10
MALLORY WEISE TEAR
Running head: MALLORY WEISE TEAR 1
Running head: MALLORY WEISE TEAR
Introduction
The following information will be an extensive in-depth review of a patient with a condition known as a Mallory Weise Tear (MWT). The paper will analyze peer-reviewed literature surrounding this condition and the pathophysiology behind it. There are complications that can arise with a diagnosis of an MWT, so the paper will discuss how to recognize the warning signs and how to manage patient care. The paper will also cover the nursing process and treatments for a patient that suffers from MWT. Last but not least, the paper will cover suggested teachings that nurses can go over with their patient and family on the how’s and why’s, along with signs and symptoms of MWT and its complications.
Scenario
A 57-year-old male presents to the emergency department with complaints of abdominal pain, dark black stools for the last four days, and having coffee ground emesis with occasional red streaks. He states a past medical history that includes mild cirrhosis related to alcohol abuse, current smoker of one pack per day, and chronic back pain from an MVA ten years ago that he treats with Aleve and ibuprofen. He has been told that he has hypertension but does not take any medication.
On examination, the vital signs are as follows: blood pressure 138/84, heart rate 105, tympanic temperature 98.9, respirations 19, O2 saturations 98% on room air. He complains of nausea and is guarding his abdomen. There is no asities or obvious jaundice noted. Upon auscultation the patient has normal heart tones and clear breath sounds bilaterally. The doctor was at the bedside and performed a digital rectal exam which reveals black stool, occult blood positive. An 18g IV was stared in his right antecubital vein and labs were sent. The labs showed the following: WBC 11, HGB 8.4 g/DL, HCT 25 %, PLT 150 K/UL, AST 78 U/L, ALT 54 U/L, Albumin 3.5 G/DL, Ammonia level 15 U/DL, Potassium 3.7 mEq/l, Sodium 135mEq/l, BUN 25 mg/dl, Creatinine 1.1 mg/dl, Glucose 96 mg/dl. The doctor mentions that most of the labs are with in normal limits but could be indicative of a hemorrhage.
Literature Review
E. Cherednikov, A.A. Kunun, E.E. Cherednikov, and N.S. Moiseeva (2016), authors of “The Role of Etiopathogenetic Aspects in Prediction and Prevention of Discontinuous-Hemorrhagic (Mallory-Weiss) Syndrome,” provided numerous etiological factors, and new insights into the pathogenesis of the disease. S.S. Flanders (2018), author of “Effective Patient Education: Evidence and Common Sense,” takes a close look at patient education related to MWT, and what aspects are most beneficial for knowledge retention. K. Hyun-Soo (2015), author of “Endoscopic Management of Mallory-Weiss tearing,” discusses surgical, nonsurgical options, and treatments available. J. Jahraus (2018), author .
The document discusses the proposal to change the name of non-alcoholic fatty liver disease (NAFLD) to metabolic associated fatty liver disease (MAFLD). It notes that NAFLD's name does not accurately capture the metabolic nature of the disease. The name change was proposed by an international panel of experts and aims to reduce stigmatization and increase consideration of the disease. If adopted, MAFLD would be used instead of NAFLD to describe fatty liver disease associated with metabolic dysfunction. The document supports the name change as a way to properly frame the growing epidemic of this liver disease.
A case presentation on severe calcific aortic stenosisM.Arumuga Vignesh
This case presentation discusses a 57-year-old male patient admitted to the hospital with dyspnea and a diabetic foot ulcer. The patient was diagnosed with severe calcific aortic stenosis along with comorbidities of hypertension, diabetes, and pleural effusion. Laboratory tests confirmed Klebsiella pneumonia as the cause of the foot ulcer. The patient is being treated with medications including amlodipine, pantoprazole, metronidazole, levofloxacin, furosemide, insulin, and N-acetylcysteine to manage his conditions while addressing any drug interactions and monitoring his health indicators.
Dr. Bilal Natiq Nuaman provides an introduction to internal medicine. He discusses that internal medicine deals with diagnosis and nonsurgical treatment of adult diseases. It includes many subspecialties like cardiology, endocrinology, gastroenterology, and others. The document then outlines the process of medical diagnosis, including taking a history, performing an examination, and ordering investigations. It provides an example of constructing a differential diagnosis for a patient presenting with left leg swelling and pain. Potential diagnoses are narrowed down based on history and exam findings. Tests are ordered to evaluate the leading hypotheses while considering pretest probabilities and potential harms of missing diagnoses or treatments.
This document discusses non-alcoholic fatty liver disease (NAFLD), which ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It occurs without significant alcohol use or other known causes. Risk factors include obesity, dyslipidemia, and type 2 diabetes. Due to the rise in metabolic syndrome, NAFLD is now the most common cause of chronic liver disease. Genetic and metabolic factors like insulin resistance and inflammation contribute to its development and progression. Liver biopsy is still the gold standard for diagnosis but carries risks, so noninvasive imaging methods are being developed and studied.
A 25-year-old female presented with abdominal pain, repeated fits and profuse vaginal bleeding after delivering a dead baby at home. She was diagnosed with HELLP syndrome based on her symptoms and lab results. She was treated aggressively in the intensive care unit with magnesium sulfate to control seizures, blood transfusions, evacuation of retained placenta, antihypertensives, and hemodialysis. Her condition improved over several days and she was discharged after 10 days on oral medications. The case illustrates the importance of early detection and rapid treatment by a multidisciplinary team for successful management of HELLP syndrome.
An acute abdomen is severe abdominal pain that comes on suddenly and may require immediate medical care. It can be caused by conditions like appendicitis, diverticulitis, gallstones, or intestinal infections. Diagnosis involves examining the patient's medical history and symptoms, as well as tests like blood tests, imaging scans, and surgery if needed. Treatment depends on the underlying cause but may include pain relievers, surgery, or other medical interventions.
The document discusses the proposal to change the name of non-alcoholic fatty liver disease (NAFLD) to metabolic associated fatty liver disease (MAFLD). It notes that NAFLD's name does not accurately capture the metabolic nature of the disease. The name change was proposed by an international panel of experts and aims to reduce stigmatization and increase consideration of the disease. If adopted, MAFLD would be used instead of NAFLD to describe fatty liver disease associated with metabolic dysfunction. The document supports the name change as a way to properly frame the growing epidemic of this liver disease.
A case presentation on severe calcific aortic stenosisM.Arumuga Vignesh
This case presentation discusses a 57-year-old male patient admitted to the hospital with dyspnea and a diabetic foot ulcer. The patient was diagnosed with severe calcific aortic stenosis along with comorbidities of hypertension, diabetes, and pleural effusion. Laboratory tests confirmed Klebsiella pneumonia as the cause of the foot ulcer. The patient is being treated with medications including amlodipine, pantoprazole, metronidazole, levofloxacin, furosemide, insulin, and N-acetylcysteine to manage his conditions while addressing any drug interactions and monitoring his health indicators.
Dr. Bilal Natiq Nuaman provides an introduction to internal medicine. He discusses that internal medicine deals with diagnosis and nonsurgical treatment of adult diseases. It includes many subspecialties like cardiology, endocrinology, gastroenterology, and others. The document then outlines the process of medical diagnosis, including taking a history, performing an examination, and ordering investigations. It provides an example of constructing a differential diagnosis for a patient presenting with left leg swelling and pain. Potential diagnoses are narrowed down based on history and exam findings. Tests are ordered to evaluate the leading hypotheses while considering pretest probabilities and potential harms of missing diagnoses or treatments.
This document discusses non-alcoholic fatty liver disease (NAFLD), which ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. It occurs without significant alcohol use or other known causes. Risk factors include obesity, dyslipidemia, and type 2 diabetes. Due to the rise in metabolic syndrome, NAFLD is now the most common cause of chronic liver disease. Genetic and metabolic factors like insulin resistance and inflammation contribute to its development and progression. Liver biopsy is still the gold standard for diagnosis but carries risks, so noninvasive imaging methods are being developed and studied.
A 25-year-old female presented with abdominal pain, repeated fits and profuse vaginal bleeding after delivering a dead baby at home. She was diagnosed with HELLP syndrome based on her symptoms and lab results. She was treated aggressively in the intensive care unit with magnesium sulfate to control seizures, blood transfusions, evacuation of retained placenta, antihypertensives, and hemodialysis. Her condition improved over several days and she was discharged after 10 days on oral medications. The case illustrates the importance of early detection and rapid treatment by a multidisciplinary team for successful management of HELLP syndrome.
An acute abdomen is severe abdominal pain that comes on suddenly and may require immediate medical care. It can be caused by conditions like appendicitis, diverticulitis, gallstones, or intestinal infections. Diagnosis involves examining the patient's medical history and symptoms, as well as tests like blood tests, imaging scans, and surgery if needed. Treatment depends on the underlying cause but may include pain relievers, surgery, or other medical interventions.
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
The document provides information about strokes (cerebrovascular accidents), including signs and symptoms, treatments, and nursing care considerations. It discusses medications and procedures that can stop a stroke from progressing if administered within 3 hours, such as tissue plasminogen activator (TPA). It also outlines nursing diagnoses, goals, and interventions for issues like impaired physical mobility and chronic confusion that may result from a stroke.
This document discusses hypertensive crisis, including its definition, causes, risk factors, clinical manifestations, diagnostic evaluation, and management. Hypertensive crisis is defined as a sudden severe elevation in blood pressure that can cause end organ damage if not promptly treated. The most common cause is poorly controlled essential hypertension. Clinical manifestations depend on the affected end organ and may include seizures, pulmonary edema, kidney injury, or retinal hemorrhage. Treatment involves rapidly lowering blood pressure by 20-25% using intravenous antihypertensive drugs to prevent further organ damage.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
The document provides guidelines for diagnosing and managing disseminated intravascular coagulation (DIC). It states that DIC diagnosis requires both clinical and laboratory information. The International Society for Thrombosis and Haemostasis scoring system objectively measures DIC and correlates with clinical outcomes. The cornerstone of DIC treatment is treating the underlying condition. Transfusions are generally reserved for bleeding patients, though platelets may be considered for patients with platelet counts under 50 · 109/l who are at high risk of bleeding or will undergo an invasive procedure.
The 22-year-old female presented with sudden severe abdominal pain, renal impairment, and was found to have HBV infection. Renal biopsy showed focal ischemic cortical necrosis and hyalinization consistent with HBV-related polyarteritis nodosa (PAN). She was treated with pulse steroids, antiviral therapy with lamivudine, and hemodialysis, and her renal function improved though remained impaired.
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
Gluten is a protein found in wheat and grain products that is used to hold foods together. It can cause issues for those with celiac disease or gluten intolerance. Celiac disease symptoms include gas, bloating, and skin rashes, and it is diagnosed through blood tests or intestinal biopsies. Lactose intolerance is caused by the inability to digest lactose sugar in dairy products, leading to symptoms like diarrhea. Alternatives to gluten and dairy include foods like soy, rice, and lactose-free products.
This document discusses the importance of conducting a thorough clinical examination for medically compromised patients. It involves taking a detailed medical history, performing a physical exam, and considering any relevant lab tests or medical consultations needed to assess a patient's health risks. The medical history covers symptoms, medical conditions, medications, and social factors. The physical exam checks vital signs and examines major organ systems. Laboratory tests and medical consultations can aid in risk assessment. Proper risk assessment is key to determining if dental treatment can be conducted safely and what modifications may be needed based on the patient's health status and procedures planned. The overall goal is to minimize health risks through modified treatment approaches.
1) A 32-year-old woman presented with a 10-year history of severe recurrent abdominal pain.
2) Extensive prior testing and evaluations did not identify a cause, though she was diagnosed with conversion disorder during one hospitalization.
