Management strategy and practice of the nokia corporation ltd

INTRODUCTIONNokia Corporation Ltd is one of the topmost mobile phone manufacturing companies. It manufactures a wide range of mobile phone handsets that befit and satisfy consumer demand. It is based in the South West part of Finland.ORGANIZATIONAL STRUCTUREWith its headquarters based in Singapore, Nokia Corporation operates in various geographical locations. The enterprise is further categorized into different business segments with each specializing in specific operations:  Nokia Treasury Asia: – This is based in the headquarters and serves the corporation’s subsidiaries of the Pacific (Asian). This region serves as the banking unit by providing a wide range of financial services.Japan/ China region: – These regions specialize in Research and Development. It is the ‘epicenter’ of new innovations/technology and new brand implementation.  Within the America’s region, Nokia Corporation has assembly, IT solutions and program design business units.In general, the company has a flat organizational structure. This is because of few levels of management (about six). The chairman, who doubles as the President is deputized by the vice Chairman (Vice President). This Manager has only four executives below him. This structure is a form of strategy for the corporation as it reduces bureaucracy and enhances both the flow of information and the decision-making process.NOKIA’S INCOME STATEMENTSThe most recent quarte’s Revenue is â‚ ¬ 9,856 millionThe net income figure during the same period was â‚ ¬ 979 million.The company’s current stock price as at 11.03 AM, 07/19/07 is $ 29.81.The previous price was $29.73. I expect the stock price to grow in the next quarter. This is due to the high demand of the company’s stocks due to its high profitability and performance in the Stock Market.FINANCIAL STRATEGIESThe Corporation operates in patents and rights. These include the GSM/WCDMA and CDMA2000. These h ave led to advantages like reduction of production and operating costs. The management of the company uses internal growth/financing that is expensive in terms of interest charges. Because of this, it issues ordinary shares when finances have to be raised. It also uses its retained earnings which are sufficient owing to its optimal dividend policy.In order to increase its profitability and market share, Nokia Corporation has entered into a joint venture with other telecommunication companies like Sanyo.  And in order to attract a competitive advantage over other companies in the industry, Nokia Corporation has embarked on acquisitions. An example is Intellisync plc in February 2006.Another of the firm’s strategy is that of mergers with other telecommunication companies. This has seen the company merging with Siemens AG in June 2006. This according to the management will give the company enviable synergistic advantages such as reduction of operating expenses. It would also e nable the company tap more expertise as well as bar new entrants from joining the industry.The investment division carries out financial plans and analysis before undertaking any financial ventures. This is geared towards risk reduction and investments on projects that can only yield positive net benefits in present value terms.Through the Finance Department, the company also carries out sensitivity analysis to determine the effect of changing certain financial parameters on the outcomes. These include the discounting rates, economic life of projects,e.t.c.In order to reduce its financial risk Nokia corporation diversifies its investments by investing in a portfolio form. These range from treasury bills, to mutual funds and other long-term projects.MANAGEMENT STRATEGIES.One of Nokia Corporation’s   management strategies is brand/design. The Corporation is the leading in in product modification, producing a wide range of Nokia handsets. It is through this that a company can gain the loyalty and confidence of the customers. The phones also have very fascinating ring tones, games and even internet solutions. They have designed them in a way that they are user friendly.The human resource department of the company comprises of experienced and highly skilled and motivated staff. The firm employs better recruitment and selection methods in fulfilling the staffing function.The management of Nokia carries out frequent environmental surveys to determine what they can be able to explore from the environment( opportunities) and what dangers the same environment poses on it (threats). This analysis is important because through it, Nokia corporation identifies the strengths at its disposal that can enable them make use of the opportunities. They also determine their   weaknesses   and how these are likely to hinder their success.In order to avoid high labor turnover especially skilled and expertise, the company adopts betters and attractive wage packages for it s employees and other perquisites. They are also actively involved in core decision making processes thus making them feel part and parcel of the organization. When it comes to conflict resolution, the management uses the collaborative style to resolve organizational conflicts. These tend to give both parties in conflict a win-win situation by giving every party equal satisfaction.Another Nokia’s management strategy is time management. In the Nokia working environment, time is the most essential asset. This resource is highly valued as idle capacity is   costly to the organization. The management, in a chart form has laid down ways in which staff and all other employees can be able to properly manage time. Every employee is required to set his/ her objectives which he/she wants to accomplish. The goals have to be prioritized   with each employee having his own individual working schedules.REFERENCEShttps://www.finance.com/credit-cards/compare-credit-cards/citi.action?ID=m ost-popular-credit-cards

