Conditions on Each Planet

Mercury : Due to mercury being extremely close to the sun, causes its planet to have no atmosphere. If any air was ever around Mercury, it would have been within its early years and from that point to now, it is gone because of all of the heat being given off of the sun. Mercury has crazy weather issues because of the lack of atmosphere, which includes a drastic weather change within day to night. Whenever the sun touches the surface of Mercury, that is when the climate reaches its highess at 801 degrees Fahrenheit in the day time. Because of the lack of atmosphere in mercury, the Mercurial sky is black and the stars can be seen in broad daylight. The night time becomes a different situation, at this point it leaves it at a chilling climate where it is -300 degree Fahrenheit. Venus : Venus contains a wonderful thick atmosphere which is made up of 97% carbon dioxide. Venus's pressure at the surface is 92 times stronger than on Earth. Its temperature goes to an extreme result of 900 degrees Fahrenheit, which mkes it the hottest planet of all. Its atmosphere is this way because of a strong volcanic activity during the past. Venus deals with sulfuric acid rain falls that come from its swirling clouds but is gone before even reaching the ground. Earth: Earth has the most dynamic weather in the solar system compared to the rest. The atmosphere has changed a lot compared to the Earth's early atmosphere, but for the last billion years, it has remained pretty constant. There are 3 very different atmospheric problems that is needed to be kept close attention to. The three atmospheric problem are the greenhouse effect, damage to the ozone layer, and acid rain. The earth is surrounded by a blanket of gases, this blanket traps energy in the atmosphere, much the same way as glass traps heat inside a greenhouse. This results in an build up of energy, and the overall warming of the atmosphere. The greenhouse effect is a natural process which made life on Earth possible. Ozone is oxygen that contains molecules that have 3 oxygen atoms. There is a layer of ozone high p in the atmosphere which shields the Earth from the sun's harmful UV rays, these rays can lead to an increase in skin cancer. The ozone is present in very small quantities but it is enough to absorb the UV rays preventing them reaching the surface. Concentrations of ozone appeared to be dropping in certain areas of the world (the layer was starting to thin-out). The cause of this reduction was thought to be man-made. Rain water is naturally acidic due to carbon dioxide which partially reacts with water to give carbonic acid. Acid rain is caused by other gases released when fossil fuels are burnt. Mars: Mars's atmosphere made up of carbon dioxide, Venus's atmosphere is much more than Mars. The temperatures on Mars ranges from 80 degrees to -200 degrees Fahrenheit. Mars experiences seasons too. There is dust storms that are frequently occurring. Mars's atmosphere, has fog and frost forming on the Red Planet because of the water vapor. Jupiter: Jupiter's atmosphere has clouds which are striped with dark belts and light zones. High winds and lightning are a regular feature on Jupiter. Other small eddies and whorls form and dissipate in the cloud layers. The temperature on Jupiter is approximately -234 degrees Fahrenheit only. Saturn: Like the other gas giant planets, Saturn's atmosphere is mainly hydrogen and helium. Saturn is a windy planet, with 1,000 mile an hour, winds do a good job of mixing the atmosphere and making it appear homogeneous through Earth based telescopes. Saturn's tilt creates seasons and uneven temperatures on the planet. The top of the clouds have an average temperature of -285 degrees Fahrenheit, with warmer temperatures deeper in. A churning hexagonal cloud formation has been spotted near the North Pole and has persisted for a few decades now. Uranus: Uranus is unlike the other planets in that it is tipped on its side, and, in essence, rolls along in its orbit. At -350 degrees Fahrenheit, its atmospheric conditions stay the same for many years at a time (its year is 84 Earth years), until it experiences seasonal changes, sparking storms in its atmosphere. Neptune: Neptune is the record holder for the windiest place in the solar system. At about 1,250 miles per hour, the winds of Neptune makes it a stormy place, evidences by a Great Dark Spot that is a giant hurricane-like storm, similar to the Great Red Spot on Jupiter. The methane gas in the atmosphere is what makes the planet appear blue. White storms clouds that zip across the planet are common. Neptune's temperature averages -373 degrees Fahrenheit. Pluto: Pluto holds the place as the farest object in the solar system feom the sun. Pluto's distance from the sun gives it a large range of temperature on its surface, its stated as the coldest by Earth's standards. It is so cold on Pluto that a regular theromater can not state its coldness, scientist have to use a Kelvin scale. Using Kelvin scale, Pluto's temperture is at 44 K which is approximately -239 degrees. Its maximum reaches at 55 K ( -218 F ) and a minimum of 33 K ( -240 F ). Pluto maybe the coldest planent but surprisely, it has a warmer atmosphere than the surface of the dwarf planet. Its warm atmosphere is from the presence of unexceptly large amounts of methane.

