Wednesday, July 31, 2019

Impact of Csr

Daycare facilities across all our production and work centers . -Achieve a healthy corporate governance. An open door policy where every employee has a forum to debate issues if at all with Management. -Promoting Organic Cotton Products helps s to take care of the different aspects which can directly or indirectly effects us and our society and they remain with us happily as long as they can. When Society is benefited, we are benefited by default. Employee morale it our workforce remain motivated, 10. If asked for suggestion, what necessary changes would you like to make in the field of CAR? Auditing should be done more strictly -special laws should be made for female workers according to us more rules and regulations should be made for women empowerment and government should have more involvement in the ongoing process. And some Governmental help would be great. Government should help We are doing it fine 1 1 . Does CAR have any economic effects on your company?Is there any substitu te of CAR? Yes No 1 4 80% 16. Have you missed any order because of not following CAR? Yes No 05 100% 17. HOW successful CAR your company? 10-30% 31 – 51 – 76- 100% 1 18. What percent of your Company's revenue goes for following CAR, every month? Approximately 2-3 % approximately 1-2 % 1-2 % Can't disclose. N/A 19. How important do you think CAR is in general? Very Important Important Not Important 3 1 1 20. Do you have any special Laws and Facilities for Women Workers? Yes 5 No O 21. Do you allow Collective bargaining? Yes No 1 4 80% 22.Do you have any special law for Child Labor? Yes No 5 0 100% 0% 23. Are you using any external or internal CAR initiatives Auditing Team? Yes 2 40% NO 3 24. On what criteria the auditing team marks you? Global Compact Global Reporting Initiative Good Business Framework CAR goals and objectives CAR practices, policies ND culture Approach to CAR related issues with respect to its internal decision making process 001 1 2 1 25 Please tick w hether you agree/disagree Witt tolling statements resource intensive and costly concept] Yes 4 80% No 1 20% 25.Please tick whether you agree/disagree with following statements. [02. CAR is rather the obligation of large multinational companies than of Seems] Yes 1 20% No 4 25. Please tick whether you agree/disagree with following statements. [03. CAR needs to be strongly promoted by government authorities] Yes 3 60% No 2 40% 25. Please tick whether you agree/disagree with following statements. 04. Seems can only commit to CAR if resources are provided by the government or other institutions] yes 5 100% NO 0 25. Please tick whether you agree/disagree with following statements. 05. CAR needs to be legislated to ensure a wide uptake] Yes 4 No 1 20% 25. Please tick whether you agree/disagree with following statements. [06. A responsible company is a firm that strictly abides to labor and environmental laws] 25. Please tick whether you agree/disagree with following statements. [07. Respo nsible businesses go beyond what is required by law to make a positive impact n society and the environment] Yes 4 No 1 20% 25. Please tick whether you agree/disagree with following statements. [08.CAR is an important prerequisite if a firm wants to enter into a business relationship with a Western company] Yes 3 60% No 2 40% 25. Please tick whether you agree/disagree with following statements. [09. CAR is an equivalent for corporate governance] Yes 4 80% No 1 20% 25. Please tick whether you agree/disagree with following statements. [10. CAR is an equivalent for philanthropy] Yes 5 100% No 0 25. Please tick whether you agree/disagree with following statements. [1 1 . CAR includes actions to protect the environment] Yes 5 100% No 0 25.Please tick whether you agree/disagree with following statements. [12. Seems can implement CAR only with the help of external advisors] Yes 2 40% No 3 60% 25. Please tick whether you agree/disagree with following statements. [13. CAR encompasses a set o f activities companies carry out independently of their daily business operations] Yes No 5 0 100% 0% new fancy name for something that local companies have already been doing for a long time] yes 5 100% NO 25. Please tick whether you agree/disagree with following statements. 15.CAR is concept which is more important for companies located in developed than in developing countries] Yes 3 60% No 2 40% 25. Please tick whether you agree/disagree with following statements. [16. CAR is more relevant for the manufacturing industries than for the service sector] Yes 4 80% NO 1 25. Please tick whether you agree/disagree with following statements. [17. CAR is primarily motivated by public relations or marketing considerations] Yes 3 60% No 2 25. Please tick whether you agree/disagree with following statements. [18. CAR can lead to an increase in profits] Yes 5 100% No 0

Tuesday, July 30, 2019

Navajo’s Resistance on Education

There are many ways to define the word â€Å"resistance. † One way that the Standard College Dictionary defines it as: To strive against; the act of resistance; act counter to for the purpose of stopping, preventing, defeating, etc. That†s how the dictionary defines it. Personally, my definition of â€Å"resistance† is the act of being against someone†s orders, rules, or demands. The reason why we resist some of these orders, rules, or demands is because our belief, morals, and religion come into play. The way that we were brought up plays a big role in our ability of making our own decisions. If we were brought up one way, and someone tries to force us to become someone else, or to mold us into something else, we would not feel right. Due to the fact that we grew attached to many ideas, beliefs and religion. The only natural thing to do is to refuse to give in to the idea of change. It†s a basic and a natural instinct. That†s exactly what the Navajos carried out. The Navajos rejected the idea of being force to become â€Å"civilized,† even after being put into the Bosque Redondo Camp. The only thing to do now was to survive and by all means refuse to accept the idea of becoming â€Å"civilized. There were several activities that the Navajos executed while they remained at the camps which showed there resistance against the ideas of General Carleton of forcing them to become â€Å"civilized. † One of the activities that the Navajos resisted against was the idea of sending their children to school and get educated. To the Navajos it seemed like a good idea, but they had other things in mind. Such as: worrying how are they going to gather the next meal to feed their families? They were living in the worst conditions imaginable. No food, shelter, or extra spare of clothes. They were very venerable to the conditions they were put in. For those reasons many of them got sick and eventually past away. But they did consider the advantages of the education program. Most of them took advantage of the opportunities given. Thinking about survival, they took such training in Carpentry, leatherworking, and blacksmithing (Osburn, The Navajos at The Bosque Redondo: Cooperation, Resistance, and Initiative,† 159). These programs are very useful only when the resources are available. When realizing that the resources were not available, they changed their priorities. Education was the very last thing on their list. Their primary priority was to find a way to get food and survive. As the Osburn states, â€Å"Yet the Indians claimed they were not opposed to education; they were simply more absorbed with the immediate concern of daily survival and considered the benefits of education to be peripheral to more urgent matters, such as obtaining enough food to fend off starvation. Their attempt to procure money and extra ration coupons for sending their children to school demonstrates the Indians† shrewd survival strategy†(159). The Navajos used simple and obvious strategies just to stay alive. It†s very much like if your stranded in an island, away from civilization. Your first instinct is not to worry about your make-up or your clothes. The first thing you have to worry about is how are you going to survive. Which eventually leads you to sub categories as: food, shelter, clothes, etc. It†s easy to say, but it is hard to do. The Navajos had to undergo many obstacles. When they realized that they were not getting enough coupons for food, and forging them wasn†t enough, they had to take drastic measures. Many of the Navajo women had to do things that were against their religion and their morals. The very last resort had to be taken, which eventually brought shame to the Navajo tribe and families. Many of the woman thought that the only way to attain extra food was prostitution. Osburn states, â€Å"Another method of obtaining extra food was prostitution, which was not a standard practice under less stressful conditions. Navajo women were generally considered to be modest and decent before and after the Bosque Redondo years†¦ While the Navajo recognized the degradation of prostitution at Fort Sumner, they also indicated that the women were compelled to set aside their moral prescription because of poverty and hunger†(159). Anybody would set aside his or her morals just to stay alive. Even if it means to kill someone just to gather food. It†s like Darwin†s theory: Survival of the Fittest. The weak people die and the strong survive. It takes valor to do something drastic like this. That is why I respect them so much. It makes people think of just the things we are capable of achieving if we just put our morals aside for awhile, and think about survival when put in a aquared situation and are forced to take extreme measures. Another activity that the Navajos resisted was the idea of â€Å"barrack housing. † Forcing them to start a new life as â€Å"civilized† people and living in a civilized community, the Navajos rejected the idea of living somewhere else that wasn†t their homeland. As the article states,† Carleton had originally planned to house the Navajo in neatly ordered barracks similar to the type of housing found in Pueblo villages. The Navajos, however, found this scheme unacceptable because their traditional housing was widely dispersed. Furthermore, they rejected the idea notion of permanent homes because of their beliefs about departed souls†(160). Lots of people wouldn†t mind starting off fresh and living in a house that was given to them. The reason being because he or she have had bad experiences in their past home and life. They are ready for a change. However, it wasn†t like that for the Navajos. They were already customed to the surrounding in which they were living before the â€Å"white people† took them out of their homeland. It†s like they stated, † The custom of our tribe†¦ is never to enter a house where a person has died, but abandon it. † Assuming that the past owners of the houses were probably killed, they rejected Carlton†s plan. Not only because they believed it was bad luck to enter someone else†s† house, but also because they were being put in an environment that they have never been exposed to. People find themselves very venerable if they have no control of the surroundings in which they are being put into. Very much like a parakeet in a cage. For years, a parakeet depends on its owner to give him food. What if the cage†s door was left open and the parakeet escapes or was left to be free. How would it live in the wild, without having the necessary skills to survive? Knowing that there is a harsh world just outside that cage, the parakeet takes his or her chances. Most of them end up finding a way to survive; yet, many of them just die of hunger because they couldn†t gather food. It†s exactly the way that the Navajos felt. The Navajos have already been customed to the surroundings of their homeland and were not prepared when they were being put into camps or the houses that were provided for them. They had no control over the resources that were provided, if they were any. They harvested many crops, but no luck. It wasn†t enough for everyone. Very much like the parakeets, they starved and died. If they did live through starvation, many of them were exposed to disease, which eventually killed them little by little. Knowing that the Navajos were sick, they never took advantage of the clinics or medicine that was provided for them. The last activity that the Navajos refuse to accept was the idea of getting medical attention. The refusal of â€Å"Anglo medical treatment. † â€Å"†¦ For similar reasons the Navajos refused medical treatment and the post hospitals. The Indians explained that they shunned the hospital because â€Å"all that have reported there have died†(160). When the Navajos noticed that many Indians were dying, the realized that the â€Å"white† people had to do something with it. Perhaps they believed that they were being slaughtered and killed. Not only that, but the Navajos didn†t want to be exposed the â€Å"white† medicine. They had their own ways of curing their sickness. Very much like people nowadays. Many of them do not believe in modern medicine and have their own way of curing themselves. For the Navajos, the only way to cure themselves and to purify their body without any modern medicine was to perform a traditional dance called â€Å"Squaw Dance. † They had their own views on how they believed they got sick. â€Å"According to this ceremony some sicknesses are the result of the ghosts of aliens, either those whom a Navajo warrior has killed or those who died from other causes and with whom the Navajo may have had contact, sexual or otherwise. Touching the corpse or stepping on the grave of an â€Å"outsider† may also cause alien ghosts to torment a Navajo with sickness† (160). Behind every culture, there are many reasons why they perform or do different things to get themselves better instead of using modern medicine. For example, â€Å"In the Navajos world view, illness is an example of disharmony in the cosmic order that the performance of a religious ceremony can correct. During the ceremony, the Navajo invoke their Holy People to rectify the disturbance or order. If the ritual is correctly carried out, the deities are obligated to grant the mortals requests, for a principle of reciprocity governs the exchange. In this regard, Navajo oral tradition emphasizes the importance of healing ritual at the Bosque (160). Nowadays, everyone grew up with an idea on how to get rid of an illness without the use of medicine. For instance, if someone has a nosebleed how do you stop it? Many people believe that lying down is one way, others to pour water over your head and pinch your nose with a wet towel and remain standing. There†s not an exact way. Probably all of them work. It†s just that most of us have been custom to one of these methods, and will not use any other one. It†s just the way we were brought up. Likewise, the Navajos didn†t want to try nothing new. Their beliefs and morals don†t allow it. The only thing left to do is to pursue your values and principles. The Navajo†s struggle for survival depended not only on resistance by their part but also the strategies that they used to attain it. Their primary objective was to survive. They accomplished this by many â€Å"patterns,† but one of those patterns stands out the most. The idea of â€Å"resistance. † They resisted â€Å"formal education,† â€Å"barrack housing,† and â€Å"Anglo medical treatment. † By refusing these ideas, many of them had to perform such tasks that would bring shame, not only to them but to their families too, just to survive. Many women became prostitutes, while others Navajos forged coupons, raided the camps but also fleeing from them, and performed ceremonies for spiritual cleansing. All of these activities played a big role in trying to change the way the Navajos lived their lives. Forcing someone to change, or to mold them in something they are not, will result in confrontation. That is why the experiment at Bosque Redondo failed to work. Gen. Carlton forced the Navajos to become â€Å"civilized† against their will, and in return was confronted and his ideas were retaliated. It was the only way that the Navajos could prevent the â€Å"white† people from forcing them to change their lifestyle, morals, beliefs, and tradition. So in conclusion, the Navajos† actions can be considered â€Å"resistance,† due to the evidence provided.