Bishop’s “The Fish” Poetry Response Essay

In the poem â€Å"The Fish,† Elizabeth Bishop uses a fish as a symbol to express the theme of life and experience. The poem by itself has little structure to it. There are no apparent rhyme schemes, nor any clear meters. However, Bishop uses very powerful diction and ideas in the poem, forcing the reader to think and relate it to a greater aspect of his/her own life. The persona has a very mature and serious tone, and some gloomy element to his/her mood. The poem uses a significant amount of imagery. Descriptions like â€Å"brown skin hung in strips† and â€Å"fresh and crisp with blood† are common throughout the poem. The reader can almost see the fish on the boat, waiting for its life to end. Bishop also uses a plethora of colors in the poem. Colors include: â€Å"brown skin,† â€Å"green weed,† â€Å"dramatic reds and blacks,† â€Å"yellowed,† â€Å"green line,† and it also contains the combination of all the colors in the sp ectrum as â€Å"rainbow, rainbow, rainbow!† was repeated in the poem. The Colors are there to enhance the imagery and also work archetypically to express the mood of the poem. When the persona states that the â€Å"oil had spread a rainbow,† it should indicate that tears has formed in her eyes, splitting the light into its spectrum, as she also mentions â€Å"sun-cracked thwarts.† At the end where â€Å"everything was rainbow,† tears had flooded her eyes, blurring every sight and showing only splashes of colors all around. At the beginning of the poem, the persona notes that the fish did not fight at all. She describes the fish as â€Å"battered,† â€Å"homely,† but yet â€Å"venerable.† Later she discovers that the fish has fought many battles, and the broken lines are signs of victory. She realizes the fish is not just something that gives up without a fight, but it is something that has just fought too long and is tired of it. The persona realizes what the fish has gone through and instantly gains respect and condemnation for it. She lets it go. For writing this poem, the author might have a family member that was suffering from a disease. After a long time of painful struggle, that member finally gives up because he/she saw through the value of life, just like the fish. However, there is one thing that I disagree with the persona, because she states the fish has â€Å"a five-haired beard of wisdom.† In my opinion it should be â€Å"five-haired beard of stupidity† since the fish cannot learn from its past.

Cardiovascular Diseases

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

Lab Report #2 Example | Topics and Well Written Essays - 1750 words

#2 - Lab Report Example Measurement is an essential aspect mainly utilized in the scientific field to quantify diverse forms of matter. This entails determining the objects’, quantity of matter, volume and their densities (Wilson & Cecilia 242). However, an object’s exact measurement despite one being an expert, accuracy mainly relies on the equipments a person utilizes to take diverse measurements. This is due to the imperfections, which result from the equipments’ errors while a researcher is taking measurements of different types of matter or their parts. Therefore, it is essential for the researcher to have adequate knowledge regarding how to minimize errors via being able to manipulate the readings one attains while measuring. Since this varies across the equipments, where some are complex especially if one lacks proper knowhow regarding particular equipment (Wilson & Cecilia 39). The study’s focus encompasses measurements of diverse objects coupled with determining their le ngths, mass, volume and densities. 1. The initial step was to take the readings of a copper wire with the help of a metric ruler. This is by placing the wire on the metric rule, reading the positions of the two sides and estimating the readings to approximately tenth of a millimeter. Then developing four sets of independent measurements to approximately 0.01cm in centimeters by estimating using diverse parts of the meter rule 3. The diameter of the copper wire was measured with the aid of a micrometer caliper where the measurements’ approximation was 0.0001cm. To increase the accuracy of the study, it entailed obtaining six independent recordings in a table. Despite the experiment carried out with high level of keenness to shun any possible errors that may emanate from carelessness or readings’ improper taking, they were inevitable. Mainly, the source of errors in this study that have prompted the results to deviate from the ordinary expected

Foreign Policy of North Korea Essay Example | Topics and Well Written Essays - 4250 words