Thesis Ideas

Thesis Ideas Thesis Ideas Thesis Ideas One of the best ways to learn about writing is to start write, to re-read and to edit your work in accordance to the required style and specified thesis format. Sometimes, a supervisor can seem to be a real pest in exhorting students to 'write it down'. But this is often the best advice. Start by writing your thesis ideas down, and ask yourself whether there is a logical flow of ideas in your writing. There is something about transferring knowledge or information from its mental repository or from some conceptual domain on to a page that tends to clarify thought and build coherence. We think a couple of basic tools are needed: an open mind; a dictionary; a thesaurus and/or style guide. If you possess these, you are in a good position to gather thesis ideas! Thesis Dissertation Writing Your writing will determine whether people understand what you have to say, and whether they agree with it and remember your conclusions. This brings us to the hard reality of who you are writing your thesis for. If you think huge hoards of fellow scholars are going to fall over themselves to borrow your thesis from a library - forget it! In reality, very few people will read your thesis, but many more will (you hope) read subsequent articles, chapters and/or even book derived from your thesis ideas. Your thesis will usually be read only by your supervisor and your examiners. The examiners, your most important audience, are also likely to read the thesis in a short period of time. Thesis Writing Consider this analogy: writing a chapter is like watching the news on television. You turn on the evening news, and what do they tell you? The answer is simple: they tell you the headlines, then they tell the news in detail, then they sum up the highlights. Formal academic writing is much the same: the entire thesis and each chapter should contain some form of introduction, a body and a conclusion. The main ideas or arguments should be captured within the introduction in order to focus the reader's attention on the main theme and motivate them to continue reading. The various sections comprising the body of your project should then continue in a logical format. The conclusion should summarize what has been written in the thesis, and link this summary with the original argument outlined in the introduction. There should always be a coherent, logical and consistent thread woven through each section, through each chapter and throughout the thesis. offers you an opportunity to order professional thesis writing assistance.   We will help you thesis ideas, writing, and editing. Do not miss this chance to ease your academic struggles!

Simile vs Metaphor The 1 Big Difference

Simile vs Metaphor The 1 Big Difference SAT / ACT Prep Online Guides and Tips Ever wonder what makes creative writing, well, creative? A big part of creative writing is coming up with a compelling way to express something.And similes and metaphors can be especially helpful when trying to do this. But what exactly are similes and metaphors? More importantly, what is the main difference between a simile and metaphor? This comprehensive simile vs metaphor guide answers both these questions and gives you several examples so you can learn how to differentiate between these two key literary devices.This article also includes key tips for using similes and metaphors in your own writing. Simile vs Metaphor:How Do They Differ? Both similes and metaphors are literary devices used by writers to compare two unalike things, ideas, actions, etc. in a non-literal manner. The two things being compared typically have one thing in common but are completely different in all other respects. Peopleuse similes and metaphors to make their writing more descriptive, more persuasive, more poetic, and more emphatic.Similes and metaphors areoften used in fiction/prose, poetry, and song lyrics. So what is the main difference between a simile and metaphor? Although the two devices are very similar- both serve the exact same purpose of comparing two different things in a figurative (non-literal) way- metaphors and similes are not identical. A simile is a type of metaphor that specifically uses the words "as" or "like" to make a comparison between two things. This usually takes the form of "A is like B" or "A is as(insert adjective)as B." By contrast, metaphors do not use the words "as" or "like." For example, you could write, "A is B" to make your comparison, even though A is not literally the same thing as B. The main takeaway here is that all similes are metaphors but not all metaphors are similes. 6 Real Simile and Metaphor Examples To help you understand the difference between a simile and metaphor, we'll look at six examples of the two. Examples of Metaphors Belowarethree examples of famous metaphors. As a reminder, metaphors compare two things without using the words "like" or "as." Metaphor Example 1 Eyes are the windows to the soul. Many famous sayings andidiomatic phrases take the form of metaphors in which the meaning is not literal but implied through a comparison. You clearly cannot literally see a person’s soul through his or her eyes; the implication here, then, is that one’s eyes and expression can reveal that person’s true feelings or character. In this sense, eyes are similar to windows because they can reveal information to the observer. Metaphor Example 2 "But thy eternal summer shall not fade"- William Shakespeare, Sonnet 18 This line of poetry comes from one of William Shakespeare’s most beloved sonnets, often called "Shall I Compare Thee to a Summer's Day?" In this poem, Shakespeare is comparinga young man's beauty to that of a warm summer day. In this particular line,the speaker assertsthat the man's "eternal summer" will never end, meaning that the speaker believes the essence of the man will live onthrough these very words. Shakespeare was a fan of metaphors- and earrings, apparently. Metaphor Example 3 "'Cause, baby, you're a firework / Come on, let your colors burst"- Katy Perry, "Firework" In her mega-hit song "Firework," Katy Perry uses a metaphor to compare "you" (the listener) to a firework. Fireworks are bright, captivating, and attention-grabbing, and so the implication here is that "you," too, are important and need to be confident in the value you bring. Examples of Similes Next up, here are some examples of famous similes. Remember that althoughsimiles perform the same function as metaphors in that theymake a comparison between two different things, similes always use the words "as" or"like" to