Macroeconomics Student Resource Center

Macroeconomics Student Resource Center This page contains links to the articles and links pages hosted on Economics at About.com. Most of the major topics in macroeconomics have at least one article associated with them, but this is a work in progress and more will be added every month. Most of the articles come from questions from readers, so if you would like to ask a question about macroeconomics, please use the feedback form. Be sure to also visit the Economics Glossary if youre looking for definitions, and Economics From A-to-Z for resources on other topics. The pages Macroeconomics Tips and Tricks and Macroeconomics Resources contain many links to other pages which contain macroeconomics information, so if what youre looking for is not here, Id suggest trying there. Term paper tips and topics can be found at Economics Term Paper Help. If you need practice economics questions, Test Yourself Macroeconomics (offsite) is the site to visit. Now to the resources! Business Cycles - Macroeconomics Beginners Guide to Economic Indicators and the Business CycleBusiness Cycle Links Economic Data - Macroeconomics Quarterly Economic DataImport and Exports Data Economic Growth - Macroeconomics The Effect of Income Taxes on Economic Growth Economic Indicators - Macroeconomics Beginners Guide to Economic Indicators Exchange Rates - Macroeconomics A Beginners Guide to Exchange RatesExchange Rates: What to Use as the Base?The Canadian Exchange Rate Financial Markets - Macroeconomics How Markets Use Information to Set PricesStock Market Resource CenterInsider Trading: What Did Martha Do?Interpreting The Price/Earnings RatioDo Changes in Stock Prices Cause Recessions?What Does The Value of the Dow Jones Represent?What is Arbitrage?When Stock Prices Go Down, Where Does the Money Go?Banking in IndiaFinance LinksStock Market Links Fiscal Policy The Logic of Collective Action Inflation and Deflation Cost-Push Inflation vs. Demand-Pull InflationDeflation Resource CenterWhy Dont Prices Decline During A Recession?What is Deflation and How Can It Be Prevented?Why Not Just Print More Money?Inflation Links Interest Rates The Dividend Tax Cut and Interest RatesInterest Rate Links Monetary Policy Expansionary Monetary Policy vs. Contractionary Monetary PolicyWhy Not Just Print More Money?Federal Reserve Links Money Money Resource CenterWhat Was The Gold Standard?What Is The Demand For Money?How Much Is The Per-Capita Money Supply?Why Does Money Have Value?Are Credit Cards a Form of Money?What is Arbitrage?When Stock Prices Go Down, Where Does the Money Go?Why Not Just Print More Money?Money Links Natural Resources We Will Never Run Out of OilSoftwood Lumber Dispute Resource Center Nominal and Real Variables The Difference Between Nominal and Real Recessions and Depressions Why Dont Prices Decline During A Recession?Do Changes in Stock Prices Cause Recessions?The Difference Between a Recession and a Depression Short Run vs. Long Run The Difference Between Short and Long Run Tariffs and Trade The Economic Effect of TariffsDoes Freer Trade Lead To Lower Environmental Standards?Softwood Lumber Dispute Resource CenterImport and Exports DataWhy Are Tariffs Preferable to Quotas? Taxes Fair Tax Resource CenterThe Effect of Income Taxes on Economic GrowthThe Dividend Tax Cut and Interest RatesTax Policy LinksWhy Are Tariffs Preferable to Quotas?The Economic Effect of Tariffs

EVALUATE THE MAIN EU REGULATORY REACTIONS TO THE FINANCIAL CRISIS Essay

EVALUATE THE MAIN EU REGULATORY REACTIONS TO THE FINANCIAL CRISIS INCLUDING THE CHANGES TO THE EU REGULATORY PROCESS FOR FINANCIAL SERVICES - Essay Example Evidently, the financial crisis began in the second quarter of 2006 in United States. To this end, there were significant losses registered banks in United States as a result of sub primal foreclosures of mortgages (Chrisdoulaki, 2010). Consequently, since the mega banks in European Union and United States were operating under business models which were similar, the financial distress facing the United States were replicated in the European Union. To this end, the mega banks located on both the European Union and United States suffered from under-capitalization and insufficient liquidity reserves. Evidently, the financial regulations of the European Union are carried out at the continental level as well as within the individual countries. The European regulatory response to the crisis was significantly slower to that of the United States. The onset of the decline in profits within the United States was immediately reflected by a similar decline in profits by E.U banks (Clark, Feldman , & Gertler, 2000). The German government and regulators in the finance industry requested the European Commission to bail them out within six months after the crisis began. The bail out of 9 billion Euros was granted and was directed at the IKB German Bank (Grote, & Marauhn, 2006). Furthermore, the governments of other member countries of the European Union pumped in capital within their financial institutions. Examples included the Northern Rock bank