Foreign Policy of North Korea - Essay Example The intention of this paper is North Korea, or the Democratic People’s Republic of Korea (DPRK), as a country under the authoritarian rule of the military and the KWP, or the political party of Kim Jong-Il. Since the government and the military regulate every domestic institution in North Korea including the media and the schools, there is no known freedom of speech in the country. Moreover, according to the Amnesty International, North Koreans who are imprisoned or detained usually suffer from torture and other forms of cruelty and degrading treatment without due process of law. The prisoners are either beaten, forced to exercise, made to sit without moving for several hours, and publicly humiliated. Usually, because of these forms of cruelty as well as forced hard labor, lack of hygiene and inadequate food, prisoners usually fall ill and die some time during custody. As a response to the lack of respect for human rights in North Korea, the Citizens’ Alliance for North Korean Human Rights, or NKHR, was established on May 4, 1996 in Seoul. The purpose is to defend the human rights and defend the lives of North Koreans. The founder and current chairperson, Reverend Benjamin H. Yoon, emphasizes that the goal of the NKHR is for the creation of a peaceful reunification of the North and the South and the formation of a democratic national community that is expected to result from such reunification. The NKHR also seeks to assist North Koreans who have just settled in South Korea in the education of their youth and the protection of their rights. Moreover, the organization seeks to collect and publicize facts and information regarding the status of human rights in North Korea, especially those in political prison camps (â€Å"Citizens’ Alliance,† 2011). Nevertheless, the NKHR, since it is based in Seoul, cannot do much to help North Koreans in North Korea. Nevertheless, the institution of the NKHR is a crucial step and a beacon of hope for North Koreans whose rights are still being violated in their own country. II. Relations with Asian Countries ` North Korea’s relations with South Korea have been â€Å"difficult and acrimonious† since the Korean War and have been a sort of â€Å"mixed† policy since North Korea seeks to develop strong economic ties with South Korea but the former does not stop denouncing the latter’s relations with the United States (â€Å"Democratic People’s,† U.S. Dept. of State, 2011). After the Korean War, both countries actually affirmed their desires for the reunification of the Korean Peninsula but until 1971, there have been no possible way for the two Korean governments to officially communicate with each other (â€Å"Democratic People’s,† U.S. Dept. of State, 2011). The differing ideologies of the two Koreas, where the north assumes a rather communist and conservative role but the south a rather a democratic one, have been responsible for the delay of goals aimed at reunification. Moreover, the intervention of the United States and other member countries to the Six-Party talks and North Korea’s continual violation of international laws against nuclear missiles have also helped put aside and indefinitely postpone reunification. However, South Korea remains as one of the DPRK’s leading partner in trade (â€Å"Korea, North,† CIA.gov, 2011). Aside from South Korea, among the countries with which North Korea has had firmly established ties with was China. China is North Korea’s largest source of food, fuel and arms, and is its biggest trading partner. As to food, China is the leading producer and importer of 45% of North Korea’s food and 80% of the latter’s consumer goods. When it comes to energy resources, China provides North Korea with around 90% of the latter’s fuel. With North Korea’s current volume of imports from China, the economic dependence of the form er on

Bioethical Research on Stem Cells Essay Example | Topics and Well Written Essays - 1000 words

Bioethical Research on Stem Cells - Essay Example Bioethics is a study that deals with all the ethical questions raised due to biological and medical researches and advancements and attempts to answer those questions and satisfy the masses. It also deals with the effect of these biological and medical advancements on the correlation of these fields with other social aspects of life like religion, politics and other social sciences. It talks about the responsibility of the government, the religious leaders, the sociologists and other social figures in regulating and taking notice of any controversial and/or disputed biological or medical issue prevailing in the society. It strives to provide proper arguments and debates to satisfy the concerned and to provide evidence for the importance of the said issue as well as to prove the relevance and unavoidability of the process to make sure that the end result and the eventual achievement is worth the sacrifice.1 Bioethics not only deals with issues related to humans, human rights and research on human issues but also emphasizes on the importance of animal rights and issues related to these non-human species. The examples of the issues related to animals are many, the prime issue being animal testing. This basically concerns the correlation of Bioethics with the animal rights foundations etc and emphasizes on the fact that animals are living beings that cannot be used just like a thing to be tested upon. The bioethical argument to that, however, would be that these tests on animals are conducted to make sure that the complex medicines, remedies and surgical procedures for solving critical health problems related to humans are working efficiently and cause no harm to human life.2 The issues that Bioethics deals with range very widely. It deals with the relationship and effects of biological, especially medical researches with the social issues prevailing in the society, however, these issues can range from being totally based on social grounds like the issue of suicide to being based on complex medicinal grounds like genetics and their effects and influences on the society and people living in it. Having said this, let's observe how vast the bioethical issues can be. Some of the common issues that Bioethics deals with would be: Suicide Infertility Genetic Modification and Gene therapy Cloning (Human and Animal) Abortion Euthanasia (Human as well as Animal) Animal Rights Human Testing Animal Testing Stem cell Research Parthenogenesis Genetic Engineering, etc Recently, the research on stem cells is being questioned on the bioethical grounds quite a lot. First, let's look at what stem cells are and what their function actually is. Stem cells are those cells that have the ability to renew or rejuvenate themselves through mitotic divisions and can transform into differentiated specialized cells of a large variety, however, the extent to which a stem cell can differentiate into a more specialized form varies greatly from one stem cell to another. These stem cells are found in almost all multicellular organisms (organisms having many cells and differentiated cell types for different bodily functions), however, when talking about

