic. The child's ability to communicate in the target language far surpasses that of the adult. In this paper differences in these two processes that most always produce such different outcomes will be explored. Before this exploration begins, however, I would like to state ... ... learning. In conclusion, because of so many varying factors, both the processes and outcomes of child first language acquisition and adult second language acquisition are extremely different, and are only connected by a common goal. References 1)Comparing and Contrasting First and Second Language Acquisition http://www.literature.freeservers.com/image_polat/ccfsla.html 2)First and second language acquisition http://homepage.ntlworld.com/vivian.c/SLA/L1%20and%20L2.htm 3)First Language Acquisition http://www.csun.edu/~galasso/lang1.htm 4) Gass, Susan M., Larry Selinker. Second Language Acquisition. London: Lawrence Erlbaum Associates Publishers, 2001. 5)Reviewing First and Second Language Acquisition: A Comparisono between Young and Adult Learners http://www.nuis.ac.jp/~hadley/publication/languageacquisition_files/language/acquisition.htm

Women Must Unite to End War :: Feminism Feminist Women Criticism

War, war machines, jihad. These words have entered the vocabulary of everyday practice during the past twenty years. They mark a new stage in the discourse of Empire, what Hardt and Negri call a global project of network power, that knits the world together in a dynamic fabric of exchange, flows but also of conflict. 9-11 was a catastrophic example of the ways in which the threads in this fabric tighten and break. American citizens felt for the first time how the apparently innocent business of moneymaking in New York City and of policymaking in Washington DC are seen as criminal elsewhere. The daily deals struck in the financial and military-political capitals of the U.S. have direct and mostly negative consequences for most of the rest of the world. These consequences are invisible to the average American citizen, they are searingly obvious elsewhere. 9-11 has a long history going back through the Gulf War to the establishment of Israel in 1948. It is a history that spans the length of the Cold War and is witness to the growing suspicion and fear of U.S. policies in the region. Indeed, the last great battle of the Cold War took place in a dry dusty landlocked backwater called Afghanistan. Having been chosen for this showdown between the two superpowers placed Afghanistan squarely on the stage of world history. It is hard to know who got there first, to find the origins of the last great battle of the cold war. One version, which I find compelling, has it that when, on December 24, 1979, the Soviets invaded and took over rule of the country with the help of Afghan tribesmen in the north, they were not venturing into virgin territory. Six months earlier, President Carter had signed the first directive for secret aid to the opponents of the pro-Soviet regime in Kabul. Zbigniew Brzezinski claims in a Jan. 15-21, 1998 interview for the French "Le Nouvel Observateur" that the U.S. government "didn't push the Russians to intervene, but we knowingly increased the probability that they would." The CIA recruited Afghan tribesmen separated from their birthplaces by war and displaced into dehumanizing refugee camps where religious education provided their only anchor. The U.S. government armed these men with guns and capitalist ideology and they won. The U.S. declared the Soviets defeated, the cold war over, and their warriors were left to fend for themselves.

Rate of Isomerism of [Co(en)2Cl2] Essay

In the course of this experiment the rate of isomerism for the coordination complex cis[Co(en)2Cl2]Cl was determined using UV/Vis spectrometry. Using a range of wavelengths the optimum spectrometer setting for analysis was identified. The corresponding maximum and minimum absorbance of the cis and trans isomers respectively at 540 nm meant that it was selected as the wavelength to determine the rate of conversion between the isomers. The first order rate constant was calculated to be 0.0092 m-1 which is somewhat similar to the literature value of 0.00845 m-1 (Brasted and Hiriyama 1958). The half-life (t 1/2) was found to be 75.34 minutes. Introduction: The compound [Co(en)2Cl2]+ is known as a coordination complex, that is, it consists of a Cobalt atom surrounded by an array of molecules to which it is bound, called ligands (Brown 2010). In this case the ligands are Ethylenediamine which are ‘bidentate’, meaning bound in two locations. These ligands are bonded between the two Nitrogen atoms as seen in figure 1 below. This complex occurs in two geometric isomers, cis-[Co(en)2Cl2] + and trans-[Co(en)2Cl2] +. In this experiment the Chloride salt form of the complexes were used i.e. cis-[Co(en)2Cl2]Cl. Figure 1: The Trans and Cis isomers of [Co(en)2Cl2]+ Source: Shapter ,J. 2014 Experiment 1: Rate of Isomerism cis[Co(en)2Cl2]Cl, Flinders University, Australia The Cis- isomer form of the complex which is purple in solution reacts to form the Trans- isomer which is green in solution. This experiment uses spectroscopy to quantify the conversion of the Cis into the Trans isomer due to the fact that the concentration of the Cis isomer is proportional to the difference in absorbance of the two complexes in solution. This isomerism of the Cis-form is a first order reaction and its rate is expressed in equation 1 below. Equation 1: By measuring the optical densities at time 0, t and infinity the rate constant k can be determined with equation 2, a rearranged and substituted form of the formula used above. Equation 2: a) Which rearranges to give: b) Experimental: Solutions of 2 Ãâ€" 10-3 M Cis- and Trans-[Co(en)2Cl2]Cl were prepared and placed in volumetric flasks of 100 ml and 10ml volumes respectively. Samples of these solutions were placed in cuvettes and measured in a spectrometer over the range of wavelengths between 350 and 700 nm. The Varian Car 50 UV-Vis spectrometer recorded the absorbance of the two isomers and produced a print out which was used to identify the correct wavelength for further spectroscopy (see Appendix 1). Using the SP – 880 Metertech spectrometer, the absorbance was measured and recorded as seen in Table 1. Next the Cis isomer solution was warmed in a water bath at 40 degrees Celsius and a sample was taken and cooled in an ice bath. The absorbance of the sample was then measured using the wavelength previously selected. This was repeated at ten minute intervals for an hour. Finally a last sample of the cis[Co(en)2Cl2]Cl was analysed with the spectrometer 24 hours after to determine the value. Results: Table 1: Absorption of the Two Isomers at Various Wavelengths Wavelength (nm) Cis Trans 350 0.468 0.144 360 0.289 0.090 370 0.207 0.087 380 0.180 0.091 390 0.170 0.091 400 0.466 0.397 410 0.123 0.070 420 0.092 0.057 430 0.066 0.049 440 0.049 0.047 450 0.041 0.048 460 0.043 0.048 470 0.049 0.045 480 0.061 0.039 490 0.076 0.031 Wavelength (nm) Cis Trans 500 0.093 0.025 510 0.110 0.020 520 0.124 0.017 530 0.134 0.017 540 0.137 0.020 550 0.134 0.025 560 0.129 0.034 570 0.122 0.044 580 0.116 0.055 590 0.065 0.109 600 0.102 0.071 610 0.095 0.075 620 0.085 0.074 630 0.073 0.067 640 0.060 0.055 650 0.049 0.049 660 0.035 0.038 670 0.026 0.028 680 0.018 0.020 690 0.013 0.013 700 0.009 0.008 Figure 1: Absorbance against Wavelength of Cis and Trans Isomers Table 2: Absorbance of Cis Isomer at 540 nm Time (min) Cis Abs ln[Dt-D∞] y = -0.01104 X – 2.40936 10 0.117 -2.51331 -2.519758607 20 0.108 -2.63109 -2.630158414 30 0.100 -2.74887 -2.74055822 40 0.093 -2.8647 -2.850958026 50 0.089 -2.93746 -2.961357833 60 0.082 -3.07911 -3.071757639 t ∞ 0.036 Figure 2: Natural Logarithm of the Cis Isomer Absorbance against Time Table 3: Slope, Y intercept and Regression Error Generated by Linest Function -0.01104 -2.40936 0.00036364 0.014162 0.995679 0.015212 921.711268 4 0.21329205 0.000926 Calculations: Mass of Cis Isomer Required to Make 2 x 10-3 M 100ml M = Mass/(Volume Ãâ€" Molar Mass) Mass req. = 2 Ãâ€" 10-3 Ãâ€" ((100/1000) Ãâ€" 285) = 57mg Mass of Trans Isomer Required to Make 2 x 10-3 M 10ml M = Mass/(Volume Ãâ€" Molar Mass) Mass req. = 2 Ãâ€" 10-3 