located in the United Kingdom. The fast pace of the spread of the financial crisis was not unexpected since most of the securitized United States debt was originated for distribution to European investors and institutions. To this end, the financial crisis that affected the European Union is blamed on the business model of â€Å"originate-to-distribute† that is synonymous with U.S banks (Mattoo & Sauve?, 2003). Evidently, the large international financial institution adopted this model which allowed the institutions to increase their lending power without disrupting the set capital standards by regulators. Moreover, this model created instruments such as credit default swaps, mortgages guaranteed by securities, and debt obligation that were collaterized (Ferran, 2012). In this regard, such instruments played a part in exploiting weaknesses evident in financial regulatory structures. In addition, under-written mortgages and securities, insufficient coordination within national regulatory bodies, and regulatory arbitrage by the regulators all played a role in undermining the regulatory structures (Smith, 2005). To this end, the challenge of identifying and enforcing effective measures in response to the financial crisis in the European Union has been slowed down since the financial regulations are normally carried out at the member country and European level ( Helleiner, Pagliari, & Zimmermann, 2010). In light of the financial crisis of 2007-2009, the subsequent sections will address the financial regulator y responses carried out by the European Union as well as changes to the EU regulatory process for financial services. Financial Regulatory Reform Plan by the European Union Following the financial crisis of 2007-2009, the European Parliament Committee for Economic and Monetary Affairs met on 21st July 2010. In this regard, they approved a version of The Dodd-Frank Act adopted by the United States. The new version would seek to improve the regulatory bodies for securities, pensions, insurance, and banking sectors. The Act would also have the authority to overrule national governments on pertinent issues. In addition, the plans by the

Chapter 4 Essay Example | Topics and Well Written Essays - 250 words - 3

Chapter 4 - Essay Example Most clients who are interested in different adverts online will depend on the information that is provided by these companies to float their adverts. The information provided gives them an opportunity to understand the regions and durations when the adverts should ne floated. There are a.lso cellular providers that have now gotten into data mining. The signals amongst the best stations and the cellular users can be used to market products that are directed to specific phone users. The calling records are projected to be one of the assets to various marketers. However, it will depend on the possibility of the customers browsing the web and accessing some sites to purchase products online. Analysis of the market is necessary given that the company finds an opportunity to understand what the customers are likely to consume and at what quantities and durations. There are four main users of data mining to marketers currently, which includes; acquisition of the customers, analysis of the basket market, analyze customer abandonment and finally to enhance customer retention and

Evaluating Teachers Assignment Essay Example | Topics and Well Written Essays - 1750 words

Evaluating Teachers Assignment - Essay Example Bearing in mind that Miss Paulson had received adequate points in her previous evaluation despite having some difficulty in managing classes goes to point out some issues in the evaluation that have to be addressed within the shortest time possible to avid the recurrence of some incidents as the one she was involved in. The officers responsible for evaluation have shown clearly that they are too lenient during their evaluation sessions. Secondly, there has been a poor teacher supervision structure, which led me to find Miss Paulson attending to individual students leaving the rest of the class unattended, which was also not reported. In this case, the state requires that teachers should be evaluated annually although tenured teachers can even be evaluated once in three years or a twice in a decade, in Ms Paulson’s case, evaluation was done within the stipulated timeframe by the law. In this case, a formal investigation is not necessary as such, incident has never been reported in the school; however, some form of internal (within the school) investigation must take place. Steps to be taken in investigating the incident Wednesday morning constitute an investigating panel Wednesday afternoon the panel to identify the students and staff to be interviewed Thursday morning interviewing of the students Thursday afternoon interviewing of staff members Friday morning Investigating panel meets to draw conclusion and finalise on the investigations. Friday afternoon the principal receives the finding of the Investigations and hands them over to the superintendent. Monday morning official communication from the