Contemporary International Trade is no longer explained by Factor Essay

Contemporary International Trade is no longer explained by Factor Proportions Theory - Essay Example While some countries were naturally rich in capital resources, other had a huge population which gave rise to an abundance of labor. The nations were said to possess competitive advantage in the factors of production which was readily available in their economies. It followed from common logic that countries having natural endowments of a specific factor would always engage in a production technology intensive in that particular factor. Therefore, a capital rich economy was always considered to engage in a capital-intensive technology for the production of commodities. The same case would apply for the labor abundant economy as well. However, in that case the countries ended up producing goods produced by only one factor-intensive type of production method. Therefore, they needed to engage in mutually beneficial exchange of goods to gain access to other types of products as well. However, the contemporary trends in international trade sometimes violate the tenets of the Factor Propor tions Theory. Homogenous countries being naturally endowed with the same pattern of factor endowments have been increasingly observed to have engaged in trading with each other. In such cases, only Factor Proportions Theory cannot explain the current trends in global trade. Consequently, specialists in trade have sought to explain the contemporary trading practices with the help of a number of alternative theories. This paper has attempted to evaluate these alternative theories and investigate their explanations about modern international trade. The Classical Theory of International Trade was the first acceptable explanation of international trading practices. About 150 years after this,the Swedish economists Eli Heckscher and Bertail Ohlin had proposed the factor proportions theory or the factor endowment theory of international trade. This theory is based on the concept of the comparative advantage (or disadvantage) of a country based on its relative abundance (or scarcity) of the factors of productionavailable within its economy.The factor proportions theory advocates that a country should be engaged in the production and export of commodities that is primarily based on a factor of production which is abundantly present in its economy.Considering the framework of a two-country, two-factor and two-commodity framework of international trade, the theory states that the different nations are endowed with different proportions of the factors of production like capital and labor. Some nations have an abundance of capital resources but are short on available labor. Such a country would be capable of producing commodities using a capital intensive mode of production at acomparatively low cost. Similarly, countries having an abundance of labor resources would produce labor intensive goods at a low cost. The first country would then be inclined to export its capital intensive goods to the second nation and import labor intensive commodities from the latter. Through i nternational trade, both countries would gain access to both the types of commodities at the least cost. However, the present international scenario presents a different picture of international trade. Current world trade is dominated by the exchange of goods between homogenous countries which are found to have an advantage in the same factor (factors) of production. In such cases, trading involves commodities which are generated by a similar

Applying Bradshaws model of river characteristics to the Barranco Del Essay

Applying Bradshaws model of river characteristics to the Barranco Del Rio, Tenerife. With the focus on the impact of landslides - Essay Example in the introductory parts of the paper for the better understanding of what will be discussed and linked with the hypothesis as well as the Bradshadow model (Arthur, 2007, page 391). The methodology used in the study has included the designs, the various equipments used in testing and experimenting as well as measuring, and the instruments. This study is therefore aimed at determining the drinks’ possible effects. It is also important to highlight that this paper has specified coherently the procedures and the results of the study. The study has been summarized with a clear conclusion. It is therefore important to highlight that the report is therefore quite detailed with the facts that were collected and the truths about Tenerife (Christine, 2001, page 281). It is important to highlight that this paper delves in the discussion of the Application of Bradshaw’s model of river characteristics to the Barranko Del Rio, Tenerife. The paper as well focuses on the impact of landslides. In the paper, there will be various diagrams that illustrate the various stages at the distinctive stages of the river. This is a report of a fieldtrip undertaken to Tenerife where variables of Bradshaw’s Model of River Characteristics were tested on a Barranko (river valley), focusing on the hypotheses that are listed below (Donald, 2008, page 518). Tenerife Island has a land of 2034.38Km2, the most densely populate is and in Spain. This as well makes it to be the largest island of the Canary Islands archipelago. It is important to highlight that it is one of the Canary Islands. It is connected using two airports that well developed for the enhancement of the accessibility of the island. These are the Tenerife north airport and the Tenerife south airport. The island was formed due to volcanic eruption and nearly visited by above 10 million tourists every year because of the scenic beauty in the island. The soils I this area are therefore the permeable volcanic type of soils that