make the comparison,whereas metaphors do not. Simile Example 1 My dad always wears glasses. Without them, he's as blind as a bat. The above simile "[as] blind as a bat" is a particularly well-knownsaying that compares a person's inability to see to the (alleged) blindness of bats, which hunt for prey primarily using echolocation instead of sight. Basically, this simile means that someone’s ability to see is quite poor. (Note that this saying isn't normally used to describe someone who is actually blind- it’s purposefully hyperbolic!) In this example, although the dad is evidently not blind- he just wears glasses to see- this simile implies that his ability to see things clearly without glasses is shockingly (and even laughably) low, comparable to a bat's inability to see clearly. Simile Example 2 "I wandered lonely as a Cloud / That floats on high o'er Vales and Hills"- William Wordsworth, "I Wandered Lonely as a Cloud" You’ve possibly already read this famous poem in English class. These two lines, the first of which contains the simile "lonely as a Cloud," come from William Wordsworth’s renowned 1807 poem, "I Wandered Lonely as a Cloud." The simile here draws a unique and compelling comparison between the loneliness of the speaker, who wanders around without accompaniment, and the "loneliness" of a cloud that floats around in the sky all by itself. Note: This simile uses another literary device called personification, whereinan inanimate object is given human-like qualities. In this case, the cloud "wanders" just as a human does. Simile Example 3 "My momma always said life was like a box of chocolates. You never know what you’re gonna get."- Tom Hanks in Forrest Gump Even if you’re not a die-hard Tom Hanks fan, you’ve probably heard this memorableline from the 1994 classic Forrest Gump. The phrase "life was like a box of chocolates" is a clear simile in that "life" is being compared to "a box of chocolates" using the word "like" (which once again shows us that this is a simile and not a metaphor). The meaning of this simile is clearly explained in the sentence that follows: "You never know what you’re gonna get." In other words, life is random and mysterious in the same exact way a box of chocolates is. You can't predict what kind of chocolate you'll get,just asyou can’tpredict what will happen in your life. As long as it's not that weird, mushy, cherry-filled chocolate, I'm good. Simile vs Metaphor Quiz Here’s a short simile vs metaphor quiz to see whether you truly know the difference betweenthe two literary devices. Mark an X under "Metaphor" or "Simile" for each phrase depending on whether you think it has a metaphor or simile. Be aware that a phrase might contain both a metaphor and simile, or neither! Phrase Metaphor Simile 1. "But soft, what light through yonder window breaks? / It is the east, and Juliet is the Sun." - WilliamShakespeare, Romeo and Juliet 2. Poor thing, your hands are as cold as ice! 3. "Elderly American ladies leaning on their canes listed toward me like towers of Pisa."- Vladimir Nabokov, Lolita 4. "Dying is a wild Night and a new Road."- Emily Dickinson 5. The song was an array of bright colors swirling around in the air. Like medicine, it made the boy perk up almost instantly. 6. "Fire away, fire away / You shoot me down but I won't fall / I am titanium"- David Guetta ft. Sia, "Titanium" 7. That girl over there looks a lot like my sister. 8. "Just like a moth drawn to a flame / Oh, you lured me in, I couldn't sense the pain"- Shawn Mendes, "Stitches" Answers Metaphor Simile Simile Metaphor Both Metaphor Neither Simile Answer Explanations 1. "But soft, what light through yonder window breaks? / It is the east, and Juliet is the Sun."- William Shakespeare, Romeo and Juliet In this classic line from Shakespeare'sRomeo and Juliet, Romeo spots a light coming from Juliet’s bedroom, causing him to compare Juliet to a sunrise- an image that evokes a sense of wonder, hope, and happiness. Because Romeo doesn’t use the words "like" or "as,"this line is a metaphor. 2. Poor thing, your hands are as cold as ice! Here, the speaker is comparing the low temperature of the listener's hands to the (literal) coldness of ice with the phrase "as cold as ice." This saying is commonly used to indicate that a person or an object is extremely cold to the touch (even thoughthe thing being described is likely not literally the same exact temperature of ice). The word "as" is used to make the comparison, so this example is a simile. This bubble is literallyas cold as ice. 3. "Elderly American ladies leaning on their canes listed toward me like towers of Pisa."- Vladimir Nabokov, Lolita This beautifully descriptive sentence from Vladimir Nabokov’s controversial 1955 novel Lolita compares the image of hunched elderly women to the Leaning Tower of Pisa, a historical Italian building most famous for its noticeable tilt. Because Nabokov uses the word "like" to make the comparison between the women and "towers of Pisa," this sentence is a simile. 4. "Dying is a wild Night and a new Road."- Emily Dickinson Renowned American poet Emily Dickinson wrote this grave, albeit poignant, sentence in a letter penned in 1869. Dickinson compares the act of dying to "a wild Night and a new Road," implying that death is a natural course of action in life. Because the comparisondoes not use the words"like" or "as," it is a metaphor. 5. The song was an array of bright colors swirling around in the air. Like medicine, it made the boy perk up almost instantly. This example uses both a metaphor and a simile to express the overall positive feelings a boy has when listening to a particular song. The first sentence is a metaphor: the song he is listening to is described as "an array of bright colors," even though music isn’t actually visible to the human eye. Since this comparison doesn’t use the words"like" or "as," it is a plain metaphor. The second sentence, however, makes another comparison, this time using the word "like." The song is described as being"like medicine" because it makes the boy feel better- the same effect medicines are supposed to have on people when they feel sick. Because the word "like" is used, this second sentence is a simile. 6. "Fire away, fire away / You shoot me down but I won't fall / I am titanium"- David Guetta ft. Sia, "Titanium" This line, taken from the chorus of the 2011 hit song "Titanium" by David Guetta, describes the speaker asthesuper-strong metal titanium. This image, then, tells us that the speaker is really similar to titanium in that he or she is both strong and resilient. Because neither"like" nor "as" ispresent here,this lyric is an example of a metaphor. 