Analysis of VSauce Essay Example | Topics and Well Written Essays - 750 words

Examination of VSauce - Essay Example Innovative re-building and a few formative stages empowers VSauce to consolidate differentiated mechanics that have seen them move the concentration from educative and useful channels to increasingly logical and comprehendible gaming channels and conventions that require the synergistic effect and sees or potentially specialized improvement from the clients and architects in the network. This gives the channels an upper hand contrasted with different destinations in that the assorted variety of the perspectives and generative viewpoints from the coordinated efforts help the site being developed and structure of bleeding edge highlights. Customization of recordings as far as quality and the topic, video, gaming, sports and the intuitive perspectives, offers opportunity of trade and move of information. This benefits consideration as it joins the decent variety old enough, social and social foundation, monetary health and opportunity of decision from the assortment which is the useful point of view of sites and their applications (Brown 8). Vsauce consolidates the training angle in the arrangement of computerized, clear and sequential logical films in the field of science giving the crowd/scholarly guest an assortment of recordings which realize the hypothetical bundle instructed in study hall climate. This angle enhances its tasks to all the more a blog, substance and chronicle website offering accommodation to the assortment of clients/guests. Likewise the fuse obliges enhanced interests of a solitary guest by fitting and giving different arrangements in a single site not at all like different locales that will give explicit answer for a particular intrigue/issue. For example, presentation of VSauce2 that has five repeating portions to cover unordinary information and innovation, â€Å"MindBlow†, a section that covers the developments that are valuable and their essentialness to the general public are funny as well as contacts the cooperative and the edu cative part of the creation part learnt in schools and ever. Additionally the â€Å"FAK† fragment for realities and information, which includes unimportant inquiries, goes about as a psychological formative program for all ages which gives the site credit in inventiveness viewpoints and shared ones as the channel’s work is from the clients. Inventiveness is apparent in the manner VSauce consolidates the decent variety of imaginative abilities from the clients and the network as a rule. The fuse of various â€Å"phases† of VSauce with time has seen improvements in the users’ commitment in understanding the user’s gifts and in accordance with the development and advancement objective of the site and offering back to the general public. For example, the ‘BiDiPi’ section that represents manufacture it, drive it and play it, fuses the abilities of the networks and the site client/fans and brings the serious part of the site to the clients w hich go about as an inspirational apparatus.

Learning to Drive Professor Ramos Blog

Figuring out how to Drive Photograph by Ingo Joseph on Pexels.com Figuring out how to drive was unquestionably probably the greatest deterrent and furthermore perhaps the best achievement. My dread was consistently what appeared to disrupt everything from getting myself into the driver seat. From the start, I needed to focus on figuring out how to function the switches in the vehicle. At that point it was really escaping the garage and onto the road. Obviously all that appeared to be excessively simple close to the last advance. The one thing I dreaded the most was the expressway. I was 17 sitting on our front strides as I treaded carefully father show my more established sibling how to give the vehicle an oil change. That old white Ford Explorer despite everything going considerably after all its experienced. We have had that truck throughout recent years and it has a bigger number of gouges and scratches than I can even monitor. This truck has been the learning vehicle for the entirety of my more seasoned kin. They all got their driver’s permit in it and obviously I needed to try to prop that custom up. As a child I generally envisioned myself driving that vehicle. When my progression father and sibling had completed I understood that was my chance to at long last inquire as to whether he could instruct me to drive. When I asked him, he took a gander at me with an unexpressed face and said,â€Å"What! Well it’s about time!† I got into the driver seat and my progression father was educating me from the traveler window. I got the vehicle t urned on and he stated, â€Å"Alright, put the vehicle on drive and when you let go of the brake, somewhat press the gas pedal so you can get a vibe how the vehicle feels.† I may have squeezed a little to hard and almost hauled my progression father from the window. That frightened me away the driver seat leaving me unfit to drive for a couple of more months. Two or three months passed by when my sister more likely than not chose I needed to conquer this dread. She left the vehicle after we dropped the more youthful children at school and said â€Å"Alright, get into the driver seat,† I was stunned and answered, â€Å"ARE YOU CRAZY!† right now I sincerely accepted my sister had lost her brain, however I obeyed got into the driver seat. The brilliant side to that morning was that the road we were on was very detached. There wasn’t much I could hit aside from a few little trees and a few brambles so that truly facilitated my nervousness overall thought. Despite the fact that I was alarmed of wrecking her splendid red Hyundai, I put the vehicle on drive and followed all the means as she said. I let go of the brake pedal and somewhat pushed on the gas. I gradually sped up and really made it down the road without hitting anything. Obviously I was just going straight so it would have been odd to have hit any of the bushes.H er point to making me drive up the road was so I could get the vibe of the vehicle really moving. After that I got enough mental fortitude to really driving on the bustling road. I first I didn’t think it was going to end well, yet I made it home with no scratch or mark to my sisters vehicle. I rehearsed each other day by driving my mother to the store which was 3 blocked away from where we live. At that point I gradually began driving further and further. I wound up driving throughout the day since I delighted in the sentiment of really driving myself. My last advance was jumping on the turnpike, yet I put that in the rear of my psyche so I didnt even consider it. I remained in the city for quite a while without expecting to take the turnpike. At that point intending to go to the sea shore with my companions turned into a burden. Everybody worked so getting somebody to drive me to the sea shore was somewhat troublesome. Significantly after I needed to drop I sort of still didn’t consider jumping on the expressway. After a month my progression father became ill. My folks both cooperated and since my mother couldn’t drive my progression father consistently did. My more established kin likewise had work each morning to they couldn’t drive her to work. That left me as the main alternative to get my mom to work. I attempted to escape that by clarifying that I scarcely began to become accustomed to driving however my mother wasn’t accepting my reason as an answer. So the following morning she woke me up too so on. I truly wasn’t upbeat about that regardless of whether I was a morning individual. I realized that the road would have been totally unique in relation to how I was driving in the city. My mother disclosed to me that it was extremely early so the interstate won’t be excessively occupied. As I got onto the expressway I froze a little when I saw what number of semi-trucks were at that point encompassing me. By the by, I needed to discard my dread and resist the urge to panic. My mother close to me truly had any kind of effect. She began the most arbitrary discussions, so I wouldn’t alarm on the trucks that were close to me. We made it to her activity without biting the dust so I’d like to state that was an extraordinary achievement. I left her there and trusted go into the road to head home since obviously I despite everything needed to get the chance to class as well. I have consistently delighted in the sentiment of achievement the same amount of as any individual. I can’t state I can get around the interstate without Google Maps however yet I can get past the road simply like some other individual. I wasn’t the best driver from the start and I can concede I drove like a grandmother as well. Presently Im ready to drive that old beat up Ford Explorer and everything started when Iâ capable was escape my customary range of familiarity. I needed to test my cutoff points and not let dread keep me away from busy. I had the option to get my permit and now I can drive myself anyplace and all it took was practice and not surrendering in any event, when mix-ups were made.