3) During her most recent hospitalization for abdominal pain, she developed hyponatremia that was initially thought to be due to poor oral intake but worsened despite IV fluids.
4) Further testing revealed findings consistent with SIADH and elevated urine porphyrin levels, leading to a diagnosis of acute intermittent porphyria, a rare genetic disorder causing episodic severe abdominal pain and other symptoms.
2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
https://gotoclass.tnecampus.org/d2l/le/content/8094442/viewContent/60403389/View 1/12
Soil Colloids (Chapter 8) Notes
Soil Colloids (Chapter 8) Notes
Did you know ....
Did you know soil fertility or the ability for a soil to provide nutrients is seated in the type of minerals it
contains? Chapter 8 will cover the various types of soil colloids including all the layer and non-layer
silicates, cation exchange, anion exchange, and sorption.
Lecture content notes are accompanied by videos listed below the notes in each submodule (e.g. Soil
Colloids (Chapter 8) Videos A though H). Print or download lecture notes then view videos in
succession alongside lecture content and add additional notes from each video. The start of each
video is noted in parenthesis (e.g. Content for Video A) within each lecture note set and contains
lecture content through the note for the next video (e.g. Content for Video B).
Figures and tables unless specifically referrenced are from the course text, Nature and Property of
Soils, 14th Edition, Brady and Weil.
Content Video A
Soil Colloids
Smallest soil particles < 1 µm
Surface area - LARGE
Surface charge - CEC
Adsorb water
AGRI1050R50: Introduction to Soil Science (2020S) LH
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2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
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Types of Colloids
Crystalline Silicate clays: ordered, crystalline, layers
Non-crystalline silicate clays: non-ordered, layers, volcanic
Iron/Aluminum Oxides – weathered soils, less CEC
Humus – OM, not mineral or crystalline, high CEC
Soil Colloids
Content Video B
Layer Silicates - Construction
Phyllosillicates
Tetrahedral Sheets
1 Si with 4 Oxygen
Share basal oxygen
Form sheets
Octahedral Sheets
6 Oxygen with Al3+ or Mg 2+
Di T i O t h d l b d # f di ti i
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Di or Tri Octahedral based on # of coordinating ions
http://web.utk.edu/~drtd0c/Soil%20Colloids.pdf
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2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
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Size .
20 Other Conditions That May Be a Focus of Clinical AttentionV-c.docxRAJU852744
20 Other Conditions That May Be a Focus of Clinical Attention
V-codes and z-codes
V-codes and Z-codes are conditions that may be the focus of clinical attention but are not considered mental disorders. They correspond to International Classification of Diseases, Ninth Revision, Clinical Modification ICD-9-CM (V-codes) and International Classification of Diseases, Tenth Revision, Clinical Modification ICD-10-CM (Z-codes that become effective in 2015. In most instances, third-party payers do not cover charges for delivering services to an individual if the diagnosis is solely a V- or Z-code alone. If the V- or Z-code is not the primary diagnosis then it should be documented following the primary diagnosis. In addition, when writing the psychosocial assessment any psychosocial and cultural factors that might impact the client's diagnosis should be documented. The psychosocial stressors reflected in these diagnoses are widespread across all classes and cultures and have been shown to impact all aspects of an individual's life from the physical and psychological to the financial. Furthermore, these conditions have been shown to significantly impact the diagnosis and outcome for a multitude of mental and medical disorders. V- and Z-codes are grouped into numerous categories including: relational problems, problems related to abuse/neglect, educational and occupational problems, housing and economic problems, problems related to the social environment, problems related to the legal system, other counseling services, other psychosocial, personal and environmental problems, and problems of personal history (APA, 2013).
Broadly speaking, the category “Relational Problems” describes interactional problems between family members (e.g., parent/caregiver-child) or partners that result in significant impairment of family functioning or development of symptoms in the distressed individual, spouses, siblings, or other family members. Relational problems are broken down into two categories, Problems Related to Family Upbringing and Other Problems Related to Primary Support Group. For example, in the first category a Parent-Child Relational Problem involves interactional problems between one or both parents and a child that lead to dysfunction in behavioral (e.g., inadequate protection, overprotection), cognitive (e.g., antagonism toward or blaming of the other) or affective (e.g., feeling sad and angry) realms. Here, the critical factor is the quality of the parent-child relationship or when the dysfunction in this relationship is impacting the course and outcome of a psychological or medical condition. Other examples include Sibling Relational Problem, Upbringing Away from Parents, and Child Affected by Parental Relationship Distress. Similarly, family relationships and interactional patterns leading to problems related to primary support group include Partner Relational Problem, Disruption of Family by Separation/Divorce, High Expressed Emotion Level with.
223 Case 53 Problems in Pasta Land by Andres Sous.docxRAJU852744
1) The pasta factory is facing increasing customer demand that exceeds its production capacity due to outdated equipment.
2) New technology allows for higher production capacity using lower quality ingredients, but requires different skills and labor than the current factory's outdated equipment.
3) Introducing new technology and expanding production would require overcoming resistance from employees accustomed to current methods and addressing concerns about job losses in the local community.
2
2
2
1
1
1
Organization Name: Insta-Buy
Insta-Buy is an E-Commerce Multinational American company. It was founded in 2010 and is based in Atlanta, Georgia. It mainly operates with grocery delivery and pick up and it offers services through web application and mobile application to various states in United States. It is one of the major online marketplaces for grocery delivery. The company is valued at $1 billion worth and has partnership with over 150 retailers. It is known for its fresh produce and timely delivery and pickup.
Predictive Analysis at Insta-Buy:
The predictive analytics is termed as what is likely to happen in the future. The predictive analytics is based on statistical and data mining technique. The aim of this technique is to predict the future of the project such as what would be the customer reaction on project, financial need, etc. In developing predictive analytical application, a number of techniques are used such as classification algorithms. The classification techniques are logistic regression, decision tree models and neural network. Clustering algorithms are used to segment customers in different groups which helps to target specific promotions to them. To estimate the relationship between different purchasing behavior, association mining technique is used (Mehra, 2014). As an example, for any product on Amazon.com results in the retailer also suggesting similar products that a customer might be interested in. Predictive analytics can be used in E-commerce to solve the following problems
1. Improve customer engagement and increase revenue
1. Launch promotions that target specific customer group
1. Optimizing prices to generate maximum profits
1. Keep proper inventory and reduce over stalking
1. Minimizing fraud happenings and protecting privacy
1. Provide batter customer service at low cost
1. Analyze data and make decision in real time
TOPICS:
Student: Ahmed
Topic: Bayesian Networks (Predicting Sales In E-commerce Using Bayesian Network Model)
Student: Meet
Topic: Predictive Analysis
Student: Peter
Topic: Privacy and Confidentiality in an e-Commerce World: Data Mining, Data Warehousing, Matching and Disclosure Limitation
Student: Nayeem
Topic: Ensemble Modeling
Student: Shek
Topic: L.Jack & Y.D. Tsai, Using Text Mining of Amazon Reviews to Explore User-Defined Product Highlights and Issues.
Student: Suma
Topic: Deep Neural Networks
REFERENCES:
Olufunke Rebecca Vincent, A. S. (2017). A Cognitive Buying Decision-Making Process in B2B E-Commerce Using Analytic-MLP. Elsevier.
https://www.researchgate.net/publication/319278239_A_Cognitive_Buying_Decision-Making_Process_in_B2B_E-Commerce_Using_Analytic-MLP
Wan, C. C. (2017). Forcasting E-commerce Key Performance Indicators
https://beta.vu.nl/nl/Images/stageverslag-wan_tcm235-867619.pdf
Fienberg, S. (2006). Privacy and Confidentiality in an e-Commerce World: Data Mining, Data Warehousing, Matching and Disclosure Limitation. Statistical Science, .
22-6 Reporting the Plight of Depression FamiliesMARTHA GELLHOR.docxRAJU852744
22-6 | Reporting the Plight of Depression Families
MARTHA GELLHORN, Field Report to Harry Hopkins (1934)
1. From Martha Gellhorn to Harry Hopkins, Report, Gaston County, North Carolina, November 11, 1934, Franklin D. Roosevelt Library, Harry Hopkins Papers, Box 66. Online transcript available at http://newdeal.feri.org/hopkins/hop08.htm.
Journalist and novelist Martha Gellhorn’s heartrending field report describing impoverished Gastonia, North Carolina, families vividly captures the desperate hope of depression-era families. Hired by Harry Hopkins, Franklin Roosevelt’s point man for federal relief efforts, Gellhorn detailed the enormous challenge facing the administration. Compounding the epic humanitarian crisis she encountered was the political opposition, which she singled out as one among many obstacles hampering relief efforts.
All during this trip [to North Carolina] I have been thinking to myself about that curious phrase “red menace,” and wondering where said menace hid itself. Every house I visited — mill worker or unemployed — had a picture of the President. These ranged from newspaper clippings (in destitute homes) to large colored prints, framed in gilt cardboard. The portrait holds the place of honour over the mantel. . . . He is at once God and their intimate friend; he knows them all by name, knows their little town and mill, their little lives and problems. And, though everything else fails, he is there, and will not let them down.
I have been seeing people who, according to almost any standard, have practically nothing in life and practically nothing to look forward to or hope for. But there is hope; confidence, something intangible and real: “the president isn’t going to forget us.”
Let me cite cases: I went to see a woman with five children who was living on relief ($3.40 a week). Her picture of the President was a small one, and she told me her oldest daughter had been married some months ago and had cried for the big, coloured picture as a wedding present. The children have no shoes and that woman is terrified of the coming cold as if it were a definite physical entity. There is practically no furniture left in the home, and you can imagine what and how they eat. But she said, suddenly brightening, “I’d give my heart to see the President. I know he means to do everything he can for us; but they make it hard for him; they won’t let him.” I note this case as something special; because here the faith was coupled with a feeling (entirely sympathetic) that the President was not entirely omnipotent.
I have been seeing mill workers; and in every mill when possible, the local Union president. There has been widespread discrimination in the south; and many mills haven’t re-opened since the strike. Those open often run on such curtailment that workers are getting from 2 to 3 days work a week. The price of food has risen (especially the kind of food they eat: fat-back bacon, flour, meal, sorghum) as high as 100%. It is getting cold;.
2018 4th International Conference on Green Technology and Sust.docxRAJU852744
2018 4th International Conference on Green Technology and Sustainable Development (GTSD)
130
�
Abstract - The Vietnamese government have plan to develop the
wind farms with the expected capacity of 6 GW by 2030. With the
high penetration of wind power into power system, wind power
forecasting is essentially needed for a power generation
balancing in power system operation and electricity market.
However, such a tool is currently not available in Vietnamese
wind farms as well as electricity market. Therefore, a short-term
wind power forecasting tool for 24 hours has been created to fill
in this gap, using artificial neural network technique. The neural
network has been trained with past data recorded from 2015 to
2017 at Tuy Phong wind farm in Binh Thuan province of Viet
Nam. It has been tested for wind power prediction with the input
data from hourly weather forecast for the same wind farm. The
tool can be used for short-term wind power forecasting in
Vietnamese power system in a foreseeable future.
Keywords: power system; wind farm; wind power forecasting;
neural network; electricity market.
I. NECESITY OF WIND POWER FORECASTING
Today, the integration of wind power into the existing
grid is a big issue in power system operation. For the system
operators, power generation curve of wind turbines is a
necessary information in the power sources balancing. From
the dispatchers’ point of view, wind power forecast errors
will impact the system net imbalances when the share of
wind power increases, and more accurate forecasts mean less
regulating capacity will be activated from the real time
electricity market [1]. In the deregulated market, day-ahead
electricity spot prices are also affected by day-ahead wind
power forecasting [2]. Wind power forecasting is also
essential in reducing the power curtailment, supporting the
ancillary service. However, due to uncertainty of wind speed
and weather factors, the wind power is not easy to predict.