7. That girl over there looks a lot like my sister. In this sample sentence, the physical appearance of "that girl" is being compared to that of the speaker’s sister. Although you might be tempted to say this is a simile because it uses the word "like," you’d be wrong! There is no metaphor or simile at play here.The "like" we see here is still being used to make a comparison, but it is a comparison between two similarthings (the two girls). Recall that the basis for any metaphor or simile is that you must be comparing two unalike things. Comparing a duck to another duckwon't give you a metaphor but WILL give you a ton of quacking. 8. "Just like a moth drawn to a flame / Oh, you lured me in, I couldn't sense the pain"- Shawn Mendes, "Stitches" This line comes from the 2015 pop hit "Stitches" recorded by Shawn Mendes. The speaker here is describing howmesmerized he is by his lover by comparing his situation to that of "a moth drawn to a flame." Because he uses the word "like" in this particular line, this lyric is an example of a simile. How to Use Similes and Metaphors in Writing: 4 Tips Now that we’ve gone over the major difference between a simile and metaphor, let’s take a look at four tips to keep in mind when you want to use one of these literary tools in your own writing. #1: Avoid Clichà ©s One big tip you’ll want to remember when writing anything- whether it’s a poem or a story- is to avoid clichà ©d metaphors and similes as much as possible. Using clichà ©d metaphors in your writing generally indicates to readers that you don’t find it necessary to take time to come up with original comparisons; it’s also often interpreted to mean that you lack creativity and are a lazy writer. Clichà ©s include any overused sayings or idiomatic expressions, such as the following: Strong as an ox Sick as a dog Time flies Hot as hell White as snow Scared to death Fish out of water Two peas in a pod Check out this website for a longer list of clichà ©s to avoid. Though you should generally avoid using these types of sayings, if you’re writing dialogue for a story, colloquial expressions such as these would beperfectly fine to use, especially if you’re trying to capture a more realistic conversation between people. That being said, definitely try toavoidusing clichà ©s in descriptions and expository passages. Coming up with your ownsimiles and metaphors will ultimately make your writing more creative, more authentic, and more compelling. #2: Don’t Overuse Similes and Metaphors Be careful of overusing similes and metaphors in any type of writing you do. Obviously, the definition of what counts as overusing figurative language will vary depending on the person. Indeed,whereas somerenowned writers adore metaphors andhave a penchant for flowery passages, others opt to avoid them as much as possible la Ernest Hemingway. No matter your preferred writing style, you don’t want your text to be ambiguous, confusing, or completely devoid of concrete substance. A passage that is 90% metaphorical is a lot more likely to exhaust and confuse readers than it is to impress or inspire them. Moreover, toomuch figurative language will weakentheimpact of each metaphor,and you want theseto be particularly powerful. So tread lightly and always err on the side of less is more! #3: Be Sure the Comparison Makes Sense Although the two things being compared in a metaphor or simile should be pretty different from each other, you need to make sure that there's still something similar between them so that the comparison makes sense to the reader and can be readily understood and interpreted. For example, if you’re trying to describe the delicious, tantalizing smell of freshly baked chocolate chip cookies, it wouldn’treally make sense to compare it to the smell of a dumpster or something else notoriously gross and stinky. Similarly, the connection between the two things must be immediately clear to the reader. If you were to write, "He looked as comfortable as a penguin," readerswould very likely have no idea how this feeling of being comfortable relates to penguins specifically. Instead, you could write, "He looked as comfortable as a penguin on ice," since penguins are mostat ease incold, icy settings. Alternatively, you could use asimile or metaphor to make an ironic or sarcastic statement. In the example given above, say you want to point out how uncomfortable the man is. This means you could write something like, "He looked as comfortable as a penguin in a Miami zoo." Because penguins' natural habitat is in the (much colder) Antarctic, the irony here is that the man is clearly not comfortablein the same way penguins must feel in a hot, caged environment. If you’re not sure whether a metaphor or simile you’ve written makes sense, ask a family member or friend to read it (ideally in context) and see whether they can grasp the meaning you’re trying to make with it. Be as comfortable (and as adorably fluffy) as these baby penguins. #4: Avoid Sticking With the First Metaphor You Think Of This final tip is for serious writers and one I got from my own creative writing professor in college. The basic point here is that you should never feel compelled to go with the first metaphor or simile you come up with. When people write stories, they can be tempted to stick with the very first "clever" metaphor or simile they think of- but oftentimes these phrases can be drastically improved upon and made clearer and more relevant. But is it really bad to stick with the first metaphor you think of? Of course not! Sometimes people do come up with amazing metaphors right away and end up keeping them as is, even in the final version of the text. But this certainly isn’t the case for most people.In reality,the best writers will be the ones who take time to reread, tweak, and improve sentences and passages- including metaphors and similes- they’ve written. Doing all this will not only give you practice with metaphors and similes, but will also help you get used to the long-winded, albeit worthwhile, process that is creative writing! What’s Next? Got questions about other common literary devices? Then check out our in-depth guide to the 31 most important literary devices you should know. Working on a story or prepping for the AP Literature test?Learn all about the most important literary elements that make up a story. Thinking about amajor in creative writing? Then you'll definitely want to take a look at the top creative writing programs in the country!