Personality psychology Essay

In this essay I will aim to demonstrate an understanding of Jung’s Personality Types by describing and evaluating his theory and show how they might be useful in helping me to determine therapeutic goals. I will also look at some of the criticism levelled at Jung’s theory,I think this allows the therapist,ie myself to better understand the positive from the negative. I am also of the opinion that detailing Jung’s early years and background play am important role in the overall evaluation. I have particular interest in when Jung met Freud and how this meeting of minds shaped or maybe changed their individual conclusions. I will cover this later in my essay. Carl Gustav Jung was born July 26, 1875, in the small Swiss village of Kessewil. His father was Paul Jung, a country parson, and his mother was Emilie Preiswerk Jung. He was surrounded by a fairly well educated extended family, including quite a few clergymen and some eccentrics as well. By the age of just six years old Jung started to learn Latin which started an interest in language and literature, especially ancient literature. Jung read several ancient languages including ‘Sanskrit’ the original Holy Hindu language book. Jung was a distant youth whilst growing up who did not enjoy his schooling years and was not competitive. Jung’s later education was in Basel, Switzerland where he attended boarding school where he found himself the centre of jealous pestering. Carl Jung began to use sickness as an excuse, developing an embarrassing tendency to faint under pressure. Carl Jung’s first career choice was archaeology; Jung went on to study medicine at the University of Basel. Whilst working under the well-known neurologist Krafft-Ebing, he established himself on psychiatry as his career. After graduating, he took a place at the Burghoeltzli Mental Hospital in Zurich under Eugene Bleuler, an expert on schizophrenia. In 1903, Jung married Emma Rauschenbach. He also taught classes at the University of Zurich, had a private practice, and invented word association at this time. (internet search) In 1907 Jung met Freud. Freud would be seduced by the esteem and personality of Jung and would soon see in him the spiritual son that could guarantee the survival of psychoanalysis. The unwillingness of Jung towards the Freudian Theory referred to the role of sexuality in the psychic development. In fact Jung on no occasion completely embraced the sexual theory of Freud. From 1912 onwards Jung found himself more and more distant from Freud’s writings. By abandoning the winding and indirect of Psycho-sexuality, Jung would launch himself in the fields of spirituality and science which was understood by only an initiated few. Jung’s inner world became something for him to study and develop his theories on and during this time Jung evolved the goal of his psychology of individuation, which is the achievement of the self and other guide marks, such as the archetypes, the collective unconscious. Jung’s theory stresses the importance of understanding our personal unconsciousness (events, feeling, behaviour patterns that we have buried in our subconscious from our own direct past) and the collective unconscious (patterns, trends, traits, behaviours that all humans have no matter what background or culture have running through our lives). Whereas Freud believed the unconscious was suppressed by the human mind. Jung in the other hand believed the unconscious mind was where the conscious mind had its origins and where our psyche begins or is created from. Balance was the key for Jung, which he believed the balancing of the two sides is what drives us humans ‘towards’ or ‘away’ from goals. The foundation of the mind that consisted of the EGO (who we think we are); the SHADOW (the part of us that we deny or do not acknowledge) was developed by Jung. He continued to believe our mind was constantly developing or moving towards our true self (individuation) and this journey was fuelled by natural laws, the principles of opposites, that every aspect of our mind has an opposite force. The principle of equivalence that equal amounts of energy are given to both sides, and the principle of entropy, that everything natural winds down as energy is  evenly distributed, eventually with the opposing side blending together creating a harmony. Jung believed that our mind’s voyage followed a repeating in the ‘rites of passage’ for birth, marriage and death, mirrored throughout all cultures and peoples. Jung believed that this drive to move towards a state if harmony or individuation, was fundamentally important to us all. Jung spent a good deal of time and energy on the importance of dreams and getting to understand what their meanings meant to each individual. Jung believed that by understanding the imageries within our dreams we  would benefit a better knowledge of ourselves. He indicated that dreams should not be interpreted too accurately, but considered for finding personal meanings in the imaginary or symbolism. Jung also recognised and identified two opposites of personality; 1. INTROVERSION 2. EXTROVERSION Introversion – when psychic energy is turned inwards towards our inner world. These people tend to be thoughtful people with reserved natures, preferring their own company and evading large groups, they may be cautious and uncertain, disliking change or new things, they may seem  defensive and they like privacy and personal space and spend a lot of time in contemplation. Extreme forms of introversion have similar qualities to autism and some forms of schizophrenia. Extroversion – is when the movement of energy is turned outwards towards the outside world. An extroverted person would show interest in the outside world, they will be objective and frank with helpful and easy-going personalities, they like action and people around them, extreme versions of extroverts would be hopeless alone and not able to bear silence or solitude, needing continuous excitement and external  inspiration to prevent boredom or unhappiness. Jung also identified four different functions (attitudes) of the mind; THINKING – when a person connects to the world via reason and intelligence. These types will have thinking searching minds, always questioning. They will be good at judging things able to see the origin and results, and will reach logical decisions. They may be open and appear cool and detached emotionally, and will be good at adjusting to new situations. FEELING – when a person makes worth decisions about the world based on how they feel about something, putting ideas, points, and issues in  order based on how they assess them and not on emotional feelings. Feeling people have a sturdy sense of traditional values and human connection is significant to them as they tend to be warm and creative. SENSATION – when a person relies sensory impressions – perceptions. These people rely on sensory impressions, how certain things appear, feel and sound. They tend to be mentally and emotionally stable people, taking things at face value, they can be seen as dull and boring which often be easy going and fun, with a calm nature. INTUITION – when the world is understood or interpreted in a particular  way mainly through the unconscious – when people speak of having a hunch, gut feeling or instinct about something, this type of person is conscious of changes. Possibilities can appear distracted or ungrounded; they will get bored of uninterested or boring details which are often not practical. They can be creative and inspirational. Jung believed that a person is essentially an introvert or an extrovert and this remains equally fixed, however, an individual will rely mainly on functioning using one of these four modalities but that opposing function also had an impression on their relationships and behaviour and these  functions may adjust throughout life. e combined two attributes and the four functions to eight different psychological types. Jung understood that most people are a blend of two or more types, and that understanding how your own personality type and that of people around you related to the world would offer a deeper understanding of yourself. For example; bringing you closer to individuation. Jung trusts that we understand and recognised the strengths and weaknesses of our mind; that we would improve and achieve balance. The functions and attitudes are also not fixed with one side of the pair  leading, the other becomes unconscious. Jung believed that the unconscious part then finds a way of expressing its hidden self. A person’s conscious orientation will be towards one of the four functions; the leading or principle function – this will decide how you respond to experiences. 1. The dominant or principle function – this will determine how you react to experiences. 2. Auxiliary functions – mainly conscious. 3. The opposite auxiliary – suppressed and partially unconscious. 4. Remaining generally unconscious Jung believed when the conscious function was solid there was a trend  for the opposing function to break through into the conscious occasionally in the form of hysteria, phobias and obsessions. He believed in order to achieve balance one must work with the repressed function in therapy which in this case has echoed Freud’s theory on repressed feelings and emotions surfacing unconsciously. These combinations of psychological types, Jung formulated into eight types, combining the two attitudes with the four functions; Extroverted and Introverted 1. Thinking Type, 2. Feeling Type, 3. Sensation Type, 4. Intuitive Type The above generalisation was Jung’s way of providing a structure in order  to begin and to understand individual’s behaviours and feelings. Although these types are still current they form the basis of personality or psychometric testing (Myers-Briggs) which is still in use today. I believe the significance of this information is that it is an opening point from which to discover and explore our own or clients mind using a structure. Jung maintains that psychological types are mostly inborn and not acquired through life’s experiences. I concur with this belief, However, Jung recognised that personality types were influenced as a child advances through life by factors such as parents and the amount of  influence each parent has over a child, and social factors such as school, peer groups surroundings. Jung also believed problems (mental ill health) arose when external influences forced children into a pattern that goes against the natural energy flow of a person’s mind or psychological type. As with Freud, most of the theories of early pioneers are quite impossible to prove or test due to no scientific way of measuring them. Also the amount of patients used was in very small numbers and little practical work was done. Jung’s work has given foundations to many modern  psychologies including theories to develop and explore further and deeper, including words that have been accepted by the modern language. For example; * Psyche * Extrovert * Introvert. * Archetype These are parallels with other great psychologies – Freud, as I already mentioned and discussed, and the work of Hans Eysenck a more modern theorist. Eysenck was the first psychologist to make this trait or temperament business into something more mathematical: he gave long lists of adjectives to hundreds of thousands of people and used a special statistics called factor analysis to figure out what factors trait dimensions  carry the most weight. He took results of this work and created a test called the Eysenck Personality Questionnaire (EPQ) instead of making these traits either-or, like Jung did, he saw them as dimensions. His first trait dimension was, like Jung, ‘extraversion-introversion’. But rather than say you were one or the other (an I or an E), he provided you a score on extraversion-introversion. Eysenck based his theories on Galen, an ancient Greek theory which was created around two thousand BC. It is one of the oldest personality theories around. Eysenck added on the two basic dimensions of  temperament (like Jung) and these were based on four types (unscientifically based on the types of fluids he believed were washing around the individuals body) a sanguine type, cheerful, optimistic and easy to be with, choleric, quick, hot tempered and aggressive. A phlegmatic type temperament, slow people who had a tendency to be sad, depressed and have a negative view of the world. Much simpler and much less sophisticated than Jung’s theory; Eysenck expands this into three dimensions of personality; 1. Introversion – extroversion 2. Neuroticism – emotional 3. Stability and psychoticism  With five further subdivisions; 1. extroversion 2. agreeableness 3. conscientiousness 4. neuroticism 5. openness The theme of four (opposing) forces repeats throughout cultures and across time, North, South, East and West, Earth, Fire, Wind and Air. In religion(used my own as my example! ) we see recurrences of types, for example; †¢The Father †¢The Son †¢The Holy Ghost or the Virgin Mother †¢The Crone Archetypal images we can recognise and begin to understand. These theories have a degree of objectivity, whilst they may give different labels to the personality types there does seem to be agreement that  you begin to understand individuals if you can assess basic similar categories or repeating personality traits. Like Jung’s theory, and the teachings in the Bible (parables) perhaps these theories have value as a way of forming a framework for us to ask question, and discovering more of ourselves. CONCLUSION Jung believed each personality type or psyche was influenced by another, it is logical to assume that in all human relationships, mainly within an analyst/patient relationship, the analyst may encourage the patient so a subjective conclusion or true individuation may not be  achievable. I feel it is important to recognise as Jung did that these types are not fixed and that a person’s personality or psyche changes throughout life and that energy flows and fluctuates between the opposing sides of our psyche so we understand that a person does not fit neatly into one of the boxes. Jung created this structure or framework to help work towards understanding of our own psyches and how better to relate to the world and people around us. Understanding how a person or patient feels, reacts and relates is obviously the first step to the beginning to help them. Being able to plan a patient’s healing journey will be more effectively tailored to them if we have a good understanding of why they think or feel the way they do and help them to understand this too. Jung believed that in order to heal, people need to learn to listen to messages from the unconscious mind, to follow their own path and think independently, and that in order to become a competent analyst you must ‘first understand yourself’ in order to efficiently help a client and to determine therapeutic goals,This is an ongoing journey of self discovery which this course is bringing out  in me. BIBLIOGRAPHY Chrysalis – Diploma in psychotherapeutic counselling – year two – Module Three Carl Jung Resources, 2014 http://www. carl-jung. net/ What Freud really said – David Stafford-Clark WWW. Philosophy. lander. edu (Internet research) Wikipedia (Internet) Carl Jung – Dr. C. George Boeree http://worldtracker. org/media/library/Psychology/Boere Hans Eysenck – Dr. C. George Boeree http://worldtracker. org/media/library/Psychology/Boere Introducing Jung a graphic guide – Maggie Hyde & Michael McGuinness Personality Types: Jung’s Model of Typology – Darl Sharp.