school is received by the parent of Jessica Robertson The students and staff to be interviewed will be selected depending on their probability of having some information relating to the incident. Among those to be interviewed will be Jessica Robertson since she is the complainant and will provide insight on the incident, which involve the pornographic picture s in class. In addition, the class monitor will be interviewed as he is in charge of the class when the teacher is not around. Those on the front row of the class will also have to be among those to be interviewed since they may have seen who interfered with Miss Paulson’s computer. Miss Paulson will also be interviewed to give her side of the story and what happened on the material day and time; any other staff member who was responsible in setting up of the projector will also have to be interviewed to get the clear picture of all that happened. The interviews will be oral to enable the panel read the body language and will be conducted with utmost confidentiality to ensure the respondents open up on the incident. The panel will have to undergo an oath of secrecy before the district attorney to ensure confidentiality of all the information. Miss Paulson will continue to teach other classes and will not be subjected to any discrimination until investigations are complete Sin ce the investigation will be done internally, any correspondence with the media and community will be done by the principal so as to avoid any form of miscommunication or misstatement. 2.) Evaluation of the conduct of professionals needs to be understood from the activities in which they engage themselves and the manner in which they carry themselves out in performing their duties. This means that any activity of a professional has to be

Situational Analysis of Starbucks Essay Example for Free

Situational Analysis of Starbucks Essay We start off with the organizational analysis’s corporate mission, products and services, leadership Organizational Culture, and Strategy. Next we analyze the firms resources by means of tangible intangible resources, capabilities and core competencies. Then we move into the financials analysis which divides into subcategories such as valuation, growth, profitability, financial strength and management efficiency. The final aspect of the internal analysis is the SWOT analysis which clarifies Starbuck’s Strengths, Weaknesses, Opportunities and Threats. The final closure of the Strategic Analysis is the recommendations for both internal and external analysis along with a conclusion. 2. 0. 0History The history of Starbucks starts in Seattle in 1971. (George, 2010) Three friends; Jerry Baldwin, Zev Sigel, and Gordon Bowker, who all had a passion for fresh coffee, opened a small shop and began selling fresh-roasted, gourmet, coffee beans and brewing and roasting accessories. (George, 2010) The company did well, but things began to change in the 80’s. (George, 2010) McDonald’s has no issue with the generating locations and hitting targeted demographics. Primarily because, McDonald’s is the oldest business in the food service industry. The most common demographic in the American trends are the tweens to teens segment. Here, the up and coming teenagers, or teenagers dive into a new hangout place in order to gain the â€Å"feel† and â€Å"experience† the coffee industry offers. Starbucks offers an influence in the youth of America into employment roles or simply influential leisure hangouts for teenagers. Adam Smith’s â€Å"The Wealth of Nations† best defined competition amongst the market as Lassiez Faire â€Å"A philosophy or practice characterized by a usually deliberate abstention from direction or interference especially with individual freedom of choice and action. † However, no single firm, or group of firms, must ultimately have complete power over any industry because that firm would have the power to regulate prices of that particular commodity. (Dept. of Labor, 2011) This would be known as a monopoly. Should a firm be in recognition of monopolistic power, they would be violating the Sherman Anti-Trust Act in practicing in unfair business practices. (Dept. of Labor, 2011) One example that led to unfair business practices is known as price fixing. (Dept. of Labor, 2011) Price fixing is defined as an agreement between business competitors selling the same product or service regarding its pricing. (Dept. of Labor, 2011) Other pieces of Government regulation is OSHA (Occupational Safety Health Administration). (Dept. f Labor, 2011) Here these laws are backed by the federal governing body of the United States Department of Labor. (Dept. of Labor, 2011) Simple laws here give the employee factions laws to simply abide by in case of any unfair management practices such as quid-pro-quo. All firms must abide by both means of competition and OSHA’s regulator laws. The only real factor in the government/political segment that affects the industry is the EBIT (Earnings Before Interest i n Taxes), because it defines the net worth after gross income a firm can accumulate in the coffee industry.