THE COMPARISON OF CONTRAST MEAD AND BOURDIEU THEORIES Essay

THE COMPARISON OF CONTRAST MEAD AND BOURDIEU THEORIES - Essay Example Perceiving a house is same as to perceive shelter. That is why it is concluded that perception is the action plans that individual takes (Baldwin, 90-91). Mead’s society based on an open society of open selves, (Herbert, pp 6). His theories are synthesis of German idealism which states that, the self’s â€Å"perception and semantics’† and "a common practice of various subjects" (Baldwin, 203-205) found particularly in social brushes., Mead’s self states to be significantly knitted within a sociological presence: For Mead, existence in community lies before individual awareness. Mead focused that all human beings including men and women start their apprehension of the social world through "play" and "game". "Play" lies prior in the childs development and growth (Baldwin, pp. 23-31). The self-development is dependent on learning in order to capture the role of other. Therefore, a child can play different actions he notices in "adult" society, and performs them out to take an understanding of the various social roles. Moreover, it is simply the matter that, what others do. Every step is a learning step that starts from imitation through play acting world of children. Whereas, Pierre Bourdie was a famous French sociologist born on first august 1930.his work provide the framework for social and symbolic violence that enables the dynamics to reveal the human power connections in our social life. However, he argued that individuals either schools or writers should bring their expertise to bear responsibly on political and social issues. He drew different methods from a broad range of various disciplines, specially philosophy anthropology and sociology. One of his famous books is â€Å"Distinction† describes the space of social lifestyle and space of social positions or a Social Critique of the assessment of Taste. Moreover, Bourdie describes the scholastic point of view, means things of logic and logic of things. Moreover, he loved intellectual combat,

Bussiness Plan II Essay Example | Topics and Well Written Essays - 3250 words

Bussiness Plan II - Essay Example eeds and demands of the clients, as opposed to general training, which is being offered by different organizations through seminars and other group programs. To ensure that it achieves its objective of providing a unique product, the company will divide its market into different segments in terms of age and geographical characteristics. The company recognizes the strength it has as it joins the market such as the experience of the founders, but it also recognizes the fact that it will face stiff competition from providers of the same service. In addition, lack of enough funds may make the company not to compete favorably with others due to lack of advertising and other promotional activities. At start-up, the company will operate from the premises of the founders so as to minimize the operation costs. Further, the company intends to break –even within the first two years of its operation. Once the company breaks-even and the sales thereof increase to a considerable level, the company will employ a number of growth strategies. These include online sales, acquisitions, decreasing operating costs, market research and reaching out to new client base among others. In cases of stiff competition, the company’s contingency plan includes sourcing of funds to be used for intense advertisement and building of co mpetitive advantage. The general core business of the company is to provide and present information for the postmodern youth worker by providing workshops, speaking engagements, consulting and seminars to disseminate relevant information pertaining to all kinds of issues of Christian adolescents and teens. This marketing plan aims at providing the business clientele with high quality services. A tailor made program will be organized for all customers with a view of meeting the diverse demands of different youth groups in the community. Presently, there are many youth workers, who are highly motivated and passionate with their work, who have been working with

Leadership and People Management Assignment Example | Topics and Well Written Essays - 750 words

Leadership and People Management - Assignment Example His action of consulting each member of the team is very crucial to mention. Every aspects of business operation such as financial, sales, human relations and maintenance operations are considered towards formulating a solution. This leads each involved to participate and form part in the decision making. In financial concerns, he was able to think of the cost and consult for figures that can contribute greatly to the existing alternatives on hand. In sales and human relations, he was able to consider the side of customers and employees respectively. His action leads to a group discussion about the issue that gave everyone a chance to voice their comments and suggestion as far as their responsibility is concerned. The consensus of each member results to output that can be consider and use in the decision making process. This will further combine their opinions and mindset in order to come up with a common decision for all. On the other hand, the ineffective actions of Bud will include of his coming late in the set meeting. Though a reason is provided for his action, a misinterpretation in line with the urgency and value of meeting is possible. He is able to create a discussion among members but no define goals is set for each responsibility. Organization of tasks in order to create a common decision is missing. The opinions, suggestions and comments from the group do not reflect goal setting towards achieving the task. His degree of initiating structure is inadequate, with regards to organizing and delegating responsibility to team members. The establishment of procedures, work timetable, and expected output from members is not evident. The degree of consideration on the other hand is given more emphasis by Mr. Bud. The environment became very warmth and full of support that lead each member to eye the effect on their own area of responsibility only. The focus towards the real issue receives little attention against other concerns that Bud and other member finds more interest, the office party and lunch meeting for instance. The idea of Bud of reaching a decision at a later time and seeking a consultant for the said issue is a result of poor focus on the task to be accomplished. The enthusiasm he shows