Monday, July 29, 2019

East Asian Studies Essay Example | Topics and Well Written Essays - 750 words

East Asian Studies - Essay Example Confusian teachings often concentrated on the development of the intellect rather than innovation and this ensured that many Chinese chose to remain in an almost static state (Confucious 13). Because of the influence of Confucianism, it became the norm for many of the Chinese people to want their lives to remain the same. The system of government of the land did not change because despite there having been many dynasties which ruled China from the ancient to the modern period. One will find that despite these numerous dynastic changes, none of the administarative rituals nor the system of governance was significantly changes to encourage the growth of the society (Holcombe 6). The elite consisting of the imperial family and the nobility, remained the same and it is these who competely dominated all matters of importance in the society. It was in the interests of these individuals to ensure that everything remained the same because it is the established system which ensured that their power was secure (He and Warren 272). It is possible that it is the elite which fostered the static nature of Chinese society since it allowed them to remain dominant while at the same time keeping the lower classes of the society subservient to their interests. The other reason why China was not able to achieve a powerful status on the global state which would have spurred its modernisation was its aversion to matters concerning the military. The Chinese society frowned upon the development of the military because the latter was considered to be a cause of instability rather than a guarantor of security (Ebrey 478; Paludan 136). Consequently, the military was extremely underfunded and its main role in the society was essentially ceremonial. It is possible that aversion to the military was based on the history of the nation where at the end of certain dynasties, the

Sunday, July 28, 2019

INDEPENDENT RESEARCH PAPER PROPOSAL Essay Example | Topics and Well Written Essays - 1250 words

INDEPENDENT RESEARCH PAPER PROPOSAL - Essay Example Like many other Chinese cosmetics companies, Herborist has also recognized the need to expand their operations in new markets and follow and extensive internationalization process while keeping the business rooted to its own unique cultural factors and a differentiated positioning strategy. Herborist is in the business of herbal cosmetic products and is an established name in the herbal care sector of China. The traditionalism and uniqueness of the herbal factor remains the unique selling proposition for the brand which it must capitalize on while entering a new potential market for its expansion process. The international expansion process of a company is guided by many factors which are likely to drive the development of the internationalization success for the company. These factors may include the following: the company may seek growth opportunities through market diversification, the company may seek to increase the revenues and profitability of the business, the company may try to gain ideas about new business processes, products and methods for innovation, the company may aim to serve a wider range of potential customers in new regions, the company may also achieve increased benefits from new supply sources and get the advantages of global sourcing and the company may achieve economies of scale through lost cost and high volume production (Bakker, 2008, pp.117-118). Herborist can focus on entering the market of Russia as a part of their international expansion strategy as this would help the company to achieve all the above mentioned benefits as well as the company will be able to benefit from the interest of the consumers in this country towards herbal skin care products and spa services that Herborist can offer (Deighton, Kornfeld, He and Jiang, 2010, p.10). The Russian cosmetic industry is a developed market in which the customers have much

Saturday, July 27, 2019

Stroke Rehabilitation Certification Program including education and Research Paper

Stroke Rehabilitation Certification Program including education and core competencies required for all Certified Rehab Registere - Research Paper Example This stroke is caused by clotting of blood, which in turn prevents blood flow through an artery or vein to the brain. When discovered early, this kind of stroke is treated by a drug that dissolves obstructing cots in the artery. Hemorrhagic stroke is the second common type of stroke. It is less common, and is caused by rupturing of a blood vessel in the brain thereby spilling to the surrounding tissue. As a result of the spillage, brain cells in the area die due to the lack of oxygen and nutrients required for them to function. The most common stroke risk factors are high blood pressure, heart disease, carotid artery disease, cigarette smoking diabetes and excessive consumption of alcohol. Its symptoms include numbness especially on one side of the body, confusion (either talking or listening), a severe headache, and dizziness, as well as, lose of balance. This paper will examine the role rehabilitation nurses’ play in caring for stroke patients, how certification for the prog ram is awarded as well as the core competencies required. The paper will also look at the impact by CNS, aspects of spheres of influence and synergy model. Introduction Stroke rehabilitation is the process within which patients suffering from stroke are treated in order for them to be able to continue with their daily life. Its main goal is to assist patients relearn the skills that were lost when stroke affected them. But the rate at which one relearns these skills varies according to the person affected. Stroke rehabilitation includes therapy to regain communication disorders such as listening, writing and comprehension. It also involves patients undergoing excises in order for them to regain their muscle strength. Once patients gain their muscle strengths, this is usually accompanied by mobility training which usually includes patients being taught how to use walking aids. In some instances, the use of electrical stimulation is involved in order to arouse weakened muscles so as t hey can contract (Chick et al., 2004). Stroke rehabilitation should begin once a patient has discovered what he/she is suffering from. This is aimed at stabilizing the patient’s medical condition. On the other hand, the duration of stroke rehabilitation depends on the recovery of the patients as most stroke survivors require more time. In essence, a rehabilitation center is supposed to ensure that a patient in a position to do better and became independent especially through enabling the patient to tolerate the changes that have emerged on their brain and body due to the stroke. This makes them be able to adjust more to living within their home, with family or even the entire community (Lindley, 2008). Need for Stroke Rehabilitation Program Stroke rehabilitation is aimed at helping stroke survivors reach high levels of independence and try to restore their productivity (Massaro, 2006). A rehabilitation program begins immediately a person is confirmed to be suffering from stro ke. They offer the program even after a patient is released from the hospital as per the flexibility of an individual. Rehabilitation does not necessarily cure the stroke, but it helps survivors achieve greatest achievable long term outcomes. On the other hand, rehabilitation will largely depend on the damage that has been caused to the brain. Of most important is to ensure that survivors are in a position of