In recent years, many wind power forecasting methods
have been proposed. In [3], a review of different approaches
for short-term wind power forecasting has been introduced,
including statistical and physical methods with different
models such as WPMS, WPPT, Prediktor, Zephyr, WPFS,
ANEMOS, ARMINES, Ewind, Sipreolico. In [4], [5], the
methods, models of wind power forecasting and its impact on
*Research supported by Gesellschaft fuer Internationale
Zusammenarbeit GmbH (GIZ).
D. T. Viet is with the University of Danang, Vietnam (email:
[email protected]).
V. V. Phuong is with the University of Danang, Vietnam (email:
[email protected]).
D. M. Quan is with the University of Danang, Vietnam (email:
[email protected]).
A. Kies is with the Frankfurt Institute for Advanced Studies, Germany
(email: [email protected] uni-frankfurt.de).
B. U. Schyska is with the Carl von Ossietzky Universität Oldenburg,
Germany (email: [email protected]).
Y. K. Wu i.
202 S.W.3d 811Court of Appeals of Texas,San Antonio.PROG.docxRAJU852744
202 S.W.3d 811
Court of Appeals of Texas,
San Antonio.
PROGRESSIVE COUNTY MUTUAL INSURANCE
COMPANY, Appellant,
v.
Hector Raul TREVINO and Mario Moyeda,
Appellees.
No. 04–05–00113–CV.
|
June 28, 2006.
|
Rehearing Overruled July 31, 2006.
.
200 wordsResearch Interest Lack of minorities in top level ma.docxRAJU852744
200 words
Research Interest: Lack of minorities in top level management positions
Describe why and how a qualitative approach may be appropriate for your area of interest for your research. Include a rationale for each proposed use of qualitative inquiry.
.
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Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
The document provides information about strokes (cerebrovascular accidents), including signs and symptoms, treatments, and nursing care considerations. It discusses medications and procedures that can stop a stroke from progressing if administered within 3 hours, such as tissue plasminogen activator (TPA). It also outlines nursing diagnoses, goals, and interventions for issues like impaired physical mobility and chronic confusion that may result from a stroke.
This document discusses hypertensive crisis, including its definition, causes, risk factors, clinical manifestations, diagnostic evaluation, and management. Hypertensive crisis is defined as a sudden severe elevation in blood pressure that can cause end organ damage if not promptly treated. The most common cause is poorly controlled essential hypertension. Clinical manifestations depend on the affected end organ and may include seizures, pulmonary edema, kidney injury, or retinal hemorrhage. Treatment involves rapidly lowering blood pressure by 20-25% using intravenous antihypertensive drugs to prevent further organ damage.
This guideline presents recommendations for the management of acute pancreatitis (AP). Key recommendations include: assessing hemodynamic status upon presentation and providing resuscitation as needed; admitting patients with organ failure to intensive care; providing aggressive intravenous hydration within the first 12-24 hours; using ERCP within 24 hours for patients with AP and cholangitis; not routinely using prophylactic antibiotics for severe AP or sterile necrosis; considering infected necrosis in patients not improving after 7-10 days and using antibiotics known to penetrate pancreatic necrosis; and providing enteral nutrition for severe AP to prevent infectious complications while avoiding parenteral nutrition.
The document provides guidelines for diagnosing and managing disseminated intravascular coagulation (DIC). It states that DIC diagnosis requires both clinical and laboratory information. The International Society for Thrombosis and Haemostasis scoring system objectively measures DIC and correlates with clinical outcomes. The cornerstone of DIC treatment is treating the underlying condition. Transfusions are generally reserved for bleeding patients, though platelets may be considered for patients with platelet counts under 50 · 109/l who are at high risk of bleeding or will undergo an invasive procedure.
The 22-year-old female presented with sudden severe abdominal pain, renal impairment, and was found to have HBV infection. Renal biopsy showed focal ischemic cortical necrosis and hyalinization consistent with HBV-related polyarteritis nodosa (PAN). She was treated with pulse steroids, antiviral therapy with lamivudine, and hemodialysis, and her renal function improved though remained impaired.
This document discusses the management of variceal bleeding, specifically focusing on esophageal and gastric varices. It provides an overview of endoscopic and medical therapies for controlling acute esophageal variceal bleeding such as endoscopic band ligation, sclerotherapy, and pharmacologic therapies like octreotide. For gastric varices, it describes different classification systems and challenges in managing bleeding, noting endoscopic therapies like sclerotherapy, ligation, and glue injection can control acute bleeding but have high rebleeding risks. It emphasizes a multidisciplinary approach is often needed for gastric variceal management.
Gluten is a protein found in wheat and grain products that is used to hold foods together. It can cause issues for those with celiac disease or gluten intolerance. Celiac disease symptoms include gas, bloating, and skin rashes, and it is diagnosed through blood tests or intestinal biopsies. Lactose intolerance is caused by the inability to digest lactose sugar in dairy products, leading to symptoms like diarrhea. Alternatives to gluten and dairy include foods like soy, rice, and lactose-free products.
This document discusses the importance of conducting a thorough clinical examination for medically compromised patients. It involves taking a detailed medical history, performing a physical exam, and considering any relevant lab tests or medical consultations needed to assess a patient's health risks. The medical history covers symptoms, medical conditions, medications, and social factors. The physical exam checks vital signs and examines major organ systems. Laboratory tests and medical consultations can aid in risk assessment. Proper risk assessment is key to determining if dental treatment can be conducted safely and what modifications may be needed based on the patient's health status and procedures planned. The overall goal is to minimize health risks through modified treatment approaches.
1) A 32-year-old woman presented with a 10-year history of severe recurrent abdominal pain.
2) Extensive prior testing and evaluations did not identify a cause, though she was diagnosed with conversion disorder during one hospitalization.
3) During her most recent hospitalization for abdominal pain, she developed hyponatremia that was initially thought to be due to poor oral intake but worsened despite IV fluids.
4) Further testing revealed findings consistent with SIADH and elevated urine porphyrin levels, leading to a diagnosis of acute intermittent porphyria, a rare genetic disorder causing episodic severe abdominal pain and other symptoms.
Similar to 10MALLORY WEISE TEARRunning head MALLORY WEISE .docx (10)
2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
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Soil Colloids (Chapter 8) Notes
Soil Colloids (Chapter 8) Notes
Did you know ....
Did you know soil fertility or the ability for a soil to provide nutrients is seated in the type of minerals it
contains? Chapter 8 will cover the various types of soil colloids including all the layer and non-layer
silicates, cation exchange, anion exchange, and sorption.
Lecture content notes are accompanied by videos listed below the notes in each submodule (e.g. Soil
Colloids (Chapter 8) Videos A though H). Print or download lecture notes then view videos in
succession alongside lecture content and add additional notes from each video. The start of each
video is noted in parenthesis (e.g. Content for Video A) within each lecture note set and contains
lecture content through the note for the next video (e.g. Content for Video B).
Figures and tables unless specifically referrenced are from the course text, Nature and Property of
Soils, 14th Edition, Brady and Weil.
Content Video A
Soil Colloids
Smallest soil particles < 1 µm
Surface area - LARGE
Surface charge - CEC
Adsorb water
AGRI1050R50: Introduction to Soil Science (2020S) LH
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2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
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Types of Colloids
Crystalline Silicate clays: ordered, crystalline, layers
Non-crystalline silicate clays: non-ordered, layers, volcanic
Iron/Aluminum Oxides – weathered soils, less CEC
Humus – OM, not mineral or crystalline, high CEC
Soil Colloids
Content Video B
Layer Silicates - Construction
Phyllosillicates
Tetrahedral Sheets
1 Si with 4 Oxygen
Share basal oxygen
Form sheets
Octahedral Sheets
6 Oxygen with Al3+ or Mg 2+
Di T i O t h d l b d # f di ti i
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Di or Tri Octahedral based on # of coordinating ions
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2/21/2020 Soil Colloids (Chapter 8) Notes - AGRI1050R50: Introduction to Soil Science (2020S)
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20 Other Conditions That May Be a Focus of Clinical AttentionV-c.docxRAJU852744
20 Other Conditions That May Be a Focus of Clinical Attention
V-codes and z-codes
V-codes and Z-codes are conditions that may be the focus of clinical attention but are not considered mental disorders. They correspond to International Classification of Diseases, Ninth Revision, Clinical Modification ICD-9-CM (V-codes) and International Classification of Diseases, Tenth Revision, Clinical Modification ICD-10-CM (Z-codes that become effective in 2015. In most instances, third-party payers do not cover charges for delivering services to an individual if the diagnosis is solely a V- or Z-code alone. If the V- or Z-code is not the primary diagnosis then it should be documented following the primary diagnosis. In addition, when writing the psychosocial assessment any psychosocial and cultural factors that might impact the client's diagnosis should be documented. The psychosocial stressors reflected in these diagnoses are widespread across all classes and cultures and have been shown to impact all aspects of an individual's life from the physical and psychological to the financial. Furthermore, these conditions have been shown to significantly impact the diagnosis and outcome for a multitude of mental and medical disorders. V- and Z-codes are grouped into numerous categories including: relational problems, problems related to abuse/neglect, educational and occupational problems, housing and economic problems, problems related to the social environment, problems related to the legal system, other counseling services, other psychosocial, personal and environmental problems, and problems of personal history (APA, 2013).
Broadly speaking, the category “Relational Problems” describes interactional problems between family members (e.g., parent/caregiver-child) or partners that result in significant impairment of family functioning or development of symptoms in the distressed individual, spouses, siblings, or other family members. Relational problems are broken down into two categories, Problems Related to Family Upbringing and Other Problems Related to Primary Support Group. For example, in the first category a Parent-Child Relational Problem involves interactional problems between one or both parents and a child that lead to dysfunction in behavioral (e.g., inadequate protection, overprotection), cognitive (e.g., antagonism toward or blaming of the other) or affective (e.g., feeling sad and angry) realms. Here, the critical factor is the quality of the parent-child relationship or when the dysfunction in this relationship is impacting the course and outcome of a psychological or medical condition. Other examples include Sibling Relational Problem, Upbringing Away from Parents, and Child Affected by Parental Relationship Distress. Similarly, family relationships and interactional patterns leading to problems related to primary support group include Partner Relational Problem, Disruption of Family by Separation/Divorce, High Expressed Emotion Level with.
223 Case 53 Problems in Pasta Land by Andres Sous.docxRAJU852744
1) The pasta factory is facing increasing customer demand that exceeds its production capacity due to outdated equipment.
2) New technology allows for higher production capacity using lower quality ingredients, but requires different skills and labor than the current factory's outdated equipment.
3) Introducing new technology and expanding production would require overcoming resistance from employees accustomed to current methods and addressing concerns about job losses in the local community.
2
2
2
1
1
1
Organization Name: Insta-Buy
Insta-Buy is an E-Commerce Multinational American company. It was founded in 2010 and is based in Atlanta, Georgia. It mainly operates with grocery delivery and pick up and it offers services through web application and mobile application to various states in United States. It is one of the major online marketplaces for grocery delivery. The company is valued at $1 billion worth and has partnership with over 150 retailers. It is known for its fresh produce and timely delivery and pickup.