is not sufficient to lead his members to formulate and come up with a right decision. There is no eagerness on his side to accomplish what is viable even when the time seems to be early. In order for the meeting to be successful, various points should be concerned about and done. Foremost is the setting of the meeting environment and work ethic, Bud should give the meeting schedule of high importance that a crucial decision needs to take place, and that his punctuality should be observed on the set schedule. In this connection, the rest of the team will be aware of the significance of the situation and this will entice goal setting and increase drive to accomplish them. As far as every aspect of the operation is concern, every detail should be considered in the process of decision making. In terms of financial issue, Bud should foresight every figure that will count. The decision to be developed should have that capability to deal with possible implications in the future and the cost benefit analysis should be given emphasis. Customers being regarded as the

Idiopathic Pulmonary Fibrosis: An Overview

Idiopathic Pulmonary Fibrosis: An Overview Jennifer Beardsley Abstract Idiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease that has no cure. The term fibrosis refers to scarring, in IPF particularly the scarring of the lungs. The scarring causes irreversible destruction and progressive decline of the lungs. When the tissue thickens, the lungs cannot properly exchange oxygen. The term idiopathic, in medicine, means that the origin of the disease is unknown. The exact cause of IPF is unknown, however, certain risk factors such as smoking, exposure to inhaled toxins such as asbestos, lung injury, viral, and bacterial infections, acid reflux and genetics associated with the disease. IPF mainly affects people ages 50 and up. â€Å"Many people live only about 3 to 5 years after diagnosis. The most common cause of death related to IPF is respiratory failure† (â€Å"What Is Idiopathic Pulmonary Fibrosis? NHLBI, NIH,† n.d.). â€Å"40,000 people die each year to IPF, the same as to breast cancer† (â€Å"Facts Abou t Idiopathic Pulmonary Fibrosis | Coalition For Pulmonary FibrosisCoalition For Pulmonary Fibrosis,† n.d.), yet IPF is still an unknown disease to many people. This paper will discuss the risk factors, disease process, complications, management, and new drug therapy clinical trials. Idiopathic Pulmonary Fibrosis: An Overview Etiology Idiopathic Pulmonary Fibrosis first started to become recognizable around the late 1800’s (Noble Homer, 2005). While currently the exact cause is unknown, there have been several risk factors that are recognized to contribute to the disease. As mentioned above, smoking, exposure to inhaled toxins such as asbestos, lung injury, viral and bacterial infections, acid reflux and genetics are associated with the disease (Noble Homer, 2005). Smoking accelerates the loss of lung function by destroying the cilia inhibiting the lungs natural ability to clean and repair itself (Oh, Murray, Molfino, 2012). Smoking also damages alveoli, causing poor gas exchange. The chemicals in cigarettes contribute to lung decline and disease and coat the lungs with tar and toxins (Oh et al., 2012). Inhaled substance and toxins such as asbestos are hypothesized to increase IPF probability (Meltzer Noble, 2008). When toxins invade the lungs, they interfere with the alveoli gas exchange process (Meltzer Noble, 2008). Lung injury can cause permanent damage. Acute lung injury has been hypothesized to accelerate an underlying progression of IPF. When cells of the lungs are damaged, it can be irreversible (Kottmann, Hogan, Phipps, Sime, 2009). Viral and bacterial infections cause a build of mucus in the lungs. When the alveoli get clogged they cannot properly exchange oxygen and carbon dioxide. Each infection acquired can cause more damage and can lead to permanent damage. When the lungs lose their ability to exchange gas, oxygen is inhibited from reaching the body’s vital organs (Kottmann et al., 2009). GER, commonly known as acid reflux, occurs when acid is aspired into the esophagus. â€Å"Researchers have found that 9 out of 10 people who have IPF also have gastroesophageal reflux disease† (â€Å"What Causes Idiopathic Pulmonary Fibrosis? NHLBI, NIH,† n.d.) Recent research has found that genetics may play an important role in the risk factor of developing IPF. â€Å"Over the past decade, one aspect that has held great promise in helping the medical community to better define the pathogenesis of IPF is the recognition that genetic factors may play a role in this disease† (Lawson, Loyd, Degryse, 2011). Pathophysiology The cause of IPF is unknown. Despite considerable advancement in understanding the progression of IPF, the knowledge of the beginning stages of IPF re still inadequately understood (Noble Homer, 2005). Originally, in the 1970’s, it was thought that inflammation of the alveoli was the cause (Noble Homer, 2005). It was believed that untreated inflammation leads to the scarring of the lungs. Anti-inflammatory and corticosteroids were widely used to treat the inflammation. However, those therapies have proven ineffective, making it evident that inflammation was not the cause (Dempsey, Kerr, Gomersall, Remmen, Currie, 2006). The second theory that came about in the 1980’s suggesting growth termed â€Å"alveolar macrophage-derived growth factor† (Noble Homer, 2005). Known as the ‘growth factor hypothesis’, it is believed that abnormal healing of trauma within the lungs exaggerates the response and growth of profibrogenic causing the scarring of IPF (Noble Homer, 2005). This theory still proves to be a highly important discovery in the pathophysiology of IPF (Dempsey et al., 2006). A third theory also came out of the 1980’s, known as the epithelial-mesenchymal hypothesis, suggests that tissue death of alveolar epithelial cells can lead to alveolar collapse (Noble Homer, 2005). The epithelial- mesenchymal cell conversion can alter and change motility and the ability to heal. â€Å"Imbalance of the normal homeostatic microenvironment might be, per se, a cause of fibroblast proliferation and myofibroblast differentiation leading to fibrosis† (Prunotto et al., 2012). Clinical Manifestation According to the Coalition for Pulmonary Fibrosis, â€Å"Idiopathic pulmonary fibrosis (IPF) is a progressive and generally fatal disease characterized by scarring of the lungs that thickens the lining of the lungs, causing an irreversible loss of the tissue’s ability to transport oxygen. IPF ultimately robs