Friday, July 26, 2019

Riordan Manufacturing Staffing strategies Essay Example | Topics and Well Written Essays - 500 words

Riordan Manufacturing Staffing strategies - Essay Example tant deadlines to be met, most of the employers don’t evaluate the pros and cons of hiring an individual and unless there are well developed staffing strategies, this will be an ongoing problem. The focus is,†People are your most important asset is wrong. People are not your most important asset: the right people are." (Jim Collins in his book "Good to Great").Hence it is very important to hire the right candidate for the right job. A well developed staffing strategy helps an organization to eliminate problems before they start. A staffing strategy provides overall guidance on how an organization deals with staff. This includes how the organization identifies with new staff, the types of people the organization wants to staff, and how to retain them. Once this strategy is decided upon, the human resource department frames some policies and procedures to support the strategy. Riordan Manufacturing is a global plastics manufacturer founded in 1991, It employs over 550 people and has projected annual earnings of $46 million. The company is wholly owned by Riordan Industries, a Fortune 1000 enterprise with revenues in excess of $1 billion. However over the years, Riordan’s management realized that employee dissatisfaction was quite high and sales sloped downwards. As the business world has become more complex and jobs more technical† (*Shah, Sterrett, Chesser, & Wilmore (2001), many corporations have turned to strategic planning. Today, organizations have realized the importance of its human capital thus, the need to further develop, retain and attract personnel to achieve business objectives. Riordans management team has realized that the companys most important asset is their employees. HRs proactive approach to recruiting the best and brightest candidates will help to provide future leaders for the company as they continue to grow and meet the demanding challenges. In order to accomplish the organizational goals, Riordan must follow suit in attracting

Thursday, July 25, 2019

The plight of the homeless in the United States Essay

The plight of the homeless in the United States - Essay Example In the United States, de-institutionalization of mentally ill population in the late 1970s and cuts in housing and social services in 1980s contributed to homelessness (Donohoe). According to National Alliance to End Homelessness, in January 2005 around 744,313 people were homeless (National Coalition for the Homeless). According to the statistics of National Law Centre, around 700,000 to 2 million people are homeless in America on a given night (Policyalmanac). The estimates of National Alliance to End Homelessness highlight that around 22 people out of every 10,000 people are homeless and on any given night in the United States, 671,859 people are homeless, in which 37 percent are families and 63 percent are individuals (National Alliance to End Homelessness). Between 2007 and 2009, family homelessness in the United States has increased by 30 percent and this percentage is expected to increase further (National Public Radio). The statistics show that homelessness in the United Stat es has actually become a serious concern for the economy. The number of homeless people in the United States is increasing rapidly and various factors are contributing to this increase. The typical reasons which may contribute to homelessness include disturbance in family support systems, natural disasters, civil wars, impact of structural adjustment activities and urbanization however, two major causes of homelessness in the United States include decline in affordable rental housing and poverty (Vickery, Williams and Lugo). The president of National Alliance to Homelessness, Nan Roman argues affordable housing crisis is the primary driver in homelessness and this problem cannot be solved unless the crisis is addressed (USA Today). In short, the problem of homelessness cannot be solved unless the root causes of the problem are addressed. Homelessness in the United States is significantly affecting the overall economy. The state incurs

Wednesday, July 24, 2019

Analysis of Ice Delight Case Study Example | Topics and Well Written Essays - 500 words

Analysis of Ice Delight - Case Study Example Most importantly, ICEDELIGHTS occupies its own niche in the market of ice cream, selling Italian "gelati," and company's core competence lies in ability to freeze "gelati" and sell them on the premises of each store location. From financial perspective, ICEDELIGHT constitutes a rather expensive franchise, comparing with other offers available on the market. Simultaneously, this new and unproven venture can yield significant profit in the light of the investment required. Moreover, the purchase of ICEDELIGHTS' franchise guarantees to a franchisee exclusive rights to operate in the entire state of Florida. From the critical viewpoint Rogers, Daniels and Garfield purchasing a rather unproven franchise ICEDELIGHTS risk experiencing liabilities of being new and lacking expertise in retail business. Practically, these aforementioned liabilities are characterized by the many challenges faced by new ventures, which include access to resources and knowledge capital, which larger and more established firms are more equipped to handle (Markman & Baron, 2003).

Global Marketing Research Assignment Essay Example | Topics and Well Written Essays - 3000 words - 2

Global Marketing Research Assignment - Essay Example It is the reason as to why they have continued to enjoy steady stream of growth and increase in the amount of revenue in their finances. It goes without saying that the company has enjoyed the near monopoly status on the global front (Hà ¤ikià ¶ & Virtanen, 2002).This paper will thus discuss the impact and growth of the Nokia Company as a single source from Finland to the external markets such as South Africa and Chile as prime exporting destinations of the mobile devices. The paper will also focus on the proper exporting mechanisms and techniques that Nokia as a Finnish company would penetrate and enter the Chilean and South African country (Kent, 2007). As much as the marketing team of the Nokia Company has strived to do its best in the recent past, there are other drafts of measures of in terms of global marketing that the company could explore for better growth. It stems from the fact that each and every country has a different market dimension and set up thus care and attention must be allocated to the various countries in a different way (Andersson & Wictor, 2003). In brief, this analysis will discuss the market topography and spectrum of the various countries with the feasible chances of penetration by Nokia, the company. South Africa is one of the most promising countries in the world in the form of a market because of the following outlined issues such as a viable economic environment (Myers, 2002). It is one of the emerging democracies in the African continent which has recorded good prospects of economic viability and growth in the recent as compared with other African nations such as Somalia (Myers, 2002). It is so because the country has one of the most diverse compositions of people with different tastes in electronic gadgets and devices (Clarke, 1996). South Africa in its structure and population has one of the most diverse societal spectrums in

Tuesday, July 23, 2019

A business innovation which has brought to life a product (good or Essay

A business innovation which has brought to life a product (good or service) - Essay Example This research will begin with the statement that 3D printing is one of the most celebrated business innovations that continue to influence the manufacturing and production industry. Chuck Hull of 3D Systems Corp created the original 3D printer in 1984. Also known as additive manufacturing, 3D printing is business and technological innovation that encompasses the process of making a three-dimensional solid product of any shape using a digital model. Indeed, 3D printing is a huge versatile and rapid process that accommodates the geometry of varying complexity in variant applications and supporting many types of materials. The 3D printers operate at resounding speeds, extremely low costs, and within a wide range of applications. The 3D printing innovation applies in the commercial sector where manufacturers use it to produce early concept models and product prototypes for business purposes. The 3D printing case is relevant in the context of digital economies since it allows for the prod uction of early concept models and product prototypes. Moreover, 3D printing applies in distributed manufacturing where it has applications in various fields including health, fashion, architecture, education, engineering, and aerospace among other fields. Additionally, products manufactured through 3D printing are applicable anywhere in the product lifecycle. To achieve 3D printing, innovators used an additive process, where successive layers of material adopt different shapes.