Predictive Analysis at Insta-Buy:
The predictive analytics is termed as what is likely to happen in the future. The predictive analytics is based on statistical and data mining technique. The aim of this technique is to predict the future of the project such as what would be the customer reaction on project, financial need, etc. In developing predictive analytical application, a number of techniques are used such as classification algorithms. The classification techniques are logistic regression, decision tree models and neural network. Clustering algorithms are used to segment customers in different groups which helps to target specific promotions to them. To estimate the relationship between different purchasing behavior, association mining technique is used (Mehra, 2014). As an example, for any product on Amazon.com results in the retailer also suggesting similar products that a customer might be interested in. Predictive analytics can be used in E-commerce to solve the following problems
1. Improve customer engagement and increase revenue
1. Launch promotions that target specific customer group
1. Optimizing prices to generate maximum profits
1. Keep proper inventory and reduce over stalking
1. Minimizing fraud happenings and protecting privacy
1. Provide batter customer service at low cost
1. Analyze data and make decision in real time
TOPICS:
Student: Ahmed
Topic: Bayesian Networks (Predicting Sales In E-commerce Using Bayesian Network Model)
Student: Meet
Topic: Predictive Analysis
Student: Peter
Topic: Privacy and Confidentiality in an e-Commerce World: Data Mining, Data Warehousing, Matching and Disclosure Limitation
Student: Nayeem
Topic: Ensemble Modeling
Student: Shek
Topic: L.Jack & Y.D. Tsai, Using Text Mining of Amazon Reviews to Explore User-Defined Product Highlights and Issues.
Student: Suma
Topic: Deep Neural Networks
REFERENCES:
Olufunke Rebecca Vincent, A. S. (2017). A Cognitive Buying Decision-Making Process in B2B E-Commerce Using Analytic-MLP. Elsevier.
https://www.researchgate.net/publication/319278239_A_Cognitive_Buying_Decision-Making_Process_in_B2B_E-Commerce_Using_Analytic-MLP
Wan, C. C. (2017). Forcasting E-commerce Key Performance Indicators
https://beta.vu.nl/nl/Images/stageverslag-wan_tcm235-867619.pdf
Fienberg, S. (2006). Privacy and Confidentiality in an e-Commerce World: Data Mining, Data Warehousing, Matching and Disclosure Limitation. Statistical Science, .
22-6 Reporting the Plight of Depression FamiliesMARTHA GELLHOR.docxRAJU852744
22-6 | Reporting the Plight of Depression Families
MARTHA GELLHORN, Field Report to Harry Hopkins (1934)
1. From Martha Gellhorn to Harry Hopkins, Report, Gaston County, North Carolina, November 11, 1934, Franklin D. Roosevelt Library, Harry Hopkins Papers, Box 66. Online transcript available at http://newdeal.feri.org/hopkins/hop08.htm.
Journalist and novelist Martha Gellhorn’s heartrending field report describing impoverished Gastonia, North Carolina, families vividly captures the desperate hope of depression-era families. Hired by Harry Hopkins, Franklin Roosevelt’s point man for federal relief efforts, Gellhorn detailed the enormous challenge facing the administration. Compounding the epic humanitarian crisis she encountered was the political opposition, which she singled out as one among many obstacles hampering relief efforts.
All during this trip [to North Carolina] I have been thinking to myself about that curious phrase “red menace,” and wondering where said menace hid itself. Every house I visited — mill worker or unemployed — had a picture of the President. These ranged from newspaper clippings (in destitute homes) to large colored prints, framed in gilt cardboard. The portrait holds the place of honour over the mantel. . . . He is at once God and their intimate friend; he knows them all by name, knows their little town and mill, their little lives and problems. And, though everything else fails, he is there, and will not let them down.
I have been seeing people who, according to almost any standard, have practically nothing in life and practically nothing to look forward to or hope for. But there is hope; confidence, something intangible and real: “the president isn’t going to forget us.”
Let me cite cases: I went to see a woman with five children who was living on relief ($3.40 a week). Her picture of the President was a small one, and she told me her oldest daughter had been married some months ago and had cried for the big, coloured picture as a wedding present. The children have no shoes and that woman is terrified of the coming cold as if it were a definite physical entity. There is practically no furniture left in the home, and you can imagine what and how they eat. But she said, suddenly brightening, “I’d give my heart to see the President. I know he means to do everything he can for us; but they make it hard for him; they won’t let him.” I note this case as something special; because here the faith was coupled with a feeling (entirely sympathetic) that the President was not entirely omnipotent.
I have been seeing mill workers; and in every mill when possible, the local Union president. There has been widespread discrimination in the south; and many mills haven’t re-opened since the strike. Those open often run on such curtailment that workers are getting from 2 to 3 days work a week. The price of food has risen (especially the kind of food they eat: fat-back bacon, flour, meal, sorghum) as high as 100%. It is getting cold;.
2018 4th International Conference on Green Technology and Sust.docxRAJU852744
2018 4th International Conference on Green Technology and Sustainable Development (GTSD)
130
�
Abstract - The Vietnamese government have plan to develop the
wind farms with the expected capacity of 6 GW by 2030. With the
high penetration of wind power into power system, wind power
forecasting is essentially needed for a power generation
balancing in power system operation and electricity market.
However, such a tool is currently not available in Vietnamese
wind farms as well as electricity market. Therefore, a short-term
wind power forecasting tool for 24 hours has been created to fill
in this gap, using artificial neural network technique. The neural
network has been trained with past data recorded from 2015 to
2017 at Tuy Phong wind farm in Binh Thuan province of Viet
Nam. It has been tested for wind power prediction with the input
data from hourly weather forecast for the same wind farm. The
tool can be used for short-term wind power forecasting in
Vietnamese power system in a foreseeable future.
Keywords: power system; wind farm; wind power forecasting;
neural network; electricity market.
I. NECESITY OF WIND POWER FORECASTING
Today, the integration of wind power into the existing
grid is a big issue in power system operation. For the system
operators, power generation curve of wind turbines is a
necessary information in the power sources balancing. From
the dispatchers’ point of view, wind power forecast errors
will impact the system net imbalances when the share of
wind power increases, and more accurate forecasts mean less
regulating capacity will be activated from the real time
electricity market [1]. In the deregulated market, day-ahead
electricity spot prices are also affected by day-ahead wind
power forecasting [2]. Wind power forecasting is also
essential in reducing the power curtailment, supporting the
ancillary service. However, due to uncertainty of wind speed
and weather factors, the wind power is not easy to predict.
In recent years, many wind power forecasting methods
have been proposed. In [3], a review of different approaches
for short-term wind power forecasting has been introduced,
including statistical and physical methods with different
models such as WPMS, WPPT, Prediktor, Zephyr, WPFS,
ANEMOS, ARMINES, Ewind, Sipreolico. In [4], [5], the
methods, models of wind power forecasting and its impact on
*Research supported by Gesellschaft fuer Internationale
Zusammenarbeit GmbH (GIZ).
D. T. Viet is with the University of Danang, Vietnam (email:
[email protected]).
V. V. Phuong is with the University of Danang, Vietnam (email:
[email protected]).
D. M. Quan is with the University of Danang, Vietnam (email:
[email protected]).
A. Kies is with the Frankfurt Institute for Advanced Studies, Germany
(email: [email protected] uni-frankfurt.de).
B. U. Schyska is with the Carl von Ossietzky Universität Oldenburg,
Germany (email: [email protected]).
Y. K. Wu i.
202 S.W.3d 811Court of Appeals of Texas,San Antonio.PROG.docxRAJU852744
202 S.W.3d 811
Court of Appeals of Texas,
San Antonio.
PROGRESSIVE COUNTY MUTUAL INSURANCE
COMPANY, Appellant,
v.
Hector Raul TREVINO and Mario Moyeda,
Appellees.
No. 04–05–00113–CV.
|
June 28, 2006.
|
Rehearing Overruled July 31, 2006.
.
200 wordsResearch Interest Lack of minorities in top level ma.docxRAJU852744
200 words
Research Interest: Lack of minorities in top level management positions
Describe why and how a qualitative approach may be appropriate for your area of interest for your research. Include a rationale for each proposed use of qualitative inquiry.
.
2019 14th Iberian Conference on Information Systems and Tech.docxRAJU852744
2019 14th Iberian Conference on Information Systems and Technologies (CISTI)
19 – 22 June 2019, Coimbra, Portugal
ISBN: 978-989-98434-9-3
How ISO 27001 can help achieve GDPR compliance
Isabel Maria Lopes
Polytechnic Institute of Bragança, Bragança, Portugal
UNIAG, Polytechnic Institute of Bragança, Portugal
ALGORITMI Centre, Minho University, Guimarães,
Portugal
[email protected]
Pedro Oliveira
Polytechnic Institute of Bragança, Bragança, Portugal
[email protected]
Teresa Guarda
Universidad Estatal Península de Santa Elena – UPSE, La
Libertad, Ecuador
Universidad de las Fuerzas Armadas – ESPE, Sangolqui,
Quito, Equador
ALGORITMI Centre, Minho University, Guimarães,
Portugal
[email protected]
Abstract — Personal Data Protection has been among the most
discussed topics lately and a reason for great concern among
organizations. The EU General Data Protection Regulation
(GDPR) is the most important change in data privacy regulation
in 20 years. The regulation will fundamentally reshape the way in
which data is handled across every sector. The organizations had
two years to implement it. As referred by many authors, the
implementation of the regulation has not been an easy task for
companies. The question we aim to answer in this study is how far
the implementation of ISO 27001 standards might represent a
facilitating factor to organizations for an easier compliance with
the regulation. In order to answer this question, several websites
(mostly of consulting companies) were analyzed, and the aspects
considered as facilitating are listed in this paper.
Keywords - regulation (EU) 2016/679; general data protection
regulation; ISO/IEC 27001.
I. INTRODUCTION
In recent years, data protection has become a forefront issue
in cyber security. The issues introduced by recurring
organizational data breaches, social media and the Internet of
Things (IoT) have raised the stakes even further [1, 2]. The EU
GDPR, enforced from May 25 2018, is an attempt to address
such data protection. The GDPR makes for stronger, unified data
protection throughout the EU.
The EU GDPR states that organizations must adopt
appropriate policies, procedures and processes to protect the
personal data they hold.
The International Organization for Standardization (ISO)
/International Electrotechnical Commission (IEC) 27000 series
is a set of information security standards that provide best-
practice recommendations for information security management
[3].
This international standard for information security, ISO
27001, provides an excellent starting point for achieving the
technical and operational requirements necessary to reduce the
risk of a breach.
Not all data is protected by the GDPR, since it is only
applicable to personal data. This is defined in Article 4 as
follows [4]:
“personal data” means any information relating to an
identified or identifiable natural person (’data subject’); an
identifiable.
200520201ORG30002 – Leadership Practice and Skills.docxRAJU852744
This document provides information on cross-cultural leadership, including readings and topics for the week. It discusses cross-cultural leadership, the GLOBE study on cultural dimensions, universally desirable and undesirable leadership attributes across cultures, and developing cultural intelligence. It also covers implications of cross-cultural leadership for organizations, traditional vs inclusive models of leadership, and developing global leadership competencies.
2/18/2020 Sample Content Topic
https://purdueglobal.brightspace.com/d2l/le/content/115691/viewContent/9226875/View 1/1
Trouble at 3Forks
Introduction: The foreclosure process can differ for deeds
versus mortgages. You will conduct research to determine
these differences since it is not only covered in the real estate
exam, but it is important to know this process in professional
practice.
Scenario: Henri and Lila own a restaurant which the
government has caused to close due to widening the road in
front of their establishment. Since this is the main source of
their income, and has caused Lila and Henri to stop payments
on their mortgage, address the following questions.
Checklist:
Explain the action that Henri and Lila should expect from the
bank regarding their property.
Describe how the banks actions would differ if it was a deed of
trust rather than a mortgage.
Respond in a minimum of 600–850-word essay with additional
title and reference pages using APA format and citation style.
Access the Unit 4 Assignment grading rubric.