Management Of Acute Coronary Syndrome

Management Of Acute Coronary Syndrome Acute coronary syndrome encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). Myocardial ischemia is caused by inadequate perfusion within the myocardial tissue due to oxygen demand exceeding oxygen supply. In a healthy person the amount of oxygen required by the myocardium (O2 demand) is determined by heart rate, myocardial contractility, myocardial wall stress, and afterload. As explained by Antman, et al (2012), oxygen supply to the myocardium requires a satisfactory level of oxygen-carrying capacity of the blood (determined by the inspired level of oxygen, pulmonary function, and hemoglobin concentration and function) and an adequate level of coronary blood flow. The coronary vessels have the ability to adjust their level of resistance to adapt to the increased oxygen demand required by the myocardium during certain times (such as during physical exertion). Ischemic heart disease is typically caused by atherosclerosis, which is a buildup of plaque inside the lumen of the coronary vessels. The emergence of atherosclerosis in the vessels does not occur overnight. Antman, et al. (2012) found that atherogenesis in humans typically occurs over a period of many years, usually many decades and that growth of atherosclerotic plaques probably does not occur in a smooth, linear fashion but discontinuously, with periods of relative quiescence punctuated by periods of rapid evolution. The process of atherosclerosis begins with an abundance of lipoproteins in the blood stream. These lipoproteins bind to the walls of vessels and are eventually deposited within the intima of the arteries. To counteract this process, phagocytes are sent into the vessel to attack these foreign particles (Antman et al., 2012). Once the phagocytes are within the intima, they mature into macrophages and become lipid-laden foam cells (Antman et al., 2012). As these plaques advance calcification occurs. This process is thought to be a key step in the formation of atherosclerotic plaques (Antman et al., 2012). Normally this narrowing of the vessel lumen does not cause chest pain or discomfort. Eventually, however, these plaques may rupture. At this point platelet activation occurs, which eventually leads to clot formation at the sight of the plaque. This clot, or thrombus, may break off and lodge in a coronary vessel. These two processes are a common pathogenic finding with acute coronary syndrome (Lincoff, Califf, Anderson, Weisman, Aguirre, Kleiman, Harrington Topol, 1997). A partial occlusion of the coronary vessels due to a ruptured plaque/platelet complex causes unstable angina or a NSTEMI. In this case, the oxygen demands of the heart cannot be met. A complete occlusion causes a STEMI (Anderson, Adams, Antman, Bridges, Califf, Casey Jr, Chavey II Wright, 2011), which eventually leads to myocardial cell death. Discussion/Analysis The emergency department providers are often the first line of defense in the management of patients with chest pain. The ability to quickly evaluate whether or not the cause of chest pain is potentially fatal is of great importance. Critical chest pain can be broken down in to non-cardiac and cardiac causes. Non-cardiac causes include: pneumothorax, pulmonary embolism, and Boerhaaves syndrome. Acute coronary syndrome is among several cardiac causes of emergent chest pain. An accurate diagnosis of the cause of chest pain requires several key components. These include: patient history (including risk factors), physical examination, diagnostics, and labs. History History is instrumental during the evaluation of a patient with chest pain. Ischemic chest pain is often described as a severe pressure or squeezing and is classically described as the feeling of an elephant sitting on my chest. Typically this pain is described as substernal chest pain which radiates to the neck, jaw, or down the left arm. Additional details regarding the onset of chest pain can also serve as important clues. For example, pain on exertion that resolves with rest suggests stable angina, whereas new onset chest pain or chest pain at rest suggests unstable angina. A good method to differentiate cardiac from non-cardiac chest pain is whether the pain improves after administration of nitroglycerin (NTG). If the pain is relieved by NTG it is considered to be likely due to cardiac causes. Additional details suggesting cardiac origin are shortness of breath, nausea +/- vomiting, diaphoresis, and the presence of syncopal/near-syncopal episodes. It is important to note that a patient with chest pain often have a silent or atypical presentation. This is especially true in elderly men (Woon Lim, 2003) and diabetics (Tabibiazar Edelman, 2003). A patient with an atypical presentation may present with shortness of breath but lack the classical symptom of angina pectoris which radiates to the jaw or left arm. Commonly these patients complain of a feeling