Monday, July 22, 2019

Ethics in Intelligence Essay Example for Free

Ethics in Intelligence Essay On a clear, late summer day in September of 2001, the hectic yet peaceful lower portion of Manhattan, New York City was turned into the site of one of the largest mass murders in world history when terrorist attacks turned the once imposing World Trade Center complex to a smoking pile of debris and left thousands of Americans dead, physically and psychologically scarred for life. In the aftermath of this act of aggression, the United States, with the cooperation of allies around the world, launched intelligence collection efforts on a scale that had never before been seen. Some nations would be able to do so as they wished without regard for the privacy or rights of their people, but for a nation conceived in liberty and human rights as the US was, issues of ethics and the preservation of individual rights had to be balanced against the dire need to protect the masses from further violence. This research will focus on the ethics of intelligence collection in the US, Constitutional implications of these efforts for American citizens, and the consideration of how much liberty US citizens should be willing to sacrifice for the greater good. Ethics of Intel Collections, Means and Methods Intelligence gathering has always been an essential part of the preservation of American security, dating back to the days of the American colonies and beyond. In the late 1990s, for all of the violence brewing in other nations and the potential for domestic terrorism in the US, the intelligence gathering efforts of American officials consisted mostly of the analysis of data from the comfort of offices located in the US and some offices scattered across the globe. However, these efforts were initially proven to be weak by international terrorist acts against American military installations in other nations, and the original emergence of Osama Bin Laden as an international terrorist to be closely monitored. With such formidable enemies to consider, it became obvious that the old ways of gathering intelligence were badly in need of change, including the introduction of more field intelligence agents, enhancements to technology, better networking with other nations, and many clandestine activities. With the need to increase and improve all levels of intelligence gathering in the US, the question arises as to how far a nation like the US, which stands as a beacon of righteousness and safety in the world, will be willing to go to gain the level of security that is needed to protect American citizens at home and abroad? The child of this need emerged, known as the Department of Homeland Security, an organization which put on a public front of protection of the US in a manner that is illustrative of ethical behavior and forceful yet proper action. With the introduction of the Department, the public gained a higher level of confidence in the protection they would be receiving. However, many of the methods that were necessary, at least behind the scenes, were of the nature that the general public would frown upon at the very least, and rise up in heated protest against at worst if it were known the full extent of what the Department was forced to resort to in the interest of intelligence gathering. Among the steps that were taken, such actions as the monitoring of telephone and Internet communications, the detention of suspected terrorists and the like began to raise the issue of the appropriateness of such activities in line with the promises and obligations of the US Constitution. Constitutional Implications of United States Intel Collection on United States Citizens The war against terrorism is unlike any other war that the US has seen; fighting an enemy that does not wear a recognizable uniform or hails from any specific geographic location poses quite a challenge and makes the application of conventional warfare tactics all but impossible. Therefore, as with those conventional warfare methods, it is necessary for certain drastic measures to be taken. However, it is important to understand that there are Constitutional implications for such actions, especially in the areas of intelligence collection which require frequent intrusions into the privacy that Americans hold so dear and have fought and died to protect for hundreds of years. First, there are misconceptions about the Constitution that are necessary to point out. Specifically, there is a thin line between the investigation of criminal activity and suspected threats to national security, which of course are in and of themselves criminal but take on an added dimension when one realizes that the safety and future of the nation hangs in the balance. In the interest of national security, it is permissible for the surveillance of Americans, domestically and abroad without the obtaining of search warrants, which are usually the standard procedure when an American is being investigated as a possible criminal, under any ordinary circumstances. In this instance, permissible and acceptable are two entirely different things. While authorities may be allowed to basically spy on their fellow citizens so that the nation is protected, where does this leave those who are the target of the surveillance? The argument can fairly be made that if one is not doing anything wrong, if they are being monitored, they actually have nothing with which to be concerned. Further, if that surveillance yields information on other wrongdoers who are in fact a threat to America, the net result makes all of it worthwhile. The issue of habeas corpus also is a key element in the consideration of the rights the accused. In the past, this legal remedy, in place since the days of the Magna Carta, existed to protect the rights of the accused. Constitutionally speaking, it had been established in the early 1940s that habeas corpus would stand if: â€Å"(1) the conviction is void for lack o f personal or subject matter jurisdiction; (2) the statute defining the offense is unconstitutional, or the conviction was obtained in violation of a federal constitutional right; (3) the statute authorizing the sentence is unconstitutional, or the sentence was obtained in violation of a federal constitutional right; (4) the sentence is contrary to the applicable statute, in excess of the statutory maximum, or otherwise unauthorized by law; or (5) the conviction or the sentence is otherwise deemed subject to collateral attack. † In times of crisis, this right has been suspended in the interest of national security, and has been suspended in the age of terrorism due to the need to make terrorists who are evading capture by authorities accountable in courts of law for their crimes. This, also, however is one of those fine points of law that draw criticism and scrutiny in many cases because anytime a right is suspended, innocent people are affected and their rights are often sacrificed, albeit for the sake of the common good. A closer look at the underpinnings of the Constitution itself reveals some interesting powers that many do not realize exist. For example, the Constitution does in fact give Congress the right to make laws as necessary to allow the Constitution to function as it was intended. This right, however, is akin to a broad stroke of a paintbrush, when the finer details of the stroke are really where the beauty lies. In other words, on the surface, it is true that Congress possesses such power, but this is also a power that is open to interpretation and debate. Where one draws the line between permissible monitoring and the trampling of the rights of the majority is an issue with which the American people are currently wrestling and undoubtedly will continue to do so for many years to come. With this in mind, there surely must be a balance to be obtained between sacrificing for the common good and giving up everything that Americans are constitutionally guaranteed. How Much Liberty Should US Citizens Give Up Under the Notion of National Security? It has been said that liberty is something which can be gained all at once, but often is stripped away one small piece at a time, like the gradual erosion of a mighty mountain. If this is true, the question of how many small pieces the citizens of the US can give away before a landslide consumes them? After the horrible events of September 11, 2001, it became readily apparent that there was a need for American governmental agencies to gather additional power if they were to properly mount an offensive against terrorism and to avert a repeat of the horrible events of that tragic day. This need to gather additional power was viewed by many as a feeble excuse for those within the government who craved power to grab as much as they wished, regardless of the inevitable fallout. Still others saw the sacrifice of a small amount of liberty as the necessary toll that needed to be paid for a much larger amount of overall protection and the long-term survival of the US while others around the world plotted to destroy the most powerful nation on earth. Again, however, as was mentioned at the beginning of this passage, small surrenders can sometimes lead to large damage over a period of time.

Sunday, July 21, 2019

Dangers of Using Cell Phones while Driving

Dangers of Using Cell Phones while Driving Michael D. Stripling Rationale: The rate at which road carnages are reported have increased significantly especially within the 21st century. Many people have been involved in accidents because of recklessness and inattentiveness in the roads as motorists. Statistics on these establishments creates the need of effective address before further harm and deaths are experienced. Many aspects in life have contributed recklessness relative to phone use by motorists. Theories relative to multitasking, movies, and ideologies devised by cell phone companies are among major contributors to phone use in cars. The young members of society bare the harm of using phones in cars because of misinformation, lack of information or ignorance to road safety measures. The youth are among the population most affected by road carnages and effects. There is need to give information to the youth on the dangers of using cell phones in cars before they engage in driving lessons and eventually driving. The information to the young people is important as it would help inculcate good cultures in driving and being considerate while on roads. The significance of the dangers of using cell phones by motorist is addressing recklessness that contributes to the death of road users through unjustified ways. Through addressing such an issue the importance of road safety will be illuminated. Road carnages have been for long related to vices like drinking and the use of drugs that interfere with cognitive abilities while on the road. This aspect will contribute an understanding of the relationship between using cell phones and using drugs while driving. Therefore, the presentation seeks to enable positive contribution in saving humanity through knowledge on ways to reduce and prevent road accidents. Outline of the Presentation Introduction The changes that have been experienced in the modern society prompting the need for the constant use of cell phones The oblivious nature and ignorance involving drivers of the dangers on road ways. The use of cell phone on own and other people’s lives Insurance Institute of Highway safety stipulates higher chances of motorist indulging car accident based on two reasons. The motorists have to divert attention to the phone’s interface. The motorist gets immersed in the conversation and attention is limited. According to Virginia Tech Transportation Institute and National Highway Traffic Safety. Use of hand-free phones are dangerous compared to hand held phones while driving The excuse of not holding phones while driving to avoid accidents is unjustified. Motorists that use hand-free phones while driving are 18% slower when braking. This stipulates that multitasking is an inconsiderate myth while driving in major roads. Young people are mostly oblivious of the recklessness and are involved in car accidents unjustifiably. Conclusion Cell phones contribute positively and immensely to people’s lives. There is need for care to avoid unjustifiable death on the roads. Introduction The modern society comprises of businessmen, students, lawyers, doctors and people of different occupations. These people have to ensure that they are constantly connected to clients, family and other people of significance in their lives. The popularity of cell phones has ensured a constant connection and updates in the lives of such people. However, most people tend to indulge in the wrong use of cell phones. This is because some people are either forgetful, oblivious or ignorant of the dangers of using cell phones while driving. The chart above stipulates how drastic accident levels are among the young people in the United States of America; which have highest cell phones popularity and usage. The popularity of cell phones has contributed to a culture which is costly to the society based on the number of deaths on roads because of recklessness. Regardless of the urgency of a call, it is not justified to put other people’s lives at risk because of own neglect and perceptions . The prohibition of using cell phones while driving is based on the imminent threats to people lives. According to the Insurance Institute of Highway Safety, motorists are four times likely to get injured while driving and using their cell phones (Violanti Marshall, 1996). The high possibility of indulging in a car accident while using of cell phones is based on two factors. While dialing, most people have to look at the phone interface. This establishes a distraction from the incoming vehicles or objects, which increases the risk to crashing into an oncoming car or object. Another evident aspect that transpires in the use of cell phones is that people can be absorbed in the cell phone conversation to the extent that their thinking is impaired. This effect is similar to driving while drunk as the driver is not within proper reasonableness to make decisions while on the road. According to the Virginia Tech Transportation Institute and the National Highway Traffic Safety Administration (NHTSA), the use of hand-free phones is also dangerous compared to hand held phones (Rosenboom, 2006). In a study conducted in 2004, the motorists that used hands free phones have to redial approximately 40% of the time compared to the hand held phones by motorists (Rosenboom, 2006). This postulates the unjustified arguments which most people tend to engage as the excuse to use cell phones while driving. According to this research, the use of hand-free phones by motorists is more dangerous compared to the hand held phones. In the cases of near accident experiences, motorists that are on hands free phones are 18% slower in braking compared to those using hand-held phones (Lamble, et al, 1999). This statistic is similar to that of a person driving while intoxicated. These statistics support the ideology that is formed against the conventional knowledge of multitasking. Multitasking is a simple myth which does not suffice on the dangerous roads as truth or wisdom. Talking and driving are both activities that require attention. Therefore, performing both tasks at the same time is subjecting the brain to impossibilities and endangering other road users’ lives. The culture has grown popular especially among the youth who make statistics as they also suffer from road carnages due to recklessness. Conclusion Cell phones are vital gadgets to people’s lives especially in the 21st century where people have the need to be connected constantly. However, despite the convenience they offer, people have to consider the relative negative attributes. In the United States, it is reported that 6.4% of all crashes are because of inattentive driving (Strayer, Et al, 2003). Driving on any road, especially highways, is a matter that should not be taken lightly. This is because many people’s lives including unaware bystanders are dependent on the attentive level of motorist. Responsibility on the roads is a matter that requires the strictest rules against offenders to avoid road carnages. Potential Questions: Q: What are the best and most effective policies that can be implemented during cell phone usage in cars to reduce road accidents? A: Yes, more comprehensive driver education and technology and just 2 ways to improve driver safety. Q: The multitasking myth is commonly associated to females, therefore, are there narrower statistics of cell phones and car accidents relative to victim’s sex? A: There is no conclusive data to suggest that female drivers are any more likely to have an accident than males due to multitasking. Q: Is the level of road accidents set to get higher in the coming future and if so, what is the best way of creating awareness at both national and international levels? A: As the population increases in the coming decades, it is logical to say that road accidents will increase proportionally. One possible way to create awareness is a national campaign akin to the DARE drug awareness program of the 90’s. References Lamble, D., Kauranen, T., Laakso, M., Summala, H. (1999). Cognitive load and detection thresholds in car following situations: safety implications for using mobile (cellular) telephones while driving.Accident Analysis Prevention,31(6), 617-623. Rosenbloom, T. (2006). Driving performance while using cell phones: an observational study.Journal of Safety Research,37(2), 207-212. Strayer, D. L., Drews, F. A., Johnston, W. A. (2003). Cell phone-induced failures of visual attention during simulated driving.Journal of experimental psychology: Applied,9(1), 23. Violanti, J. M., Marshall, J. R. (1996). Cellular phones and traffic accidents: an epidemiological approach.Accident Analysis Prevention,28(2),