Why did presidents Ford and Carter lose public confidence Essay

Why did presidents Ford and Carter lose public confidence - Essay Example The main intention of the pardon by President Ford was to move on from the Watergate scandal (Greene, 276-283). However, the people had a different view as they felt this was just an everyday political move. On the other hand, Carter campaigned with the promise of honesty to the citizens, which was well accepted at first and gained him the presidential position. However, his leadership was poorly reflected by his inability Another reason why President Ford was unable to gain the confidence of the people is that he inherited the economic problems from Nixon’s era, and was also incapable of restoring economic stability in the country. The inflation continued to rise along with the level of unemployment (Greene, 276-283). Furthermore, there was an increment in the interest and regardless of the reduction in taxes; the people were still economically unstable. There was also problems in the foreign interests of the country as in Vietnam the North significantly defeated the South. As mentioned above, Carter gained the confidence of the people through his campaign policy of honesty (Rosenbaum, 331-337). However, there was still an economic crisis in the country. In the addition, there was also a rise in the oil costs which further worsened the situation. Carter made some progress in the form of pioneering many peace treaties; however, we failed to fix the Iranian hostage problem (Rosenbaum, 331-337). There were American hostages that were captured by Islamic terrorists in Iran, and Carter failed to free them, which led to the loss of confidence from the people. Hence, the reason the two presidents lost the confidence of the people is that they unable to resolve the pertaining situations that were affecting the country such as the economy and the high levels of unemployment. In addition, some of the decision making was poor by both presidents, for example, the pardoning of Nixon by Ford when he

Strategic Plan for a Popcorn vending business Research Paper

Strategic Plan for a Popcorn vending business - Research Paper Example The names of management team members are John Smith, Jessica Wilson, Michelle Williams, Peter D’Souza and Tracy Crosby; the company was founded to meet the growing demand of high quality and efficient popcorn vending machines. The company has grown from one location in a shopping mall to five different locations in various parts of the town; the expansion has been done in a period of two years and it is expected that the number of locations will expand further in future as vending machine industry is expected to grow at an accelerating rate of about 10% (Gerdees, 4). In order to penetrate further in the vending industry, the company aims to introduce new and innovative commercial vending machines for restaurants along with food and beverage equipment. Currently, the company is employing a secretary, one general manager, two supervisors, ten paid line employees and an accounting manager. Since the company is small, there is also one Human Resource Manager, one Production, Operations & IT manager and one Marketing & Sales manager. The span of control and line of communication is shown in the following figure: The management team ensures that the communication in the organization is open so that the employees can have easy exchange of information and the business plans are effectively developed and implemented. With the help of the organization chart, everyone within the organization will be aware of their reporting responsibilities that who will be evaluating their job and performance. The chart will even ensure that everything is well-organized and co-ordinated. At present, the company is manufacturing the pop corn vending machines for small organizations and it is planning to design customized popcorn vending machines in the next two years that can be placed in public places so that the pop corns are easily accessible by the people. However, the company will offer newly designed coffee vending machines along with soft drinks vending machines so