Technology Has Played Many Roles - Free Essay Example

Technology has played many roles in many peoples lives, if we have a question then we quickly go and run to our device expecting to find the answer that we are looking for whether its right or wrong. Instead of depending on google or any online websites we can actually spend the time to go and research what we need or maybe in fact ask a friend for help. People have not only looked up to technology for answers but theyve become obsessed to their devices. Its gotten to the point that wherever they go they cant keep their eyes and hands off of it as if they are permanently glued to their device, its a high chance that they dont even know whats going on around them because they are too focused on something else more important. Its time that people should value what they see and are doing than rather reading words that really cant express what can really be going on in person. The first thing we have to understand is that technology isnt our companion for life and we should not depend on it whatsoever. Its not healthy to have our eyes wide open 24/7 and quickly moving our thumbs as fast as we can to send a message back over and over. In todays most disappointing society we live off of a bright device instead of living in the outside world. There is so much we can experience but we just dont because our main focus is whats going on media. Meeting new people or having great friendships and relatives can bring so much happiness and joy to your life in fact anyone can be a helping hand so stop expecting an answer from google that isnt a person in your life. Internet should never guide you for success because you are the only person who should put the effort for a good outcome so never depend on technology depend on yourself and maybe for others that can help you strive for the best. Its not just teens who are attached to their mobile devices but its parents too. Almost everyone is obsessed to have the latest new phone in their hands, and the instant we get a message or call we are so quickly to attend to answer but in person we tend to ignore and not pay attention to someone who is talking or trying to have your attention which is awfully disrespectful. This topic isnt for just a certain group in society this is a worldwide issue that can easily be solved but we just make it hard on ourselves by simply being obsessed and so attached to a phone or any other kind of media device. For example, if a student in school gets assigned a topic they run to google as fast as they can and skim through every word and assume theyve learned it already and are done. Almost all our life theyve taught us to stop depending on someone and all we do is depend on a screen for answers that half of the time are not right. Schools have libraries, many other resources and its like thats all gone through the trash, there are so many local places and people willing to help and wasting their time for you but instead you take advantage of a screen rather than someone whos actually willing to provide you with help that includes opinions, facts and many other useful information. Besides that you can be socializing at the same time but people choose to communicate to google that isnt a person and that is not healthy in any way. Its important that we realize this world wide issue thats been going on for the longest, first we need to put down all of our devices and appreciate every person in our life that surround us. Every little talk you have with your parents, grandma, cousins, siblings, aunts, and relatives is one in a lifetime and you should not waste the best opportunity that life can give you to talk to the people you have around you. We should be taking the time to value life instead of posting a unnecessary selfie on any app or responding to a boy who is just temporary and etc. Everything is temporary online but not the people you care about are temporary. We seek for so much online but cant seek to many family members that dont have phones to be able to communicate with us, it shouldnt make them any less important. Theres so many parents that are hypocrites that are constantly telling others and their kids to stay off their phone but most of their time they are on facebook publicizing their entire life. This goes for all ages, its upsetting to see such a busy society on their phone rather than spending time with loved ones and aside from that work too people are so busy on their phone but dont get busy with other important task that need to be done. Many of you might argue and say that technology has shaped yall in a positive matter and I understand that technology has its advantages and disadvantages just like any other topic. You might say that technology is the only way to talk to family that is far away, and I get that, but people are using technology in not a useful way. They have so many other ways to find other information because if not then no tutors, libraries, school, textbooks would exist those are all resources to help us but so many of us choose to ignore it and thats so ungrateful of us and we should appreciate and take advantage of those opportunities that can help us and apart from that people arent spending quality time with their family because to them they are less important and this is not okay we have to appreciate what we have in person rather than a screen. In conclusion, technology has changed many people and thats not how it should be. Its okay to use it on your off time but we shouldnt trap ourselves in our own bubble 24/7 ignoring whats around us. Theres so many problems going all around us and need of socializing with your loved ones and we should value that more than anything because life is the most beautiful thing and a device wont make you laugh, smile like a person who truly is around so its important to appreciate what we see outside a phone than in an actual phone.