Cell-based Therapy For Myocardial Regeneration

Cell-based Therapy For Myocardial Regeneration ABSTRACT Myocardial infarction is one of the main cause of mortality in many countries. Therefore, an effective therapy for myocardial infarction is required. Reperfusion and other conventional therapy have been the mainstay therapy for myocardial infarction. However, many patients remain refractory to this therapy. Cell-based therapy is considered a novel therapy, in which stem cells are used for cardiac repair. Stem cells are potential therapeutic and promising option that could be the alternative solution for salvaging damaged cardiomyocyte. Based on current studies, stem cells are a promising therapeutic approach for myocardial infarction. However, some challenges need to be answered by future studies before this novel therapy can be widely applied. This essay provides an overview of the progress in stem cell therapy for myocardial infarction. INTRODUCTION The robust potential of stem cells were still a mystery, but today, we are constantly getting new information on this particular topic. One of the prospects of stem cell therapy is to treat damaged cardiomyocyte (Fischer, et.al, 2009; Beltrami, 2003).Acute myocardial infarction is one of the main causes of mortality and morbidity in many countries. Not only this disease causes a massive socio-economic burden, but also reduces the quality of live for patients who survive the attack (Hamm, 2016). Currently, one of the mainstay therapy for myocardial infarction is rapid revascularization to limit ischaemic damage. Reperfusion and other conventional therapy have undoubtedly saved so many lives, yet there are patients remained refractory to this therapy and left with no other treatment options. In addition to that, many patients who have underwent reperfusion strategy and survived, often left with significant impairment of left ventricular systolic function. One big question remain unansw ered. Is there any other treatment option for these patients? Medical therapeutic approach to reduce damaged cardiomyocyte and generate new functioning muscle is the current unmeet need. Stem cells emerge as the novel procedure to restore damaged cardiomyocytes, and this procedure is popularly known as cellular cardiomyoplasty (Pendyala, et.al, 2008; Reinlib, 2000). Many preclinical and clinical trials have documented the potential use of stem cells to generate viable cardiomyocyte and improve cardiac function (Bergmann, et.al, 2009). To date, there are many different types of adult stem cells and progenitor cells used for this procedure, some of which are bone marrow derived stem cells, hematopoietic stem cells, mesenchymal stem cells and so on. Since the advance of stem cells technology is faster than ever before, this essay aimed to give an evidence based update on stem cells use for myocardial infarction, what we have achieved so far, and what does the future hold for this breakthrough. CELL-BASED THERAPY FOR MYOCARDIAL REGENERATION After an ischaemic attack due to occluded coronary vessels, heart muscle usually left damaged and nonfunctioning. However, recent evidence suggested that the cardiac muscle could actually undergo a limited amount of renewal. A prospect of inducing muscle cell to undergo division for cardiomyocyte replacement, or generating new muscle by stem cells are certainly intriguing (Roell, et.al, 2002; Santoso, et.al, 2011). Stem cells are capable to proliferate in the same state (self-renewal) and differentiate into multiple cell lineages. On the other hand, progenitor cells are more specific and have limited differentiation potential. Mechanism on how stem cells work are as follows: firstly, these stem cells need to be extracted from the source (eg. bone marrow), after that these stem cells need to be delivered to the injured area. These cells are implanted in the myocardium, and due to the nature of these cells, they would grow and differentiate/transdifferentiate into cardiomyocyte. To achieve the goal of cardiac repair, these cells should also have the ability to fuse with the surrounding tissues that their harmonious contraction increases the heart contraction. Furthermore, these newly-formed cardiomyocyte should also express the appropriate electromechanical properties required for contraction to yield a synchronous contraction (Templin, et.al, 2011; Makino, et.al, 1999). Many clinical studies have documented the feasibility and safety of cellular cardiomyoplasty in patients with coronary artery disease (Makino, et.al, 1999; Strauer, et.al, 2002). To date, there are some different types of adult stem cells and progenitor cells used for this procedure, some of which are bone marrow derived stem cells, hematopoietic stem cells, mesenchymal stem cells and many others (Jackson, et.al, et.al, 2001; Kamihata, et.al, 2001; Bolli, et.al, 2011) POTENTIAL SOURCE AND TYPE OF STEM CELLS Bone Marrow Derived Stem Cells Bone marrow derived stem cells (BMCs) are the most widely studied type of stem cells. Orlic et al. (2001) first describe the ability of bone marrow cells to regenerate infarcted myocardium in mouse models. The transplanted cells showed transdifferentiation into cardiomyocyte which eventually lead to improved left ventricular ejection fraction (Orlic, 2001). The three types of stem cells derived from bone marrow are hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), and endothelial progenitor cells (EPCs) (Orlic, 2001; Piao, et.al, 2005; Badorff, et.al, 2003). The role of BMCs for acute myocardial infacrtion has been reported to improve left ventricular ejection fraction (LVEF), both in REPAIR-AMI and BOOST trial (Meyer, et.al, 2006; Schachinger, et.al, 2006).BOOST trial demonstrate an acceleration of LVEF after intracoronary BMCs transfer (ejection fraction increased by 6.7% in the BMCs group as compared to 0.7% in the control group), and significant result was sustained until 18 months (Meyer, et.al, 2006). While in REPAIR AMI trial, improvement of LVEF, infarct size and wall thickening of infarcted segments were reported at two years follow up. At two years, the cumulative end point of death, myocardial infarction, or necessity for revascularization was significantly reduced in the BMC group compared with placebo (hazard ratio, 0.58; 95% CI, 0.36 to 0.94; P=0.025) (Assmus, et.al, 2010; Perin, et.al, 2012). Skeletal Myoblast Skeletal muscle has the ability to regenerate under certain circumstances. Skeletal resident stem cells are usually known as satellite cells, and these cells would differentiate to new myocytes in response to injury. However, whether this ability can be translated to a different condition, as in cardiomyocyte repair, should be further studied (Taylor, 198; Reinecke, et.al, 2002). MAGIC trial, a randomized controlled phase II trial, showed no significant changes in terms of global and regional LV function in skeletal myoblast- treated patients (Mensche, et.al, 2008). Another study performed by Dib et al.(2005) showed an increased in LV ejection fraction in the group treated with transepicardial injection of autologous SMs. Mesenchymal Stem Cells Mesenchymal stem cells (MSCs) are another potential option for cellular cardiomyoplasty. Mesenchymal stem cells can be found in various tissue, such as bone marrow and adipose tissue (Pittenger, 2004). One interesting mechanism by which MSCs mediate cardiac function improvement is the paracrine effect. MSCs may secrete soluble cytokines and growth factors that would eventually influence adjacent cardiomyocyte (Gharaibeh, et.al, 2011). Hare JM et al. (2009) studied the efficacy of intravenous allogenic human mesenchymal stem cells in patients with myocardial infarction. According to this study, intravenous MSCs were safe as showed by the similar adverse event rates in both intervention and control group. MSCs injection favorably affected patient functional capacity, quality of life and LV remodeling (Hare, et.al, 2012). Endothelial Progenitor Cells Endothelial progenitor cells (EPCs) have been linked with neovascularization in ischemic tissue. This interesting finding lead to the use of EPCs for another therapeutic purpose like cellular cardiomyoplasty (Isner, et.al, 1999). The human peripheral blood-derived EPCs would be a potential approach because those cells can be easily isolated without the need of major surgical intervention (Lin, et. Al, 2000). This assumption was later confirmed by Badorff et al. In this study, Badorff et al. (2003) reported that EPCs from healthy volunteers and Coronary Artery Disease (CAD) patients can transdifferentiate into functionally active cardiomyocytes when co-cultivated with rat cardiomyocytes. However, this finding was later opposed by Gruh I et al. According to this study, there was no significant evidence of transdifferentiation of human EPCs into cardiomyocyte (Gruh, et.al, 2006). Resident Cardiac Stem Cells Until recently, we believe that heart is a fully mature organ with no capability of self-renewal. However, the adult heart is not a terminally   differentiated organ, but harbors stem cell with regenerative capacity, namely resident cardiac stem cells (CSCs). Although the origins of CSCs are yet unclear, they can be isolated from heart tissue and expanded ex vivo for use as a cell-based therapy. There were many types of CSCs have been described in previous studies, like: epicardium-derived cells, cardiosphere-derived cardiac cells, and cardiac Sca-1+ cells. These resident stem cells have the potential to differentiate into different types of cells like vascular smooth muscle and myocardial cells (Tang, et.al, 2013; Tang, et.al, 2006; Fazel, et.al, 2006). Embryonic Stem Cells and Induced Pluripotent Stem Cells (iPS) Embryonic stem cells (ESC) are derived from the blastocyst (inner cell mass) of human embryo prior to implantation. ESCs are pluripotent cells, which means they have the capability to differentiate into any cells, one of which is cardiac myocytes. Due to the source of these cells, there are ethical issues regarding the use of ESC (Kofidis, 2005).The huge potential of ESC comes with a price. The pluripotency of ESC made these cells predisposes to tumor formation including teratomas. Amariglio N et al. (2009) documented the occurence of a human brain tumour following neural stem cell therapy. A boy with telangiectasia was treated with intracerebellar and intrathecal injection of human fetal neural stem cells. Four years later, he was diagnosed with a multifocal brain tumour. After thorough analysis, the tumor was of nonhost origin, indicating it was derived from the transplanted neural stem cells (Amariglio, 2009). To date, due to the scarcity of studies on ESC and negative experiences of previous studies, the significance of ESC as cell-based therapy for myocardial infaction remains elusive. The above-mentioned limitation would hopefully be elucidated in future research. Human Umbilical Cord Blood Cells Human umbilical blood cells (hUCB) contains a large number of non-hematopoietic stem cells which rarely express human leukocyte antigen (HLA) class II antigens, thus reducing the risk of rejection. Many studies have reported the efficacy and safety of hUCB administration in acute myocardial infarction model, with conflicting result (Henning, 2004; Moelker, 2007).According to Henning RJ et al. (2004) hUCB administration reduce infarction size and improve ventricular function in rats without requirements for immunosuppression (Henning, 2004). Similar positive finding were documented by Kim et al. Circulating Blood-derived Progenitor cells Circulating blood-derived progenitor cells (CPCs) are similar to BMCs, which mainly composed of EPCs. Santoso T et al. (2011) studied the safety and feasibility of combined granulocyte colony stimulating factor (G-CSF) and erythropoetin (EPO) based-stem cell therapy using intracoronary infusion of peripheral blood stem cells in patients with recent anterior myocardial infarction. G-CSF is used to mobilized stem cells to the injured area, inhibits cardiomyocyte apoptosis, promotes neovascularization, and increase the production of nitric oxide. While EPO, that is originally thought to be a hematopoietic hormone only, also may inhibited apoptosis and induced angiogenesis. This phase I study concluded that this procedure is safe and resulted in improved endpoints for LV ejection fraction and cardiac viability (Santoso, 2011). Cardiopoietic Stem Cells Cardiopoietic stem cells are not a distinct type of stem cells but refer to the novel way of processing stem cells in order to get a lineage specification. Cardiopoietic stem cells are harvested stem cells that are treated with a protein cocktail to replicate natural cues to heart development, before being injected into the patients heart. The C-CURE trial studied the efficacy of bone marrow derived-mesenchymal stem cells in chronic heart failure. The isolated mesenchymal stem cells were exposed to a cardiogenic cocktail that trigger expression and nuclear translocation of cardiac transcription factors, before being injected to the patients heart. After six months follow up, patients in the treatment group significantly improved in terms of LVEF and fitness capacity. There was no evidence of increased cardiac or systemic toxicity induced by cardiopoietic cell therapy (Bartunek, 2013). Unfortunately, data comparing the efficacy and safety between cardiopoietic stem cells and ordinary stem cells without cocktail-based priming is still lacking. DELIVERY METHODS In order to make these stem cells reach the heart, a reliable delivery method need to be employed. The ideal method should be able to safely and efficiently deliver an optimal number of stem cells to the target tissue. Beside the high efficacy, this delivery method should be as minimally invasive as possible for the sake of patients comfort. There are some delivery methods worthy to know. Intracoronary Infusion As the name implies, intracoronary infusion is a process of delivering stem cells through coronary artery, usually through intracoronary catheterization. Stem cells are infused under pressure via a ballon catheter. The ballon was inflated in order to prevent anterogade blood flow that would compromize stem cells delivery. Catheter guided cell transfer has its unique advantage of safety under local anesthesia, and a part of routine cardiac catheterization. The intracoronary method provide a maximum number of cells to the target area, with good blood supply which is crucial for cell survival. Multiple studies have reported the use of intracoronary infusion for stem cells delivery (Strauer, 2002; Schachinger, 2006). Intravenous Peripheral Infusion Intravenous stem cells administration is one of the easiest method to be employed. Intravenous administration is possible through homing phenomenon of stem cells to the injured heart. Unfortunately, intravenous peripheral infusion comes with some disadvantages. First, only 3% of normal cardiac output will flow per minute through the left ventricle. This low amount of blood would limit the amount of stem cells delivered. Secondly, due to the passing of venous blood in the lung, many cells would trap in lung vasculature that eventually lead to stem cells reduction (Grieve et.al, 2012). Intramyocardial, Transendoccardial and Transpericardial Route As mentioned earlier, the downside of intravenous administration is the passing of the blood in certain organs that would entraped some of the stem cells. Unlike intravenous route, intramyocardial method is undoubtly provide direct access to the injured cardiomyocyte bypassing the need for mobilization, homing and any risk of cells entrapment in other organ, thus provide a more effective way to deliver abundant stem cells to the injured area. However, this method comes with its own expense of a more invasive method, not to mention the risk of ventricular perforation in the already damaged cardiomyocyte. Intramyocardial delivery usually performed during an open heart surgery or needle-tipped delivery catheter (Strauer, 2003; Forrester, 2003). Nelson et al.