of indigestion or epigastric discomfort. Thus it is very important to consider ACS in these patients. The presence of risk factors plays an important role in the evaluation of chest pain, especially in a patient with known disease. The landmark Framingham Heart Study showed that cardiac risk can be influenced by diet, lifestyle, and familial risk factors (Oppenheimer, 2005). The more risk factors that a person carries, the greater their risk of developing ischemic heart disease. These risk factors are generally grouped into two categories: those that are modifiable and those that are not. Risk factors amendable are as follows: Tobacco smoke (American Heart Association, 2012) High blood cholesterol (AHA, 2012) High blood pressure (AHA, 2012) Physical inactivity (AHA, 2012) Obesity and overweight (AHA, 2012) Diabetes mellitus (AHA, 2012) Risk factors that cannot be changed include: Age- 82% of people who die of coronary heart disease are >65 (AHA, 2012) Male sex (AHA, 2012) Heredity- this includes both family history and race (AHA, 2012) Risk is higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans (AHA, 2012) Patients presenting with unstable angina or NSTEMI have variable levels of risk of cardiac death and ischemic cardiac events (Antman, Cohen, Bernink, McCabe, Horacek, Papuchis, Mautner Braunwald, 2000). The trial conducted by Antman et al. (2000) set out to develop a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for UA/NSTEMI. In doing so, the TIMI risk score was created. The scores are calculated using a score of 1 for each risk factor (7 total categories) assigned to a given patient. According to Antman, et al (2000) the score determines the patients risk of death, myocardial infarction, or severe ischemia. Antman, et al. (2000) found 7 prognostic variables that increase a patients risk. These are: Age 65 years or older At least 3 risk factors for coronary artery disease (male, dyslipidemia, smoking, hypertension, diabetes mellitus, obesity family history) Prior coronary stenosis of 50% or more ST-segment deviation on ECG at presentation At least 2 anginal events in prior 24 hours Use of aspirin in prior 7 days Elevated serum cardiac markers In TIMI 11B/ESSENCE, event rates increase significantly as the TIMI-score increases (Antman et al., 2000). A score of 0/1 showed a 4.7% event rate; 8.3% for 2; 13.2% for 3; 19.9% for 4; 26.2% for 5; and 40.9% for 6/7. This landmark pair of trials allows practitioners a quick assessment of a patients risk of suffering a serious cardiac event. Physical Exam Physical exam is also a key component in the evaluation of a patient with chest pain, as many clues can suggest acute coronary syndrome. Unstable vital signs can be an important hint that the patient has suffered an MI. A general examination may reveal a patient who is diaphoretic and/or using accessory respiratory muscles. The cardiovascular exam could reveal a new murmur, S3/S4 gallop, or JVD. Finally, during the pulmonary exam rales may be heard upon auscultation. Diagnostics Diagnostic testing is an essential part of the evaluation of a patient presenting with chest pain. Several important diagnostic tools were introduced to the emergency department in the latter half of the 20th century that greatly improved the diagnosis and care of acute coronary syndrome. Electrocardiogram The introduction of coronary care units in the 1960s allows physicians to utilize the electrocardiogram (ECG) to monitor potential fatal arrhythmias in patients with acute myocardial infarction (Julian, 1987). Shortly thereafter the portable electrocardiogram became commonplace within the emergency department to assist in diagnosing complications of acute coronary syndrome (Drew, et al, 2004). A patient presenting with myocardial ischemia will typically have symmetrically-inverted T waves in leads V2-V6 (Dubin, 2000). As the name suggests, a STEMI is an ST-segment elevation myocardial infarction, though ST-segment elevation can occur with Prinzmetals angina in absence of an infarction (Dubin, 2000). Additionally, the ECG allows us to evaluate necrosis of the heart in the form of the presence of Q-waves. Q-waves are the first downward deflection of the QRS complex (Dubin, 2000). As Dubin (2000) explains, a positive Q-wave MI must: Lack a preceding spike in the QRS complex Be at least 1 mm wide or Have an amplitude of 1/3 the QRS complex An additional benefit of the ECG is that it allows the practitioner to identify the location of an acute event. Each lead corresponds to a particular location of the heart. For example, leads II, III, and AvF are the inferior leads and reflect the inferior portion of the heart. Due to the relatively high specificity but low sensitivity of the 12 lead ECG in diagnosis of acute coronary syndrome, a group of researchers in Canada recently set out to enhance ischemia detection by conducted a trial which added a new criteria using a three vessel specific leads derived from the