Passive Voice Definition and Examples

In traditional grammar, the term passive voice refers to a type of sentence or clause in which the subject receives the action of the verb. (For example, the sentence A good time was had by all is constructed with a passive voice, in contrast with Everyone had a good time, which is constructed using an active voice.) In Defense of the Passive Voice Linguist Jane R. Walpole, who has authored several books on the subject of grammar believes that the passive voice can be a valuable tool if used correctly. Indiscriminate slandering of the passive voice ought to be stopped, she writes. The passive should be recognized as a quite decent and respectable structure of English grammar, neither better nor worse than other structures. When it is properly chosen, wordiness and obscurity are no more increased than when the active voice is properly chosen. Its effective and appropriate use can be taught. Passive Voice Examples Though many style guides discourage the use of the passive voice, the construction can be quite effective, especially when the performer of an action is unknown or unimportant. Passive constructions can also enhance cohesion. Here are some good examples: [Fern] found an old milking stool that had been discarded, and she placed the stool in the sheepfold next to Wilburs pen.—from Charlottes Web by E.B. White America was discovered accidentally by a great seaman who was looking for something else...America was named after a man who discovered no part of the New World. History is like that, very chancy.—from The Oxford History of the American People by Samuel Eliot Morison Her bones were foundround thirty years laterwhen they razedher building toput up a parking lot.—Chicken-Licken by Maya Angelou from Oh Pray My Wings Are Gonna Fit Me Well In the beginning, the Universe was created. This has made a lot of people very angry and has been widely regarded as a bad move.—from The Hitchhikers Guide to the Galaxy by Douglas Adams Fiction was invented the day Jonas arrived home and told his wife that he was three days late because he had been swallowed by a whale.—Gabriel Garcia Marquez Pandora, from Greek mythology, was given a box with all the worlds evils in it.—from The Last Lecture by Randy Pausch The young gentleman was later seen by me in front of the gare Saint-Lazare.—Passive from Exercises in Style by Raymond Queneau Evasive Use of the Passive Voice Noted Chicago-based journalist Sydney J. Harris, best remembered for his long-running weekday column, â€Å"Strictly Personal, wryly noted that the use of the passive voice as a vehicle with which to make excuses is a sign of immaturity. We have not passed that subtle line between childhood and adulthood until we move from the passive voice to the active voice—that is, until we have stopped saying It got lost, and say, I lost it, he observed. And yet, the practice is common enough, especially in the world of politics, as evidenced by these mistakes were made disclaimers: [W]hen [New Jersey Governor Chris Christie] said mistakes were made, did he know he was quoting Nixon press secretary Ron Ziegler, or did that particular obfuscatory use of the passive voice just pop into his head?—Katha Pollitt, Christie: A Bully’s Bully. The Nation, February 3, 2014 Mistakes were made. I didnt make them.—Chief of Staff and later Secretary of State Alexander Haig, Jr., on the Watergate scandals, January 1981 We did not achieve what we wished, and serious mistakes were made in trying to do so.—President Ronald Reagan, regarding the Iran-Contra affair, January 1987 Clearly, no one regrets more than I do the appearance of impropriety. Obviously, some mistakes were made.†Ã¢â‚¬â€Chief of Staff John Sununu, when caut using government military aircraft for personal trips, December 1991 Mistakes were made here by people who either did it deliberately or inadvertently.—President Bill Clinton, when it was discovered that he had invited the countrys senior banking regulator to a meeting with the Democratic Party’s senior fund-raiser, January 1997 I acknowledge that mistakes were made here.—Attorney General Alberto Gonzales, regarding the firing of eight U.S. attorneys, March 2007 Proper Uses of Passive Voice in Journalism Lauren Kessler and Duncan McDonald, authors of When Words Collide, a grammar and usage guide for media writing, suggest that there are two situations in which the passive voice must be used for journalistic purposes. The first is when the receiver of the action is more important than the creator of the action. This is the example they cite: A priceless Rembrandt painting was stolen from the Metropolitan Museum of Art yesterday by three men posing as janitors. Here, even though it receives the action, the painting remains the subject of the sentence because a Rembrandt is more important than the thieves who stole it. The second compelling use for the passive voice in journalism when a writer simply doesnt know who the person or thing responsible for creating an action is. This is the example they cite: The cargo was damaged during the trans-Atlantic flight. Here, theres no way to know what caused the damage. Was it turbulence? Vandalism? Human error? Since there can be no answer (at least without further investigation), the passive voice must be used. True Passives, Semi-Passives, Passive Gradient The most common form of the passive in English is the short passive or agentless passive: a construction in which the agent (i.e, the one who performers an action) is not identified. For example, Promises were made. In a long passive, the object of the verb in an active sentence becomes the subject. According to linguist Christopher Beedham, statistics indicate that about four-fifths of the occurrences of passive voice lack a by-phrase, however, in the active construction, subjects are required—meaning there can be no active sentences that dont have a subject. So where do all these passives with no agent come from whereby the agent is unknown? he asks. Not from an underlying active, obviously. It is common practice to assume a dummy subject in such cases, equivalent to someone, i.e. underlying My house was burgled is the sentence Someone burgled my house. But that is stretching a point beyond credibility. For the answer, Beedham refers to the authoritative reference text A Comprehensive Grammar of the English Language. Citing the following examples, he explains that the way to get past this problem is by using a passive gradient along with the concept of the semi-passive: This violin was made by my father.This conclusion is hardly justified by the results.Coal has been replaced by oil.This difficulty can be avoided in several ways. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - We are encouraged to go on with the project.Leonard was interested in linguistics.The building is already demolished.The modern world is getting more highly industrialized and mechanized.My uncle was/got/seemed tired. The dotted line indicates the break between real passives and semi-passives, he says. Those above the line are real passives, those below the line are increasingly remote from the ideal passive with a unique active paraphrase, and are not real passives at all—they are semi-passives. Rise of the Get-Passive Often the passive voice is formed by using the appropriate form of the verb to be (for example, is) and a past participle (for example, formed). However, passive constructions arent always made up of be and a past participle. The get-passive construction has become increasingly popular. The passive in English is usually formed with the verb to be, yielding they were fired or the tourist was robbed, explains noted American linguist and author Arika Okrent. But we also have the get passive, giving us they got fired and the tourist got robbed. She goes on to say that while the get-passive dates back at least 300 years, its use has seen a marked increase over the last 50 years. It is strongly associated with situations which are bad news for the subject—getting fired, getting robbed—but also situations that give some kind of benefit. (They got promoted. The tourist got paid.) However, the restrictions on its use may be relaxing over time and get-passives could get a whole lot bigger. Sources Walpole, Jane R. Why Must the Passive Be Damned? College Composition and Communication. 1979Beedham, Christopher. Language And Meaning: The Structural Creation of Reality. John Benjamins. 2005Okrent, Arika. Four Changes to English So Subtle We Hardly Notice Theyre Happening. The Week. June 27, 2013Knight, Robert M. A Journalistic Approach to Good Writing: The Craft of Clarity. Second Edition. Iowa State Press. 2003Kessler, Lauren; McDonald, Duncan. When Words Collide. Eighth Edition. Wadsworth, 2012Quirk, Randolph;  Greenbaum, Sidney; Leech, Geoffrey N.;  Svartvik, Jan. A Comprehensive Grammar of the English Language. Pearson Education ESL.  February 1989