(2009) documented that intamyocardial delivery of iPS originating from reprogrammed fiobroblast, yielded progeny that properly engrafted and resulted in restored contractile performance, increased ventricular wall thickness, and elec tric stability (Nelson, et.al, 2009). STUDIES USING STEM CELLS IN MYOCARDIAL INFARCTION Many studies have been carried out to investigate the efficacy and safety of stem cell therapy in patients with myocardial infarction. Each of these studies investigated different kind of stem cells with different delivery methods. The ultimate goal of these studies is to answer whether stem cell therapy could be a feasible therapeutic approach for patients with myocardial infarction. The result of these studies were not always positive, even some of the studies did not document any beneficial effect of stem cell therapy. However, this conflicting result need to be intepreted with caution due to the different study method, different type of stem cells used, and different delivery methods employed. Three meta- analysis on the efficacy of BMCs therapy for myocardial infarction have been published. In a meta-analysis by Delewi R et al, intracoronary BMCs infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. The benefit in terms of LVEF improvement was more pronounced in patients with a worse baseline LVEF (LVEF cut off: 40%) and younger age (age cut off: 55 years) (Delewi, et.al, 2013).   In a second meta-analysis by Clifford DM et al. (2012) which include thirty-three RCTs, there was no significant difference in hard end point like mortality and morbidity in the BMCs treated group. However global heart function, as represented by LVEF and infarct size, was improved significantly and was sustained long term (12 to 61 months) in the BMCs group (Clifford, et.al, 2012). The third meta-analysis by Long C et al. (2013) further confirmed the beneficial effect of intracoronary BMCs in patients with acute my ocardial infraction. According to this meta-analysis, BMCs therapy significantly improved LVEF, while mildly but not significantly reduced left ventricular end-systolic volume and left ventricular end-diastolic volume (Lond, et.al, 2013). These three meta-analysis synonymously agree that BMCs therapy is beneficial in terms of improved heart function and reduced infarct size. CHALLENGES AND THE FUTURE We have just entered the new era of stem cell therapy. When advanced therapy like primary PCI and thrombolytic showed more limited beneficial for patients with myocardial infarction, the concept of cell-based therapy is definitely appealing. This new approach could be the answer that have been waited for sometime. As we have discussed previously, there are many issues on stem cell therapy that need to be addressed in future studies. Firstly, what is considered to be the best stem cells to replace cardiomyocyte. Secondly, the right delivery method of these stem cells need to be determined. Whether different type of stem cells required certain delivery methods also need to be further elucidated. Another question is the right timing of delivery (acute, sub-acute or chronic), whether it contributes to the fate of stem cells. Fourth, the concentration of stem cells, dose-effect relationship and safety of stem cell therapy need to be further investigated. One particular topic in regard to stem cell safety is the tumorigenicity of ESC. We need to disentangle a way to reprogram these cells so they can differentiate into functional cells, but lack the ability to form tumours. Finally, novel diagnostic tools are required to detect and evaluate stem cells therapy. Future studies would hopefully provide s olid proof on hard end-points (eg. mortality), instead of surrogate markers like LVEF or infarct size. CONCLUSION Tremendous progresses were made in cell-based therapy, and future advances would further lead us to a new solution for ischaemic heart disease. Stem cells own robust potential in medicine, one of which is to replace damaged cardiomyocyte. More evidents are needed in advance to widely use of this modality. REFERENCES Amariglio N, Hirshberg A, Scheithauer BW, et al. (2009). Donor-derived brain tumor following neural stem cell transplantation in an ataxia telangiectasia patient. Assmus B, Rolf A, Erbs S, et al. (2010). Clinical outcome 2 years after intracoronary administration of bone marrow-derived progenitor cells in acute myocardial infarction. Circ Heart Fail, 3, pp.89-96. Assmus B, Schachinger V, Teupe C, et al. (2002) Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction (TOPCARE-AMI). Circulation. 106, pp.3009-3017. Badorff C, Brandes RP, Rà ¼diger P, et al. (2003). Transdifferentiation of blood-derived human adult endothelial progenitor cells into functionally active cardiomyocytes. Circulation. 107, pp.1024-32. Beltrami AP, Barlucchi L, Torella D, et al. (2003) Adult cardiac stem cells are multipotent and support myocardial regeneration. Cell, 114(6), pp.763-776. Bergmann O, Bhardwaj RD, Bernard S, et al. (2009). Evidence for cardiomyocyte renewal in humans. Science. 324, pp. 98-102. Bolli R, Chugh AR, DAmario A, et al. (2011). Effect of cardiac stem cells in patients with ischemic cardiomyopathy: Initial results of the SCIPIO trial. Lancet, 378, pp. 1847-1857. Cao F, Sun D, Li C, et al. (2009). Long-term myocardial functional improvement after autologous bone marrow mononuclear cells transplantation in patients with ST-segment elevation myocardial infarction: 4 years follow-up. Eur Heart J, 30, pp.1986-94. Chang ZT, Hong L, Wang H, Lai HL, Li LF, Yin QL. (2013). Application of peripheral-blood-derived endothelial progenitor cell for treating ischemia-reperfusion injury and infarction: a preclinical study in rat models. J Cardio Thor Surgery. 8, pp.33. Clifford DM, Fisher SA, Brunskill SJ, et al. (2012) Stem cell treatment for acute myocardial infarction. Cochrane database of systematic reviews. Issue 2. Art. No.: CD006536. Doi : 10.1002/14651858.CD006536.pub3. Delewi R, Hirsch A, Tijssen JG, et al. (2013). Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis. Eur Heart J, doi:10.1093/eurheartj/ eht372. Dib N, Michler RE, Pagani FD, et al. (2005). Safety and feasibility of autologous myoblast transplantation in patients with ischemic cardiomyopathy: four-year follow-up. Circulation. 112, pp.1748-55. Duckers HJ, Houtgraaf J, Van Geuns RJ, et al. (2010). Abstract 12225: First-in-man experience with intracoronary infusion of adipose-derived regenerative cells in the treatment of patients with ST-elevation myocardial infarction: The apollo trial. Circulation, 122, A12225. Fazel S, Cimini M, Chen L, et al. (2006). Cardioprotective c-kit + cells are from the bone marrow and regulate the myocardial balance of angiogenic cytokines. J Clin Invest, 116, pp. 1865-1877. Fernandes S, Amirault JC, Lande G, et al. (2006). Autologous myoblast transplantation after myocardial infarction increases the inducibility of ventricular arrhythmias. Cardiovasc Res, 69, pp.348-358. Fischer KM, Cottage CT, Wu W, et al. (2009). Enhancement of myocardial regeneration through genetic engineering of cardiac progenitor cells expressing Pim-1 kinase. Circulation, 120(21), pp.2077- 2087. Fischer UM, Harting MT, Jimenez F, et al. (2009). Pulmonary passage is a major obstacle for intravenous stem cell delivery: the pulmonary first-pass effect. Stem Cells Dev, 18, pp.683-692. Forrester JS, Price MJ, Makkar RR. (2003). Stem cell repair of infarcted myocardium: an overview for clinicians. Circulation, 108, pp.1139-1145. Gharaibeh B, Lavasani M, Cummins JH, Huard J. (2011). Terminal differentiation is not a major determinant for the success of stem cell therapy cross-talk between muscle-derived stem cells and host cells. Stem Cell Res The, 2, pp.31. Gimble JM, Katz AJ, Bunnell BA. (2007). Adipose-derived stem cells for regerative medicine. Circ Res, 100, pp.1249-60. Grieve SM, Bhindi R, Seow J, et al. (2012). Microvascular obstruction by intracoronary delivery of mesenchymal stem cells and quantification of resulting myocardial infarction by cardiac magnetic resonance. Circ Heart Fail, 3, pp.e5-e6. Gruh I, Beilner J, Blomer U, et al. (2006). No evidence of transdifferentiation of human endothelial progenitor cells into cardiomyocytes after coculture with neonatal rat cardiomyocytes. Circulation, 113, pp.1326-1334. Hamm CW, Bassand JP, Agewall S, et al. (2016). ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal doi:10.1093/eurheartj/ehr236. Cited from: http://www. escardio.org/guidelines-surveys/esc-guidelines/Pages/ ACS-non-ST-segment-elevation.aspx Hare JM, Fishman JE, Gerstenblith G, et al. (2012). Comparison of allogeneic vs autologous bone marrow-derived mesenchymal stem cells delivered by transendocardial injection in patients with ischemic cardiomyopathy the POSEIDON randomized trial. JAMA. 308, pp.2369-2379. Hare JM, Traverse JH, Henry TD, et al. (2009). A randomized, double-blind, placebo controlled, dose-escalation study of intravenous adult human mesenchymal stem cells (prochymal) after acute myocardial infarction. J Am Coll Cardiol, 54, pp.2277-2286. Henning RJ, Abu-Ali H, Balis JU, Morgan MB, Wiling AE, Sanberg PR. (2004). Human umbilical cord blood mononuclear cells for the treatment of acute myocardial infarction. Cell Transplant. 13, pp.729-739. Hsieh PCH, Segers VFM, Davis ME, et al. (2007).   Evidence from a genetic fate-mapping study that stem cells refresh adult mammalian cardiomyocytes after injury. Nat Med, 13, pp.970-974. Isner JM, Asahara T. (1999). Angiogenesis and vasculogenesis as therapeutic strategies for postnatal neovascularization. J Clin Invest, 103, pp.1231-1236. Jackson KA, Majka SM, Wang H, et al. (2001). Regeneration of ischemic cardiac muscle and vascular endothelium by adult stem cells. J Clin Invest, 107, pp.1395-1402. Kamihata H, Matsubara H, Nishiue T, et al. (2001). Implantation of bone marrow mononuclear cells into ischemic myocardium enhances collateral perfusion and regional function via side supply of angioblasts, angiogenic ligands, and cytokines. Circulation, 104, pp.1046-1052. Kim BO, Tian H, Prasongsukarn K, et al. (2005). Cell transplantation improves ventricular function after a myocardial infarction: a preclinical study of human unrestricted somatic stem cells in a porcine model. Circulation. 112, pp.I96-I104. Kofidis T, de Bruin JL, Yamane T, et al. (2005). Stimulation of paracrine pathways with growth factors enhances embryonic stem cell engraftment and host-specific differentiation in the heart after ischemic myocardial injury. Circulation, 111, pp. 2486-2493. Kornowski R, Fuchs S, Leon MB, et al. (2000). Delivery strategies to achieve therapeutic myocardial angiogenesis. Circulation, 101, pp.454-458. Krishna KA, Krishna KS, Berrocal R, Rao KS, Rao KRS. (2011). Myocardial inraction and stem cells. J Pharm Bioallied Sci, 3, pp.182. Lin Y, Weisdorf DJ, Solovey A, Hebbel RP. (2000). Origins of circulating endothelial cells and endothelial outgrowth from blood. J Clin Invest, 105, pp.71-77. Long C, Yi TJ, Hui J, et al. (1999). Long-term effects of bone marrow-derived cells transplantation in patients with acute myocardial infarction: a meta-analysis. Chin Med J, 126, pp.353-360. Makino S, Fukuda K, Miyoshi S, et al. (1999). Cardiomyocytes can be generated from marrow stromal cells in vitro. J Clin Invest, 103, pp.697-705. Makkar RR, Smith RR, Cheng K, et al. (2012). Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): a prospective, randomised phase 1 trial. Lancet, 379, pp.895-904. Menasche P, Alfieri O, Janssens S, et al. (2008). The myoblast autologous grafting in ischemic cardiomyopathy (MAGIC) trial: first randomized placebo-controlled study of myoblast transplantation. Circulation. 117, pp.1189-1200. Menasche P, Hagege AA, Vilquin JT, et al. (2003). Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. J Am Coll Cardiol, 41, pp.1078-1083. Meyer GP, Wollert KC, Lotz J, et al. (2006).   Intracoconary bone marrow cell transfer after myocardial infraction: eighteen months follow up data from the randomized, controlled BOOST (bone marrow transfer to enhance ST-elevation infarct regeneration) trial. Circulation, 113, pp.1287-1294. Moelker AD, Baks T, Wever KM, et al. (2007). Intracoronary delivery of umbilical cord blood derived unrestricted somatic stem cells is not suitable to improve LV function after myocardial infarction in swine. J Mol Cell Cardiol, 42, pp.735-745. Nelson TJ, Martinez-Fernandez A, Yamada S, Perez-Terzic C, Ikeda Y, Terzic A. (2009). Repair of acute myocardial infarction by human stemness factors induced pluripotent stem cells. Circulation, 120, pp.408-416. Oh H, Bradfute SB, Gallardo TD, et al. (2003). Cardiac progenitor cells from adult myocardium: homing, differentiation, and fusion after infarction. Proc Natl Acad Sci USA, 100, pp.12313-12318. Orlic D, Kajstura J, Chimenti S, et al. (2001).   Mobilized bone marrow cells repair the infarcted heart, improving function and survival. Proc Natl Acad Sci USA, 98, pp.10344-10349. Pendyala L, Goodchild T, Gadesam RR, Chen J, Robinson K. (2008). Cellular cardiomyoplasty and cardiac regeneration. Curr Cardiol Rev, 4, pp.72-80. Perin EC, Wilerson JT, Pepine CJ, et al. (2012). Effect of transendocardial delivery of autologous bone marrow mononuclear cells on functional capacity, left ventricular function, and perfusion in chronic heart failure the FOCUS-CCTRN Trial. JAMA, 307, pp.1717-1726. Piao H, Youn TJ, Kwon JS, et al. (2005). Effects of bone marrow derived mesenchymal stem cells transplantation in acutely infarcting myocardium. Eur J Heart Fail, 7, pp.730-738. Pittenger MF, Martin BJ. (2004). Mesenchymal stem cells and their potential as cardiac therapeutics. Circ Res, 95, pp.9-20. Povsic TJ, OConnor CM, Henry T, et al. (2011). A double-blind, randomized, controlled, multicenter study to assess the safety and cardiovascular effects of skeletal myoblast implantation by catheter delivery in patients with chronic heart failure after myocardial infarction. Am heart J, 162, pp.654-662. Ramshorst JV, Antoni L, Beeres SLMA, et al. (2011). Intramyocardial bone marrow-derived mononuclear cell injection for chronic myocardial ischemia, the effect on diastolic function. Circ Cardiovasc Imaging, 4, pp.122-129. Reejhsinghani R, Jen Shih HH, Lotfi AS. (2012). Stem cell therapy in acute myocardial infacryion. J Clin Exp Cardiolog, 8, pp.11. Reinecke H, MacDonald GH, Hauschka SD, Murry CE. (2000). Electromechanical coupling between skeletal and cardiac muscle. Implications for infarct repair. J Cell Biol, 149, pp.731-740. Reinecke H, Poppa V, Murry CE. (2002). Skeletal muscle stem cells do not transdifferentiate into cardiomyocytes after cardiac grafting