Community Health Social Care Essay Example for Free

Community Health Social Care Essay Welcome to the Foundation Degree in Community Health and Social Care offered in partnership with a number of Further Education colleges, and validated by the University of Wolverhampton. Foundation Degrees are a vocationally focused higher education qualification located at intermediate level in the Framework for Higher Education Qualifications. This foundation degree has links with local and national employers ensuring that skills are developed through work-based learning, which is a major part of any foundation degree. This combined with higher-level knowledge and understanding reinforces and supports the development of vocational skills. Although the University of Wolverhampton has validated the foundation degree, the study will take place in one of the partner colleges. In the following pages you will find a brief description of the programme, the modules and other information that we think you will find useful. More detailed information about each module will be given by module leaders during your studies. We have also included details of awards that you may wish to progress onto after you complete the foundation degree. We work closely with the course leaders in all colleges. Arrangements will be made for you to visit the University. We look forward to seeing you then. If you have any issues or concerns that you wish to discuss please contact your course leader at your college. 2About this Guide The purpose of this guide is to provide you with information about the modules offered within the Foundation Degree. In addition to the information contained in this Pathway Guide, you will need to be aware of: The University Academic Principles and Regulations, which are available from the university web site. These regulations explain how the credit system operates, and the number of credits that must be studied at different levels in order to qualify for the different awards offered. Each college will arrange their own timetable – the course leader at your college will make you aware of this. All modules on the Foundation Degree in Community Health and Social Care are compulsory. On successful completion of the Foundation Degree, you will be awarded a ‘pass’. The University can also provide you with a formal transcript of your module results if you wish. If you decide to complete end your studies after successfully completing year One, you may be eligible for a Certificate of Higher Education. At the end of this guide you will find information on further study at the University of Wolverhampton. Introduction to the Health and Social Care Subjects The Foundation Degree provides an educational opportunity for undergraduates who come from a variety of backgrounds. The Foundation Degree aims to provide appropriate academic health and social care teaching for a wide variety of students, from across the NHS and the health and social care arena. The award may be studied on a full or part time basis. Full details of this can be found by asking the contact at your local college. We may be able to award some students credits for specific modules if they can demonstrate that they have already met the learning objectives. This is known as Accreditation of Prior Achievement. Please discuss this with the tutor at your college in the first instance. It is expected that all student will have work experience (this can be paid or unpaid) within the Health or Social Care field.

Martin Luther King Jr’s “Letter from Birmingham Jail” Essay Example for Free

Martin Luther King Jr’s â€Å"Letter from Birmingham Jail† Essay Martin Luther King Juniors â€Å"letter from Birmingham Jail† was the reflection upon protest against unjust laws was established against him and his fellow men. Throughout his letter he uses many great philosophers and historical events to justify his own protest to be necessary to do what’s right. King was the leader of civil-rights group that supported protest against traditional views of the society and unjust laws established in the era.† In any nonviolent campaign there are four basic steps: collection of the facts to determine whether injustices exist; negotiation; self purification; and direct action. † ( Taylor) In his letter from Birmingham Jail King states: â€Å"It was illegal to aid and comfort a Jew in Hitler’s Germany. Even so, I am sure that, had I lived in Germany at that time, I would have aided and comforted my Jewish brothers. If today I lived in a Communist country where certain principles dear to the Christian faith are suppressed, I would openly advocate disobeying that country’s anti-religious laws† (King, 6). Here in this excerpt shows that King encourages protest because in some extreme circumstances becomes necessary, be it in Hitler’s Germany, a Communist country, or any situation in which injustices are occurring. In the end of the sentence King openly admits that he would protest against established laws or traditions by all means necessary because they favor the unjust. The letter was written to his fellow clergymen to explain his prior actions and to attempt justified and appropriate for the situation. He expressed that he exhausted every other option to justify them. In the letter he tried to explain to the clergy that his actions although illegal were possible and direct action was the only available option left, which could make a difference. â€Å"One may well ask: â€Å"How can you advocate breaking some laws and obeying others?† The answer lies in the fact that there are two types of laws: just and unjust. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that â€Å"an unjust law is no law at all†. Now, what is the difference between the two? How does one determine whether a law is just or unjust? (King, 5). Throughout history, there have been many unjust laws. Many people follow laws just because they are laws. Sometimes people don’t even agree with a law, but they go along because it’s in society acceptable or because it’s just the law. I think that by writing the letter, and putting forward the definition, King is challenging his readers to consider whether or not a law is just. If a law is unjust, it is the responsibility of the people to get it overturned. A society should not live with an unjust law. By choosing to go against law it shows that king primarily a teleological thinker. In conclusion, King wrote â€Å"Letter from Birmingham City Jail† for the purpose of making his audience realize that they are not carrying out our Constitution and the Declaration of Independence which is the United States was founded upon. King only wants what should be granted to all United States citizens, this being freedom, justice, and equality. He is saying he is in jail for only doing what is right, by trying to achieve what is right through non-violence and the fact that he is in jail is unjust, does not support equality, and freedom. Work Cited Taylor, Justin.† Between Two Worlds. Martin-luther-king-jr-letter-from-birmingham-jail† http://thegospelcoalition.org/. 23 Jan. 2013.