The Therapeutic Process and the Therapeutic Relationship...

This essay will explore the nature of the therapeutic process; using my fifty minute long real play session with one of my colleagues. Also, I will explore my experience of the therapeutic relationship and how it influences therapeutic change and increase the affectivity of the therapy. In addition to this, I will be attaining feedback from my client after discussing each stage of the therapeutic process in detail to help me understand what worked well for the client and gain more insight into what I need to improve in order for my future sessions to be more successful. Before the beginning of the session, I made sure I place the chairs in an appropriate position to promote equality and decrease the power dynamic between myself and the†¦show more content†¦I made sure I used a welcoming tone as the way a counsellor greets their client will influence the clients feeling towards the counsellor, and their confidence in the counsellor. It is equally important to be friendly so that the client feels at ease and valued as a human being. However counsellors need to refrain from putting on an act and remain congruent and true to themselves from the beginning, while trying to meet them in a person to person encounter to avoid intimidation Geldard and Geldard (2005) . i asked her brief questions about her name and how she was to get acquainted with her and build rapport. Asking questions helps facilitate a dialogue and encourages the client to talk and tell their story Miller (2006). The client seemed tense and uneasy and spoke with a very high tone of voice when she greeted me and introduced herself. When asked about the main reason for turning to therapy, she started fidgeting and looked unsettled; this could be because of the unfamiliar environment or she was not sure if she trusted me enough to tell me her story. Either way, I remained silent whilst maintaining eye contact to give her the space, time she needed in order to settle down and work out what she wanted to bring to the session. The client seemed very confused as though she was not sure of what to say and looked up the ceiling taking pauses, blinking, sighing as she spoke about the presenting issue. i nodded continuously toShow MoreRelatedBenefits Of Being A Nurse Patient Communication996 Words   |  4 Pagesresources that separates the therapeutic and non-therapeutic communications for health care providers. The chosen articles are related to PICOT statement. Therapeutic communications can be applied for every single patient in hospital including patients with COPD. First of all, therapeutic communication is the â€Å"ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention† (therapeutic communication in psychiatricRead MorePersuasion And Healing : A Comparative Study Of Psychotherapy Essay1601 Words   |  7 Pages In an attempt to further examine the nature of the therapeutic process and its effects on change, Jerome Frank joined forces with his daughter, Julia Frank, as co-author to the latest edition of his book called, Persuasion and healing: A comparative study of psychotherapy. The book’s main theoretical model points revolve around healing in all forms during psychotherapy and the role of persuasion and rhetoric in that process. To illustrate the diverse forms of help cross-culturally, heRead MoreAssignment Questions On Mastering Competencies1137 Words   |  5 Pageswith Rupture Resolution Strategies: A Proposal and Re commendations by Daniel J. Gaztambide, as cited in Safran et al., (2011), rupture is defined â€Å"as a tension or breakdown in the collaborative relationship between patient and therapist,† ranging from minor transactions that over time may impact the relationship to more dramatic negative processes such as overt hostility (P 185). Safran and Muran (2000) call this â€Å"rupture markers.† As the name suggests, rupture markers are signals that a strain or incongruenceRead MoreEssay on Establishing a Therapeutic Alliance1107 Words   |  5 Pages Research has shown that a strong therapeutic alliance is necessary for establishing a beneficial contact between the therapist and the client. If the therapist does not encourage the creation of a reliable therapeutic alliance from the beginning of the treatment, it will be hard to develop a constructive relationship with the client later. Establishing the therapeutic alliance will increase the chances of achieving t he goal of the treatment because the clients will be willing to cooperateRead MoreWhy the Clinician-Client Relationship is Critical to the Outcome of Therapy1333 Words   |  6 Pagesï » ¿ Why the Clinician-Client Relationship is Critical to the Outcome of Therapy Kori McCurren Columbia College Abstract The following will discuss the benefits of a positive Clinician-Client relationship during the therapeutic process. It will discuss different ways to foster Clinician and Client relationship in order to gain a positive report. It will provide supporting evidence that the relationship positively influences the outcome of the therapy. It will show the viewRead MoreWhat Makes A Successful Therapeutic Relationship?1093 Words   |  5 Pagescreate a successful therapeutic relationship, there are some key elements that need to be a part of the formula. Each therapist may end up having a different recipe, but it is important that a therapist knows what ingredients he or she may need and what they can add for it to be successful. Throughout this paper, this writer will discuss characteristics she hopes to embody as a therapist, as well as the values and skills she wishes to bring with her into a therapeutic relationship. Values There areRead MorePerson Centered Therapy : A Critical Analysis1606 Words   |  7 Pagesbriefly outlines what PCT is, but focuses more heavily on the various approaches used by social workers throughout the therapeutic relationship. More specifically, PCT approaches such as, counselor/client congruence, empathic understanding, and unconditional positive regard are the main approaches highlighted in this analysis as they play an integral role in the counseling relationship. â€Æ' Person-Centered Therapy: A Critical Analysis of PCT Approaches Often social workers are faced with having toRead MoreReflection on Video Vignette Pregnant Stroke1011 Words   |  5 PagesIn this essay, I aim to elaborate on my knowledge and understanding of therapeutic communication prior to and after observing the video ‘Handover’ relating to ‘Pregnant stroke’; scenario-based videos. In particular, my focus is to relate the techniques utilized in the video for therapeutically communicating with the client with construction and enhancement of my personal skills of therapeutic communication, through analyzation and reflection. The video initiated as the paramedic staff informedRead MoreGroup Dynamics And Therapeutic Factors947 Words   |  4 Pages(1) Group Dynamics and Therapeutic Factors As Yalom stated therapeutic change is an enormously complex process that occurs through an intricate interplay of human experience. What Yalom is inferring to in regards to therapeutic change is that individuals are skeptic towards change because it brings discomfort but in the group setting change is inevitable. Through the course of therapy, individuals are bound to change due to the many different group mechanisms that play out. Many theorists haveRead MoreThe Five Stages Of Counseling Essay1363 Words   |  6 Pages The five stages of counseling, relationship building, assessment, goal setting, intervention, and termination form the basic counseling structure, regardless of the type of therapeutic form the therapist chooses to practice. The counseling process becomes a continuous flow from one stepping-stone to the next in order to achieve the client’s goals and improve well-being. The first stages build a foundation by establishing rapport and assessing the problem; the middle stages work toward finding solutions