Ãâ€" ((10/1000) Ãâ€" 285) = 5.7mg k k = (ln[D0-D∞] -ln[Dt-D∞]) / t k = 0.0092 m-1 ln[Dt-D∞] ln[D0-D∞] -3.0718 -2.5198 Half life t 1/2 = ln[2/k] = 75.3422 min Error Propagation: Measured weight of isomers Cis 56.7mg Trans 5.7mg Resolution of Scales ‘Satorius Extend’: 0.1mg Volumetric glassware 100ml  ± 0.1 ml ‘A’ Class 10ml  ± 0.025 ml ‘A’ Class Discussion: Methanol was used as a solvent in this experiment to avoid the chemical interactions that may have occurred had water been used in its place (Mahaffy 2011). In the initial solution of the Cis isomer accuracy wasn’t as important as it was being measured to find the optimal wavelength for analysis as seen in Figure 1 and Appendix 1. Preparation of the Cis Isomer solution measured to produce Figure 2 required a mass of the compound as close as possible to the calculated amounts (See Results – Calculations) in order to produce results that allowed for the accurate determination of the rate constant (k) and half-life (t1/2). The relationship between k and t1/2 is that k is a factor in the formula of t1/2 (See Results – Calculations) and determines what unit of time that the half-life is expressed in (in this case minutes-1). Figure 1 plots the absorbance of the two isomers against the various wavelengths from 350nm 700nm. From this graph the wavelength of 540nm was id entified as the ideal to be used to determine the reaction rate of the isomers. This was due to the local maxima of the Cis isomer at this  point which coincides with the local minima of the Trans isomer. This data is confirmed by the printout of the Varian Car 50 UV-Vis spectrometer which also marked the 540nm point on its plot (see Appendix 1). This clear difference in absorption of the two isomers at this wavelength meant that the rate of inter-conversion could be determined. The graph of the natural logarithm of the absorbance of the Cis isomer against time can be seen in figure 2. By observing the points on the plot a straight line of decay confirms that this reaction is first order, a logarithm of the measured absorbance values (Christian 2010). Calculations were carried out on the data in table 2 to determine the k and t1/2 (see Results – Calculations). The k value calculated of 0.0092 m-1 roughly matches the figure generated by the linest function 0.01104m-1 (see Table 3, top left) and is also similar to the literature value of 0.00845m-1. With the calculated k value of 0.0092 the t1/2 was determined to be 75.3422 minutes. Slight variations between the k value calculated from the points in figure 2 and that generated by the linest function can be accounted for by the fact that the linest function is a calculate d line of best fit and so does not fit the data points collected exactly but is an approximation. The slight difference between the literature value of k 0.00845m-1 and the calculated k of 0.0092m-1 can be accounted for by human error in time, volume and mass measurement. The range of error in this measurement is  ±0.00075 which is the difference between the calculated and literature values. Conclusion: In this experiment the rate constant (k) was determined to be 0.0092m-1  ±0.00075 and the t1/2 was calculated to be 75.3422 minutes. References: Brasted, R. Hirayama C. 1958 The cis-trans Isomeration of Dichlorbis-(ethylenediamine)-cobalt(III) Chloride and Dichlorbis-(propylenediamine)-cobalt(III) Chloride in Alcohols, Journal of Chemistry, Department of Chemistry, University of Minnesota. Vol. 80 pp 788 – 794. Brown, T. LeMay H. Bursten, B. Murphy, C. Langford, S. & Sagatys D. 2010. Chemistry: The Central Science, Pearson, Australia. pp 1196 – 1197. Christian, G. 2010. Analytical Chemistry 6th Ed., John Wiley & Sons, USA. pp 159, 270 – 271. Mahaffy, P. Bucat, B . Tasker, R. Kotz, J. Treichel, P. Weaver, G. & McMurry, J. 2011. Chemistry: Human Activity, Chemical Reactivity, Nelson Education, Canada. pp 99, 115 – 116. Appendices: Appendix 1: Figure 3: Absorbance of Cis and Trans Isomers at Various Wavelengths (Varian Car 50 UV-Vis spectrometer)

Case Analysis of Mdd, Gad, and Substance Use

Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Nicole Gapp University of Minnesota School of Nursing Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Major Depressive Disorder (MDD) is a mood disorder with symptoms that greatly affect the life of the individual. MDD could in fact be called a public health crisis, as it is projected that it will soon overtake heart diseases as the major worldwide health concern (Boyd, 2008).Diagnostic criteria for MDD are depressed mood or loss of interest or pleasure in nearly all activities, present for at least 2 weeks. Findings and behaviors associated with MDD are disruption of sleep, suicidal ideation, feelings of worthlessness and hopelessness, and fatigue and loss of energy. MDD is also associated with a high impairment in occupational, social, and physical functioning, causing as much disability and distress as chronic medical disorde rs (United States Department of Health and Human Services, 1999).MDD has been shown to be associated with increased medical illnesses. MDD can make everyday living a challenge, as research shows that depressive symptoms are associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning (Yen, Rebok, Gallo, Jones, & Tennstedt, 2011). It is important for MDD to be identified and treated early on, as MDD that is not treated appropriately results in recurrent depressive episodes, with each successive episode increasing in severity.As MDD is highly associated with suicidal ideation and suicide, it is imperative that MDD be treated to ensure patient safety. Risk factors for MDD are a prior episode of depression, lack of social support, lack of coping abilities, medical comorbidity, substance use, and presence of life and environmental stressors. In addition, major depression may follow adverse or traumatic life events, especially those that involve the loss of an important human relationship or role in life. Social isolation, deprivation, and financial deprivation are also risk factors (APA, 2002).Genetics play a role in the development of MDD, and deficiency or dysregulation of neurotransmitters are also thought to play a part in its etiology. Psychological theories of MDD hypothesize that an early lack of love and warmth may be involved with the development of depressive symptoms, while developmental and family theorists have proposed that parental loss, emotionally inadequate parenting styles, or maladaptive patterns in family interaction may contribute to the etiology of MDD.Women are twice as likely as men to be diagnosed with MDD, though it is believed that the incidence in men is under-diagnosed. Prevalence rates are unrelated to race (Boyd, 2008). Nursing responses to MDD should involve interventions to treat symptoms within the biologic domain, such as changes in appetite, weight, sleep, or energy, as well as symptoms within the psychological domain, such as changes in mood and affect, thought content, suicidal behavior, and cognition and memory. Many types of interventions are used to treat the varied effects and symptoms of MDD.Pharmacologic interventions, such as selective serotonin reuptake inhibitors, tricylic antidepressants, monoamine oxidase inhibitors, and other classes of antidepressants may be used to decrease or manage depressive symptoms. Medication should be continued for at least six months to a year after complete remission of depressive symptoms. Lifestyle patterns, such as good sleep hygiene, activity and exercise, and adequate intake of well-balanced meals should also be encouraged, as these patterns help the client move toward a healthy daily routine that supports remission or recovery.Psychotherapy, such as cognitive therapy, behavior therapy, and interpersonal therapy, has been shown to be effective in individuals with MDD, and a combination of psychotherapy and pharmacotherapy is recommended for patients with severe or recurrent MDD as a strategy to prevent relapse (Boyd, 2008). In addition, electroconvulsive therapy has been shown to be an effective treatment for MDD, especially severe MDD that has not responded to medications. Major depression frequently occurs in conjunction with