Submit your response to the Unit 4 Assignment Dropbox.
Assignment Details
https://kapextmediassl-a.akamaihd.net/business/MT431/1904c/rubrics/u4_rubric.pdf
Mitchell, Taylor N.
Donaldson, Jayda N
Recommended Presentation Outline
My Name is …
The title of my article is…
I found it in…
My article is relevant and interesting because….
The Economics Article
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Economics
The study of the allocation of scarce resources: implies a cost to every action
Basic assumption
People are rational
People act to maximize their happiness
Economics is predictive
5
Economic Modeling
"The theory of economics does not furnish a body of settled conclusions immediately applicable to policy. It is a method rather than a doctrine, an apparatus of the mind, a technique of thinking which helps its possessor to draw correct conclusions." (John Maynard Keynes)
P
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Demand
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Tastes
Prices of Substitutes
Prices of Compliments
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P
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Price Elasticity of Demand
A measure of sensitivity of quantity demanded to a change in price
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(P/P)
Inelastic demand means that E is small
11
Supply
Function of
Costs of Production
Input Prices
Technology
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Utility Maximization
MAX U(F, N)
Subject to the budget constraint:
PnN + PfF = I
(with a little algebra)
N= I/Pn - (Pf / Pn) F
15
Good X
Y
I/PY
U2
U1
U3
16
Theory of the Firm
Firm Maximizes profits
Max: p = Revenue - Costs
Max: p = P(Q)* Q- C(Q)
First Order Conditions:
dp/dQ = P’(Q)*P + P(Q) - C’(Q) =0
P’(Q)*P + P(Q) = C’(Q)
Marginal Revenue = Marginal Costs
17
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Assumptions of Perfect Competition
Free Entr.
21 hours agoMercy Eke Week 2 Discussion Hamilton Depression.docxRAJU852744
21 hours ago
Mercy Eke
Week 2 Discussion: Hamilton Depression Rating Scale
COLLAPSE
Top of Form
Depression or Major Depressive Disorder is considered as a mental health disorder that negatively impacts how an individual feel, think and behave. Individuals who suffer from depression exhibit feelings of sadness and loss in interest in once enjoyed activities (Parekh. 2017). It can cause different kinds of emotional and physical problems and can minimize an individual’s ability to be functional in their daily routines. Annually, approximately 6.7% of adults are impacted by depression. It is estimated that 16.6% of individuals will experience depression at some time in their life (Parekh. 2017). Depression is said to manifest at any time, but on average, the first manifestation occurs during the late teens to mid-20s. The female population is susceptible to experience depression than the male population. Some research indicated that one-third of the female population would experience a major depressive episode in their lifetime (Parekh. 2017).
Among all the mental disorders, depression is one of the most treatable. It is estimated that between 80-90 % of individuals suffering from depression respond well to treatment and experienced remission of their symptoms (Parekh. 2017). As a mental health professional, prior to deciphering diagnosis and initiating diagnosis, it is paramount to conduct a complete diagnostic evaluation, which includes an interview and, if necessary, a physical examination (Parekh. 2017). Blood tests can be conducted to ascertain that depression is not precipitated by a medical condition like thyroid dysfunction. The evaluation is to identify specific symptoms, medical and family history, cultural factors, and environmental factors to derive a diagnosis and establish a treatment plan (Parekh. 2017). One of the assessment tools for depression is the Hamilton Depression Rating Scale. In this discussion, I will be discussing the psychometric properties of the Hamilton Depression Rating Scale and elaborate on when it is appropriate to utilize this assessment tool with clients, including whether the tool can be utilized to evaluate the efficacy of psychopharmacologic medications.
The Hamilton Depression Rating Scale (HDRS) was introduced in early 1960. It has been considered as a gold standard in depression studies and a preferred scale in the evaluation of depression treatment. It is the most vastly utilized observer-rated depression scale worldwide (Vindbjerg.et.al., 2019). The HDRS was initially created to measure symptoms severity in depressed inpatient; however, the 17-item HAM-D has advanced in over five decades into 11 modified versions that have been administered to various patient populations in an array of psychiatric, medical, and other research settings (Rohan.et.al., 2016). There are two most common versions with either 17 or 21 items and is scored between 0-4 points. Each item assists mental health professionals or c.
2/19/2020 Originality Report
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%81
SafeAssign Originality Report
Spring 2020 - InfoTech Import in Strat Plan (ITS-831-08) - First Bi-Term • Week 4 Assignment
%81Total Score: High riskMohana Murali Krishna Karnati
Submission UUID: 52814687-34c0-ee43-84bc-c253ad62fe7a
Total Number of Reports
1
Highest Match
81 %
Week 4 Assignment.docx
Average Match
81 %
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Average Word Count
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Highest: Week 4 Assignment.docx
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Running Head: SERVER VIRTUALIZATION 1
SERVER VIRTUALIZATION 8
Week 4 Assignment
Technet Case Study for Virtualization Mohana Murali Krishna Karnati
University of the Cumberlands
Technet Case Study for Virtualization
Technet is a hypothetical business in the storage manufacturing industry. This paper intend to elaborate the server virtualization concept using Microsoft
virtualization software from Windows server 2012R2. Organization’s Preparedness for Virtualization. As of now, the IT system design is a mishmash of old
frameworks that were obtained through various acquisitions of different providers in the storage industry. In any case, these old frameworks are aging and will soon
need to be upgraded. Generally, these old frameworks support applications that have been in service for about 10 years. The IT system situated in one of Technet
branch in Asia for instance comprise of old servers that have been in service for the last 5 years. These old servers were launched to support production and
productivity applications. The expense for permit of these old applications are presently being inspected to check whether they can be dropped and the
information moved to current Technet Enterprise Resource Planning (ERP) applications. Consequently, since several IT related components are potential
contender for upgrading, this makes the likelihood of changing over current physical server farms into virtualized computing resources appropriate. Microsoft
Licensing of Virtualized Environments
Datacenter and the Standard edition are the two license version for Windows Server 2012R2 offered by Microsoft. There is likewise a free version called
Hyper-V Server which is an independent system that only contains the Windows hypervisor, a driver model as well as virtualization modules. Every window
version underpins Hyper-V, which is Microsoft's Type-1 hypervisor offering, likewise referred to as a bare-metal installation, and each Hyper-V server is known as a
Host (Portnoy, 2012). The Windows Server.
20810chapter Information Systems Sourcing .docxRAJU852744
208
10
chapter Information Systems
Sourcing
After 13 years, Kellwood, an American apparel maker, ended its soups!to!nuts IS outsourcing
arrangement with EDS . The primary focus of the original outsourcing contract was to integrate
12 individually acquired units with different systems into one system. Kellwood had been satis-
" ed enough with EDS ’ s performance to renegotiate the contract in 2002 and 2008, even though
at each renegotiation point, Kellwood had considered bringing the IS operations back in house,
or backsourcing. The 2008 contract iteration resulted in a more # exible $105 million contract that
EDS estimated would save Kellwood $2 million in the " rst year and $9 million over the remaining
contract years. But the situation at Kellwood had changed drastically. In 2008, Kellwood had been
purchased by Sun Capital Partners and taken private. The chief operating of" cer (COO), who was
facing a mountain of debt and possibly bankruptcy, wanted to consolidate and bring the operations
back in house to give some order to the current situation and reduce costs. Kellwood was suffering
from a lack of IS standardization as a result of its many acquisitions. The chief information of" cer
(CIO) recognized the importance of IS standardization and costs, but she was concerned that the
transition from outsourcing to insourcing would cause serious disruption to IS service levels and
project deadlines if it went poorly. Kellwood hired a third!party consultant to help it explore the
issues and decided that backsourcing would save money and respond to changes caused by both the
market and internal forces. Kellwood decided to backsource and started the process in late 2009. It
carefully planned for the transition, and the implementation went smoothly. By performing stream-
lined operations in house, it was able to report an impressive $3.6 million savings, or about 17% of
annual IS expenses after the " rst year. 1
The Kellwood case demonstrates a series of decisions made in relation to sourcing. Both the
decision to outsource IS operations and then to bring them back in house were based on a series of
This chapter is organized around decisions in the Sourcing Decision Cycle. The ! rst question
regarding information systems (IS) in the cycle relates to the decision to make (insource) or
buy (outsource) them. This chapter ’ s focus is on issues related to outsourcing whereas issues
related to insourcing are discussed in other chapters of this book. Discussed are the critical
decisions in the Sourcing Decision Cycle: how and where (cloud computing, onshoring,
offshoring). When the choice is offshoring, the next decision is where abroad (farshoring,
nearshoring, or captive centers). Explored next in this chapter is the ! nal decision in the
cycle, keep as is or change in which case the current arrangements are assessed and modi-
! cations are made to the outsourcing arrangem.
21720201Chapter 14Eating and WeightHealth Ps.docxRAJU852744
2/17/2020
1
Chapter 14
Eating and Weight
Health Psychology (PSYC 172)
Professor: Andrea Cook, PhD
February 18, 2020
The Digestive System
– Food nourishes the body by providing energy for
activity
– Digestion begins in the mouth
• Salivary glands provide moisture that allows food to
have taste
• Importance of good mastication
The Digestive System
The Digestive System
– Food is swallowed and then moves through the
pharynx and esophagus
– Peristalsis moves food through the digestive
system
– In the stomach, food is mixed with gastric juices
so it can be absorbed by the small intestine
– Most nutrients are digested in the small intestine
– Digestion process is complete when waste is
eliminated
The Digestive System, Continued
2/17/2020
2
Microbiome
4YouTube: What is the human microbiome?
Supporting the Gut Microbiome
Dysbiosis = unbalanced gut microbiome
• associated with weight gain, insulin resistance,
inflammation
Probiotics
• contain live microorganisms
• maintain or improve the "good" bacteria (normal microflora)
in the body
• e.g., fermented foods, yogurt, sauerkraut, kimchi
Prebiotics
• act as food for human microflora
• helps improve microflora balance
• e.g., whole grains, bananas, greens, onions, garlic
5
https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-
answers/probiotics/faq-20058065
Supporting the Gut Microbiome
Medication overuse
• anti-inflammatories, antibiotics, acid blocking drugs, and
steroids damage gut or block normal digestive function
Stress
• chronic stress alters the normal bacteria in the gut
Lifestyle
• plenty of fiber, water, exercise and rest
Healthy Defecation
• three bowel movements a day to three each week
• no intestinal pain or bloating
• no straining
6
https://drhyman.com/blog/2014/10/10/tend-inner-garden-gut-flora-may-
making-sick/
2/17/2020
3
Bristol Stool Chart
7
Factors in Weight Maintenance
– Stable weight occurs when calories eaten equal those
expended for body metabolism and physical exercise
[OLD THINKING]
– Complicated interplay of nutrients, hormones, and
inflammation
• Metabolic rates differ from person to person
• Ghrelin, a hormone, stimulates appetite
• Leptin, a protein, signals satiation and fat storage
• Insulin, a hormone produced in pancreas
– unlocks cells for glucose use for energy
– cues hypothalamus for satiation and decreased appetite
Factors in Weight Maintenance
What is obesity?
– Overeating is not the sole cause of obesity
– Various methods to assess body fat
• Skin-fold technique
• Percentage body fat
• Body mass index (BMI)
– Can also be thought of in terms of social and
cultural standards
– ideal body = thinner in past 50 years
What is Obesity?
2/17/2020
4
BMI
10
– Obesity rates have increased, especially
“extreme” obesity
• past 30 years obesity rates have nearly doubled to
600 million
• 37.8% of US adults are obese and an additional 32.6%
are over.