a patient of the ability to breathe†(â€Å"Facts About Idiopathic Pulmonary Fibrosis | Coalition For Pulmonary Fibrosis,† n.d.). IPF usually occurs in older adults in their 50’s or 60’s, and tends to occur more in men than in women (Lawson, Loyd, Degryse, 2011). According to the Coalition For Pulmonary Fibrosis, IPF affects about 128,100 people in the United States, with 48,000 new cases diagnosed annually (â€Å"Facts About Idiopathic Pulmonary Fibrosis | Coalition For Pulmonary Fibrosis,† n.d.). â€Å"IPF has been reported to occur throughout the world in many different racial and ethnic groups. Studies in the United States have sugge sted that Caucasians are more likely to be diagnosed with IPF and have higher mortality rates from IPF than African Americans. It is unclear if these findings are due to real differences in racial characteristics or to an under-diagnosis of this condition in minority populations† (Siegel, 2011). IPF symptoms develop over time and usually are not diagnosed until serious damage has already been done to the lungs (â€Å"What Are the Signs and Symptoms of Idiopathic Pulmonary Fibrosis? NHLBI, NIH,† n.d.). Patients are often misdiagnosed with diseases that present similar symptoms such as Chronic Obstructive Pulmonary Disorder (â€Å"Facts About Idiopathic Pulmonary Fibrosis | Coalition For Pulmonary Fibrosis,† n.d.). Idiopathic pulmonary fibrosis usually present gradually with a nonproductive cough and dyspnea. (Hyzy, Huang, Myers, Flaherty, Martinez, 2007). The main symptom patients complain of being shortness of breath (Noble Homer, 2005). Other common symptoms include: â€Å"dry, hacking cough; rapid, shallow breathing; gradual, unintended weight loss; Fatigue (tiredness) or malaise (a general feeling of being unwell); clubbing, which is the widening and rounding of the tips of the fingers and toes† (â€Å"What Are the Signs and Symptoms of Idiopathic Pulmonary Fibrosis? NHLBI, NIH,† n.d.). The gold standard for diagnosis of patients with IPF is a surgical lung biopsy (SLB), however critical risk for these patients usually prevent a high-risk surgical procedure (Kaarteenaho, 2013). â€Å"The mortality, which can occur shortly after the procedure, has probably been the major reason to refrain from performing SLB† (Kaarteenaho, 2013). With that in mind, diagnosis of IPF includes clinical, radiologic and histopathologic aspects (Wolters, Collard, Jones, 2014). The American Thoracic Society states, â€Å"in the absence of a definitive lung biopsy, the presence of all four major criteria and three minor criteria, as set forth in the current guidelines, increases the likelihood of a correct diagnosis of IPF: Major Criteria †¢Exclusion of other known causes of interstitial lung diseases, such as certain drug toxicities, environmental exposures, and connective tissue diseases †¢Abnormal pulmonary function studies that include evidence of restriction (reduced vital capacity often with an increased FEV:FVC ratio) and impaired gas exchange (increased AaPO2 with rest or exercise or decreased DLCO) †¢HRCT scan showing bibasilar reticular abnormalities with minimal ground-glass opacities †¢Transbronchial lung biopsy or BAL showing no features to support another diagnosis Minor Criteria †¢Age >50 years †¢Insidious onset of otherwise unexplained dyspnea on exertion †¢Duration of illness greater than or equal to 3 months †¢Bibasilar inspiratory crackles (dry or â€Å"Velcro-like† in quality)† (Raghu et al., 2011). The physical assessment is an important part of diagnosis, however, symptoms can mimic other diseases and make it hard to differentiate (Meltzer Noble, 2008). Attention should be paid to key risk factors such as work related inhaled chemical exposure and smoking. Fine inspiratory â€Å"Velcro-like† crackles can be heard upon examination and advance towards the upper airway as the disease progresses (Meltzer Noble, 2008).Clubbing of the fingers and toes is found in 50% of patients (Meltzer Noble, 2008). Lab results are often inconclusive to IPF, but as part of a puzzle can help to identify the disease. An ABG will more than likely read normal (Meltzer Noble, 2008). The pulmonary function test (PFT) can lend valuable information to diagnosing IPF. While IPF is a restrictive disease, it can often imitate obstructive disorders or congestive heart failure (CHF) (Meltzer Noble, 2008). â€Å"Routine spirometry reveals decreased measures of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The ratio of FEV1/FVC remains normal (or increased) in IPF, consistent with restrictive physiology† (Meltzer Noble, 2008). Subsequently, the PFT can also reveal reduced TLC, RC, and RV. Reduced gas transfer may also be noted with a DLCO (Meltzer Noble, 2008). Almost every patient with Idiopathic Pulmonary Fibrosis will have abnormal radiological findings (Meltzer Noble, 2008). The imaging modality of choice in diagnosing IPF is High-resolution computed tomography (HRCT) (Hospenthal, 2006). â€Å"Patchy, predominantly peripheral, subpleural, bibasal reticular opacities, often associated with traction bronchiectasis† (Harari Caminati, 2005). A phenomenon referred to as honeycombing is a prevalent finding in IPF, seen below is figure 3. Figure 1: Chest radiograph of a patient with IPF. Chest radiograph reveals peripheral, subpleural reticular opacities, most profuse at the lung bases (Harari Caminati, 2005). Figure 2: Chest HRCT in a patient with IPF. HRCT shows patchy, predominantly peripheral, subpleural, bibasal reticular abnormalities, traction bronchiectasis and bronchiolectasis and irregular septal thickening. There is also ground glass (Harari Caminati, 2005). Figure 3: Chest HRCT in a patient with IPF. HRCT shows predominantly peripheral and subpleural fibrosis with honeycombing (Harari Caminati, 2005). Complications Idiopathic pulmonary fibrosis is a highly progressive disease. Because the tissues in the lungs are scarred, they cannot properly exchange gas and the low amount of oxygen delivered to the body causes several complications and puts strain on the right side of the heart. According to the America Thoracic Society, â€Å"There is an increasing awareness of complications and comorbid conditions frequently associated with IPF† (Raghu et al., 2011). Some of the most common complications are: Pulmonary hypertension, cor pulmonale, respiratory failure and lung cancer (Daniels, Yi, Ryu, 2008). Depression is also often seen in people with IPF because of its devastating prognosis (â€Å"Living With Idiopathic Pulmonary Fibrosis NHLBI, NIH,† n.d.). Acute exacerbations (unexplained worsening of dyspnea) of IPF represent the most destructive and deadly complication (Raghu et al., 2011). â€Å"It is presently unclear if acute exacerbation of IPF is simply a manifestation of an unid entified respiratory complication (such as pulmonary emboli, infection) contributing to an acute worsening in a patient with IPF or represents an inherent acceleration in the pathobiological processes involved in IPF† (Raghu et al., 2011). Medical Management There is currently not a cure for idiopathic pulmonary fibrosis (â€Å"What Is Idiopathic Pulmonary Fibrosis? NHLBI, NIH,† n.d.). Until recently, primary methods of management have been anti-inflammatories and lung transplants (Dempsey, Kerr, Gomersall, Remmen, Currie, 2006). While Anti-inflammatory are still used today it is not due to the effectiveness of treatment, but lack thereof for alternatives (Dempsey et al., 2006).