Taxation Rules of ITAA 97

Question: Define the Taxation for Rules of ITAA 97. Answer: Part 1: Capital Gain Tax According to the rules of ITAA 97, if an asset if acquired before 20 September 1985 the same shall be exempted from the taxation under capital gain sources. However, if there is any substantial change made in the asset that improves its valuation or quality then the same shall be taxable under the sources of capital gain (David et al. 2015). In the present situation, Fred purchased the holiday home on March 1987, which falls under the principles of capital gain section 104 ITAA 97. Taxation on capital gain arises when the price of disposing the asset is higher than the acquisition cost that is taxable as per the percentage specified in rules of ITAA 97, whereas the loss on capital asset can either be carried forward or can be set off (Cornish and Lock 2015). Taxable value of capital gain can be determined by using indexation method or discounting method whichever is appropriate as per the nature of the asset. In case of indexation method, the taxable value is measured by adjusting the acquisition cost with the factor of indexation if the asset is purchased before September 21, 1999. Accordingly, the taxable value on sale of asset is measured by deducting the ancillary costs on sales i.e. legal fees, commission or brokerage. Besides, cost of acquisition is to be adjusted by including the costs on stamp duties, legal fees or registration fees (Trel and Ko 2015). In case of holiday home acquired by Fred during the year 1987 and created a garage in 1990, hence the indexation factor is relevant to determine the taxation of acquisition cost. Moreover, Fred assignment of a builder in January 1990 for creation of garage would be incorporated in the cost of acquisition. Therefore, capital gain taxable value for the sale of holiday home by Fred is measured as under: Computation of capital gain during the current tax year 2016 using indexation method: Particulars Amount $ Amount $ Fair value consideration 800,000.00 Less: Expenses related to sale: Legal fees 1,100.00 Commission 9,900.00 (11,000.00) Net value of consideration 789,000.00 Less: Cost of acquisition: Purchase cost subject to indexation 149,668.87 (100000*67.8/45.3) Stamp duty 2,000.00 Legal fees 1,000.00 Cost of building a garage 20,000.00 (172,668.87 ) Capital gain 616,331.13 Table 1: Capital Gain using indexation method (Source: Created by author) In view of the ITAA 97 provisions for the purpose of capital gain deduction, individual taxpayer is eligible to claim deduction by discounting method. The assessees can use both the methods if the asset has been acquired for more than 12 months i.e. it has to be long- term assets (Allen and James 2015). Discounting method is entitles the individual to measure the taxable value of capital asset by applying the deduction at 50% on the net value of capital gain. As a result, the taxable value on sale of holiday home by Fred is computed as follows: Computation of capital gain during the current tax year 2016 using discounted method: Particulars Amount $ Amount $ Fair value consideration 800,000.00 Less: Expenses related to sale Legal fees 1,100.00 Commission 9,900.00 11,000.00 Net sale of consideration 789,000.00 Less: Cost of acquisition Purchase cost 100,000.00 Stamp duty 2,000.00 Legal fees 1,000.00 Cost of building a garage 20,000.00 123,000.00 Capital gain 666,000.00 Discount @50% 333,000.00 Net capital gain 333,000.00 Table 2: Capital Gain using discounting method (Source: Created by author) As the value of net capital gain in the discounted method is less than the value of capital gain computed in the indexation method, it is suggested to consider the discounted method for capital gain valuation. In case of capital loss set off as per the rulings under taxation system, it is adjusted with the value of capital gain as well as can be carried forward to the subsequent years (Campanale, Fugazza and Gomes 2015). It is given that Fred has net capital loss from the sale of securities valued to $10,000 during the last taxation year he is eligible to adjust such amount of loss from the sale of shares. Besides, the setoff for capital loss is eligible only if the shares were held for more than 12 months before its sale. In case the share were held for less than 12 months then it would be termed as short- term capital asset and loss on such sale shall not be adjusted with the long- term capital gain. Since, the nature of capital loss on shares is not mentioned in the case, it has b een assumed that the capital loss on shares was long- term. As a result, Fred is entitled to claim set off resulting in net capital gain amounted to ($333,000- $10,000) = $323,000. Provision of capital gain in ITAA97 provides exemption on certain assets, which involves residential house, collectibles and personal use assets. Further, collectibles include assets like paintings, drawings, jewelery, photographs, antiques coins and other movable assets (Chauton et al. 2015). It is stated that if the value of collectibles are less than $500 and the interest of collecting it by the individuals developed before December 1995 then the amount of gain from sale shall be exempted. In the present case, Fred incurred capital loss on sale of antique vase amounted to $10,000, which clarifies the value of vase was higher than $500 but the date of acquisition is not mentioned. Hence, capital gain or loss from the sale of antique vase shall not be exempted rather Fred would be entitled to claim set off from the capital profits raised from holiday home. Part 2: Fringe Benefit Tax (a) Fringe Benefit Tax Assessment Act (FBTAA) 1986, refers the fringe benefit as allowances or advantages either in cash or in kind provided by the employers to the employees in consideration of employment during the financial year. Certain allowances are taxable and certain allowances are exempted in the books of employers according to FBTAA 1986 and TR 97/17 of ITAA 97 rules (Bradley and Gephardt 2015). Section 58X, FBTAA 1986 states that the exempted benefits should be incurred for the purpose of employers work including the expenses on electronic gadgets, briefcase, software or protective clothes. To measure the fringe benefit taxable value higher gross- up rates and lower gross- up rates are applied in compliance with the requirements of section 136 in FBTAA 1986 (Radzi and Lewis 2015). TR97/17 provides that the fringe benefit taxable value is computed by applying higher gross- up rate for the employers who pays the charge of Goods and Service Tax (GST) on the expenses of benefits (Wanna 2015). Further, the employers are eligible to claim credit on GST paid on such benefits. Besides, lower gross- up rate is applied for the allowances, which