traditional 12 lead ECG (Horacek, Mirmoghisi, Warren, Wagner Wang, 2008). This trial showed a statistically significant improvement in the ability of the vessel specific lead protocol to detect ischemia (Horacek et al., 2008). Horacek et al. (2008) found the following sensitivity and specificity for conventional STEMI criteria versus that of the vessel specific leads (VSL): Vessel Sensitivity Specificity Left Anterior Descending 74% conventional, 91% VSL 97% conventional, 97% VSL Right Coronary Artery 60% conventional, 70% VSL 94% conventional, 94% VSL Left Circumflex Artery 36% conventional, 71% VSL 100% conventional, 100% VSL Totals Set 60% conventional, 76% VSL 96% conventional, 96% VSL Based on these results, Horacek et al. (2008) concluded that using vessel specific leads can identify acute ischemia better than existing STEMI criteria. While a STEMI criteria using vessel specific leads has yet to become a mainstay within the standard emergency room protocol, this study provides exciting new improvements in the detection and management of patients with ACS. Serum Biomarkers The use of biochemical markers to detect cardiac cell death significantly evolved in the 1980s and 1990s. Initially, nonspecific markers such as aspartate transaminase and total creatinine kinase were used to detect myocardial necrosis (Lewandrowski, Chen Januzzi, 2002). During the mid-1990s the more cardiac specific enzymes CK-MB became the gold standard for detection of myocardial injury (Lewandrowski et al., 2002). CK-MB, which commonly rises 4-9 hours after the onset of angina, was not without its shortcomings. CK-MB may be falsely elevated due to several different causes, including recent strenuous exercise or skeletal muscle damage, or renal failure (Vivekanandan Swaminathan, 2010). In the late 1990s a more predictable biomarker, troponin I, was introduced for more accurate detection of acute coronary syndrome (Heeschen, Goldmann, Moeller Hamm, 1998). According to Heeschen et al. (1998), Troponin I can be evaluated at the bedside in the emergency room and has a higher diagno stic sensitivity for the detection of acute myocardial infarction (60% vs 48%) when compared to CK-MB. The reason for this improvement in accuracy is that troponin I is not found in skeletal muscle tissue or renal failure (Heeschen et al., 1998). As Heeschen et al. (1998) demonstrated in a head to head study that cTnI test systems produced no positive results in patients with end-stage renal failure and acute or chronic skeletal muscle injury, whereas 30% and 71% of the patients, respectively, had increased CK-MB mass concentrations. One disadvantage of troponin I, however, is that it has a lower sensitivity for the detection of acute myocardial infarction compared to that of CK-MB (Heeschen et al., 1998). This is due to an increased level of cTnI in patients with unstable angina (Heeschen et al., 1998). For this reason, a typical workup for a patient with chest pain in the emergency room includes both cTnI and CK-MB assays, which are drawn at presentation and every 3-6 hours therea fter (Ross, Bever, Uddin Hockman, 2000). Imaging A common component of a chest pain protocol is a chest x-ray. This is normally either a standard AP/lateral series or a portable chest x-ray if the patient is unable to get out of bed. The chest x-ray is useful to eliminate other possible causes of chest pain, such as an aortic aneurism or a pneumothorax. Contrast-enhanced computed tomographic angiography, or CTA, has become an integral part of the management of acute coronary syndrome due to its high sensitivity and specificity (Hoffman, Truong, Schoenfeld, Chou, Woodard, Nagurney, Pope Udelson, 2012). According to the ROMICAT-I study performed by Hoffman et al., (2012), CTA is an effective way to rule out myocardial infarction or ischemia as well as major cardiovascular events over the next 2 years from presentation. The data presented in ROMICAT-I showed that patients undergoing CTA decreased their hospital stay by 7.6 hours compared to standard therapy (Hoffman et al., 2012). Additionally, 50% of CTA patients were discharged from the hospital within 8.6 hours of presentation versus only 10% of patients undergoing standard therapy (Hoffman et al., 2012). Finally, the mean time to diagnosis was significantly decreased with the CT group versus the standard group (Hoffman et al., 2012). Overall, CTA was shown to reduce time spent in the hospital and time to diagnosis when compared to standard therapy for acute coronary syndrome. This is important to note considering the importance of quick coronary reperfusion of STEMI patients (Trost Lange, 2011). An additional observation was that these benefits were achieved without an increase in the cost of care (Hoffman et al., 2012). There was no overall difference between the groups in incidence of myocardial infarction 30 days after initial presentation (Hoffman et al., 2012). It is important to note that a patient undergoing a