ther psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, the co-occurring mental health problem should be treated in addition to major depression (President and Fellows of Harvard College, 2011). The patient described in this case analysis has comorbid diagnoses of generalized anxiety disorder and substance abuse. Generalized Anxiety Disorder is a psychiatric disorder characterized by excessive worry and anxiety with an insidious onset.The anxiety of GAD persists for at least six months, with excessive anxiety and worry occurring for more days than not, and for some individuals, persisting daily. Risk factors for GAD are thought to be unresolved conflicts, cognitive misinterpretations, and multiple stressful life events (Boyd, 2008)). Few studies have examined the genetic basis of GAD, but it is thought to be moderately heritable. In clinical settings, the incidence of GAD is equally distributed in women and men. However, in wider studies GAD is twice as common in women.In no studies has the prevalence of GAD been related to race (Boyd, 2008). Patients with GAD often have associated depressive symptoms, and MDD is a common comorbid disorder. For this reason, there has been debate surrounding whether GAD is a separate disorder than MDD, or if GAD symptoms are part of the course of MDD. However, research shows that many patients with GAD do not present with a distinct MDD symptom profile. This does not support the hypothesis that co-morbidity between MDD and GAD is artificially inflated because of the similar symptom criteria required by th e current diagnostic system.Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait (Sunderland, Mewton, Slade & Baillie, 2010). Current diagnostic criteria state that GAD exists when the excessive worry does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder. For example, a patient who experiences persistent excessive anxiety but has minimal or no depressive symptoms would be diagnosed with GAD (Boyd, 2008). However, research has shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage.One particular study comparing individuals with MDD and individuals with MDD and a comorbid anxiety disorder showed that after adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a r ecurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was also characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts (Seo, Jung, Kim, T. , Kim, J. Lee, Kim, J. & Jun, 2011). Patients with GAD are often highly somatic, with many complaints of physical symptoms. One study concluded that painful physical symptoms in patients with GAD are twice as prevalent as in the control group, which consisted of individuals with neither GAD nor MDD. The presence of comorbid MDD was associated with a significantly higher prevalence of painful physical symptoms. Painful physical symptoms were significantly associated with functioning and health status impairment both in GAD alone and in GAD and comorbid MDD compared with controls (Romera, Fernandez, Perez, Montejo, Caballero, F. Caballero, L. , Arbesu & Gilaberte, 2010). In addition, those with GAD also often experience poor sleep habits, irritability, and poor concentration. Patients with GAD often feel frustrated, demoralized, and hopeless. They often feel restless and on edge and experience clinically significant distress or impairment of functioning resulting from anxiety, worry, or physical symptoms. GAD has a significant negative impact on work functioning, although smaller than the effect of MDD (Plaisier, Beekman, de Graaf, Smit, van Dyck & Penninx, 2010).Interventions addressing symptoms of the biologic domain include eliminating caffeine, diet pills, amphetamines, ginseng, and ma huang, which have all been shown to be anxiety-producing substances (Boyd, 2008). In addition, good sleep hygiene should be promoted, as a common symptom of GAD is sleep disturbances. The nurse should teach the patient breathing control and progressive muscle relaxation as calming techniques, help the patient identify other positive coping strategies, and educate the patient on time management.Pharmacological int erventions, such as the use of benzodiazepines, certain antidepressants, and other non-benzodiazepine anxiolytics may be effective in reducing anxiety. Roughly 75% of those with GAD have at least one additional current or lifetime psychiatric diagnosis, with MDD being one of the more common comorbidities. Alcoholism is also a significant problem associated with GAD. Patients may use alcohol, anxiolytics or barbiturates to relieve anxiety, and this may lead to abuse and dependency. Such is the case of the patient described in the case analysis, who also has a substance-related disorder.The DSM-IV-TR defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress. This impairment may be manifested by recurrent use, resulting in failure to fulfill major role obligations at work or home, recurrent use in situations that are physically hazardous, recurrent substance related legal problems, or continued use despite feeling persist ent or recurrent effects of the substance. To constitute substance abuse, three or more of these manifestations must be present within a 12-month period.In general, men consume more alcohol and abuse drugs more than women, though women are more likely to abuse prescription medication. Substance abuse and dependency are not correlated so much with gender as with an early age of initiation of substance use (Boyd, 2008). Comorbid mental disorders occur often with substance dependence and abuse. For some, comorbid mental disorders are byproducts of long-term substance abuse. Other people have mental conditions that predispose them to substance abuse, with substance abuse becoming a comorbid problem as they use drugs and/or alcohol to self-medicate existing mental illnesses.There is a well-documented association between depression and alcohol abuse and dependence which cannot be explained solely by the random overlapping of these two conditions. A systematic review of 35 studies estimate d the prevalence of current alcohol problems in depressed patients to be 16%, as compared to 7% in the general population. The three most commonly described causal hypotheses for this comorbidity are as follows: 1) an independent depressive episode (e. g. he self-medication theory), 2) alcohol induced depressive symptoms and 3) the existence of shared biological and environmental factors that predispose persons to both (Cohn, Epstein, McCrady, Jensen, HunterReel, Green & Drapkin, 2011). In addition, men with at least four heavy drinking occasions were found to be 2. 6 times as likely to be classified as being depressed as men who drank heavily less than four times in the previous 28  days (Levola, Holopainen & Aalto, 2011). Specific substances that have been abused by the patient who is the subject of this analysis are alcohol, cocaine, heroin, and the prescription drugs oxycodone and Valium.At the time of admission, the patient was no longer regularly using drugs or alcohol, but his history of substance abuse, including overdose, is extensive. Thus, although the patient is already withdrawn from drugs and alcohol, his long-term substance use has significant physical and mental consequences. The depression of the central nervous system by alcohol causes relaxed inhibitions, heightened emotions, mood swings, and cognitive impairments such as reduced concentration and attention, and impaired judgment and memory. In particular, this patient engages in periodic binge drinking, drinking up to 15 drinks in one evening.This alcohol use would result in several days of intoxication, which were interspersed with periods of sobriety. The amount of alcohol consumed in an episode of binge drinking can cause severely impaired motor function and coordination difficulties, emotional lability, stupor, disorientation, and in extreme cases, even coma, respiratory failure, or death. Long-term abuse of alcohol can adversely affect all body systems, and research has shown a conne ction between alcohol dependence and increased risk for diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke (Smith & Book, 2010).Cocaine users typically report that cocaine enhances their feelings of well-being and reduces their anxiety. However, long-term cocaine use leads to increased anxiety. Severe anxiety, restlessness, and agitation are all symptoms or cocaine withdrawal. Withdrawal causes intense depression, craving, and drug seeking behavior that may last for weeks (Boyd, 2008). Valium, a benzodiazepine, is a prescription drug that this patient abused. Patients who abuse benzodiazepines often feel hyperactive or anxious after using them.Often, patients who abuse these drugs combine them with alcohol, putting the patient at risk of coma or death. Symptoms during benzodiazepine withdrawal include anxiety rebound, such as tension, agitation, tremulousness and insomnia, as well as symptoms of autonomic rebound, sensory excitement, motor excitati on, and cognitive excitation, such as nightmares and hallucinations (Boyd, 2008). Opiates are powerful drugs that can quickly trigger addiction when used improperly. Heroin is an opiate that was abused by this patient.Heroin is the most abused and most rapidly acting of all opiates. It can be injected intravenously, and such was the method of delivery for this patient. Heroin produces profound degrees of tolerance and physical dependence. Withdrawal from opiates should be tapered, and if abruptly withdrawn from someone dependent on them, severe physical symptoms may occur, along with nervousness, restlessness and irritability (Boyd, 2008). In addition to heroin use, the patient attempted to commit suicide by overdosing on oxycodone, a prescription opiate.Overcoming substance abuse and preventing relapse can be especially difficult as denial is common in substance abusing patients. Denial is defined as the patient’s inability to accept his loss of control over substance use, o r to accept the consequences associated with the substance use (Boyd, 2008). Because many patients find it difficult or impossible to believe they have a serious problem with drugs and alcohol, many do not seek treatment, or stop treatment prematurely. Motivation is a key predictor of whether individuals will change their substance abuse behavior.Several effective modalities are used effectively to treat addiction, such as 12-step programs, social skills groups, psychoeducational groups, group therapy, and individual and family therapies. Depending on the individual, different treatment techniques will be more or less helpful. History of Present Illness The patient is a 58-year-old Caucasian male who was participating in a partial hospitalization program (PHP) at Hennepin County Medical Center (HCMC) for the treatment of severe major depressive disorder. He has been involved in PHP since his last discharge from the HCMC psychiatric inpatient unit in early March.The patient was coope rative with treatment and medication compliant. He was put on a 72-hour hold after becoming angry and hostile during the PHP group and threatening to hang himself that evening when he got home from PHP. He eventually committed himself voluntarily to the HCMC psychiatric inpatient unit. Upon introduction, the patient appears to be clean, casually dressed, and of normal weight. He is alert and oriented. His attention, cognition, and abstract reasoning are intact, and his thought content is appropriate and organized.In conversation, he is pleasant and cooperative, exhibiting a stable mood and a slightly blunted affect. The patient will talk to staff members but interacts minimally with peers and does not attend groups unless encouraged by staff. The patient has a normal gait but moves quite slowly. In addition it appears that his thought processes are slowed, as he is slow to respond during conversation and seems to have difficulty finding the words to express what he wants to say. The patient appears to have intact recall, short-term, and long-term memory.He appears to be an adequate historian though he exhibits poor judgment due to his depressive and anxious symptoms, as evidenced by his extensive history of drug and alcohol abuse and dependency. The patient has psychiatric diagnoses of severe and recurrent major depressive disorder, generalized anxiety disorder, and polysubstance abuse. The patient has been suffering from MDD with chronic suicidal ideation since age 15. His first suicide attempt was at age 15, and he began abusing drugs and alcohol at approximately the same time.His extensive history of substance abuse includes use of alcohol, cocaine, and IV heroin. His alcohol abuse as a teenager led to a DWI charge. He has participated in mental health outpatient treatment and has undergone chemical dependency treatment numerous times. He completed high school without apparent difficulty. The patient seems to be of average intelligence, though his IQ is not listed in the record. He does not have a history of violent or sexual crime. He has a history of five suicide attempts. He began smoking as a teenager and currently smokes one pack of cigarettes per day.In 1983, the patient married and remained so until his wife died 25 years later, in 2008. He had no children. According to the patient, he was happily married, and he called his relationship with his wife â€Å"the best thing that has ever and will ever happen to me. † While he was married, he got completely clean from drugs and alcohol, remaining drug free and sober for 12 years. Though he struggled with episodes of depression and suicidal ideation, he was able to manage his symptoms with medication and mental health outpatient treatment. Most of my problems faded into the background,† said the patient. During this time, he and his wife bought a condo, and the patient was employed as a janitor and handyman, working at the Minneapolis-Saint Paul airport. He remained at this job for over a decade and was promoted to the position of supervisor. He had, as he said â€Å"everything I ever wanted. † In 2007, his wife became very ill and eventually died in 2008 after complications from a surgery intended to prolong her life. The patient reports that as his wife got sicker, he became increasingly depressed.Unlike in the previous 12 years, medication and outpatient treatment did not seem to manage his symptoms. In addition, he started experiencing extreme and persistent anxiety, feeling â€Å"like I was always one second away from a panic attack. † He was diagnosed with generalized anxiety disorder and was prescribed benzodiazepines to manage this condition. As his wife got sicker, he slowly began to self medicate with alcohol and admitted to â€Å"popping an extra pill† occasionally to decrease his anxiety.When his wife died, the patient became so depressed and anxious that he was unable to concentrate at work. He had to give up his job as a supervisor, and said, â€Å"I couldn’t even manage myself, how was I supposed to handle anyone else. † As his depression and anxiety got worse, he turned increasingly to alcohol and drugs. He reported binge drinking, consuming up to 20 drinks in one evening. He would remain intoxicated for several days, and would switch to using drugs as the alcohol cleared his system. He reported being either drunk, high, or both almost every day.Although he used cocaine and heroine, which were the drugs he used as a teenager, he also became dependent on prescription benzodiazepines to manage his increasingly severe anxiety. The increase in anxiety may be explained by his cocaine use, which, though it reduces anxiety while high, causes increased anxiety with long term use. Additionally, though proper use of benzodiazepines decreases anxiety, benzodiazepine abuse or dependency results in increased anxiety levels. When his request for more prescription benzodiazepines was denie d due to drug seeking behavior, he gained possession of Valium illegally and continued abusing them.He was arrested for illegal Valium possession in 2009, and received two DWIs between 2008 and 2011. His medical record notes that he has a history of antisocial behavior, though it does not expand on this statement beyond the mention of his previous arrests. With no income coming in and increasing amounts of money used to fuel his drug and alcohol addiction, he lost his condo and all of his savings and was living at the Salvation Army homeless shelter by June 2008. His depression grew in severity as the major life losses piled up and his substance dependency problem worsened.In 2008, he lost consciousness due to heroin intoxication. In August of that year, the patient overdosed on oxycodone, intending to kill himself. He was brought to HCMC, and for the past several years has experienced being in and out of the psychiatric inpatient. In 2010, he moved from the homeless shelter to Alte rnative Homes in Minneapolis. Following his latest psychiatric hospitalization in March, he began the partial hospitalization program at HCMC. Upon discharge from the current hospitalization, he will be returning o Alternative Homes and participating again in the PHP program. A common finding associated with a diagnosis of either MDD, GAD, or substance abuse is the presence of sleep disturbances. Such is the case with the patient described. These sleep disturbances may present themselves as difficulty falling asleep, trouble maintaining sleep, or waking up too early (National Insititute of Health, 2005). This patient currently experiences insomnia, getting only 3-4 hours of sleep per night. Reportedly, this insomnia has been a chronic issue.The insomnia the patient experience sets him up for a negative cycle. Because of his depression and anxiety, it is difficult for the patient to sleep. This lack of sleep, in turn, exacerbates his anxiety and depressive symptoms. As his symptoms p rogress in severity, he turns to substances to self medicate. The use of substances results in a worsening of his insomnia. Thus, finding a way for the patient to get adequate sleep is important. He has tried a variety of medications to promote sleep, but none have been effective.He can no longer be prescribed many of the medications for insomnia because of his history of abuse and overdose using prescription drugs. Thus, the options available to him for sleep promotion lie in the realm of sleep hygiene promotion. The patient might also consider participating in a sleep study, as this may reveal additional factors that prevent him from getting the sleep he needs. In addition to his mental illnesses, the patient also has significant medical problems. He has been diagnosed with hypertension, hepatitis C, diabetes mellitus, osteoarthritis of the left shoulder, and acid reflux.Research shows that diabetes mellitus, gastrointestinal problems, hypertension, liver disease are correlated wi th substance abuse (Moffitt, Caspi, Harrington, Milne, Melchior, Goldberg & Poulton, 2010). Indeed, the patient’s hepatitis C is a direct consequence from his use of street drugs. Interestingly, multiple studies have revealed that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and mortality among diabetic patients (Moffitt et al. 2010). Also, as previously discussed, patients with GAD and MDD report more painful physical symptoms than the general population, and the patient’s osteoarthritis pain could well be exacerbated by the presence of these psychiatric conditions. Thus, it is possible that with improved management of his psychiatric conditions, his medical problems may improve as well. Family and Social History The patient’s social and family history is somewhat lacking. The patient was adopted at a young age.He has three non-biological brothers and he reports that he is estranged from all of them, and is not willing to contact them until he has â€Å"my life back together. † In addition, both of his adoptive parents are dead. The patient was not keen on discussing his adoptive family or his childhood and adolescence, but stated that this adoptive family â€Å"were good people, and tried hard to give me everything I needed. † He denies any history of physical, emotional, or sexual abuse. According to the social history, there is no history of mental illness in his adoptive family.This does not mean that environmental or social factors play no role in the etiology of his mental illness, but that these factors may be less obvious. Information on the patient’s biological mother and family history is unavailable. The patient was given up for adoption at birth, and remained a ward of the state, living in various foster homes, until he was adopted at age 3. As the patient wa s given up for adoption and adopted at such a young age, he has he has no recollection of his biological family or his time in the foster care system.Any instances of abuse, neglect, or trauma in his early years are thus unknown. Because there is no available family history, it is impossible to know if any of the patient’s first-degree relatives suffered from mental illnesses, or if the biological mother used drugs or alcohol during her pregnancy. This lack of information is unfortunate, as it is impossible to conjecture whether, or to what degree, the patient’s mental disorders have a basis in genetics or in disturbed fetal development.Because MDD, GAD, and substance abuse have all been shown to have a moderate to high degree, of heritability, it is very plausible that mood, anxiety, or substance related disorders were present in his biological family. The patient seems to have very limited social support, as he is estranged from his adoptive siblings and has no commu nication with his biological family. The patient also has a history of limited social interactions and close friendships. He reports that he has felt disconnected from others for as long as he remembers, and that he had few close friendships throughout his childhood, adolescence, and adulthood.In addition, the patient reports that most of the relationships that he would call the closest have been with people who have substance abuse problems, as he spent â€Å"years and years running with the wrong crowd. † The basis of most of these relationships was a shared interest in drug and alcohol use, and he does not think that these friends would be of any support to him in pursuing and maintaining recovery. During the time that he was sober, he states that his wife was â€Å"the only friend I really needed† and as a result, he did not form many close friendships with his peers.He states that he currently has no supportive relationships. Furthermore, he has little desire to f orm such relationships. Application of Developmental Theories Viewing the patient and his family and social history through the lens of attachment theory provides a possible framework for viewing the patient’s development of mental illnesses. Attachment theory, a biologically based framework first proposed by John Bowlby in the mid 1950s, is the theoretical approach used to describe the importance of stable and secure relationships of all infants, especially those in foster care (Bruskas, 2010).This theoretical approach reasons that infants and children have a need to belong and to experience secure relationships with a small number of consistent â€Å"preferred† primary caregivers in order to successfully develop into normal healthy adults who can actively and emotionally participate in social life (Boyd, 2008). In particular, a child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.If the attachment figure is broken or disrupted during the critical two year period the child will suffer irreversible long-term consequences of this deprivation, which might include delinquency, reduced intelligence, increased aggression, depression, and affectionless psychopathy–an inabilityto show affection or concern for others. Research, such as the Adverse Childhood Experiences Study, correlates untreated childhood adversity with an increased risk toward poor developmental health and other major diseases seen later in life such as cardiac disease, depression, and even premature death (Felitti & Anda, 2010).Studies reveal that infants in foster care are among the most vulnerable because of their complex and immense brain development, and the importance of attaining developmental milestones. The onset of brain development begins soon after conception and will continue to mature well into adulthood, but the most abundant and dramatic time of growth is during the first few years of life, specifically within the first three years. The primary and most important developmental milestone for any infant is to establish a relationship, especially one with a