exclude the charges of GST hence, the employers are not eligible to claim credit on the same (Nijland and Dijst 2015). The present situation involves fringe benefit taxability for Periwinkle Ltd, manufacturer and direct seller of bathtubs that provided certain allowances to Emma in the year 2016. The organization offered a car allowance to its employee Emma valued at $33,000 including GST charges. She used the car for travelling 10,000 kilometers and spent $550 as repair charges including GST when the car remained unused for 10 days. Moreover, the car was parked at the airport for unused 10 days and scheduled for annual repairs for another 5 days. FBTAA 1986 framework states that if the car allowance provided to the employee is used for personal purpose along with the official work then the amount of benefit shall be taxable in the employers books. However, if the car is used for the official work only then it would fall under the exemption category subjected to the type of sedan car or station wagon that has a capacity to carry maximum nine passengers and less than one ton carriage (Hodgson and Pearce 2015). Further, benefit on car parking is applied if it is parked at the employees premises or at a station or airport. Besides, in case the car is under repairs and maintenance then it will not be considered as car used for personal purpose. Accordingly, tax liability on fringe benefit on car allowance offered to Emma for the year ended 31 March 2016 is follows: Cost of the car $33,000.00 car used for 10,000 Kms Number of days car was not in use 10 days Proportionate cost of car as per the use 33,000*350/360 = $32,083.33 Higher gross- up rate 2.1463 Taxable value $68,860.45 Amount of FBT on the taxable value @49.0% $33,741.62 Table 3: Fringe Benefit Tax (Source: Created by author) Since the car value is inclusive of GST charges and employer is subjected to claim GST credit, higher gross- up rate is to be used to measure the taxable benefit of the car allowance. Additionally, the expenses on repairs and maintenance $550 shall not be considered for taxable value as it is not used for personal purpose in FBTAA 1986. On the contrary, car-parking value for 10 days at the airport shall be taxable as it was under Emmas possession. Cost of car for 10 days $ 33,000.00 - 32,083.33 = 916.67 Higher gross- up rate 2.1463 Taxable value = 1,967.44 Amount of FBT on the taxable value @49.0% 964.04 Table 4: Fringe Benefit Tax (Source: Created by author) The company provided loan benefit to Emma on 1 September 2015 amounted to $50,000 at an interest rate of 4.45%. It is considered as fringe benefit since the loan amount offered to Emma was less than the standard interest rate prevailing in the present taxation year FBTAA 1986. The current interest rate as on March 2016 is 5.45% p.a. whereas the company provided the loan to Emma at an interest rate of 4.45%. Therefore, Periwinkle is liable to pay fringe benefit tax on the amount of loan for the difference of interest rate (5.45% - 4.45%) = $5,000 which is taxable at the rate 49.0% i.e. $2,450. Besides, utilization of loan will not affect the liability of tax to the organization since the taxability of loan allowance does not depend on the nature of its use (Ryen, Temba and Matotay 2015). Another allowance Periwinkle offered to Emma was the product of bathtub valued at $1,300 while the production cost was $700 with the sale price to the general consumers was $2,600. As the product offered by the organization at a less price than the general price, the amount shall be taxable under FBTAA 1986. Therefore, the company is liable to pay tax on $1,300 ($2,600- $1,300) = $637 at the rate of 49%. (b) In case the loan allowance offered by Periwinkle to Emma for the acquisition of shares instead of providing to her husband then the regulations of section 136, FBTAA 1986 will be attracted. It mentions that the employer is liable to pay taxes on the allowances while the purpose and nature of the loan allowance is not relevant to determine its taxability. Therefore, the value of tax on loan amount will be the same as it was determined in the requirement (a) $637. Besides, Emma will be entitled to claim interest- deduction on the full value of loan as it was utilized by her to acquire the shares during the taxation year (Sun and Im 2015). Reference List Allen, J. and James, R., 2015. Using the Personal Residence for Retirement Income.Journal of Financial Service Professionals,69(4), pp.71-79. Bradley, B. and Gephardt, R., 2015. Fixing the Income Tax with the Fair Tax.Yale Law Policy Review,3(1), p.4. Campanale, C., Fugazza, C. and Gomes, F., 2015. Life-cycle portfolio choice with liquid and illiquid financial assets.Journal of Monetary Economics,71, pp.67-83. Chauton, M.S., Reitan, K.I., Norsker, N.H., Tveters, R. and Kleivdal, H.T., 2015. A techno-economic analysis of industrial production of marine microalgae as a source of EPA and DHA-rich raw material for aquafeed: Research challenges and possibilities.Aquaculture,436, pp.95-103. Cornish, A. and Lock, H., 2015. Transport, accommodation and meals: FBT tricks and traps.Tax Specialist,19(2), p.58. David, M.I.S., Robu, V., Petcu, M. and Ciora, C., 2015. Economic and financial performances within the scope of accounting and fiscal standards applicable to real estate transactions.Valuation of real estate investments, p.91. Hodgson, H. and Pearce, P., 2015. TravelSmart or travel tax breaks: is the fringe benefits tax a barrier to active commuting in Australia? 1.eJournal of Tax Research,13(3), p.819. Nijland, L. and Dijst, M., 2015. Commuting-related fringe benefits in the Netherlands: Interrelationships and company, employee and location characteristics.Transportation Research Part A: Policy and Practice,77, pp.358-371. Radzi, R.M. and Lewis, M.K., 2015. Religion and the Clash of Ideals and Realities in Business: The Case of Islamic Bonds (Sukuk).Thunderbird International Business Review,57(4), pp.295-310. Ryen, A., Temba, E. and Matotay, E., 2015. Company welfare and social work ethics: a space for social work?: A discussion based on cases from Norway and Tanzania.Journal of Comparative Social Work,5(1). Sun, S.L. and Im, J., 2015. Cutting Microfinance Interest Rates: An Opportunity Coà ¢Ã¢â€š ¬Ã‚ Creation Perspective.Entrepreneurship Theory and Practice,39(1), pp.101-128. Trel, A. and Ko, H., 2015. Housing production under less-regulated market conditions in Turkey.Journal of Housing and the Built Environment,30(1), pp.53-68. Wanna, J., 2015. 4. Australian and New Zealand responses to the fiscal tsunamiof the global financial crisis: preparation and precipitous action with the promise of consolidation.The Global Financial Crisis and its Budget Impacts in OECD Nations: Fiscal Responses and Future Challenges, p.92.