CTA is exposed to increased radiation. Additionally, patients undergoing CTA were more likely to undergo invasive coronary procedures when compared to standard evaluation. Based on this data, a question arises as to whether every patient presenting with possible acute coronary syndrome should undergo a CTA. The population studied in ROMICAT-I consisted of low to intermediate risk patients. Overall, CTA was shown to decrease the time to diagnosis and hospital stay for patients with possible ACS. In contrast, CTA increases a patients exposure to radiation and increases the likelihood that these patients will undergo an increase in invasive coronary procedures. These factors should all be considered when evaluating a patient presenting with chest pain. Treatment Pharmacologic Aspirin: Early aggressive aspirin (ASA) therapy (162-325mg followed by 81-162mg daily) is currently recommended for all patients with acute coronary syndrome, unless contraindicated (Kirk, Kontos Diercks, 2011). Plavix (Clopidogrel): According to the CURE trial Clopidogrel has been shown to provide a 20% reduction in cardiovascular death, MI, or stroke for NSTEMI patients with positive biomarkers or ischemic ECG changes (Kirk et al., 2011). It is important to note that the significant anti-platelet benefits of Clopidogrel administration should also be weighed against the increased risk of bleeding events if the patient may be a candidate for coronary artery bypass surgery. Antianginal Agents: Nitroglycerin (NTG): NTG is commonly administered by EMS respondents but can also be ordered once the patient arrives in the emergency department, typically sublingually or in the form of Nitropaste. Nitroglycerin dilates the coronary arteries, which reduces myocardial oxygen demand (Trost Lange, 2011). For this reason, it is important to evaluate the patients baseline blood pressure. If SBP is less than 100, caution should be used. Morphine: Intravenous morphine may be given in the event that chest pain is not relieved by NTG administration. Morphine reduces ventricular preload, thereby decreasing myocardial O2 demand (Trost Lange, 2011). Beta-Andrenergic Blockers: Beta-blockers decrease demand on the heart by decreasing heart rate, blood pressure, and myocardial contractility (Trost Lange, 2011). In a patient presenting with ACS, IV Lopressor is typically the agent of choice. These are especially effective agents in patients with elevated blood pressure or tachycardia. It is important to evaluate relevant contraindications to beta-blocker therapy, such as: HR Calcium-Channel Blockers: Diltiazem and Verapamil improve cardiac O2 supply by vasodilation of the coronary vessels, reduce O2 demand by reducing afterload, and reduce heart rate and contractility (Trost Lange, 2011). Calcium-channel blockers are 2nd line treatments for ACS and are typically reserved for patients who are unable to take a beta-blocker (Trost Lange, 2011). Contraindications include: sick sinus syndrome, 2Â ° or 3Â ° AV heart block, hypotension, acute MI with pulmonary congestion, atrial fibrillation or flutter with accessory bypass tract, and ventricular tachycardia, severe left ventricular dysfunction, and cardiogenic shock (Epocrates, 2012). Antithrombotic therapy: Antithrombotic therapy is recommended in a patient with suspected ACS, unless contraindicated (Trost Lange, 2011). Unfractionated heparin is easy to administer (IV) and is rapidly reversible with protamine in the event of bleeding. (Trost Lange, 2011). As with any antithrombotic, there is a risk of bleeding so these patients require close monitoring. Low molecular weight heparin is more predictable, has a lower incidence of thrombocytopenia, and does not require monitoring (Trost Lange, 2011). LMWH is the preferred agent for a more conservative, ischemia-guided strategy to prevent in hospital death or myocardial infarction (Trost Lange, 2011). Bivalirudin is an antithrombotic agent that does not cause thrombocytopenia (Trost Lange, 2011). It has been shown to be equally as effective as unfractionated heparin or LMWH but with a significantly lower rate of bleeding (Trost Lange, 2011). Oxygen administration should be administered for patients who are short of breath, showing signs of shock, or O2 saturation Next Step for NSTEMI or Unstable Angina Patients If a patient is considered to be high risk, such as a patient is at risk of future ischemia or infarction, an early invasive strategy is recommended (Trost Lange, 2011). For these patients, cardiac catheterization should be performed within 24-48 hours of admission (Trost Lange, 2011). In a low risk patient, a more conservative treatment is typically recommended. For these patients, catheterization is only recommended if recurrent or provocable ischemia occurs (Trost Lange, 2011). TIMI scores are a valuable tool to assess the patients risk and to guide the practitioner on the appropriate next step. Next Step for STEMI Patients Prompt coronary reperfusion