primary caregiver.This period presents sensitive â€Å"windows of opportunity† for the development of particular parts of brain structure and circuitry influenced and dependent on social experiences for optimal brain development (Bruskas, 2010). The majority of children entering foster care are infants, and the impact of not addressing mental health needs of preverbal children can have deleterious effects (National Research Council Committee on Integrating the Science of Early Childhood Development, 2000).Although an infant may not be able to articulate losses because of their preverbal age, they nonetheless experience grief and loss, and for many, these experiences will be forever embedded in their memory (Felitti & Anda, 2010). Moreover, the consequences of unresolved losses have a much more devastati ng affect in infancy than adulthood because of the potentially permanent psychological impact on the developing brain of an infant or child (Bruskas, 2010).Infants and children in foster care who are not afforded supportive primary caregivers to help them develop an internal ability to regulate their own will continue to use whatever coping methods they can. Under stress-provoking adversities such as abuse, neglect, and relationship disruptions, children’s coping strategies to manage such circumstances may present as hostility, frustration, and anxiety with underlying feelings of fear, abandonment, and powerlessness (Bruskas, 2010).The relationships infants and children develop while in foster care are crucial; relationships characterized by trust and commitment help an infant or child become more resilient toward the challenges and obstacles that all humans face in life; conversely, a lack of such relationships in life can result in long-term dysfunction socially and physica lly. Attachments and â€Å"templates† of the world are significantly developed by the time a child reaches a year old (Bruskas, 2010).Efforts to address behavioral problems later in life may prove to be more difficult and costly as brain structure becomes permanent and behavior becomes more difficult to change. Due to the patient’s experience of foster care as an infant and toddler, it is likely that he was unable to form a secure attachment with a primary caregiver. Although this disruption in attachment is not the sole contributor to his problems with depression, anxiety, and substance abuse, it is very possible that the chaotic structure of his early years play a large role in the development of these conditions.Applying the concepts of Erikson’s model of psychosocial development allow for a greater understanding of the patient’s current state. Because of the disruption of relationships early in life, the patient may not ever have resolved the developm ental conflict of basic trust vs. mistrust, which is often resolved in infancy. This may be one reason behind his feeling of disconnectedness from others. According to Erikson, this inability to resolve this developmental conflict results in a decreased sense of drive and hope. It is also likely that the patient was able to resolve the developmental conflict of autonomy vs. hame and doubt, which is often resolved in toddlerhood (Boyd, 2008). This may explain the patient’s reliance on his wife as the sole supportive relationship in his life, as well as his fast descent into previous behaviors after his wife’s death. As the patient was never able to develop a sense of autonomy, it seems that he became extremely emotionally dependent on his wife. Because of this relationship, he was able to progress at his job and maintain his recovery. However, with the death of his wife, he was brought back to the conflict of autonomy vs. shame and doubt.Really, it was through the prese nce of his wife that he was able to take initiative, be industrious, and have an intimate relationship, all of which are successful outcomes of developmental conflicts. The marriage provided him with hope, purpose, a sense of devotion and fidelity, as well as affiliation and love. In short, it seems that his wife was his mental and emotional anchor. The recurrence of symptoms of his mental disorders after the loss of the anchor of his life threw him back into the early developmental conflicts that he was unable to resolve due to his unstable childhood.According to Erikson, in order for the patient to move forward from his regressed state he must tackle and resolve the conflicts of trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role diffusion, and intimacy vs. , isolation to reach the adulthood stage of generativity vs. stagnation. Ultimately, with the resolution of all these conflict, the patient will reach a mature sta te in which he is able to attain ego integrity instead of falling into despair. Patient Prognosis and Treatment RecommendationsIt is important to remember that the patient was seeking help and trying to recover prior to his most recent hospitalization. He was enrolled in and regularly attending the partial hospitalization program. In addition, he was no longer abusing drugs or alcohol. PHP staff report that he had been medication compliant, cooperative, and was motivated to change. The patient’s recent hospitalization was precipitated by a change in drug dose and type. He reported that it was only after the medication change that the suicidal ideation intensified.Thus, an important goal for this patient is to find the drug types and dosages that will successfully manage his depression and anxiety. However, because the patient has such an extensive history of addiction, primary care providers are hesitant to prescribe large dosages of often highly addictive medications. This h esitation is especially understandable given the patients past abuse of prescription drugs, including an overdose with the intent to commit suicide. However, the types and dosages of the drugs he is currently receiving are not enough to manage his symptoms.The severity of the patient’s depression and anxiety necessitates the use of powerful antidepressants and anxiolytics, but his past substance abuse and dependency make the prescription of these drugs a last resort. Appropriate pharmacotherapy is also complicated by the fact that this patient has tried various classes and types of drugs to manage his symptoms, but no drug therapy has been effective enough to prevent the periodic recurrences of major episodes of depression and anxiety.To manage his depression, the patient has tried typical and atypical antipsychotics, anticonvulsants, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors, as well as other classes of antidepressan ts, such as Serotonin Norepinephrine Reuptake inhibitors, Norepinephrine Dopamine Reuptake Inhibitors, Alpha-2 Antagonists, and Serotonin-2 Antagonist/Reuptake Inhibitors. Although the apparent failure of all these drugs to manage his depression might cause one to suspect that he is exhibiting purely drug seeking behaviors, the depressive symptoms he xperiences impair and affect him so severely that a denial of the reality of these symptoms would be unsafe and unethical. Electroconvulsive therapy has been recommended to treat his depression, but the patient has refused to undergo this treatment modality. The patient’s anxiety is more easily managed than his depression, and benzodiazepines have proven effective. However, his past abuse of benzodiazepines make his primary care providers reluctant to give them to him, and they have prescribed non-benzodiazepines, such as Buspar and Zolpidem, instead.Unfortunately, these medications have not been effective in controlling the pati ent’s anxiety. As a result, the patient has been asking repeatedly for benzodiazepines, while promising that he will use them responsibly. Ultimately, for the patient to achieve effective maintenance of his comorbid mental disorders, he must be able to take medications as prescribed. Due to his history of substance abuse and his still unstable depression and anxiety, it is unlikely that the patient will be able to take his medications as prescribed.It is recommended that a staff member have control of his drugs while he is attending the PHP, and that once discharged, a home health nurse be sent to administer his medication. This