2020/2/21 Critical Review #2 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/2criticalreviews 1/10
Santa Monica College Democracy and Di�erence Through the Aesthetics
of Film
Tahvildaran
Assignment Objectives: Enhance and/or improve critical thinking and
media literacy skills by:
1. Developing a clear and concise thesis statement (an
argument) in response to the
following question: Does the �lm have the power to
transform political sensibilities?
2. Writing an outline for a �ve paragraph analytical essay
building on a clear and
concise thesis statement, including topic sentences and
secondary supports.
3. Identifying and explaining three scenes from the �lm text in
support of the thesis
statement/argument.
4. Writing an introductory paragraph for the outlined analytical
essay
Be sure to read thoroughly the writing conventions below before beginning this
assignment.
Note: You are NOT writing a full essay; rather, you are outlining an analytical
essay by completing the dialogue in the boxes below.
Writing a Critical Review (analytical) Essay
2020/2/21 Critical Review #2 - WebCOM™ 2.0
https://smc.grtep.com/index.cfm/smcc/page/2criticalreviews 2/10
1. Every essay that you write for this course must have a clear thesis, placed
(perhaps) somewhere near the end of the introductory paragraph. Simply
stated, a THESIS (or ARGUMENT) expresses, preferably in a single sentence,
the point you want to make about the text that is the subject of your essay. A
THESIS should be an opinion or interpretation of the text, not merely a fact or
observation. The best possible THESIS will answer some speci�c questions
about the text. Very often the THESIS contains an outline of the major points
to be covered in the essay. A possible thesis for an essay on character in
Perry Henzell’s The Harder They Come might read somewhat as follows:
The protagonist of THTC is not a hero in the epic sense of the word, but a
self-centered young man bred of economic oppression and cultural
dependency. The characters in this �lm have no real psychological depth, but
are markers for a society of consumption and momentary glory.
(You might then go on to exemplify from the text and argue in favor or
against this interpretation: your essay need not hold to only one perspective.)
What single, clear QUESTION does the above THESIS attempt to answer?
2. Each essay should be organized into �ve (5) paragraphs, each based on one
of two to four major ideas, which will comprise the BODY of the essay. Each
paragraph must have a topic sentence, often (but not always) towards the
beginning of the paragraph, which clearly states the ARGUMENT or point to
be made in the paragraph. Following the thesis set forth.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
10MALLORY WEISE TEARRunning head MALLORY WEISE .docx
1. 10
MALLORY WEISE TEAR
Running head: MALLORY WEISE TEAR
1
Running head: MALLORY WEISE TEAR
Introduction
The following information will be an extensive in-depth review
of a patient with a condition known as a Mallory Weise Tear
(MWT). The paper will analyze peer-reviewed literature
surrounding this condition and the pathophysiology behind it.
There are complications that can arise with a diagnosis of an
MWT, so the paper will discuss how to recognize the warning
signs and how to manage patient care. The paper will also
cover the nursing process and treatments for a patient that
suffers from MWT. Last but not least, the paper will cover
suggested teachings that nurses can go over with their patient
and family on the how’s and why’s, along with signs and
symptoms of MWT and its complications.
Scenario
A 57-year-old male presents to the emergency department with
complaints of abdominal pain, dark black stools for the last four
days, and having coffee ground emesis with occasional red
streaks. He states a past medical history that includes mild
2. cirrhosis related to alcohol abuse, current smoker of one pack
per day, and chronic back pain from an MVA ten years ago that
he treats with Aleve and ibuprofen. He has been told that he
has hypertension but does not take any medication.
On examination, the vital signs are as follows: blood pressure
138/84, heart rate 105, tympanic temperature 98.9, respirations
19, O2 saturations 98% on room air. He complains of nausea
and is guarding his abdomen. There is no asities or obvious
jaundice noted. Upon auscultation the patient has normal heart
tones and clear breath sounds bilaterally. The doctor was at the
bedside and performed a digital rectal exam which reveals black
stool, occult blood positive. An 18g IV was stared in his right
antecubital vein and labs were sent. The labs showed the
following: WBC 11, HGB 8.4 g/DL, HCT 25 %, PLT 150 K/UL,
AST 78 U/L, ALT 54 U/L, Albumin 3.5 G/DL, Ammonia level
15 U/DL, Potassium 3.7 mEq/l, Sodium 135mEq/l, BUN 25
mg/dl, Creatinine 1.1 mg/dl, Glucose 96 mg/dl. The doctor
mentions that most of the labs are with in normal limits but
could be indicative of a hemorrhage.
Literature Review
E. Cherednikov, A.A. Kunun, E.E. Cherednikov, and N.S.
Moiseeva (2016), authors of “The Role of Etiopathogenetic
Aspects in Prediction and Prevention of Discontinuous-
Hemorrhagic (Mallory-Weiss) Syndrome,” provided numerous
etiological factors, and new insights into the pathogenesis of the
disease. S.S. Flanders (2018), author of “Effective Patient
Education: Evidence and Common Sense,” takes a close look at
patient education related to MWT, and what aspects are most
beneficial for knowledge retention. K. Hyun-Soo (2015), author
of “Endoscopic Management of Mallory-Weiss tearing,”
discusses surgical, nonsurgical options, and treatments
available. J. Jahraus (2018), author of “Medical Complications
of Eating Disorders,” discusses eating disorders that contribute
to MWT. Specifically, conditions discussed are those that
involve self-induced vomiting. D.T. Martin, and M.A.
Schreiber (2014), authors of “Modern Resuscitation of
3. Hemorrhagic Shock: What is on the horizon?”, this article
explored the pathophysiology, diagnosis, and treatment of
hemorrhagic shock, a subset of hypovolemic shock. B. Nojkov
and M.S. Cappell (2016), authors of “Distinctive Aspects of
Peptic Ulcer Disease, Dieulafoy's lesion, and Mallory-Weiss
Syndrome in Patients with Advanced Alcoholic Liver Disease or
Cirrhosis,” discusses distinctive aspects of advanced liver
disease and cirrhosis of the liver, as it relates to patients with
MWT. K. Rich (2018), author of “Overview of Mallory-Weiss
Syndrome,” discusses the medical diagnosis of MWT in general.
Pathophysiology
Mallory and Weiss presented the cause of upper gastrointestinal
bleeds not associated with peptic ulcers or non-variceal upper
gastrointestinal bleeds. The MWT represents a tear or
laceration in the mucosa lining in the stomach or
gastroesophageal junction. There are different severities when
talking about MWT meaning that some are far worse than
others. An MWT can result from actual physical trauma to the
area. Most often MWT is associated with alcohol induced
vomiting that causes an increase in intraesophageal pressure
caused by prolonged severe vomiting. Aside from alcohol,
development of an MWT can also be associated with eating
disorders, violent hiccups, hiatal hernia, gastritis, and the
overuse of non-steroidal anti-inflammatory drugs. Some of the
physical traumatic causes for an MWT can be linked to
transesophageal echocardiograms,
esophagogastroduodenoscopy, and blunt abdominal trauma. The
combination of a weakened mucosal lining and increased
esophageal pressure increased the chances of having an MWT
(Cherednikov, Kunun, Cherednikov, & Moiseeva, 2016).
Nursing Process
Nursing Actions
When the patient is presenting with gastrointestinal bleed there
are some common nursing actions that need to be done. The
nurse can anticipate starting one if not two large bore IV
catheters. This would be wise incase the patient does need
4. blood products. Blood must be administered by itself, therefor
necessitating the second line to run fluids. The nurse can
expect to give packed red blood cells (PRBC’s) and if there is a
coagulopathy problem, then other blood products such as fresh
frozen plasma (FFP), platelets, and possibly cryoprecipitate can
be used. Having a second site will also allow IV fluids, like
isotonic solutions to be given to replace fluid loss. The
registered nurse will need to get a complete set of vital signs,
complete a physical assessment, and a throughout health history
assessment to help determine the cause of the MWT. Labs will
be ordered so the nurse should be on the lookout for those
results and report any abnormalities to the doctor right away.
With any gastrointestinal bleed, the nurse needs to be vigilant
in assessing for increased bleeding such as vomiting bright red
blood, and the subtle signs of hemodynamic instability which
are increased heart rate and lower blood pressure. Medications
There is no specific medication that treats MWT, medications
are used to treat the common causes of MWT. A proton pump
inhibitor (PPI) can be prescribed to decrease the acidity of
gastric acid and reduce the erosions of the mucosal lining. The
registered nurse should be prepared to administer an antiemetic
medication to suppress and treat nausea and vomiting. Some of
the more common PPI’s you will see are Protonix and
Omeprazole. These medications decrease the amount of acid
your stomach makes. Zofran, Phenergan, and Compazine are
medications used to treat nausea and vomiting. If your patient
is on anticoagulation therapy for any reason, you could be
administering the reversal medication. Some examples of this
would be if your patient was on Coumadin then Vitamin K and
possibly fresh frozen plasma will be ordered to reverse the
medications effects. Some of the antiplatelet medications do
not have an antidote, so depending on the severity of the bleed,
a transfusion of platelets may be ordered (Davis Drug Guide,
2017).
Pertinent Specific Treatment
Most patients that suffer from an MWT do not need more than
5. close hemodynamic monitoring, fluid resuscitation, and rest
from the underlying cause to treat the condition. However, the
degrees of an MWT can vary greatly and a more complicated
bleed could occur that requires further invasive interventions.
When diagnosing MWT, an endoscopy is performed by the
doctor. If the bleed is severe, they have a few options for
treatment to choose from. They will localize the bleed and the
doctor will inject epinephrine around the site, this is the most
common drug treatment for local injections. If the injections do
not stop the bleeding, there are clips and bands that can be
deployed to stabilize the area. If hemostasis cannot be
achieved, then the patient will have to go for emergency surgery
to cauterize the vessel (Hyun-Soo, 2015).
Coagulation studies, hemogram, and electrolyte panel will be
performed for all patients suffering from an MWT.
Coagulopathies will be treated with either medication reversal
agents or blood products. Electrolyte and fluid replacement
may be needed due to prolonged vomiting and dehydration. If
hemoglobin is low and the patient is hemodynamically unstable,
a blood transfusion may be ordered (Nojkov & Cappell, 2016).
Comfort Measures
This can be a stressful time and diagnosis for patients and their
families. Some comfort measures that the nurse can facilitate
for the patient to help ease the anxiety include active listening
to the patient and family concerns. The nurse should
collaborate with chaplain services to help ease the anxiety of
the patient and family members. Also providing education and
utilizing the hospitals multidisciplinary team to help find
outside resources to help alleviate the stress or concerns the
patients or family have. Guided imagery can be used as an
alternative method for pain relief. Music therapy can be used to
distract the patient from pain. When the patient can eat again,
offering soft foods or cold liquids (patients’ preference) to help
alleviate his or her sore throat.
Safety Issues
The safety issues to be concerned with when you have a patient
6. with MWT, are based on the assessment and the treatments of
the patient. If the patient is hemodynamically unstable, the
patient is at risk for falls. Patients with MWT should be placed
on fall precautions and should be encouraged to call for
assistance if they need to get out of bed. Another major safety
issue the nurse should be aware of is possible ineffective airway
clearance. If the patient is vomiting, there is a great risk for
aspiration. Sedation medication used during endoscopy may
cause ineffective airway clearance and a throat numbing spray
used during the same procedure can increase the risk of
aspiration. The nurse will collaborate with speech therapy to
complete a swallow evaluation before allowing the patient to eat
and drink to avoid aspiration complications. The nurse will
ensure the patient passed the swallow evaluation and place the
patient on aspiration precautions. The nurse will make sure
there is a suction equipment in the patient’s room. The nurse
will put pads on bedrails to prevent bruising and monitor for
any bleeding.