The Dalai Lama And The Tibet Politics Essay

The Dalai Lama And The Tibet Politics Essay General Background: The Tibet is an autonomous region which is located in China and beside Nepal, this region was an independent country in 10th century, but it has suffered many invasions from the Mongol empire until an English invasion. In 1904, a British army gets to the Tibet and in 1906 the Tibet becomes a British protectorate; in 1907 Great Britain and Russia gives sovereignty to China; in 1912, 1931-1933 and in 1949 there are several attempts of Tibets independence. The Dalai Lama has been involved in this problem since 1904 when he was exiled in Mongolia, since this date he has been promoting the liberalization of the Tibet. Since 1949 that China invaded the Tibet there has been a loss of the Tibets liberty by the communist ideology of China, since this year China gave the power to the Dalai Lama in terms of internal issues but education and culture is managed by China. China and Tibet have had several disputes through many years because of the want of the Tibet for independence and the want of China of the Tibet as a definite region of China and the Dalai Lama has been affected by this conflict because he is a pacific mediator and has lost his credibility. The Dalai Lama as a politic figure does not recognize: the social system, the Tibet as a part of a Chinese territory, he insists in making The Tibet an independent republic and take out any person who is not a Tibetan citizen. This situation is a conflict, not only because it is a long term issue but also because it has involved a lot of persons and it has been difficult to find a solution to the problem. Since the conflict starts, around 1900-1907 with the invasion of the Tibet by United kingdom and China and continue escalation all the XX Century, this conflict has involved a lot of Chinas generations and Tibets generations, now the kids of both regions not only know the conflict, but also are determined to fight for the specific objectives that each region has. This conflict has a lot of issues that apparently are not able to negotiate: the different cultures of the regions are the protagonist (parties) of the conflict, and like every culture around the world they are trying to protect their believes and values as hard as possible, no one wants to negotiate even a custom. This issue has faced some of the most important people in the history, Mao Tse Tung and Dalai Lama, both with no congruent objectives what made so difficult a negotiation between them. The conflict starts not only by a land interest but also cultural affairs en which both sides dont want to give a step back in order to protect their culture and their sovereignty, unfortunately this has caused a lot of damage in the region, a lot of violent deaths. Human Rights organizations estimate that a many more than 1 million people lost their lives, and also that a lot more than 100,000 people are living in exile in India, Nepal and other countries; frustration in some people who want to protect their family and rancour (Ill feeling). The above confirms the affirmation that the Tibets conflict is a cultural derived problem: as it was told before, the parties are trying to protect their cultural and economic believes, but also each leader has entered the game to protect their own thoughts and culture with which he was raised There are many perceptions in this conflict; China argues that Tibet is part of china since hundreds of years, because of the dynastic unions between them and the conquerors made by China through history. This contrasts with the argument that gives the Tibet that China has controlled them using the force and has imposed them his traditions also the Tibet views China as a different country with its own traditions. Tibet civilians feel that the China government does not respect them and that they are treated in a different way than the China civilians are treated. This conflict is intractable now that Tibet and China have had strong discussions and wars, both have suffered many deaths because of this and there still exists a conflict of values and customs between both, in spite of the fact that many countries have gotten its independence either in pacific or horrible ways since the Tibet doesnt have the support of the strong countries nor NGOs it is really complicated for it to get to its main objective. In a future the conflict could be tractable if they start to develop a good international relationship and try to find a way to solve their differences and get to a win-win situation. This conflict is systemic now that it involves more than two parties, there have been third parties involved such as Great Britain, Nepal, Mongolia and nowadays United States is mediating. Also, there have been several issues such as geographical, resource issues, ideological issues and custom issues. There are three main sources of the conflict: conflict of interests and values because both have the same interests but here comes the goal conflicts which are different, while China wants the Tibet to be part of his domain, the Tibet wants freedom. This conflict is presented in an intergroup level of organization now that it is between China as a whole and the Tibet as a whole and having the Dalai Lama as a mediator but more towards defending Tibet. A big problem is that in spite of the fact that there are two distinguished parties; one is inside the other one, because Tibet is located in the south west of Chinas territory. Stages Latent conflict: the conflict started to appear when Great Britain and Russia give the sovereignty over Tibet to China, because since then China has the government of Tibet, controls almost all the factors that influence the region. Conflict emergence: Dalai Lama had had the government of Tibet for a while and the Chinas army made an invasion where Tibet was forced to face the direct loss of life and freedom. Escalation: Dalai Lama was ruling in parallel with Chinese government but when Tibetan territory was considered a Chinese province, there was developed a rebellion against China. Chinas army killed a lot of Tibetans so Dalai Lama had to escape to India. This conflict reached an escalated form because several characteristics, among them are the