is paramount in patients presenting with STEMI (Trost Lange, 2011). A door-to-balloon time of less than 90 minutes is considered to be the goal (Trost Lange, 2011). If the patient presents to a facility without a percutaneous coronary intervention facility the patient should be either: Treated with fibrinolytic therapy if not contraindicated (Trost Lange, 2011) Or Transferred to a nearby PCI facility (Trost Lange, 2011). Conclusion Acute coronary syndrome is spectrum of diseases typically caused by atherosclerotic disease. Emergency department practitioners must be able to rapidly diagnose and manage ACS patients in order to potentially preserve precious heart muscle. While treatments for ACS have improved dramatically over the past 30 years, several recent innovations have brought upon exciting new possibilities for the care of these patients. These include new vessel specific ECG leads, cardiac specific biomarkers, and the use of computed-tomographic angiography to assess patients with possible ACS. One component of the management algorithm that has not changed is the need for a strong history and physical examination to aid in diagnosis. Urgency in obtaining diagnosis cannot be stressed enough, and patients presenting with STEMI should be rapidly sent for PCI or transferred to a facility with PCI capabilities.

Creative Management Essays -- essays research papers

Creative Management gives creative ideas of how a manger should present himself and how to approach different situations. Creative Management written by Shiegru Kobanashi, focuses mainly on the importance of teamwork, and on group management. How can we transform our present methods of production, under which we become slaves to machines, and regulations for the temporary increase in productivity, into one in which we are the masters of our work? How can we establish a system, which will make people work voluntarily and feel good about doing it. The book starts with waking up make sure you have proper hygiene. Wear simple clothes. Not close that stand out. A fussy dresser doesn’t impress people, but it gives a false impression of the person wearing the clothes you should wear clean, pleasing clothes that match your personality. A manager should always meet someone with a smile. It will lighten the mood and there is no better way to show your personality them by your smile. â€Å"Face every day with a smile, and you will lead a pleasant life everyday.†(Page 86) It expresses the importance of saying the simple words good morning and good night. When talking to employees you should speaking sincerely and low toned which will make others understand your thinking or feeling. Speaking forcefully and loud with raw emotion can affect other people as well as yourself. The book also emphasizes the importance of a manager to use empathy when dealing with fellow employees. Always put yourself in other people’s position. If you base all decisions and give information to workers solely on how you feel chances are the advice you give will not be what the person coming to you needed. Everyone is different and everyone’s lives are different. A good manager should get to know his employees as best as possible. Giving the manager a little incite into each of their lives. The more you know about your fellow workers the easier it will be to put yourself in there shoes and give the correct advice. .  Ã‚  Ã‚  Ã‚  Ã‚  The world is filled with all types of temptations, and sometimes a manager is put into a situation where he has the opportunity to make some extra cash or maybe get something from some one for doing a not so legal favor. When these situations occur you should stop think things through. You have a mind and are used to doing your own thinking, but you a... ...wth are discussed. This type of meeting takes place every six months. Each department manager or team leader becomes familiar with other functions and groups, learns from hearing their work revised, and participates in policymaking. They learn the significance of his department’s activities in relation to the whole company. They discuss policy making ideas, review appraisals, and set goals. Teams don’t function on order from above, rather it functions on it’s own ideas. The same thing can be said about the individuals who make team, and revise goals that are also handled by team. In other words they work as a unit. A manager should hold himself as a person of power who is still an equal of his work force. The job of the manager is not to order people around and push his ideas. A manager's job is to keep the work force unified and keep it working as a team. Most people in today’s society are power hungry and are only in it for them selves. They don’t realize that if everyone is successful you will be successful they will be to. So remember . there is no â€Å"I† in team. Working to getter and putting minds together is much more efficient then one person how thinks they know everything