â€Å"Immunosuppressive or cytotoxic agents are used among steroid nonresponders, patients experiencing serious adverse effects from corticosteroids, and patients at high risk for corticosteroid complications† (Harari Caminati, 2005). â€Å"Single-lung transplantation results in an actuarial survival of 73% at 1 year and 57% at 3 years† (Harari Caminati, 2005). Unfortunately, most patients are not eligible for transplant due to age or comorbidity factors (Harari Caminati, 2005). In the spring of 2014 the FDA announced two new drugs for the management of IPF (â€Å"CPF Celebrates Historic Year of Progress in Pulmonary Fibrosis | Coalition For Pulmonary Fibrosis Coalition For Pulmonary Fibrosis,† n.d.). Ofev (nintedanib) and Esbriet (pirfenidone) were both shown to slow the progress of IPF in clinical trials. â€Å"Pirfenidone is a transforming growth factor-beta inhibitor and tumor necrosis factor-alpha inhibitor† (Gohil, 2015). Ofev is a â€Å"fibroblast growth factor receptor (FGFR) antagonist, platelet-derived growth factor receptor (PDGFR) antagonist, and vascular endothelial growth factor receptor (VEGFR) antagonist† (Gohil, 2015). The two treatments are still in the early stages with little known about their effectiveness. Prognosis Prognosis for IPF is dim. It is a fatal disease (Meltzer Noble, 2008). The median survival rate is 3 years after diagnosis (Peljto et al., 2013). Factors associated with â€Å"shortened survival time include: older age, smoking history, lower body mass index (BMI), more severe physiologic impairment, greater radiologic extent of disease, and the development of other complications or conditions, in particular, pulmonary hypertension, emphysema, and bronchogenic cancer† (Ley, Collard, King, 2011). Clinical Trials During the past decade, there has been a notable amount of research into the treatment of idiopathic pulmonary fibrosis. IPF is no longer believed to be due to inflammation, but multiple injuries with atypical cell repair. According to The Coalition for Pulmonary Fibrosis, â€Å"there are many therapies under investigation in clinical trials that include: †¢Antifibrotic or antifibrogenic agents (such as Pirfenidone, interferon and certain blood-pressure-lowering medications) to suppress the scarring process †¢Antioxidants (such as N-acetylcysteine) to prevent damage to lung tissue †¢Monoclonal antibodies to inhibit â€Å"bad† cytokines (protein growth factors, such as TGF-beta, TNF-Alpha, or CTGF, that activate inflammation)† (â€Å"Active Clinical Trials and Investigational Research in IPF | Coalition For Pulmonary FibrosisCoalition For Pulmonary Fibrosis,† n.d.). References Active Clinical Trials and Investigational Research in IPF | Coalition For Pulmonary FibrosisCoalition For Pulmonary Fibrosis. (n.d.). Retrieved February 17, 2015, from http://www.coalitionforpf.org/active-clinical-trials-and-investigational-research-in-ipf/ Facts About Idiopathic Pulmonary Fibrosis | Coalition For Pulmonary FibrosisCoalition For Pulmonary Fibrosis. (n.d.). Retrieved February 17, 2015, from http://www.coalitionforpf.org/facts-about-idiopathic-pulmonary-fibrosis/ Hospenthal. (2006). Diagnosis and management of idiopathic pulmonary fibrosis: Implications for respiratory care. Respir Care, 51, 382–391. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16563193 Hyzy, R., Huang, S., Myers, J., Flaherty, K., Martinez, F. (2007). Acute exacerbation of idiopathic pulmonary fibrosis. Chest, 132, 1652–1658. doi:10.1378/chest.07-0299 Kaarteenaho, R. (2013). The current position of surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis. Respiratory Research, 14, 43. doi:10.1186/1465-9921-14-43 Lawson, W. E., Loyd, J. E., Degryse, A. L. (2011). Genetics in pulmonary fibrosisfamilial cases provide clues to the pathogenesis of idiopathic pulmonary fibrosis. The American Journal of the Medical Sciences, 341(6), 439–43. doi:10.1097/MAJ.0b013e31821a9d7a Ley, B., Collard, H. R., King, T. E. (2011). Clinical course and prediction of survival in idiopathic pulmonary fibrosis. American Journal of Respiratory and Critical Care Medicine, 183(3), 431–440. doi:10.1164/rccm.201006-0894CI Meltzer, E. B., Noble, P. W. (2008). Idiopathic pulmonary fibrosis. Orphanet Journal of Rare Diseases, 3, 8. doi:10.1186/1750-1172-3-8 Noble, P. W., Homer, R. J. (2005). Back to the future: Historical perspective on the pathogenesis of idiopathic pulmonary fibrosis. American Journal of Respiratory Cell and Molecular Biology, 33(8), 113–120. doi:10.1165/rcmb.F301 Peljto, A. L., Zhang, Y., Fingerlin, T. E., Ma, S.-F., Garcia, J. G. N., Richards, T. J., †¦ Schwartz, D. A. (2013). Association between the MUC5B promoter polymorphism and survival in patients with idiopathic pulmonary fibrosis. JAMA, 309(21), 2232–9. doi:10.1001/jama.2013.5827 Raghu, G., Collard, H. R., Egan, J. J., Martinez, F. J., Behr, J., Brown, K. K., †¦ Schà ¼nemann, H. J. (2011). An Official ATS/ERS/JRS/ALAT Statement: Idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. American Journal of Respiratory and Critical Care Medicine, 183, 788–824. doi:10.1164/rccm.2009-040GL Siegel, M. D. (2011). Breathing in America: Diseases, Prognosis, and Hope. Critical Care Medicine, 39, 1857. doi:10.1097/CCM.0b013e31821b1e92 What Are the Signs and Symptoms of Idiopathic Pulmonary Fibrosis? NHLBI, NIH. (n.d.). Retrieved February 17, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/ipf/signs What Is Idiopathic Pulmonary Fibrosis? NHLBI, NIH. (n.d.). Retrieved February 14, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/ipf Wolters, P. J., Collard, H. R., Jones, K. D. (2014). Pathogenesis of idiopathic pulmonary fibrosis. Annual Review of Pathology, 9, 157–79. doi:10.1146/annurev-pathol-012513-104706