constant search for independence from Tibet, the disrespect of human rights for Tibetans, coalition of ideologies (Tibetans are against communist ideology or social system) and the principal is that China is not willing to lose Tibet because that land is very rich in minerals. In general there are a lot of issues in terms of politics, the nature of society, law, human rights, religion, culture, the identity of people, the economy, and the state of the natural environment. The condition that most encouraged this escalation was that China killed a lot of people and its trying to impose communism, and by the other side, China sees Tibetan religion as a big threat to the communist party so they dont let Tibetans to act against their principles and Tibetans dont want to accept them because their unique leader is Dalai Lama and rightness is what Buddhism establishes. This escalation is considered a rational action because there have been simultaneous activities that have encouraged this conflict, Dalai Lama and Tibetans are defending their culture, religion and territory, and China is reacting to Tibet rejection to its ideologies and is not willing to lose this land. Both parties tend to use distributive strategies because they look for keeping the same territory and their own ideologies so their motivations and interests are incompatible, where a win-lose situation takes place, for example, Tibetans ideal situation is having freedom, being directed by Dalai Lama and the right to develop their own religion and culture not the ones that Chinese government is imposing them, so they use strategies like claiming for peaceful negotiation and agreements to get to a deal where they can get the so called Tibetan independence, but instead, China uses stronger strategies like invasion and imposition. This conflict is being managed in the way that there have been some temporal agreements that are good for both and help maintaining peace but sometimes they have been disrupted by one of the two parties. Nowadays, Dalai Lama has a government in exile, hes directing Tibet from the outside but Tibetans and he will fight until he can get back to his motherland and reach independence. The conflict is mainly of competitive nature since both territories are fighting over the domain of the Tibet. They are trying to earn international trust and support from other countries to each one of them get to its goals and interests. This is why it is a continuous competition. Is there any trust within the parties? To answer this question we have to say the types of trust that we know: The identification based trust, and the calculus based trust. So the first one is inexistent in the conflict, because this kind of trust is based on the identification with the other since you have the same goals, interests, meetings, activities and other things (in common), and it is evidential that the Chinese government and the Tibetan population have different interests, goals and activities, for example: the Goal of the Chinese government is to control The Tibet, and the goal of the Tibetan is to control herself. So according to the latest, there is one trust yet, the calculus based trust,   this one is the one in which you analyze the possible rewards or punishment that you will have if you trust the other. As well as the Identification based trust, the calculus based trust is inexistent too, why?, it is because of the continuous attacks made by the Chinese and Tibetan , government and population respectively, so both motivated by the past have a perception in which they won`t trust each other, because they have been punished in the past. We think that they in the future can trust each other, but the first step to do it is by the calculus based trust, they have to be concern that they are causing problems to both sides so they have to create this calculus based trust by no attacking the other, by accomplishing what they say and finally negotiate about this conflict in a problem solving way, and maybe in a far future they can have an identification based trust. If a specific tactic is scheduled as unethical, it will depend of the ethical approach: for example, it could be said that the military massacre that occurred in 1959 by the hands of China is ethical if we analyze the issue in an End result way, but if we analyze it in Social contract way (Point of view of the countries outside the conflict) it will be said that is totally unethical. Based and the Social Contract analysis, it has been unethical tactics for both parties: China has invaded and killed in the Tibet area, also China has tried to create a bad reputation of the Dalai Lama. By the Tibet side, it can be said that some militia has used the force, and there are some comments about the manipulation that Dalai Lama could do through culture and regional feelings (emotional manipulation). The conflict had some negotiations, for example in 1950, China -commanded by Mao Tse Tung- entered to the Tibet with 40000 soldiers, this attack impose to the Tibetan leaders to accept a an alliance called Agree of 17 points, in which the communist leaders of China and the leaders of the Tibet, agreed in the restoration of the China`s sovereignty in Tibet, this alliance was signed in May of 1951. According to this we can conclude that the Chinese government had negotiated, and in this negotiation the Chinese government put his interests over the Tibetan population using his power to dominate them, so is a domination style. CONCLUSION The conflict between China and the Tibet comes since hundreds of years, across the history the Tibet has done revolutions to be free and China has made campaigns to dominate the Tibet , and fewer times that China has negotiated, China has used a dominated style (win-lose situation), the winner has been China, who is the owner of Tibet. The Dalai Lama, leader of the Tibet is hidden on India, he had been attacked by China with a bad-image campaign, and the China government is discriminating the Tibetans population, China puts his interests over the Tibet interests. China has some interests on the Tibet like the geopolitical strategy -The Tibet has a lot of natural resources that China is interested in-, the power, the cultural issues and the imposition of socialism.