Patient and Family Teaching
Readiness to Learn
It is important to assess the patient’s readiness to learn before
providing them with information. The nurse needs to evaluate
the patients emotional and physical state and decide when the
best time to begin teaching. The nurse should assess what
teaching style will be most beneficial to the patient. Many
factors need to be addressed and taken into consideration with
the assessment such as the patients pain level, education level,
primary language spoken, and what knowledge they have on the
subject already (Flanders, 2018). The nurse will also complete
a cultural assessment to gain an understanding of what the
illness means to the patient. The nurse should also assess
barriers to communication such as hearing and vision.
Teaching Strategies
Once the nurse has established the patient’s language of choice
and combination of learning styles, teaching strategies can be
selected that will be effective for the patient. Learning about
7. something new especially under a stressful situation takes time.
It is always good to try and involve the patient’s family with
teaching sessions. Patient teaching should be done in stages or
segments to enhance absorption of information. It is suggested
that the nurse should not introduce more than three topics at a
time. The patient in the hospital with MWT will be in the
hospital for a couple of days at minimum, affording the nurse
multiple teaching opportunities. The nurse should take notes on
the questions the patient has during teaching and find any
additional resources as needed. It is important to be attentive to
the patient, have uninterrupted time, maintain good eye contact,
and be at eye level with the patient. It is also very important to
acquire the appropriate teaching aids to maximize the education
experience. Example, if the patient does not read well, do not
load him or her up with papers and pamphlets, rather get
creative and utilize websites and videos. If written material is
used, go over it with the patient and them give them time to go
over it themselves. Give the patient a pen and paper and
encourage them to write down any question they may come up
with (Flanders, 2018). The learning environment should also be
free from distractions.
Content
Patient teaching will begin on admission. The patient will be
notified of all options available prior to any actions taking
place. The nurse will complete teaching with the patient and
family on the pertinent subjects specific to the patient’s needs.
For alcohol abuse the nurse will teach the patient about
different treatment options including, cutting back on alcohol
consumption and participation in alcoholics anonymous. The
nurse will teach the patient about smoking cessation and the
different options for quitting. For hypertension the nurse will
teach the patient the importance of taking prescribed medication
and checking blood pressure daily. The nurse will teach the
patient to take the medications even if feeling fine. In regard to
signs and symptoms, the nurse will educate the patient on what
to be aware of. The nurse will impress upon the patient to call
8. the doctor if they notice black, tarry stools, or coffee ground
emesis.
Realistic Complications
Complication 1
The most obvious severe complication associated with MWT
would be, hypovolemic shock related to hemorrhage. This is a
medical emergency where there could be a tear or laceration
large enough to cause a severe bleed. Hypovolemic shock
occurs when there is a significant loss of blood. The body
compensates at first by intense vasocontraction but is then
followed by vasodilation and cardiovascular failure. Noticeable
signs and symptoms of patient deterioration to hypovolemic
shock would be a decrease in blood pressure and an increase in
heart rate. The nurse will perform vitals every four hours as a
preventative measure for hypovolemic shock. The nurse can
anticipate rapid blood transfusions and fluid resuscitation. The
nurse can also anticipate having to administer a vasoactive drip
to maintain adequate perfusing blood pressure. Vasopressin and
Levophed are the two most common vasopressors used to assist
in blood pressure control while trouble shooting the underlying
cause and volume resuscitation (Martin & Schreiber, 2014).
Complication 2
The second complication of MWT is the chance of the patient
extending the bleed or re-bleeding after a treatment. The nurse
must be on high alert for the signs and symptoms of bleeding,
which are decreased blood pressure and increased heart rate.
For early detections of a re-bleed the nurse will do vitals every
four hours. If a re-bleed occurs the nurse will notify the doctor.
At this point the doctor may order an endoscopy or choose to
monitor the patient depending on the severity of the bleed. If
the bleed is extensive it may require a surgical procedure. The
patient may experience dark stools for the next few days
because of the old blood in the intestinal tract, but he or she
should report these finding along with any new bleeding or
bloody emesis immediately. Report the findings to the doctor
and an anticipate a series of hemoglobin and hematocrit
9. laboratory draws approximately every four to six hours.
Monitor the trend and make sure it is going in the right
direction (Rich, 2018).
Complication 3
Another complication that can be seen with a patient suffering
from MWT is dehydration and electrolyte imbalances related to
vomiting and being nothing by mouth (NPO). Frequent
vomiting can cause dehydration which can lead to a number of
electrolyte imbalances, mainly hypokalemia. Hypokalemia if
not treated can lead to a more serious complication like
arrhythmias. Sign and symptoms of hypokalemia are muscle
cramps, spasms, heart palpitations, and difficulty breathing.
Anticipate labs such as a basic metabolic panel will be along
with an electrolyte replacement protocol. Other electrolytes
than can be altered from being NPO are the magnesium and
phosphorus levels. These labs should also be monitored and
replaced per protocol as well. Dehydration can also contribute
to hypotension and symptomatic orthostatic hypotension. The
patient will more than likely be given a fluid bolus along with
maintenance intravenous fluids per the doctors’ orders (Jahraus,
2018). The nurse should anticipate placing the patient on a
heart monitor.
Conclusion
Although a Mallory Weise Tear can have very serious
complications, the majority of them heal on their own. This
ailment can be prevented and with good patient teaching,
hopefully the patient will not have a reoccurrence. The paper
discussed peer-reviewed literature surrounding MWT and the
pathophysiology. Next the paper provided complications that
can arise with a diagnosis of MWT, the warning signs and how
to manage patient care. The paper also covered the nursing
process and treatments for a patient that suffers from MWT.
The final paragraph of this paper covered teachings for the
patient and family on signs and symptoms of MWT and its
complications. While creating this paper this author learned
various techniques to research topics, and how to properly
10. format a paper. The experience afforded the author the
opportunity to practice skilled necessary to complete a
bachelor’s program in nursing.
Nursing Narrative
While performing my assessment on the patient I noticed bloody
sputum in his emesis basin. I asked the patient when this had
happened, he stated “I started coughing up some blood this
morning, it happened twice, it hasn’t happened again”. It is
now 1100, patient stated “it happened around 0730”. I elevated
the head of the bed to a minimum of 30 degrees and notified the
Dr. I have instructed the patient to notify the nurse right away if
it happens again. I also provided information on how to try not
to put any stress on his esophagus. If he needs to cough or
sneeze to try and do so into a pillow. Patient will remain on a
clear liquid diet. I will continue to monitor patient.
MALLORY WEISE TEAR 2
References
Cherednikov, E. F., Kunun, A. A., Cherednikov, E. E., &
Moiseeva, N. S. (2016). The role of etiopathogenetic aspects in
prediction and prevention of discontinuous-hemorrhagic
(Mallory-Weiss) syndrome. EPMA Journal, 7.
http://dx.doi.org/10.1186/s13167-016-0056-4
Flanders, S. A. (2018). Effective patient education: Evidence
and common sense. Medsurg Nursing, 27(1), 55-58. Retrieved
from
https://search.proquest.com/nahs/docview/2006753584/fulltext/
BE98929276D04CCEPQ/1?accountid=100141
11. Hyun-Soo, K. (2015, March ). Endoscopic management of
Mallory-Weiss tearing. Clinical Endoscopy, 48(2), 102-105.
http://dx.doi.org/10.5946/ce.2015.48.2.102
Jahraus, J. (2018). Medical complications of eating disorders.
Psychiatric Annals, 48(10), 463-467.
http://dx.doi.org/10.3928/00485713-20180912-04
Martin, D. T., & Schreiber, M. A. (2014, December ). Modern
resuscitation of hemorrhagic shock: What is on the horizon? .
European Journal of Trauma and Emergency Surgery, 40(6),
641-656. http://dx.doi.org/10.1007/s00068-014-0416-5
Nojkov, B., & Cappell, M. S. (2016, Jan 7). Distinctive aspects
of peptic ulcer disease, Dieulafoy's lesion, and Mallory-Weiss
syndrome in patients with advanced alcoholic liver disease or
cirrhosis. World Journal of Gastroenterolgy, 22(1), 446-466.
http://dx.doi.org/10.3748/2Fwjg.v22.i1.446
Rich, K. (2018, June). Overview of Mallory-Weiss syndrome.
Journal of Vascular Nursing, 36(2), 91-93.
http://dx.doi.org/10.1016/j.jvn.2018.04.001
a tumult ensued in the cemetery; too many had suddenly
stormed to his coffin, crying,
sobbing, screaming in a wild explosion of despair. It was
almost a riot, a fury. All
order was overturned through a sort of elemental ecstatic
mourning such as I have
never seen before or since at a funeral. And it was this
gigantic outpouring of grief
from the depths of millions of souls that caused me to
realize for the first time how
12. much passion and hope this lone and lonesome man had
borne into the world through
the power or a single idea.
1
So wrote an observer about the funeral of Theodor Herzl, the
founder of political
Zionism. Born in Budapest, Hungary, part of the Austro-
Hungarian Empire, Herzl had a
talent for writing and became the Paris correspondent for an
Austrian newspaper. Already
concerned about the rise of anti-Semitism in Austria, Herzl
reported on the Dreyfus
Affair, which began in 1894.
2
Captain Alfred Dreyfus was a Jewish officer in the French
army who was unjustly accused and convicted of giving military
secrets to Germany. The
verbal and physical assaults on Jews that occurred during the
affair intensified Herzl’s
search for a solution to the prejudice and persecution Jews
faced in Europe. Influenced by
the nationalism of the age. he proposed that Jews migrate to
establish their own state
13. outside of Europe in his 1896 The Jewish State. The state would
provide them with a safe
haven. Herzl envisaged the creation of a Society of Jews that
would raise funds and gain
the diplomatic support of the Great Powers for the creation of
the Jewish state. Herzl’s
ideas were greeted with skepticism in some quarters and with
opposition in others such as
among Jews who favored assimilation. On the other hand, other
groups such as the
Lovers of Zion in Russia and millenarian Christian evangelicals
supported political
Zionism. The latter offered hope to Russian Jews who endured
pogroms that destroyed
Jewish lives and property and who faced job and residential
discrimination.
Herzl helped to organize and presided over the First Zionist
Congress. It met in Basle,
Switzerland, in January 1897. The delegates endorsed the Basle
Program, which
contained Herzl’s ideas; and the congress established the
Zionist Organization. Herzl,
therefore, also played an important role in the organization of
14. the Zionist movement. He,
moreover, helped to establish contacts within the British
government that would
eventually lead to Britain’s formal support for a Jewish
homeland in Palestine after his
death. After the failure of his diplomatic overtures to the
Ottoman Empire, which ruled
Palestine, and to Germany, Herzl focused his efforts on Britain
in 1902-4. He was
somewhat flexible as to the location of a Jewish state, though he
preferred Palestine
because of its historical and religious significance to the Jewish
people. When, however,
Joseph Chamberlain suggested the possibility of Egypt as an
area for Jewish settlement,
Herzl smiled and replied: No, we will not go to Egypt. We have
been there.”
3
On the
other hand, the Zionist leader was willing to entertain the
possibility of British Kenya as
an area for Jewish colonization, but only as a stepping stone to
Palestine. The British
1
15. Howard M. Sachar, A History of Israel: From the Rise of
Zionism to Our Time (New York: Alfred A.
Knopf, 1976), pp. 63-64.
2
Jacques Kornberg points out that it was rising anti-Semitism in
Austria that first led Herzl to seek a
solution to the Jewish plight. See his Theodor Herzl: From
Assimilation to Zionism (Bloomington and
Indianapolis: Indiana University Press, 1993), p. 2.,
3
Sachar, A History of Israel, p. 54.
themselves grew cooler towards this idea. Russian Jews in
particular insisted that there
could be no Zionism without Zion and that Palestine should be
the Jewish homeland.