Saturday, July 20, 2019

Thomas P. Oneill :: essays research papers fc

Thomas P. O'Neill Tip was a man who was not bashful to call himself "a man of the house." Thomas P. O'Neill was a person whose greatest charm was that he seemed "completely out-of-date as a politician." (Clift) He was a gruff, drinking, card playing, backroom kind of guy. He had an image that political candidates pay consultants to make over. He knew these qualities gave him his power because they "made him real." (Sennot 17) His gigantic figure and weather beaten face symbolizes a political force of five decades, from Roosevelt's new deal to the Reagan retrenchment. He was the last democratic leader of the old school and "the longest-serving speaker of the house (1977-1986) and easily the most loved." (Clift) Thomas P. O'Neill (1912-1994) always knew why he was in Washington, and what he stood for. He was a native of Boston and always prided himself on his theory that "all politics is local." (O'Neill 1) Tip was a friend of everyone. When ordinary people wanted something of O'Neill he gave it to them. When anyone asked him a favor, he would do it. O'Neill served fifty years in public life and retired with only fifteen thousand dollars to his name. He devoted his life and his money to the people of Boston. Tip came of age in the Great Depression, arrived in congress from Massachusetts in 1952 and "came to power amid the plenty of the '60s and '70s." (Woodlief 4) He was a rampant liberal who "would usually vote yes on any bill that helped people (he once voted to put money into an appropriations bill to study knock knees)." (Gelzinas 6) When Reagan came into office in 1980 big government began to feel the pinch and O'Neill's big hearted liberalism was on the way out. In 1980, O'Neill was a target of a clever Republican ad campaign that pictured him in a limo as a symbol of a bloated out of control congress. The advertisement backfired and it sent O'Neill into folk hero status. Tip even "made an appearance on "Cheers" as an effect of the advertisement." (Time 18) Tip said that he "only made one vote that he regretted." (O'Neill 218) It was a yes vote on the 1964 Gulf of Tonkin Resolution that gave Lyndon Johnson full control over all military intervention in Vietnam. He did this because it was a time when Congress did what leadership asked, in fact there was not one descending vote in the house on this issue (414-0). Right away he had speculation that the White House might use this as a device to open up full