Sociological Criticism Essay Essay Example

Sociological Criticism Essay Essay Name: Course: Institution: Date: We will write a custom essay sample on Sociological Criticism Essay specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Sociological Criticism Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Sociological Criticism Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Sociological Criticism Essay The Library of Babel written by Jorge Luis Borges is a story in which the writer attempts to envision the universe as a library consisting of a large variety of books that have been published using a unique format (Ackerley 171). The writer expresses his perception as the earth containing a large area that is occupied by hexagonal spaces of which each consists of requirements that are bare for the survival of humanity. Although the organization of various books is unsystematic and pointless, the occupants assume they consist of all the achievable arrangement of a few fundamental elements. One of the sociological theories found in this book is Mystery. This has been expressed by the author where he causes the readers to visualize an atmosphere of the unknown that consists of things that cannot be perceived in the realistic sense (Ackerley 171). For example, the author’s idea of the entire universe turning into a library can only be viewed in the imaginary sense and hardly in actuality because the earth consists of a lot more than just books including natural features such as plants and water that cater for other living organisms like animals. The second theory is on functionality, in which the author expects his imaginary library to consist of data that will be of immense use to the readers. He describes its usefulness as having futuristic information, biographies of any individual, and the data translated in all languages of the earth. This shows that the author values the imaginary library because of more of its functionality rather than its appearance. The author views the books that are currently being used in the world as useless and therefore, wants the imaginary library to have the functionality of providing information that has more value and meaning to the inhabitants of the earth. The other sociological theory found is purification, in which the author believes the futility of books to have left the librarians in a depressed state and hence believe in performing superstitious actions including destroying those books (Daniel 270). This is done to cleanse the meaninglessness in the library and is achieved by the librarians seeking a supernatural source known as the Crimson Hexagon. Figurative interaction is another theory in which the author believes that within the whole range books found in the library, there has to be one faultless book that has been read by a messianic body (Daniel 271). The author uses this symbolic language to express how he believes that in the midst of all the books he found meaningless, there is a certain book with supernatural influence, in which the librarians honor and seek. The social patterns displayed in the characters of this story appear as learned. This is because the author talks about librarians who have great enthusiasm in being acquainted with a high level of information and hence the reason why they feel the urge to make the library in being more useful. For example, the librarians are illustrated as being in a state of despair after realizing that the content in the library books is pointless. This shows their interest in becoming great-learned people. The librarian characters are also shown as being sacred in the scene where they seek for a supernatural source to guide them and give advice on how to transform the library from an empty state to a more purposeful and significant functionality of learning (Perla 17). The librarians also believe that the supernatural power exists in one unique book within the current library, which acts as a guide for referring the reader to useful information. The narrating character, used by the author to tell the story appears to be truly creative. This is evident in his concept of an imaginary library in which its elements are made of the entire universe. The creativity appears where the narrator expresses an idea that cannot be rationalized within the real world. The narrator also appears to be explorative since within the description of his imagination, he brings in the element of discovery where he expresses a particular result if his ideas were brought to life (Perla 17). For example, the narrator experiments by creating a scenario in which the whole universe would transform into a library that would provide all humankind with the information they needed. In addition, the narrator creates a scenario in which the information would include the biographies of each individual that existed on earth. The social patterns illustrated in the author’s culture include being learned or the educated culture. This is because of his background of working in an occupation, where he is surrounded by educative or learning materials. Jorge Luis Borges had various roles including being a poet, writer, essayist, librarian and a University lecturer. This shows that in his career, he was surrounded by various fields of education and hence his interest