Herzl died from a heart attack in 1904, but the British gave
formal diplomatic support for
a Jewish homeland in Palestine through the Balfour Declaration
of November 1917.
Britain gained control over Palestine as a mandate under League
of Nations supervision
after WWI and so was able to give effect to its promise. The
following selection is taken
from Herzl’s The Jewish State.
16. 4
.
1. Introduction
The Jewish Question still exists. It would be foolish to deny it.
It is a remnant of the
Middle Ages, which civilized nations do not even yet seem able
to shake off, try as they
will. They certainly showed a generous desire to do so when
they emancipated us. The
Jewish Question exists wherever Jews live in perceptible
numbers. Wherever it does not
exist, it is carried by Jews in the course of their migrations. We
naturally move to those
places where we are not persecuted, and there our presence
produces persecution. This is
the case in every country, and will remain so, even in those
highly civilized countries─
for instance, France─until the Jewish question finds a solution
on a political basis. The
unfortunate Jews are now carrying the seeds of Anti-Semitism
into England; they have
already introduced it into America.
17. We are a people─one people.
We have honestly endeavored everywhere to merge ourselves in
the social life of
surrounding and to preserve the faith of our fathers. We are not
permitted to do so. In
vain are we loyal patriots, our loyalty in some places running to
extremes; in vain do we
make the same sacrifices of life and property as our fellow-
citizens; in vain do we strive
to increase the fame of our native land in science and art, or her
wealth by trade and
commerce. In countries where we have lived for centuries we
are still cried down as
strangers, and often by those whose ancestors were not yet
domiciled in the land where
Jews had already had experience of suffering. The majority may
decide which are the
strangers; for this, as indeed every point which arises in the
relations between nations, is
a question of might. I do not here surrender any portion of our
prescriptive right, when I
make this statement merely in my own name as an individual. In
the world as it now is
18. and for an indefinite period wilt probably remain, might
precedes right. It is useless,
therefore, for us to be loyal patriots, as were the Huguenots,
who were forced to emigrate.
If we were left in peace. …
But I think we shall not be left in peace.
4
Theodor Herzl, The Jewish State (American Zionist Emergency
Council, 1946 ed.), translated from the
German by Sylvie D’Avigdor,
http://www.jewishvirtuallibrary.org/jsource/Zionism/herzl/2d.ht
ml
2. The Jewish Question
No one can deny the gravity of the situation of the Jews.
Wherever they live in
perceptible numbers, they are more or less persecuted. Their
equality before the law,
19. granted by statute, has become practically a dead letter. They
are debarred from filling
even moderately high positions, either in the army, or in any
public or private capacity.
And attempts are made to thrust them out of business also:
“Don’t buy from Jews!”
Attacks in Parliaments, in assemblies, in the press, in the pulpit,
in the street, on
journeys─for example, their exclusion from certain hotels─even
in places of recreation,
become daily more numerous. The forms of persecution varying
according to the
countries and social circles in which they occur. In Russia,
imposts are levied on Jewish
villages; in Rumania, a few persons are put to death; in
Germany, they get a good beating
occasionally; in Austria, Anti-Semites exercise terrorism over
all public life; in Algeria,
there are traveling agitators; in Paris, the Jews are shut out of
the so-called best social
circles and excluded from clubs. Shades of anti-Jewish feeling
are innumerable. But this
is not to be an attempt to make out a doleful category of Jewish
hardships.
20. I do not intend to arouse sympathetic emotions on our behalf.
That would be foolish,
futile, and undignified proceeding. I shall content myself with
putting the following
questions to the Jews: Is it not true that, in countries where we
live in perceptible
numbers, the position of Jewish lawyers, doctors, technicians,
teachers, and employees of
all descriptions becomes daily more intolerable? Is it not true,
that the Jewish middle
classes are seriously threatened? Is it not true, that our poor
endure greater sufferings than
any other proletariat? I think that this external pressure makes
itself felt everywhere. In
our economically upper classes it causes discomfort, in our
middle classes continual and
grave anxieties, in our lower classes absolute despair.
Everything tends, in fact, to one and the same conclusion, which
is clearly enunciated in
the classic Berlin phrase: “Juden Raus” (Out with the Jews!)
THE PLAN
21. The whole plan is in its essence perfectly simple, as it must
necessarily be if it is to come
within the comprehension of all.
Let the sovereignty be granted us over a portion of the globe
large enough to satisfy the
rightful requirements of a nation; the rest we shall manage for
ourselves.
The creation of a new State is neither ridiculous nor impossible.
We shall have in our day
witnessed the process in connection with nations which were
not largely members of the
middle class, but poorer, less educated, and consequently
weaker than ourselves. The
Governments of all countries scourged by Anti-Semitism will be
keenly interested in
assisting us to obtain the sovereignty we want.
The plan, simple in design, but complicated in execution, will
be carried out by two
22. agencies: The Society of Jews and the Jewish Company.
5
The Society of Jews will do the preparatory work in the domain
of science and politics,
which the Jewish Company will afterwards apply practically.
The Jewish Company will be the liquidating agent of the
business interests of departing
Jews, and will organize commerce and trade in the new country.
We must not imagine the departure of the Jews to be a sudden
one. It will be gradual,
continuous, and will cover many decades. The poorest will go
first to cultivate the soil. In
accordance with a preconceived plan, they will construct roads,
bridges, railways and
telegraph installations; regulate rivers; and build their own
dwellings; their labor will
create trade, trade will create markets and markets will attract
new settlers, for every man
will go voluntarily, at his own expense and his own risk. The
labor expended on the land
will enhance its value, and Jews will soon perceive that a new
23. and permanent sphere of
operation is opening here for that spirit of enterprise which has
heretofore met only with
hatred and obloquy.
PALESTINE OR ARGENTINE?
Shall we choose Palestine or Argentine? We shall take what is
given us, and what is
selected by Jewish public opinion. The Society will determine
both these points.
Argentine is one of the most fertile countries in the world,
extends over a vast area, has a
sparse population and a mild climate. The Argentine Republic
would derive considerable
profit from the cession of a portion of its territory to us. The
present infiltration of Jews
has certainly produced some discontent, and it would be
necessary to enlighten the
Republic on the intrinsic difference of our new movement.
Palestine is our ever-memorable historic home. The very name
of Palestine would attract
24. our people with a force of marvelous potency. If His Majesty
the Sultan were to give us
Palestine, we could in return undertake the whole finances of
Turkey. We should there
form a portion of a rampart of Europe against Asia, an outpost
of civilization as opposed
to barbarism. We should as a neutral State remain in contact
with Europe, which would
have to guarantee our existence. The sanctuaries of Christendom
would be safeguarded
by assigning to them an extra-territorial status such as is well-
known to the law of
nations. We should form a guard of honor about these
sanctuaries, answering for the
fulfillment of this duty with our existence. This guard of honor
would be the great symbol
of the solution of the Jewish question after eighteen centuries of
Jewish suffering.
3. The Jewish Company
OUTLINES
5
These became known as the Zionist Organization/Jewish
25. Agency and Jewish National Fund respectively.
The Jewish Company is partly modeled on the lines of a great
land-acquisition company.
It might be called a Jewish Chartered Company, though it
cannot exercise sovereign
power, and has other than purely colonial tasks.
The Jewish Company is an organization with a transitional
character. It is strictly a
business undertaking, and must be carefully distinguished from
the Society of Jews.
The Jewish Company will first of all convert into cash all
vested interests left by
departing Jews. The method adopted will prevent the
occurrences of crises, secure every
man’s property, and facilitate that inner migration of Christian
citizens which has already
been indicated.
PURCHASE OF LAND
26. The land which the Society of Jews will have secured by
international law must, of
course, be privately acquired. Provisions made by individuals
for their own settlement do
not come within the province of this general account. But the
Company will require large
areas for its own needs and ours, and these it must secure by
centralized purchase. It will
negotiate principally for the acquisition of fiscal domains, with
the great object of taking
possession of this land “over there” without paying a price too
high, in the same way as it
sells here without accepting one too low. A forcing of prices is
not to be considered,
because the value of the land will be created by the Company
through its organizing the
settlement in conjunction with the supervising Society of Jews.
The latter will see to it
that the enterprise does not become a Panama, but a Suez.
6
4. Local Groups
THE PHENOMENON OF MULTITUDES
27. I do not want to hurt anyone’s religious sensibility by words
which might be wrongly
interpreted.
I shall merely refer quite briefly to the Mohammedan
pilgrimages to Mecca, the Catholic
pilgrimages to Lourdes, and to many other spots whence men
return comforted by their
faith, and to the holy Hock at Trier. Thus we shall also create a
center for the deep
religious needs of our people. Our ministers will understand us
first, and will be with us
in this.
We shall let every man find salvation “over there” in his own
peculiar way. Above and
before all we shall make room for the immortal band of our
Freethinkers, who are
continually making new conquests for humanity.
6
The French entrepreneur Ferdinand de Lesseps had been
successful in building the Suez Canal, but failed
28. in the attempt to build a canal through Panama.
5. Society of Jews and the Jewish State
THE GESTOR OF THE JEWS
Externally, the Society will attempt, as I explained before in the
general part, to be
acknowledged as a State-forming power. The free assent of
many Jews will confer on it
the requisite authority in its relations with Governments.
Internally, that is to say, in its relations with the Jewish people,
the Society will create all
the first indispensable institutions; it will be the nucleus out of
which the public
institutions of the Jewish state will later be developed.
CONSTITUTION
Politics must take shape in the upper strata and work
downwards. But no member of the
Jewish State will be oppressed, every man will be able and will
29. wish to rise in it. Thus a
great upward tendency will pass through our people; every
individual by trying to raise
himself, raising also the whole body of citizens. The ascent will
take a normal form,
useful to the State and serviceable to the National idea.
Here I incline to an aristocratic republic. This would satisfy the
ambitious spirit of our
people, which has now degenerated into petty vanity. Many of
the institutions of Venice
pass through my mind; but all that which caused the ruin of
Venice must be carefully
avoided. We shall learn from the historic mistakes of others, in
the same way as we learn
from our own; for we are a modern nation, and wish to be the
most modern in the world.
Our people, who are receiving the new country from the
Society, will also accept the new
constitution it offers them. Should any opposition manifest
itself, the Society will
suppress it. The Society cannot permit the exercise of its
functions to be interpreted by
short-sighted or ill-disposed individuals.
30. LANGUAGE
It might be suggested that our want of a common language
would present difficulties. We
cannot converse with one another in Hebrew. Who amongst us
has sufficient
acquaintance with Hebrew to ask for a railway ticket in that
language! Such a thing
cannot be done. Yet the difficulty is very easily circumvented.
Every man can preserve
the language in which his thoughts are at home. Switzerland
affords a conclusive proof of
the possibility of a federation of tongues. We shall remain in
the new country what we
are here, and we shall never cease to cherish with sadness the
memory of the native land
out of which we have been driven.
We shall give up using those miserable stunted jargons, those
Ghetto languages which we
still employ, for these were the stealthy tongues of prisoners.
Our national teachers will
give due attention to this matter; and the language which proves
31. itself to be of greatest
utility for general intercourse will be adopted without
compulsion as our national tongue.
Our community of race is peculiar and unique, for we are bound
together only by the
faith of our fathers.
Questions
1. What was the situation of Jews in Europe as described by
Herzl?
2. What does Herzl advocate as the solution to the Jewish
predicament? What means
should be used to implement the solution?
3. What does Herzl view as the possible locations for a Jewish
state, and which does he
seem to prefer? Why? What does he think the Jewish state
should be like in terms of
government, language, and religion?