would reduce the potential for abuse. In addition, the use of coping mechanisms besides substance abuse may help the patient adhere to the prescribed drug regimen, as well as decrease his depression and anxiety. Coping skills the patient has identified as helpful are watching television and spending some quiet time alone.However, interaction with othe rs should also be encouraged, as too much time spent alone will only reinforce depressive symptoms of isolation. An increase in the quantity and quality of sleep will also aid the patient in his recovery, as sleep deprivation is positively correlated with depressive symptoms and anxiety levels. The patient’s prognosis is one of cautious hopefulness. Though the patient has experienced severe recurrences of MDD, GAD, and substance abuse in recent years, the patient had maintained a long period of sobriety prior to this, during which he was happy, productive, and high functioning.The patient’s ability to achieve remission from his mental illnesses during his marriage to his wife shows that investing in a supportive relationship is an important and powerful coping skill for this patient. Thus, if the patient is able to form and maintain new supportive relationships, his chance of recovery will improve substantially. It is also important to remember that he was doing very w ell until his wife died. According to the Holmes and Rahe Index, the death of a spouse is the number one most stressful event that occurs in the life of an individual (Perry & Potter, 2009).It is not an exaggeration to say that with his wife’s death, life as he knew it ended. Many people experience periods of long and severe depression following the death of a loved one. For this patient, his descent into depression, combined with the resurgence of his anxiety sent his life into a complete tailspin. Under the severe stress of not only his wife’s death but also his inability to keep working, he returned to his former coping mechanisms of drug and alcohol abuse.These habits detracted him from working through the grief of his wife’s death, and furthermore caused him to lose his house and his savings, thus increasing his depression and anxiety, thus perpetuating the substance abuse. Now that the patient has withdrawn from drugs and alcohol and is in a safe environme nt, he can continue his grief work. As a result, his depression may begin to subside, and he may be able to get closer to his previous level of functioning. DSM-IV-TR Axis I: Major Depressive Disorder, Generalized Anxiety Disorder, Polysubstance Abuse Axis II: Cluster B traitsAxis III: Hypertension, Hepatitis C, Diabetes Mellitus, Type 2, Osteoarthritis of the left shoulder, Acid Reflux, Bilateral hearing loss Axis IV: Chronic mental illnesses, chronic medical conditions, death of spouse, family estrangement, lack of social support, unemployment, financial insecurity, acute hospitalization, Axis V: 35 (current), 75 (potential) Patient Goals: †¢ I want to find medications that will help my depression and anxiety †¢ I want to keep from abusing my medications †¢ I want my grief over my wife’s death to get better †¢ I want to take one day at a time †¢ I want to feel less alone †¢ I want to get better sleepNursing Goal: Patient will be safe during hos pital stay. Interventions: †¢ Assess for suicidal ideation every shift. †¢ Perform rounds every 15 minutes to ensure patient safety. †¢ Ensure that the patient has no access to potentially harmful objects and/or substances. †¢ Observe, record, and report any changes in mood or behavior that may signify increasing suicide risk and document results of regular surveillance checks. Nursing Goal: Patient will seek help in dealing with grief-associated problems. Interventions: †¢ Develop a trusting relationship with the client by using empathetic therapeutic communication (Eakes, Burke & Hainsworth, 1998). Educate the client that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever (Matthews & Marwit, 2004). †¢ Identify available community resources, including grief counselors and community or Web-based bereavement groups. †¢ Focus on enhanci ng coping skills to alleviate life problems and distressing symptoms such as anxiety and depression. Nursing Goal: Patient will practice social and communication skills needed to interact with others. Interventions: †¢ Discuss causes of perceived or actual isolation. Assess the patient’s ability and/or inability to meet physical, psychosocial, spiritual, and financial needs and how unmet needs further challenge the ability to be socially integrated. †¢ Use active listening skills to establish trust one on one and then gradually introduce the patient to others. †¢ Provide positive reinforcement when the patient seeks out others. †¢ Encourage the client to be involved in meaningful social relationships and support personal attributes (Gulick, 2001). Nursing Goal: Patient will use effective coping strategies instead of abusing drugs and alcohol.Interventions: †¢ Assist the client to set realistic goals and identify personal skills and knowledge. †¢ Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client to express emotions such as sadness, guilt, and anger, verbalize fears and concerns, and set goals. †¢ Offer instruction regarding alternative coping strategies (Christie & Moore, 2005). †¢ Encourage use of spiritual resources as desired. Nursing Goal: Patient will identify actions that can be taken to improve quality of sleep.Interventions: †¢ Obtain a sleep-wake history, including history of sleep problems, changes in sleep with present illness, and use of medications and stimulants. †¢ Encourage the patient to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts. †¢ Encourage the patient to use soothing music to facilitate sleep (Lai & Good, 2005). †¢ Teach the patient sleep hygiene guidelines for improving sleep habits (ie. go to bed only when sleepy, avoid afternoon an d evening naps, use the bed only for sleeping, get up at the same time every morning). Use relaxation techniques to decrease anxiety before going to sleep. †¢ Refer to a sleep center if interventions are ineffective. Analysis of Interaction Before interacting with the patient, I read the patient’s medical record and notes. I paid particular attention to ways the patient said he learned best, which for my patient was one on one conversation. Prior to approaching the client, I asked myself if I had any beliefs, biases, or limitations that would affect my interaction with the patient or prevent the formation of a therapeutic relationship.In order to set the tone of a professional therapeutic relationship, I introduced myself to the client, saying that I was a student nurse and shaking his hand. I made some small talk with him about such topics as sports and the patient’s hobbies in order to show interest in the patient and develop rapport. During this conversation, t he patient grew more visibly at ease. His face became less taut, his answers became longer and less forced, and he moved from an erect posture so a somewhat more relaxed position in his chair. The patient spoke slowly and eemed to have difficult finding the words he wanted to use. Such a speech pattern is characteristic of depression, one of the patient’s psychiatric diagnoses. This first conversation was punctuated with the start of morning group. After morning group, I gave the patient some space, as I did not want him to feel overwhelmed or threatened by my questions. About a half hour later, I asked the patient if we could continue the conversation we were having that morning, and he agreed without hesitation. In this second interaction, I began with a few open-ended questions about how group had been.I then started asking the patient some more questions about his readmission into the hospital and precipitating events. I asked open-ended question, and often responded to h is answers by asking further open-ended questions. For example, after asking the patient if he was having suicidal thoughts, he responded that he did not want to hurt himself right now. I replied with the open-ended question, â€Å"So are you feeling safe? † using reflection to redirect the idea back to the patient and allow him to explore whether or not he felt safe.I focused on actively listening to the patient, following the patient’s lead and sometimes asking clarifying questions. Because of the patient’s slower rate of response, I employed the use of silence to allow him to gather his thoughts and proceed at his own pace. As the patient told me more about recent events in his life, including the death of his wife, the loss of his job and his descent into substance abuse, he began to look away more and more. This decrease in eye contact might be the result of the patient feeling ashamed, embarrassed, or guilty about his feelings and behaviors.In order to mai ntain connection with the patient and assure him of my nonjudgmental view of his situation, I used empathy and restatement, saying, â€Å"It sounds as though you have had a very difficult past couple of years. † Upon saying this, the patient looked up, maintained eye contact, and agreed. He then began to expand on his current feeling of hopelessness, saying, â€Å"I wonder if life is worth living, and sometimes I just want to go to sleep and not wake up. † As he explored and expanded on his feelings I alternated between using silence and validating what he said.The silence allowed him to express intense feelings without interruption, while statements of restatement and interpretation, such as â€Å" It sounds like you have been feeling pretty hopeless,† demonstrated empathy and a nonjudgmental attitude toward what the client was feeling. At one point, the patient put his head in his hands, saying â€Å"I had so much going for me, and after my wife died, everyth ing went to pot. † I felt that in this moment, what the client needed was neither a cheery reassurance that things would get better, nor dispensation of advice, but rather a person to understand and acknowledge his current misery.I replied that sometimes life gets you down, and sometimes when it rains it pours, and it’s ok to be sad about that. The patient seemed appreciative of the acknowledgment of his pain and the justification of his sadness. I sat silently with him for 2-3 minutes, as I felt it was important for him to feel, sit with, and process these emotions for a short period of time. During these periods of silence, I continued to lean forward slightly, as I had done throughout the interaction, to show that I was still interested and engaged despite the lack of verbalization.Because I had acknowledged the patient’s hardships and thereby connected with him, I felt that I was in a good position to explore with him goals he had for the future, and ideas th at could help him reach these goals. I made sure to approach this topic not by giving advice or suggestions, but by asking him open-ended questions about what things made him feel less sad or anxious and what things he wanted to work on during his stay. These open ended questions elicited the response of his goals for the future, and his verbalization that he needed to find better coping mechanisms, because his old ones didn’t seem to work.He also stated that he knew he needed to â€Å"continue grieving my wife, because the drugs and alcohol kept me from doing that. † I thought that this realization of substance abuse as inhibitory to his grief process was very insightful, and told him so. He made a small smiling expression and responded that he wanted to â€Å"get back on the straight and narrow† and take his medications â€Å"the way I’m supposed to—no more, no less. † The patient’s elucidation of his goals and his insight into help ful and hindering coping devices was a very positive outcome of this therapeutic conversation.The patient seemed less burdened after the opportunity to talk about his recent losses in life, and more hopeful after verbalizing his goals and ways to meet them. References Ackley, B. J. & Ladwig, G. B. (2008). Nursing Diagnosis Handbook (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. American Psychological Association. (2002). Boyd, M. A. (2008). Psychiatric nursing: contemporary practice (4th ed. ). New York: Lippincott Williams & Wilkins. Bruskas, D. (2010). Developmental health of infants and children subsequent to foster care.Journal of Child and Adolescent Psychiatric Nursing, 23(4), 231-241. doi:http://dx. doi. org/10. 1111/j. 1744-6171. 2010. 00249. x Christie, W. & Moore, C. (2005). The impact of humor on patients with cancer. Clinical Journal of Oncology Nursing, 9(2), 211-218. Cohn, A. M. , Epstein, E. E. , McCrady, B. S. , Jensen, N. , HunterReel, D. , Green, K. E. , & Drapki n, M. L. (2011). Pretreatment clinical and risk correlates of substance use disorder patients with primary depression. Journal of Studies on Alcohol and Drugs, 72(1), 151-157. Eakes, G. G. , Burke, M. L. & Hainsworth, M. A. 1998). Middle-range theory of chronic sorrow. Image Journal Nursing Scholar, 30, 179. Felitti, V. J. & Anda, R. F. (2010). The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare. Cambridge University Press. Gulick, E. (2001). Emotional distress and activities of daily living functioning in persons with multiple sclerosis. Nursing Resolutions, 50(3), 147-154. Lai, H. L. & Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-244.Lawrence, A. E. , Liverant, G. I. , Rosellini, A. J. , & Brown, T. A. (2009). Generalized anxiety disorder within the course of major depressive disorder: Examining the utility of theDSM-IV hierarchy rule. Depression and Anxiety, 26(10), 909-916. Levola, J. , Holopainen, A. , & Aalto, M. (2011). Depression and heavy drinking occasions: A cross-sectional general population study. Addictive Behaviors, 36(4), 375-380. doi:http://dx. doi. org/10. 1016/j. addbeh. 2010. 12. 015 Matthews, L. & Marwit, S. (2004). Complicated grief and the trend toward cognitive-behavioral therapy.Death Studies, 28, 849-863. Moffitt, T. E. , Caspi, A. , Harrington, H. , Milne, B. , Melchior, M. , Goldberg, D. , & Poulton, R. (2010). Generalized anxiety disorder and depression: Childhood risk factors in a birth cohort followed to age 32 years. Diagnostic issues in depression and generalized anxiety disorder: Refining the research agenda for DSM-V (pp. 217-239). Washington, DC, US: American Psychiatric Association; US. National Institute of Health. (2005). National Research Council Committee on Integrating the Science of Early Childhood Development. (2000). Perry, A. G. , Potter, P.A. (2009). Fundamentals of Nursing (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. Plaisier, I. , Beekman, A. T. F. , de Graaf, R. , Smit, J. H. , van Dyck, R. , & Penninx, B. W. J. H. (2010). Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics. Journal of Affective Disorders, 125(1-3), 198-206. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 01. 072 President and Fellows of Harvard College. (2011). Harvard Mental Health Letter. Harvard Health Publications. Retrieved from http://www. health. harvard. du Romera, I. , FernandezPerez, S. , Montejo, A. L. , Caballero, F. , Caballero, L. , Arbesu, J. A. , . . . Gilaberte, I. (2010). Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: Prevalence of painful somatic symptoms, functioning and health status. Journal of Affective Disorders, 127(1-3), 160-168. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 05. 009 Seo, H. , Jung, Y. , Kim, T. , Kim, J. , Lee, M. , Kim, J. , . . . Jun, T. (2011). Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression.Journal of Nervous and Mental Disease, 199(1), 42-48. doi:http://dx. doi. org/10. 1097/NMD. 0b013e3182043b60 Smith, J. P. , & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive Behaviors, 35(1), 42-45. doi:http://dx. doi. org/10. 1016/j. addbeh. 2009. 07. 002 Sunderland, M. , Mewton, L. , Slade, T. , & Baillie, A. J. (2010). Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: True co-morbidity or symptom similarity?Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 40(7), 1113-1123. doi:http://dx. doi. org/10. 1017/S0033291709991590 United States Department of Health and Human Services. (1999). Yen, Y. , Rebok, G. W. , Gallo, J. J. , Jones, R. N. , & Tennstedt, S. L. (2011). Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life. The American Journal of Geriatric Psychiatry, 19(2), 142-150. doi:http://dx. doi. org/10. 1097/JGP. 0b013e3181e89894 Case