in being associated with his learned culture. Borges’ work shows that he is critical and selective. For example, criticism is shown where he despises the current libraries by regarding the information contained as useless. This is the reason he expresses his idea of creating a particular library that is much greater in terms of its provision of significant information. The author displays his critiquing selective behavior where he expresses his comments on the functionality of the current libraries. The author also appears to honor and acknowledge the value of education in the society. This is evident in the way he expresses education in the story to the extent of including some form of divine power controlling the impact of information provided by educative materials. Reference Ackerley, C. â€Å"Borges’s the Library of Babel and Jeans’s the Universe Around Us.† The Explicator. 63.3 (2005): 170-172. Print. Eilon, Daniel. â€Å"Swift Burning the Library of Babel.† The Modern Language Review. 80.2 (2007): 269-282. Print. Sasso?n-Henry, Perla. â€Å"Borges’ â€Å"the Library of Babel† and Moulthrop’s Cybertext â€Å"reagan Library† Revisited.† Rocky Mountain Review of Language and Literature. 60.2 (2006): 11-22. Print.

Understanding Diffusion in Geography

Understanding Diffusion in Geography In geography, the term diffusion refers to the spread of people, things, ideas, cultural practices, disease, technology, weather, and other factors from place to place. This kind of proliferation is known as spatial diffusion. The three main types of this phenomenon are expansion diffusion, stimulus diffusion, and relocation diffusion.   Spatial Globalization is a form of spatial diffusion. Inside the home of an average American couple, youll find a good example of globalization. For instance, a womans handbag may have been made in France, her computer in China, while her spouses shoes may have come from Italy, his car from Germany, hers from Japan, and their furniture from Denmark. Spatial diffusion begins at a clear point of origin and spreads from there. How quickly and through what channels the diffusion spreads determines its class or category. Contagious and Hierarchal Expansion Expansion diffusion comes in two types: contagious and hierarchal. Infectious diseases are a prime example of contagious expansion. A disease follows no rules, nor does it recognize borders as it spreads. A forest fire is another example that fits this category. In the case of social media, memes and viral videos spread from person to person in contagious expansion diffusion as they are shared. Its no coincidence that something that spreads quickly and widely on social media is deemed going viral. Religions spread through contagious diffusion as well, as people must come in contact with a belief system to somehow to learn about and adopt it. Hierarchical diffusion follows a chain of command, something you see in business, government, and the military. The CEO of a company or the leader of a government body generally knows information before it is disseminated among a wider employee base or the general public. Fads and trends that start with one community before spreading to the wider public can also be hierarchical. Hip-hop music springing up in urban centers is one example. Slang expressions that owe their genesis to one particular age group before being more widely adopted- and perhaps eventually making it into the dictionary- would be another. Stimulus In stimulus diffusion, a trend catches on but is changed as it is adopted by different groups, such as when a certain religion is adopted by a population but the practices are blended with the customs of the existing culture. When slaves brought Voodoo, which has its origins in African tradition, to America, it was blended with Christianity, incorporating many of that religions important saints. Stimulus diffusion can also apply to the more mundane as well. Cat yoga, an exercise fad in the United States, is much different than the traditional meditative practice. Another example would be the menus of McDonalds restaurants from around the world. While they resemble the original, many have been adapted to suit local tastes and regional religious food doctrines. Relocation In relocation diffusion, that which moves leaves behind its point of origin but rather than simply being changed along the way or changing when it arrives at a new destination, it may also change points along the journey as well as the eventual destination, simply by being introduced there. In nature, relocation diffusion can be illustrated by the movement of air masses that spawn storms as they spread across a landscape. When people immigrate from country to country- or simply move from the country to the city- they often share cultural traditions and practices with their new community when they arrive. These traditions may even be adopted by their new neighbors. (This is especially true of food traditions.) Relocation diffusion can occur in the business community as well. When new employees come to a company with good ideas from their previous workplaces, smart employers will recognize the found knowledge as an opportunity and leverage it improve their own companies.

Cardiovascular Diseases

Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases