Warrantless Wiretapping

Dave Gorman November 20, 2008 Writing About World Affairs Word Count: 708 Warrantless Wiretapping Since the September 11, 2001 attacks on the United States, many of the counterterrorism measures taken by President George W. Bush and his administration have been questioned concerning their legality, morality and practicality. Chief among the issues being debated is that of warrantless wiretapping and data mining inside of the United States. This unprecedented use of executive power has been directed by the National Security Agency since 2001. Bush administration officials argue that the civil liberties concerns are unfounded. They also state the NSA program does not target Americans. â€Å"Nothing could be further from the truth,† wrote John Yoo, a former official in the Justice Department’s Office of Legal Counsel. Several official also assert that the program had helped expose a plot byIyman Faris, an Ohio truck driver and naturalized citizen who pleaded guilty in 2003 to supporting al Qaeda by planning to demolish the Brooklyn Bridge with blowtorches. Another plot involving fertilizer bomb attacks on British train station was revealed and thwarted in part due to the NSA’s program, officials said (Bush Lets U. S. Spy†¦). Many law scholars, judges, activists, and intelligence experts have pronounced that the counterterrorism actions taken by the Bush administration, namely warrantless wiretapping have been unlawful, impractical, and immoral. While the administration contends that the measures it has taken since September 11 have made the United States safer, those same opponents would vie that it has not, while still violating civil liberties and Constitutional law.

Implementation of Lsb Steganography and Its Evaluation for Various File Formats

Int. J. Advanced Networking and Applications Volume: 02, Issue: 05, Pages: 868-872 (2011) 868 Implementation of LSB Steganography and its Evaluation for Various File Formats V. Lokeswara Reddy Department of CSE, K. S. R. M. College of Engg. , Kadapa, A. P. India Email: [email  protected] com Dr. A. Subramanyam Dept. of CSE, AITS, Rajampet, Y. S. R. (Kadapa) Dist.. A. P. Dr. P. Chenna Reddy Dept. of CSE, JNTUCE, Pulivendula, Y. S. R. (Kadapa) Dist.. A. P. ———————————————————————ABSTRACT————————————————————-Steganography is derived from the Greek word steganos which literally means â€Å"Covered† and graphy means â€Å"Writing†, i. e. covered writing. Steganography refers to the science of â€Å"invisible† communication. For hiding secret information in various file formats, there exists a large variety of steganographic techniques some are more complex than others and all of them have respective strong and weak points. The Least Significant Bit (LSB) embedding technique suggests that data can be hidden in the least significant bits of the cover image and the human eye would be unable to notice the hidden image in the cover file. This technique can be used for hiding images in 24-Bit, 8-Bit, Gray scale format. This paper explains the LSB Embedding technique and Presents the evaluation for various file formats. Keywords: Steganography, Least Significant Bit (LSB), GIF, PNG, BMP. ——————————————————————————————————————-Date of Submission: 24, August 2010 Date of Acceptance: 08 November 2010 are transferred through unknown cover carriers in such a manner that the very existence of the embedded messages is undetectable. Carriers include images ; audio, video, text or any other digitally represented code or transmission. The hidden message may be plaintext, cipher text or anything that can be represented as a bit stream. II. IMAGE STEGANOGRAPHY Image compression techniques are extensively used in steganography. Among the two types of image compressions, lossy compression and loss less compression; lossless compression formats offer more promises. Lossy compression compression may not maintain the original image’s integrity. Lossless compression maintains the original image data exactly, hence it is prefered. Example of Lossy compression format is JPEG format files. Examples of Lossless compression formats are GIF[3] and BMP formats. We have used an 8-bit image size for implementation of our steganography. Improvement in stegnographic techniques is make it possible to apply the Detecting LSB Steganography in Colour and Gray- Scale Images which were confined to gray scale images in the initial stages The difficulty in colour images control is solved later on in many techniques such as the analysis of the variation of the gradient energy. The secret message embedded in the target image is detected in both gray and colour images, and the length of the embedded message is estimated [5, 6]. ——————————————————————————————————————-I. INTRODUCTION Digital content is now posing formidable challenges to content developers, aggregators, distributors and users. Th e destruction, extraction or modification of the embedded message is required to develop more robust systems so that the digital content processing and organization becomes easy. Cryptography was created as a technique for securing the secrecy of communication and many different methods have been developed to encrypt and decrypt data in order to keep the message secret. Unfortunately it is sometimes not enough to keep the contents of a message secret, it may also be necessary to keep the existence of the message secret. The technique used to implement this, is called steganography. The shift from cryptography to stegnography is due to that concealing the image existence as stegno-images enable to embeded the secret message to cover images. Steganography conceptually implies that the message to be transmitted is not visible to the informal eye. Steganography has been used for thousands of years to transmit data without being intercepted by unwanted viewers. It is an art of hiding information inside information. The main objective of Steganography is mainly concerned with the protection of contents of the hidden information. Images are ideal for information hiding[1,2] because of the large amount of redundant space is created in the storing of images. Secret messages Int. J. Advanced Networking and Applications Volume: 02, Issue: 05, Pages: 868-872 (2011) III. HIDING METHODS IN IMAGE STEGANOGRAPHY In Image Steganography, There are a variety of methods using which information can be hidden in images. Least Significant Bit Replacement Technique: In image steganography almost all data hiding techniques try to alter insignificant information in the cover image. Least significant bit (LSB) insertion is a common, simple approach to embedding information in a cover image. For instance, a simple scheme proposed, is to place the embedding data at the least significant bit (LSB) of each pixel in the cover image[7,8,9] . The altered image is called stego-image. Altering LSB doesn’t change the quality of image to human perception but this scheme is sensitive a variety of image processing attacks like compression, cropping etc. We will be emphasizing more on this technique for the various image formats. Moderate Significant Bit Replacement Technique: The moderate significant bits of each pixel in the cover image can be used to embed the secret message. This method improves sensitivity to modification, but it degrades the quality of stego-image. Experiments have shown that the length of hidden messages embedded in the least significant bits of signal samples can be estimated with relatively high precision. IV. THE LSB TECHNIQUE The least significant bit i. e. the eighth bit inside an image is changed to a bit of the secret message. When using a 24bit image, one can store 3 bits in each pixel by changing a bit of each of the red, green and blue colour components, since they are each represented by a byte. An 800? 600 pixel image, can thus store a total amount of 1,440,000 bits or 180,000 bytes of embedded data. As an example, suppose that we have three adjacent pixels (9 bytes) with the RGB encoding. 10010101 00001101 11001001 10010110 00001111 11001011 10011111 00010000 11001011 When the number 300, can be which binary representation is 100101100 embedded into the least significant bits of this part of the image. If we overlay these 9 bits over the LSB of the 9 bytes above, we get the following (where bits in bold have been changed) 10010101 00001100 11001000 10010111 00001110 11001011 10011111 00010000 11001010 Here the number 300 was embedded into the grid, only the 5 bits needed to be changed according to the embedded message. On average, only half of the bits in an image will need to be modified to hide a secret message using the maximum cover size. Since there are 869 256 possible intensities of each primary colour, changing the LSB of a pixel results in small changes in the intensity of the colours. The human eye cannot perceive these changes – thus the message is successfully hidden. With a well-chosen image, one can even hide the message in the LSB without noticing the difference[10]. Fig. 1 Block Diagram for implemented Logic of LSB embedding V. DESIGN DETAILS This section focuses on algorithms Steganography and Steganalysis[10] A. Algorithm for Hiding (Steganography) 1. 2. 3. Read the original image and the image which is to be hidden in the original image Shift the image to hide in the cover image by X bits. And the original image or cover image with 240 which is 11110000 So four MSB’s set to 0. Because of this only four LSB’s considered further. The shifted hidden image and the result of step 3 are bitored. This makes changes only in the X LSB bits so that the image is hidden in the original image. of LSB 4. In MATLAB we convert it to unit8 format. This image can be called as the stego image B. Algorithm for Steganalysis 1. The stego image is bit shifted by 4 bits since it was shifted by 4 bits to insert it into the original image. 2. The image is the ANDED with 255 i. e. , 11111111, which gives the original image. It is ANDED with 255 because initially all the LSB’s were made 0. Now it is recovered back. 3. To get it to Unit8 format we, convert it back to unit8 which is the extracted image. Int. J. Advanced Networking and Applications Volume: 02, Issue: 05, Pages: 868-872 (2011) that a message is being passed is being achieved. C. LSB in GIF 870 Fig. 2: Block Diagram for Steganalysis VI. IMAGE ANALYSIS A. LSB in BMP The BMP file format also called bitmap or DIB file format (for device-independent bitmap), is an image file format used to store bitmap digital images. Since BMP is not widely used the suspicion might arise, if it is transmitted with an LSB stego. When image are used as the carrier in Steganography they are generally manipulated by changing one or more of the bits of the byte or bytes that make up the pixels of an image. The message can be stored in the LSB of one colour of the RGB value or in the parity bit of the entire RGB value. A BMP is capable of hiding quite a large message. LSB in BMP is most suitable for applications, where the focus is on the amount of information to be transmitted and not on the secrecy of that information. If more number of bits is altered, it may result in a larger possibility that the altered bits can be seen with the human eye. But with the LSB the main objective of Steganography is to pass a message to a receiver without an intruder even knowing that a message is being passed is being achieved. B. LSB in PNG Portable Network Graphics (PNG) is a bitmapped image format that employs lossless data compression. PNG was created to improve upon and replace GIF. Since PNG is widely used the suspicion might not arise if it is transmitted with an LSB stego. When images are used as the carrier in Steganography they are generally manipulated by changing one or more of the bits of the byte or bytes that make up the pixels of an image. The message can be stored in the LSB of one colour of the RGB value or in the parity bit of the entire RGB value . A PNG is capable of hiding quite a large message. LSB in PNG is most suitable for applications where the focus is on the amount of information to be transmitted and not on the secrecy of that information. If more number of bits is altered it may result in a larger possibility that the altered bits can be seen with the human eye. But with the LSB the main objective of steganography i s to pass a message to a receiver without an intruder even knowing Graphics interchange format also known as GIF is one of the machine independent compressed formats for storing images. Since GIF images only have a bit depth of 8, amount of information that can be hidden is less than with BMP. Embedding information in GIF images using LSB results in almost the same results as those of using LSB with BMP. LSB in GIF is a very efficient algorithm to use when embedding a reasonable amount of data in a grayscale image. GIF images are indexed images where the colours used in the image are stored in a palette. It is sometimes referred to as a colour lookup table. Each pixel is represented as a single byte and the pixel data is an index to the colour palette. The colours of the palette are typically ordered from the most used colour to the least used colours to reduce lookup time. Some extra care is to be taken if the GIF images are to be used for Steganography. This is because of the problem with the palette approach. If the LSB of a GIF image is changed using the palette approach, it may result in a completely different colour. This is because the index to the colour palette is changed. The change in the resulting image is noticeable if the adjacent palette entries are not similar. But the change is not noticeable if the adjacent palette entries are similar. Most applications that use LSB methods on GIF images have low security because it is possible to detect even moderate change in the image. Solutions to these problems could be 1. Sort the palette so that the colour difference between consecutive colours is minimized 2. Add new colours, which are visually similar to the existing colours in the palette. 3. Use Gray scale images. In a 8 bit Gray scale GIF image, there are 256 shades of gray. This results in gradual changes in the colours and it is hard to detect. VII. EXPERIMENTED RESULTS Following experimental results highlights on 8 bit LSB Steganography. A. Results for . png image 8 bit stego image Int. J. Advanced Networking and Applications Volume: 02, Issue: 05, Pages: 868-872 (2011) 871 B. Results for . bmp file 8 bit stego image PSNR is measured in decibels (dB). PSNR is a good measure for comparing restoration results for the same image, but between-image comparisons of PSNR are meaningless. MSE and PSNR values for each file format is shown in table 1. Table 1: Image quality metrics for bmp file Cover image 224. 948 24. 6100 Stego image 244. 162 24. 2540 Cover- Stego image 69. 826 29. 690 MSE PSNR Stego Recovered IX. EVALUATION OF DIFFERENT TECHNIQUES There are many steganographic algorithms available. One should select the best available algorithm for the given application. Following characteristics are to be evaluated while selecting a particular file format for Steganography. Steganography says that the secret message is to be hidden and it should result in an distortion less image. The distortion must not be visible to the human eye. The amount of data embedded in the image also plays an important role. The algorithm decides how much amount of data could be embedded in the image resulting in a distortion less image. Steganalysis is the technique of detecting the hidden information in the image. The algorithm for Steganography must be such that the steganalysis algorithms should fail. i. e the Steganography algorithms must not be prune to attacks on steganalysis. During communication the intruder could check the original image to remove the hidden information.. He/she may manipulate the image. This manipulation may include cropping or rotation etc of the images. The manipulations done may cause the image distortion. Steganographic algorithms chosen must be such that it overcomes such manipulation and the steganographic data reaches the destination in the required format. VIII. EVALUATION OF IMAGE QUALITY For comparing stego image with cover results requires a measure of image quality, commonly used measures are Mean-Squared Error, Peak Signal-to-Noise Ratio[3] and histogram. A. Mean-Squared Error The mean-squared error (MSE) between two images I1(m,n) and I2(m,n) is: M and N are the number of rows and columns in the input images, respectively. Mean-squared error depends strongly on the image intensity scaling. A mean-squared error of 100. 0 for an 8-bit image (with pixel values in the range 0-255) looks dreadful; but a MSE of 100. 0 for a 10- bit image (pixel values in [0,1023]) is barely noticeable B. Peak Signal-to-Noise Ratio Peak Signal-to-Noise Ratio (PSNR) avoids this problem by scaling the MSE according to the image range Int. J. Advanced Networking and Applications Volume: 02, Issue: 05, Pages: 868-872 (2011) Table 2: Comparison of LSB technique for various file formats LSB LSB LSB In BMP in GIF In PNG Percentage Distortion less High Medium High resultant image Invisibility Steganalysis detection Image manipulation Amount of embedded data Payload capacity Independent of file format X. CONCLUSION Since BMP uses lossless compression, LSB makes use of BMP image. To be able to hide a secret message inside a BMP file, one would require a very large cover image. BMP images of 800? 600 pixels found to have less web applications. Moreover such uses are not accepted as valid. For this reason, LSB Steganography has also been developed for use with other image file formats. Although only some of the main image steganographic techniques were discussed in this paper, one can see that there exists a large selection of approaches to hiding information in images. All the major image file formats have different methods of hiding messages, with different strong and weak points respectively. LSB in GIF images has the potential of hiding a large message, but only when the most suitable cover image has been chosen. High Low Low High High Low Medium Low Low Medi um Medi um Low Medium Low Low Medium Medium High Authors Biography 872 Steganography: Seeing the Unseen†, Computer Journal, February 1998. [5] Li Zhi,Sui Ai Fen. , â€Å"Detection of Random LSB Image Steganography† The IEEE 2003 International Symposium on Persona1,lndoor and Mobile Radio Communication Proceedings, 2004. [6] Jessica Fridrich, Miroslav Goljan, and Rui Du. , â€Å"Detecting LSB Steganography in Color and GrayScale Images†, – IEEE Multimedia. [7] F. Collin,Encryptpic,† http://www. winsite. com/bin/ Info? 500000033023. [8] G. Pulcini, Stegotif,† http://www. geocities. om /SiliconValley/9210/gfree. html. [9] T. Sharp, Hide 2. 1, 2001,†www. sharpthoughts. org. [ 10] Deshpande Neeta, Kamalapur Snehal, Daisy Jacobs â€Å"Implementation of LSB Steganography and Its Evaluation for Various Bits† Digital Information Management, 2006 1st International conference. pp 173-178,2007. V. Lokeswara Reddy did his M. Tech (CSE) from SRM University, Chennai in the year 2005. He did his M. C. A from S. V. University, Tirupati in the year 2000. He is pursuing his Ph. D from JNTUA, Anantapur. He has a total of 09 years of experience in teaching. Currently he is working as Associate Professor at K. S. R. M College of Engineering, Kadapa. He has presented 2 papers in International and National Conferences. Dr. A. Subramanyam received his Ph. D. degree in Computer Science and Engineering from JNTU College of Engineering, Anantapur. He has obtained his B. E. (ECE) from University of Madras and M. Tech. (CSE) from Visweswaraiah Technological University. He is having 17 years experience in teaching. He is currently working as Professor & HOD in the Department of Computer Science and Engineering of Annamacharya Institute of Technology & Sciences, Rajampet, Y. S. R. (Kadapa) Dist. A. P. He has presented and published number of papers in International and National Conferences, International and National Journals. He is guiding few Ph. D. s. His research areas of interest are parallel processing, network security and data warehousing. Dr. P. Chenna Reddy did his B. Tech (CSE) from S. V. University College of Engineering, Tirupati in the year 1996. He did his M. Tech from JNTU, Anantapur. He completed his Ph. D from JNTU, Hyderabad. He has a total of 13 years of experience in teaching. Currently he is working as Associate Professor at JNTUA College of Engineering, Pulivendula, Y. S. R. (Kadapa) Dist. , A. P. He has number of publications to his credit. References [1] Pfitzmann Birgit. Information Hiding Terminology, First International Workshop, Cambridge, UK, Proceedings, Computer Science, 1174. pp. 347-350, May–June. [2] Westfield Andreas and Andreas Pfitzmann, Attacks on Steganographic Systems, Third International Workshop, IH'99 Dresden Germany, October Proceedings, Computer Science 1768. pp. 61- 76, 1999. [3] Moerland, T. , â€Å"Steganography and Steganalysis†, Leiden Institute of Advanced Computing

Bilingual Education Essay

The presence of bilingual students in U. S. schools is significant and the result of internal and external historical factors. Educators and policymakers must consider their needs and potential contribution to our education system. The multiplicity of languages and the complex nature of bilinguals renders a complicated but exciting educational field for research, practice, and educational innovation. Unfortunately, languages become entangled in political battles, dragging the education and the future of innocent children into such conflicts. Indigenous inhabitants, colonizers, and immigrants to the United States have and continue to represent a variety of language backgrounds. Like it or not, the United States is highly multilingual. Fashions in using language in education and attitudes toward bilingualism have undergone many changes since the United States became independent. During the initial colonization of the United States, European settlers used the languages of their countries of origin. The Continental Congress considered French and German important for political purposes. It recognized the need to disseminate information among disparate populations to broaden the cause of independence (Heath, 1976). The settlers established schools that educated their children in their own languages, especially French, German, Spanish, and Swedish, while teaching English as a second language. Schools that used English as the medium of instruction taught one of the other European languages as a second language ( Keller & Van Hooft, 1982). The presence of many languages in U. S. schools was an accepted reality until the 1870s. â€Å"Newspapers, schools, and societies provided instructional support for diverse languages† (Heath, 1981, p. 7). There was, however, concern for seeking a common language, especially to conduct government affairs (Heath, 1981). The original colonies and territories incorporated later into the Union comprised local governments that used different languages, such as German in Pennsylvania, French in Louisiana, and Spanish in New Mexico and California. English, nevertheless, always played an important role in the public life of the colonies because from the beginning England colonized the United States. The form of government embraced after the American Revolution reflected English values (Conklin & Lourie, 1983). Economic and historic factors helped solidify the position of English as the language of government. During the first half of the 20th century, English was imposed as the language of instruction in most states. As many as 34 states enacted laws mandating English as the language of instruction. Other languages were forbidden and teachers could be fined or jailed if found using them: â€Å"No polyglot empire of the old world has dared be as ruthless in imposing a single language upon its whole population as was the liberal republic ‘dedicated to the proposition that all men are created equal'† ( Johnson, 1949, pp. 118-119). Political, social, and economic rationales for denigrating all languages other than English advanced linguistic and cognitive theories that attacked bilingualism. Public schools quickly adopted a â€Å"sink or swim† attitude during the first half of the 20th century. Special programs such as English as a Second Language (ESL) served only adults. The assumption was that children learn languages easily and nothing special needed to be done. Nevertheless, despite the lack of public support for bilingual education, there were bilingual programs–mostly dual language programs–in private and parochial schools. These schools extended the required curriculum to include instruction in the cultural, linguistic, and religious heritages of the particular ethnic group. A great number of them were bilingual (Fishman & Markman, 1979). National interest in bilingual education spread when Title VII, the Bilingual Education Act (an amendment to the Elementary and Secondary Education Act) was enacted in 1968. This federal legislation provided funds to create bilingual programs in poor school districts (Lyons, 1990). The impact of the federal law, both good and bad, was widely felt. A number of states reversed the laws that permitted English as the only language of instruction by passing bilingual education legislation. Massachusetts was the first state to enact such a law with its Transitional Bilingual Education Act (1971). More than 20 other states followed Massachusetts’ example by creating transitional bilingual education programs (August & Garcia, 1988). Evidently, during the past two centuries, use of languages in education has been increasingly politicized. History has repeated itself but in modified ways. The acceptance of languages in education observed in the early part of the 19th century was apparent again in the 1970s but languages other than English appeared in schools with a much lower status with respect to English than they had a century earlier. The imposition of English only at the turn of the century reappeared in the 1980s, although this time some minority students were served by special English language programs rather than leaving all to sink or swim. Efforts to make English speakers fluent in other languages have also seen ups and downs. Suspicion toward foreigners in the early part of the century discouraged second language learning. Interest in foreign language learning following World War II wavered in the 1970s. The pendulum is swinging again in favor of bilingualism for English speakers. Foreign language programs are starting earlier in elementary schools and bilingual education programs that promote bilingualism are becoming increasingly popular (Met & Galloway, 1992). However, most successful bilingual programs have been created not by legislative mandates but by concerned educators and communities working together. Good education for bilingual students should not be the outcome of compliance with legislation. Schools must be willing to create good programs suitable for all students, including bilinguals. To overcome resistance to implementing bilingual education, many communities resort to politics or lawsuits to force school districts to provide bilingual education. However, political solutions create their own problems, paradoxically compromise and rigidity. For example, laws and regulations that impose a 3-year maximum for students attending bilingual education programs arose as a compromise between the forces for and against bilingual education. Research shows time and again that students profit from long-term bilingual instruction, even though some students who stay shorter periods eventually succeed in mainstream education (Kleinfeld, 1979). Consequently, it is clear that historically Americans have not showed great tolerance to linguistic diversity. There have been repeated efforts to make English an official language in the country by restricting bilingualism, as well as attempts to enhance more ESL programs on the other side. There is an ongoing disagreement regarding whether or not ESL program meets its initial objective, the ways it affects American society, and its necessity. The opponents of bilingual teaching argue it is expensive for the country, keeps immigrants socially isolated, slows down the assimilation process, creates a retreat of an official language and dissolves the unity of America. Generally, a lot of people form negative assumptions about bilingual programs based on their ideological beliefs, political views, personal observations, negative experience or simply generalizations and stereotyping based on limited knowledge about ESL classes (Rojas, 2003). These judgments usually lack evidence and logical reasoning, and thus cannot objectively analyze the program’s weaknesses or disadvantages. As Maria Brisk observes, â€Å"Much of the debate on bilingual education is politically motivated, more suitable for talk shows than for improving schools† (Rojas, 2003). And indeed, ESL programs are viewed more as a tool to solve multiple social problems (which, certainly, are also important)–minority groups’ rights, language diversity, melting pot, the unity of the country, a threat to the existence of dominant culture, and so on–instead of focusing on the quality of education our school-age population is receiving and the environment they are placed in. Policymakers should definitely pay more attention to the program’s educational effectiveness and dramatic improvement in students’ academic progress when deciding whether public schools need ESL classes. Because public schools have quite a significant influence on children’s learning and personal development, we are responsible of making it a positive schooling experience for all students despite their ethnic background or native language. Bilingual education helps students to learn English faster, provides a friendly learning environment, improves academic progress, encourages kids to become proficient in two languages, teaches cultural awareness, and preserves minorities’ linguistic human rights. It has been proven that students who are enrolled in bilingual classes have better scores on standardized tests, such as the ACT’s and SAT’s, than those who are not enrolled in bilingual classes. Bilingual education is beneficial for our country and enables students to learn English as well as keeping their native tongue for future success in our global economy. Bilingual education works in our society and should stay intact within the schools and should be funded to enable students who wish to take these classes should be able to. However, it is not the question of whether bilingual programs work (obviously they do), but more the question of how our society addresses cultural and linguistic diversity. Recent studies have proven that bilingual teaching dramatically increases students’ educational progress both in English communicational skills and other content in curriculum. Students who attend a regular English class right away usually fall behind in subjects taught in English and experience negative consequences in psychological development. ESL system doesn’t disregard the need for acquisition of English; indeed, it one of the most important outcomes of effective bilingual education programs (Zehr, 2004). Looking at the money spent on bilingual education program (when funds are being cut off from other public services across the country) may lead to consideration of abolishing bilingual system and focusing on the projects that affect all students in education system instead. The United States spends approximately $12 billion on bilingual education each year (Wood, 1997) and over $100 million was spent to study the effectiveness of ESL programs (Mujica, 2003). Because American taxpayers don’t benefit from bilingual instruction directly, many communities and states are unwilling to pay that expense and are quick to cut back regardless its potential positive results. Nevertheless, even though we give up other things that could be otherwise purchased, bilingual programs in public schools is a critical factor in foreign students’ learning process. Besides the fact that bilingual teaching dramatically increases academic performance, it also encourages more parents to send their children to school and that, in turn, motivates more students to become educated. In other words, the money spent on ESL programs should not be associated with an opportunity cost of ignoring other important problems. Instead, it is a valuable investment in students’ success at school as well as assimilation into American society. The issue of bilingual education in relationship to our global economy enables students enrolled in these classes to have a better future than those students who only speak English. Jeff MacSwan, supporter of bilingual education and assistant professor of curriculum and instruction at Arizona State University, is quoted about bilingual education in our global economy when he says, â€Å"Multilingualism is an asset, and Arizona must embrace it† (MacSwan, 1998). Arizona Senator John McCain also believes that bilingual education is an asset to children. He states that, â€Å"Arizona should strengthen them (bilingual classes) and make similar resources available to all children† (MacSwan). In fact, McCain has introduced a program that enables students to be in programs like these. McCain’s program is called â€Å"English-Plus† (MaSwan) which acknowledges the great importance of bilingualism in our modern global economy. McCain is quoted concerning bilingual education when he says, â€Å"People should not have to abandon the language of their birth to learn the language of their future†¦The ability to speak languages in addition to English is a tremendous resource to our community† (MacSwan). In addition, the benefits of bilingual education in our global economy can be seen when US Secretary Richard Riley said, â€Å"When they enter the work force in several years we will regret the inability of our children to speak two languages. Our global economy demands it; our children deserve it† (Pratt, 2000). Undoubtedly, in addition to educational advantage, adult bilinguals with a complete grasp of two or more languages, can be more successful economically and benefit more to their communities than their single-language peers. Our public services employ staff as translators in order to keep abreast of the constantly growing immigrant population. Increased marketable skills are an advantage of bilingual fluency. Because of the aforementioned educational advantages, bilinguals can offer a flexibility and level of problem-solving ability that surpasses the average monolingual. According to Graciela Kenig, author of The Best Careers for Bilingual Latinos: Market Your Fluency in Spanish to get Ahead on the Job, employers are looking for people â€Å"with a broader scope of experience and strong problem-solving ability. † (1998, p. 5). The marketplace is also focusing on the global economy. Bilinguals are uniquely qualified to give the U. S. a competitive edge. The utilization of well-educated American bilinguals can give our country a significant advantage in the global marketplace. In aspect of Rudolph Giuliani’s view that bilingual education doesn’t work and that it is too expensive should be better thought out and he should look at the benefits that come from it. Giuliani was quoted regarding bilingual education by saying, â€Å"It’s cruel to them and gives them less of a chance to succeed† (Willen, 1998). Giuliani has some reason to argue that it is too expensive considering that â€Å"New York City alone spends $300 million annually on its program serving 126,000 students† (Chavez, 1995). In addition, Giuliani has a reason to argue that bilingual education it too time consuming considering the outrageous number of students who are eligible for bilingual classes. Although these are good reasons Giuliani should realize that, â€Å"half the Hispanic children in bilingual classes (New York City) are American-born. And many- if not most- speak English better than they do Spanish† (Chavez, 1995). The number one reason why these students are enrolled in these particular classes is because that New York automatically places these students in these classes by whether or not they score above the 40th percentile on a standard eyes test. These tests should not be done because it is evident that the students are learning English just maybe not as fast at other students. Giuliani’s claims are somewhat relevant but he should consider all of the benefits that come from bilingual education. Although Giuliani believes it is too expensive this should not be an issue considering that our country can benefit as a whole with multilingualism. During the Restrictive Period (1880s-1960s) the need of being able to effectively communicate in English was motivating immigrants to learn the language and assimilate into society (Ovando, 2003). Single language was meant to unify the members of a society (Schaefer, 2003, p. 66). However, today conformity to a single language would probably be regarded as â€Å"racist† (Mujica, 2003). Currently, most people would rather agree with Eliana D. Rojas, an assistant professor of bilingual education, that the right to maintain one’s native language and culture is a part of a person’s human rights (Mujica). The main reason so many people protest attempts to implement bilingual programs in public schools is a belief that such step will lead to dissolving the unity of the country. The government provides funds for translators in most government organizations which allow immigrants to function in their own language, doesn’t encourage foreigners to learn English and thus isolates them from the rest of the community. In response, they are more likely to form a small group or even a subculture within the dominant society with different norms, values and language. â€Å"We cannot assimilate and we won’t! † one day proclaimed the executive director of the League of United Latin American Citizens, an organization originally supporting pro assimilation (Mujica, 2003, p. 2). According to the Census statistics in 2000, 18 percent of American population over the age of 5 speaks a language other than English as their primary language (Schaefer, 2003, p. 65), while 8 percent of them are classified as â€Å"limited English proficient† (Mujica, 2003, p. 2). Hispanic population is the fastest growing minority in the U. S. and large parts of the country are becoming increasingly â€Å"Latinized†. Americans â€Å"feel strangers in their own neighborhoods and aliens in their own country† (Schaefer, 2003, p. 66). It may look like sooner or later we will have to say â€Å"Hasta la Vista to the ‘United’ States and Adelante to Canadian-style discord over the issues of language and ethnicity† (Mujica, 2003, p. 4). Therefore, blaming such programs as bilingual instructing in schools is based primarily on nationalistic concerns. The recent studies have proven, though, that only a small percent of children attending bilingual classrooms will still be able to communicate in their native language in a few years (Worthy, 2003). In some ESL classes students are actually encouraged to maintain their first language and are introduced to elements from both American and their native cultures. It seems apparent that a child will more likely associate himself or herself with other immigrants rather than Americans and it may seem hard for that student to assimilate into American society. It may be difficult for him or her to learn English later because any language cannot be taught successfully in isolation – proficient communicational skills can only develop through everyday practice and a practical need to apply new knowledge. In reality it takes about the same time for a person to learn English in the all-English class than gradually switching from the native language to the regular English instructing. Despite the fact they differ in the length of the transition to English and how long they allow students to remain in bilingual classrooms, all ESL students receive enough practice and even become monolingual English speakers pretty soon, as a yearlong study of fifth-grade children attending bilingual class has proven (Worthy, 2003). As the teacher encouraged students to read, write and speak Spanish, most of them were losing their ability to communicate in Spanish and had English as their dominant language both in school and informal situations. The study concludes that at a certain time social and peer pressure are more important for children than family influence, the reason why many of them started feeling uncomfortable speaking their native language with their friends (Worthy, 2003). Evidently, bilingual education is an asset to our country and the benefits can be seen throughout our global economy. People such as Giuliani should embrace the idea of this type of education and should help fund programs as it will undoubtedly further enrich our economy. In addition, why should students loose their native language simply for the reason that the majority of people speak English? The ability to speak multiple languages enables them for future aspirations, success, and priority over those who can only speak only English fluently. Our society extremely benefits from bilingual education and there no significant reason for eliminating it. All in all, bilingual education in public schools is definitely not a threat to an official language or unity of the country. Nor it is a waste of funds since it is so essential in children’s first years of education. ESL classes do not slow down assimilation, and even if in some cases American culture is so diverse that even abolishing all programs helping immigrants to maintain their language will not have a great impact on American melting pot. Instead, English-only initiatives have only negative consequences for limited-English proficient groups and their interaction with the dominant society (Barker, 2001). Abolishing bilingual education in schools will not create an intense for immigrants to learn English, but most likely will result in protests, racial conflicts, even prejudice against minority groups, and that is a certain way to dissolve a country. References August, D. , & Garcia E. E. (1988). Language minority education in the United States. Springfield, IL: Thomas. Barker, Valerie, Howard Giles, Kimberly Noels, Julie Duck, Michael Hecht, and Richarde Clement. (Mar 2001). The English-only movement: A Communication analysis of changing perceptions of language vitality. Journal of Communication,51 (1), 3. Proquest. DeVry University, Federal Way, WA. Retrieved February 3, 2006 from http:\www. il. proquest. compdauto>. Chavez, Linda. (1995, April 2). Bilingual education was to teach English, not trap students. Minneapolis Star Tribune, 23. Conklin, N. F. , & Lourie, M. A. (1983). A host of tongues: Language communities in the United States. New York: The Free Press. Fishman, J. A. , & Markman, B. R. (1979). The ethnic mother-tongue school in America: Assumptions, findings, directory. New York: Ferkauf Graduate School, Yeshiva University. Heath, S. B. (1976). A national language academy: Debate in the new nation. International Journal of the Sociology of Language, 47(11), 9-43. Heath, S. B. (1981). English in our language heritage. In C. A. Ferguson & S. B. Heath (Eds. ), Language in the U. S. A. (pp. 6-20). Cambridge, UK: Cambridge University Press. Johnson, G. W. (1949). Our English heritage. Philadelphia: Lippincott. Keller, G. D. , & Van K. S. Hooft. (1982). A chronology of bilingualism and bilingual education in the United States. In J. A. Fishman & G. D. Keller (Eds. ), Bilingual education for Hispanic students in the United States (pp. 3-19). New York: Teachers College, Columbia University. Kenig, Graciela. (1998). The best careers for bilingual latinos: Market your fluency in Spanish to get ahead on the job. McGraw-Hill. Kleinfeld, J. S. (1979). Eskimo school on the Andreafsky: A study of effective bicultural education. New York: Praeger. Lyons, J. J. (1990). The past and future directions of federal bilingual education policy. In C. B. Cazden & C. E. Snow (Eds. ), English plus: Issues in bilingual education (pp. 66-80). Newbury Park, CA: Sage. Macswan, Jeff. (1998, August 6). Bilingual education an asset that can offer global rewards. Arizona Republic. Retrieved February 4, 2006 from www. onenation. org/0898/080698. html Met, M. , & Galloway, V. (1992). Research in foreign language curriculum. In P. Jackson (Ed. ) Handbook of research on curriculum (pp. 852-890). New York: Macmillan. Mujica, Maero E. (2003, Dec). Why the US needs an official language. The World and I, 18(12), 36. Proquest. Devry University, Federal Way, WA. Retrieved February 4, 2006 from http://www. il. proquest. com/pdauto Ovando, Carlos J. (Spring 2003). Bilingual education in the United States: Historical development and current issues. Bilingual Research Journal 27(1), 1, 25. Proquest. DeVry University, Federal Way, WA. Retrieved February 4, 2006 from http:\www. il. proquest. compdauto>. Pratt, Chasity. (2000, April 4). One class, two languages: Both English, foreign benefit bilingual schools. Newsday, 6. Rojas, E. D. & Reagan, T. (Winter 2003). Linguistic human rights: A new perspective on bilingual education. Educational Foundations 17(1), 5. Proquest. DeVry University, Federal Way, WA. Retrieved February 4, 2006 from http:\www. il. proquest. compdauto Schaefer, Richard T. (2003). Sociology: A Brief introduction. McGraw Hill: New York Willen, Liz. (1998, January, 16). Bilingual debate: Rudy’s push to limit education programs draws flak. Newsday, 8. Wood, Daniel B. (1997, July 30). Next big push from California: No bilingual education. The Christian Science Monitor United States. Retrieved February 4, 2006 from http://csmweb2. emcweb. com/durable/1997/07/03/us/us. 1. html Worthy, J. , Alejandra Rodriguez-Galindo, Lori Czop Assaf, Leticia Martinez and Kimberly Cuero. (Summer 2003). Fifth-grade bilingual students and precursors to ‘subtractive

Zimmer Essay Example | Topics and Well Written Essays - 500 words

Zimmer - Essay Example This allowed orthopedic companies to lower costs due to greater technology. Zimmer pioneered minimally invasive surgeries (MIS), which lowered surgical times, lessened pain, and improved recovery. The industry was forecasted to grow at 23 percent annually, but much of this growth was to occur in the spinal product segment. Zimmer did not cater to this market at all and instead focused on the knee and hip segments. Zimmer Holdings was founded in 1926 after Justin Zimmer, the original founder, could not convince his employer to sell aluminum splints. Zimmer left his job and created his own company. Over the next few years, Zimmer expanded and became a major domestic player in the orthopedic industry. In 1972 Zimmer was bought out by Bristol-Myers, which had designs on Zimmer reaching a global market. In 1989 Bristol-Myers merged with Squibb to form Bristol-Myers Squibb (BMS). In 2001, with the company already a major global pharmaceutical company, a decision was made to turn Zimmer into an independent publicly traded company. BMS appointed several individuals in management positions so as to smooth the transition to the NYSE. By the following year, Zimmer was second in the knee market worldwide, third in the hip market, and fourth in the trauma market. The president of Zimmer Incorporated, J. Raymond Elliott, quickly assessed where the company was at and decided to expand the company into Europ e. Also, Elliott wanted to do something about the spine market, where Zimmer had no presence at all. Sulzer Corporation was founded in 1834 as a Swiss manufacturing cast-iron company. Throughout the years Sulzer expanded and acquired many medical technologies. By the new millennium, Sulzer Medica (SM), as it was known by then, was a global player in the biomedical implant business. After going through some legal troubles, the company was rebranded as Centerpulse Orthopedics. Zimmer was

Violent Video Games Essay Example | Topics and Well Written Essays - 750 words

Violent Video Games - Essay Example It is important to note that besides social networking sites, violence video games have the greatest following among the youth. However, critical consideration of the facts surrounding the act is important to establish ways of managing it so that the future society is saved of devastating socio-economic results. There is a raging debate on the issue of violence video games on the young minds but a lot of focus is evidently put on the negative side. It is important to carry out investigative research that explores the advantages as this equally provides measures of dealing with it. The young generation is subjected to unstable emotional behavior and most of their actions are rarely guided by logics (Kassin, et al. 97). They lack good understanding between reality and fiction which is important when it comes to dealing with the violence video games. This is an age bracket with a lot of energy where physical might and battle for social supremacy reigns and playing such violence video ga mes holds a lot of impact. In-depth analysis of merits and demerits of this popular entertainment is the best avenue to establish it effect on the structural and functional concept relating parents to children. There are observed advantages from the video games which have set its industry bursting with young clients. It is important that the positive side of such a game is also taken into consideration. It would be important to highlight such advantages. Violence video games improve the ability of an individual to concentrate. The mental engagement required while playing such games boosts the focus of the young people and this helps them to learn how to capture detail and master concepts in other social aspects of life like class work. There is a sense of accomplishment when the young people take the game. It is common to come across children saying how they enjoyed the game and this is a pathway to internal spirit of achieving goals in the society (Kassin, et al. 57). Most of the y oung people in the contemporary society have several issues to deal with due to the pressure of changing socio-economic and political environment. This means that they need some form of stress relief which such violence video game with the fantasies in them provide. Some of the content of the violence video games is composed of historical activities and this offers lessons to kids about some significant facts which sum up to sharpen their overall cognitive skills. Research indicates that cognitive ability of the young people improves as they engage their mental and physical efforts towards achieving specific goals. Language development is equally derived partially from the communication experienced by the players of such violence video games. Tactics of winning requires repeated trials by the young players and this boosts their overall learning process. The increasing exposure of the young children to such violence video games has several disadvantages to the society at large. The c ontent of the violence video games includes uncensored sexual acts which intoxicates the children’s morals and may affect their overall productivity in the society. There is an observed increase in childhood aggression which may outplay the emotional stability of the young people. This is worsened by increasing addiction which deepens the defilement of the young people’s mind and lack of concentration on more important issues (Kassin, et al. 37). Much time for learning especially homework and household chores

The role of Multinational Corporations in Developing Economies Essay

The role of Multinational Corporations in Developing Economies - Essay Example On the other hand, Maheshwari (2006, p.53) generally postulates six characteristics of a multinational corporation: (1) operates and carries direct investment to several nation-states; (2) formulates and maintains an industrial organization; (3) widely functions on the basis of globally owned assets; (4) largely transfers capital, goods, and services from home to host countries; (5) transfers resources but does not trade such resources; and (6) manages not its local subsidiaries but the nationals or people from the host country. Maheshwari (2006, p.52) notably provides several examples of MNCs such as Goodyear, Pepsi, and Nestle Corporations. These multinational corporations function and operate in numerous nation-states -- particularly those so-called Third World nations such as Indonesia -- as their host countries. Many of the MNC’s home countries are highly industrialized nations of which the United States is highly prominent. Multinational corporation fundamentally originates from a humble beginning, so to speak: firms. When firms firmly decide to become multinational corporations, there are necessary factors that they systematically fill-up or comply to. Maheshwari (2006, p.53) strongly argues that the underlying reason why certain firms become multinational corporations is because of their desire for vertical expansion. It implies that these firms wanted to substantially expand their business enterprise from production towards distribution. In setting up subsidiaries in other nation-states, these firms -- which ultimately become multinational corporations -- greatly endeavor either to accumulate raw materials from the resources of their host countries or to acquire global markets for the distribution or sale of their capital, goods, and/or services (Maheshwari, 2006). First, firms pursue an expansion business in order to acquire raw materials from the countries whose natural resources are exceedingly abundant. Normally, these firms are

Leading and Managing in Nursing Term Paper Example | Topics and Well Written Essays - 750 words

Leading and Managing in Nursing - Term Paper Example In the contemporary world, the success of healthcare practices and strategies is largely dependent on the leadership style employed. Consequently, the personal characteristics of the leader are imperative as he or she guides the process. As reiterated by NHS Leadership Academy (2013: 3), "The way we manage ourselves is a central part of being an effective leader". For instance, a leader ought to identify his or her strengths and weaknesses in order to make out how to engage his or her followers in nursing. It is worth noting that people respond to leadership in different ways and hence the leadership style adopted by the leader is imperative. The first stage of Gibbs reflective model is a description (Peate, 2013: n.p). Student nurses are faced by a lot of challenges and nurse leaders given the role of teaching them must apply effective methods of leadership. My role involves leading and teaching lower year student nurses how to do aseptic wound dressings. In the process of teaching student nurses, I observed that many of them had a habit of making excuses for poor performance, and also avoided responsibilities. In relation to the second stage of the Gibbs reflective model, which entails explication of feelings (Peate, 2013: n.p), I felt that the students needed to be more accountable of their actions and as a result shun away from giving excuses for their poor performance. Aseptic wound dressing requires a nurse to prepare well in order to avoid spreading infections to the wound (Nicol, Payne and Edwards, 2008: 1). The nurse students made me look bad and therefore I felt dejected. The third stage of the Gibbs reflective model is the evaluation (Peate, 2013: n.p). Personally, I felt that the student nurses were not doing their best in terms of following instructions. However, after discussing this issue with my colleagues, I found out that they were experiencing the same problems with their student nurses.  Ã‚  

Revolution Assignment Example | Topics and Well Written Essays - 250 words - 1

Revolution - Assignment Example On average, the ratio of a British citizen’s tax to that of a colonist was 30-1. Although the issue of ‘taxation without representation’ enraged the colonists, it was barely the main reason for the American Revolution. The French and Indian war, which had put the Brits in bad debt, started mainly as a result of the colonists’ failures (Webster, 1802). However, I agree with the fact that the war was unavoidable although my reasons for this stand are different. One of the reasons I believe the revolution was unavoidable is because independence is inevitable. The idea of equality was fast spreading in Europe and this influenced the colonists into fighting for their own freedom. Additionally, harsh economic conditions contributed to the colonists’ agitation further making the revolution unavoidable. I agree with the writer on the role played by the American Revolution in the institution of slavery. The main contradiction brought by this revolution was the whites trying to gain their freedom while at the same time enslaving the blacks. According to Webster (1802), this was abusing the doctrine of political equality which allows all people to have equal rights to life, property and security. However, it is worth noting that the whites viewed the revolution as a means to political-economical liberation rather than personal repression the blacks suffered

An Argumentive Paper About Using Animals for Testing Cosmitics Research

An Argumentive About Using Animals for Testing Cosmitics - Research Paper Example This essay stresses that one of the negative impacts that comes to mind when reading this article is that the act of animal testing, along with the justifications for animal testing place wrong ideas in the minds of society and therefore in time, creates a society that, like animal testing, is willing to sacrifice one person, or thing, in order to gain another. This should not be the case since all life has value. One other negative effect that we can observe from this article is that the cost that animal testing has racked up is too large to ignore. As previously mentioned, there are more practical, economical and accurate tests and methods available. There are many alternatives to animal testing that can be more economical, accurate and less cruel. This portion of the paper is aimed to discuss and list some of the alternatives one can make use of instead of animal testing. The animals get hurt from these tests do not have a voice of their own. Some people may not know this, and som e might even deny this but animals have feelings and sensations as well as we do and although they are unable to vocalize it, they also feel pain and suffering. This is the reason why there are animal rights movements, because animals cannot fight for themselves, and that they do need someone to defend them as they cannot do it themselves. This paper firmly believes that the practice of animal testing is both cruel and unnecessary. Based on the information and evidences provided about, we can definitely see that animal testing causes harm, no just to animals, but to society, and even humans as well and also see that there are safe, humane and practical alternatives to animal testing that are also potentially more accurate. ... The statement being made is that animal testing in cosmetics is a fact and that it has a negative effect. The first article we can look at is one by idausa.org. It states certain details and information regarding animal testing in cosmetics. It states certain details such as death of animals involved in animal testing with cosmetics, cruel and inhumane testing as well as the inaccurate nature of these tests. This gives us a good jump-off point for our argument regarding the negativity and cruelty behind animal testing. The article also provides us information on some affordable and more effective methods of testing, which will be discussed later in the paper. Another paper we can look at is one by mercyforanimals.org. It provides us with a graphic account of certain tests that are done by some companies and what effects they have on animals such as rabbits, rats, and others. These tests result in discomfort, suffering and even death for the animals involved. The article states that a lthough there are no laws that specifically require animal testing for cosmetic products, some companies still opt to do them despite the pain, suffering and death on th part of the animal. Lastly, one article by humanesociety.org discusses the kind of tests that are done to animals, provides us some reasons as to why it is done, but at the same time recognizes that these tests are wrong, and that there are alternatives that are not cruel, and are to an extent, more effective than animal testing. Negative effects of animal testing As this paper's main goal is to argue that animal testing is negative practice, it must first discuss its negative

Article Essay Example | Topics and Well Written Essays - 500 words - 10

Article - Essay Example The article notes that Just-in case distribution helps companies to reduce the cost of keeping large stock by ensuring just in time supplies. In addition, the just-in case distribution also aids in reducing the cost of transportation since shipping of goods is on demand. The article asserts that the just-in-case plan was a response to the vulnerable just-in-time supply chains. The article notes that just-in-time management exposes companies to a greater risk of running out of merchandise in case of disruptions. Indeed, the article reckons that combining the just in case with just-in-time strategy was a means of seeking to a balance between holding the minimum inventory possible and yet never running out of stock. The just-in case just-in time distribution strategy expands and increases the network of distribution centers hence reducing the distance by moving the inventory more close to the customers. Apparently, the article shows that companies can achieve greater efficiency upon transporting its goods to the customers immediately. As such, many companies seek competitive advantage amidst stiff competition arising in market by offering excellent customer service. Multiple and strategically place distribution channels help in minimizing the time, money and distant spent in delivering merchandise to the customers. However, the article observes that retailers often avoid transporting merchandise to the last miles by directing the nearby customers to collect their merchandise from the nearby shop. From the content of the article, I feel that the Just-in-case  is an effective strategy in supply chain management. Indeed, the just-in-time management exposes companies to a greater risk of running out of merchandise in case of disruptions. I therefore relate the article with the benefits of the just-in case management that allows retailers to enjoy a lot of stability since there is efficient distribution of goods and they do not have to rely on one

Reality in the eye of representation Assignment

Reality in the eye of representation - Assignment Example The paper "Reality in the eye of representation" through analysis of various works produced in the eighties will give a clear picture of whether representation is a copy of reality or reality is a mere effect of representation. The use of signs in place of something else is known as representation. An artist can represent the world and reality through simple acts giving its element some unique attributes. The signs are thus organized in some kind of semantic construction and show relations. For example, both modern and ancient philosophers consider a man as a representative of all animals. The term representation can therefore be used to give various meanings such resemble or look like. It can also be used to stand for an object or individual. Representation therefore helps stimulate sensory information pertaining to an individual or item as described through a medium used. How perfect a representation look like the intended object depends on resolution that an artist assigns on the art and the word choice. Influence that presentation has on reality and the opposite of the same was a typical 1980s concern in art. Many arts were used to critique popular traditions. In 1980s videos portrayed the structural experiments of the past decades as political influenced. The arts instead looked to critique the social and economic premise on which the television was invented. The artist argued that the videos looked like TV shows though with something missing. The critique of representation became more popular.

Review of Continental Airlines organizational structure Essay Example for Free

Review of Continental Airlines organizational structure Essay 1.Does the organizational design of this corporation help or hinder it in achieving its organizational goals? Continental Airlines utilizes a divisional structure relative to the management of its various entities. This structural design is due to the complex nature of the aviation industry as well as the autonomy required in operating a twenty-four hour a day, seven day per week worldwide business. In my opinion, the structural design of this organization with the exception of Continental Express and Continental Micronesia can really not be structured in any other way, and therefore should be considered helpful. The airline business is an incredibly tough business as it is. The costs of operations in relation to profit per passenger mile are very low. This airline and its management team have emerged from bankruptcy and now fly the newest fleet of aircraft in the sky today. Chairman and CEO Gordon Bethune with his years of experience in the aviation industry have afforded the opportunity for Continental to receive more awards for customer satisfaction than any other airline. Obviously, this is a far cry from the pre-bankruptcy days of this airline which now proudly stands as an industry leader. (No, I do not work, nor have I ever worked in the airline industry). The organizational structures leadership includes various notables that have grown up within the industry filling various leadership positions for other airlines. It seems as though Mr. Bethune has installed an incredibly capable team to steer this company into the future. I carved out Continental Express and Micronesia since they are basically licensed businesses that fly under the Continental flag. Their existence within the Continental family does provide routes to smaller and far-eastern destinations but are independently managed and therefore not considered (by me) as anything more than a profit center on the organizational chart. 2.If you were to change this organization, what issues would you need to consider and why? What would be the advantages and disadvantages of organizational change? If I had the ability and experience to effect change for this organization, the first issue I would consider would be consolidation of the airlines in  general. I address this issue because I do not necessarily feel that consolidation is all that its cracked up to be. Bigger airlines mean bigger bureaucracy and smaller profit potential. Both of these translate to decreased customer satisfaction as well as the potential for employee dissatisfaction. Mr. Bethune prides himself in being one of the people, he is often seen walking in the terminal, shaking hands and recognizing employees for doing an outstanding job. As a rated company pilot, he is also seen on the flight deck of the occasional 757 or 777. It is hard to imagine how the current structure could be improved beyond what it already is. He is leading by example as a leader should. Should airline consolidation continue, the main advantage would be for the traveling public. The customer could potentially book a trip around the world simply by calling the Continental reservation line. Until that customer shows up for the trip to commence, he may not even realize that hes not even on a Continental flight. Thats the beauty of being big. The trip might be made up of legs flown by Northwest connecting to Varig connecting to Delta connecting to Qantas, etc. This seamless travel experience for the customer should be considered as an upside to consolidation. The main disadvantage might possibly be that the customer has no idea who to call when things go wrong. He might be stranded in a foreign land after his connection with China Airlines cancelled and hes not sure of whom to contact to get back on track. The second issue I might consider would be mandatory retirement of pilots once they reach their sixtieth birthday. Organizationally, this federally mandated policy weakens the organization. My best and most experienced pilots are being forced out of my company. If this policy is unchangeable, I must find a way to keep this incredible resource happy and employed in some form or fashion that augments my existing infrastructure. This disadvantage to my organization structure is a hurdle that is out of my control but directly affects the bottom line relative to people and organizational power. Reference: www.continental.com/company/investor.governance.asp

Amniotic Fluid Volume In Pregnancy

Amniotic Fluid Volume In Pregnancy Objectives . To assess the relationship between the amniotic fluid volume (AFV) in low risk pregnancy and the perinatal outcome, using either AFI or SDP, and to evaluate the effects of different fetal positions and Attitudes on those measurements Methods . A prospective study was performed, in which a sample of 3000 low-risk pregnant women were studied using routine ultrasound, including fetal biometry and measurement of AFI, and SDP. Data were analysed using multiple linear regression, and constructing a curve for both the AFI, and SDP measurements, according to gestational age, the fetal positions and attitudes, in addition to the assessment of the final perinatal outcome. Results . The 50th percentile remained practically constant at approximately 150 mm between the 20th and 33rd week, after which there was a decline in volume, which became evident after the 38th week. At the 40th week, the 10th percentile was around 62 mm and the 2.5th percentile around 33 mm. Among the group with intact membranes, no significant differences in perinatal outcome could be seen in relationship to the AFI and SDP, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. Fetal position had significantly affected the AFI, which was remarkably lower in breech pregnancies, but without similar effect on SDP. There was no significant difference for either SDP (P = 0.8) or AFI (P = 0.3) between fetuses lying on the right or the left side of the maternal abdomen. Conclusions . The percentiles incidence of amniotic fluid measurements in low-risk pregnant women showed significant decrease with gestational age, especially after the 33rd week pregnancy. Fetal position and laterality had affected significantly the AFI, but not the SDP. Key words: Amniotic fluid index, low-risk pregnancy, obstetric ultrasonography Abbreviations: AFI: amniotic fluid index, AFV: amniotic fluid volume, GA: gestational age, p: percentile Introduction The importance of variations in volume of amniotic fluid to fetal well-being has been particularly well-established, and are closely correlated to an increase in perinatal mortality and morbidity rates (1, 2), although some doubts have recently been raised (3). Fetal well-being is an important question that can, however, remain unanswered in many situations, but progress in diagnostic techniques has resulted in better perinatal outcomes, and has also contributed to understanding the complex physiological and pathological interaction between fetus and mother (4, 5). AFI and SDP are the sonographic parameters most commonly used to estimate amniotic fluid volume. Both use a two-dimensional measurement to estimate a three- dimensional parameter and are therefore subject to error. Amniotic fluid index (AFI), a semiquantitative ultrasound measure used to denote the volume of amniotic fluid, was first described in 1987 by Phelan et al. (6, 7). Since AFI involves measurements in four quadrants and SDP only measures the deepest pocket, it is possible that fetal position would affect these two indices differently. The relative accuracy of SDP and AFI is still controversial. Using invasive methods, some studies have shown these methods to be comparable, while others have shown that one index might be better than the other. However, none of these studies took into account the potential effect of fetal position on the amniotic fluid volume indices (8). Many studies have shown an increased risk of intrapartal fetal distress in parturient women with oligohydramnios, as identified by ultrasound examination. The exact pathophysiologic mechanism of olighydramnios has not been defined, but one likely explanation is an increased risk of umbilical cord compression during uterine contractions (7,9). However, doubts remain concerning normal values of AFI for each gestational age. The reference curves established some years ago are still in use in current obstetrical practice, but there is a need for new data, using a reliable reference low-risk pregnant women sample, to establish the limits of AFI that would indicate perinatal risk (9). Some existing curves (10 13), were based on relatively small sample sizes, and normal AFI for each gestational age was not yet definitely established. The purpose of this study was to estimate the curve for the amniotic fluid volume in low risk pregnancy, using a set of obstetric sonograms of women between the 20th and 42nd week, using two established parameters, the AFI and SDP, and to assess the effects of those measurements on the final perinatal outcome, in addition to studying the effects of different fetal positions and attitudes on those measured parameters. Material and methods A prospective study was carried out to estimate and evaluate the reference curve of AFI values in low-risk pregnant women, and to follow its effects on the final perinatal outcome. The study was performed at the Feto-maternal Unit, Department of Obstetrics and Gynecology at El-Minya University, Egypt. Inclusion criteria were: gestational age clearly established by last menstrual period, and confirmed by early ultrasound examination performed in first trimester of pregnancy; and gestational age between 20 and 42 weeks. Women excluded were those with pregnancy-induced hypertension, diabetes mellitus, chronic hypertension, gestational diabetes, fetal macrosomia, ruptured membranes, placental senescence, twin pregnancy, fetal growth restriction, fetal abnormalities, fetal death, fetal isoimmunisation, or other conditions, such as metabolic disorders, kidney and heart disorders, and hypo- and hyperthyroidism. Amniotic fluid volume was measured using a 3.5 MHz linear transducer linked to a ALOKA SS 280. A scanner using the 4-quadrant technique for the assessment of AFV, described by Phelan et al.(6, 7, 9), with a modification proposed by Jeng et al.(11). A total of 3000 women between the 20th and 42nd week of pregnancy were evaluated in this study, between August 2008 and December 2010. In order to avoid any possible bias due to repetition of examinations in women with some undetected problem, an independent sample was chosen. Therefore, only the first ultrasonographic examination of each woman was included in the study, and different sample populations were used for each gestational age, in a cross-sectional design. A formal consent had been taken form the women included in the study, after full explanation and counseling, and approval of the regional ethical committee. The uterus was imaginarily divided into right and left halves along the linea nigra on the surface of the maternal abdomen. Using the mid-point between the fundus uteri and the pubic symphysis, the uterus was also divided into upper and lower halves. With the transducer head perpendicular to the ground, the largest amniotic fluid pocket in each quadrant was identified. The vertical diameter of this largest pocket of each one of the four quadrants was then measured. The AFI was defined as the sum of the measurements of each quadrant in millimeters. All examinations were performed by only one professional in order to avoid inter-observer variability. The intra-observer variability of the measures performed with this technique was estimated to be high (correlation coefficient 0.92) (14-18). Both AFI and SDP were measured at the same time during the examination. SDP was obtained by measuring the depth of the single deepest vertical amniotic fluid pocket that was clear of umbilical cord or fetal parts (19,20). AFI was calculated as the sum of the depths of the deepest pockets from each of the four quadrants of the uterus. The position of the fetal trunk was characterized by three parameters. Initially, the ultrasound probe was placed transversely on the maternal abdominal wall, with the midpoint of the probe over the sagittal midline of the maternal abdomen, at the level of the fetal abdominal circumference (Figure 1). A vertical line (Line Y) was drawn downwards from the center of the ultrasound probe. A horizontal line (Line X) was drawn across the maximum diameter of the fetal abdominal circumference. Line X was thus divided by Line Y into a shorter part (S) and a longer part (L). The first parameter to be determined was the position of the fetal trunk. This was assigned as either fetal trunk left or fetal trunk right depending on whether L was on the left or the right side, respectively, of the maternal abdomen (21-24). Next, we determined by how much the fetal trunk lay to one side of the uterus, by calculating the laterality score, defined as S/(S + L). This score ranged from 0 to 0.5; a score of exactly 0.5 meant that the fetal trunk was on the sagittal midline of the maternal abdomen, and a score of 0 meant that the fetal trunk was to the side and did not cross over Line Y. The use of the laterality score has not been reported previously. Finally, we determined the orientation of the ventral part of the fetal abdomen: a line (Line Z) was drawn from the fetal hepatic vein to the fetal spine, and the angle (A) between Lines Z and Y was determined. Fetuses were classified into one of three groups: ventral anterior (A = 300.1 360- or0-60-), ventral lateral (A = 60.1 120- or 240.1 300-) and ventral posterior (A= 120.1 240-). Figure I. The study population was categorized into different groups according to the fetal position, and AFI and SDP in the different groups were compared. Pearsons correlation coefficient between laterality score and AFI was considered the primary outcome measure. For an r of 0.25, a minimum of 62 cases was needed at a Type I error of 0.05. Based on the curve of Jeng et al. (25), and adopting a mean AFI measurement of 140 mm at 40 weeks, and a standard deviation of 48 mm, a sample size of at least 120 measurements for each week of pregnancy was estimated, assuming an ÃŽ ± error of 0.05 and a maximum difference of 10 mm between population and sample measurements. The AFI was correlated to perinatal outcome based on the Apgar score, umbilical cord blood pH, birthweight, frequency of cesarean section for fetal distress, operative delivery for fetal distress, including both cesarean section, vaginal forceps, and ventous extractions, and referral to the neonatal intensive care unit (NICU). Fishers exact test was used for statistical evaluation. P < 0.05 was considered statistically significant. The computer program nQuary Advisor Release 3 (Statistical Solutions Ltd, Cork, Ireland) was used to calculate the sample size needed in order to obtain significance levels at p < 0.05 and 0.01 with 90% confidence intervals (CI). Data were analysed using multiple linear regression, and by constructing a curve of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the amniotic fluid measurements according to gestational age. All statistical analyses were performed using the Statistical Package for Social Sciences for Windows version 10.0 (SPSS Inc, Chicago, IL, USA). Students t- test, Pearsons correlation coefficient, linear regression and ANOVA were used as appropriate. A P-value of < 0.05 was considered statistically significant. Results The 3000 pregnant women included in the study had a mean age of 25.9 years (range 13 46), with low parity (45% were primigravida). The sample was basically from a low risk population because of the exclusion criteria used. The values of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI, and SDP according to gestational age are shown in Figure II, III and IV show the data after being submitted to a smoothing process using quadratic polynomial adjustments. Analysis of the 50th percentile measurements of the AFI, and SDP curve at different gestational ages revealed that these values remained practically constant, at around 150 mm, between the 20th and 33rd week of pregnancy. At this point, values began to decrease, and this decline became particularly evident after the 38th week, reaching 130 mm at the 39th week, 120 mm at the 41st week and 116 mm at the 42nd week of gestation. Table I, and II The mean gestational age at the time of examination was 33.3 Â ± 2.8 weeks. The mean SDP and AFI were 5.5 (range, 2.8 9.3) cm and 14.5 (range, 6.7 29.3) cm, respectively. There were no significant differences in mean AFI measurements when these data were controlled for age, race, literacy, parity or previous caesarean scar (data already published elsewhere) (18). Measurements of the 10th percentile remained 100 mm until the 33rd week, when an accentuated decrease started, declining even more sharply after the 38th week of gestation, reaching values 80 mm and 40 mm at the 42nd week. According to the published normal ranges, six cases had polyhydramnios (AFI = 29.3 cm at 29 weeks gestation, SDP = 9.1 cm at 37 weeks and SDP = 9.3 cm at 33 weeks gestation) and two cases had oligohydramnios (AFI = 6.7 cm at 36 weeks gestation). Twelve hundreds and five (42%) cases were fetal trunk right and 1663 (58%) were fetal trunk left. There were no significant differences between these groups with respect to gestational age (33.1 Â ± 2.4 vs. 33.4 Â ± 2.7 weeks, P = 0.7), mean SDP (5.4 Â ± 1.3 vs. 5.5 Â ± 1.4 cm, P = 0.3) and mean AFI (15.1 Â ± 5.1 vs. 14.1 Â ± 4.0 cm, P = 0.8).Table III In fact, our results showed that fetal position had a significant effect on AFI but not on SDP; the more the fetus was positioned to one side of the uterus, the lower was the AFI. Both methods show good correlation between the measurements and the actual volume of amniotic fluid. The effect of laterality score on amniotic fluid volume indices was assessed by Pearsons correlation coefficient and linear regression. It had no significant effect on SDP (r = 0.13, ÃŽ ² = 1.1, standard error = 0.9, P = 0.23). However, it did significantly influence AFI (r = 0.31, ÃŽ ² = Transverse section of maternal trunk level of fetal abdomen8.7, standard error = 3.0, P = 0.005). The regression line is shown in Figure III. In other words, when the laterality score increased, the AFI increased proportionately. When the laterality score was 0.5 (fetal trunk positioned at the midline of the maternal abdomen), the AFI was, on average, 4.35 cm higher than it was when the laterality score was 0 (fetal trunk lay on the side and did not cross the midline of the maternal sagittal plane). Figure III, IV. There were two case of high AFI (29.3 cm) in the study population. In order to exclude the possibility that the results were influenced by this single case, we repeated the analysis quadrants of the ipsilateral side, the vertical depth of these two quadrants being be much shallower compared with those on the contralateral side. Although amniotic fluid should be displaced to the contralateral side, this may not be reflected completely in a two-dimensional measurement of the depth of the other two pockets. Therefore, it is not surprising to find that AFI measurement is lower when the fetus lies on one side of the uterus instead of centrally. The difference was statistically significant and is clinically important. When the fetus lay on one side of the uterus, the AFI was, on average, 4.35 cm lower compared with the AFI for a fetus lying centrally. On the contrary, SDP is apparently rather inert to fetal position. Since SDP only measures the deepest pocket, it is understandable that the effect of fetal position on its measurement is less. Based on the results of this study, SDP may be a better index for estimation of amniotic fluid volume than is AFI, because the association between SDP and laterality score remained non-significant (P = 0.4, ÃŽ ² = 0.8, standard error = 0.9). Further analysis was also performed with linear regression to control for the effect of gestational age. These results showed that the laterality score had a significant effect on AFI (ÃŽ ² = 9.6, standard error = 3.0, P = 0.002) that was independent of gestational age (ÃŽ ² = −0.4, standard error = 0.2, P = 0.019). AFI was significantly higher in cephalic fetal position, more than with breech ones. This result had been clearly apparent after 32 weeks gestation, and with less AFI with the ventral fetal trunk attitude with the breech position, than other. SDP had not show the same picture in different fetal positions, either breech or cephalic, so SDP as an AFV parameter had not been affected with the different fetal positions. Of the 3000 fetuses, 345 were ventral anterior, 1720 were ventral lateral and 803 were ventral posterior. The respective gestational ages of these groups were 33.5 Â ± 2.7, 32.8 Â ± 2.7 and 34.2 Â ± 2.8 weeks, the SDPs were 5.5 Â ± 1.4, 5.5 Â ± 1.3 and 5.5 Â ± 1.4 cm, and the AFIs were 14.5 Â ± 5.3, 14.4 Â ± 4.4 and 14.8 Â ± 4.4 cm. None of these was significantly different between the three groups (P = 1.0, P = 0.14 and P = 0.9, respectively). The 3000 pregnant women were divided into two subgroups according to the status of the fetal membranes. The membranes were found to be ruptured at the time of the examination in 1400 (44%) women; 750 (25%) had oligohydramnios. The membranes were intact in 1600 (55); 350 (15%) had hydramnios. Table I shows the maternal variables of the two groups. The median interval between the ultrasound examination and delivery was 4 h (range 0-24 h) in the group with ruptured membranes and 6 h (range 0-70 h) in those with intact membranes. In the group with ruptured membranes there was a significant difference in the frequency of operative delivery due to feta distress between the parturients with oligohydramnios and those with a normal volume of amniotic fluid [10.6% and 3.0%, respectively, p < 0.02, OR 3.86 (range 1.34-1.11)]. No significant differences were found regarding the other variables of perinatal outcome (Table II). In the group with intact membranes, there was a 50% increased risk of operative intervention due to fetal distress (OR 1.5), though not significant (CI 0.48-4.63) (Table III). Discussion There is a variation in AFI measurements according to gestational age. Values in the current study remain relatively constant until the 33rd week of pregnancy when a progressive decrease starts, becoming particularly evident after the 38th week of gestation. The normal lower and upper limit values of the AFI commonly used up to now, which vary between 50 and 200 mm, are similar to those found in the present study up to the 40th week of pregnancy. When adopting reference values between 80 and 180 mm for every week of pregnancy (19,20), incorrect diagnosis are likely to occur. Our findings, suggested a strong influence of fetal position on sonographic indices of amniotic fluid volume. Furthermore, we recruited women with apparently normal pregnancies and hence most likely with normal amniotic fluid volumes. Further studies should look at the relationship between fetal position and amniotic fluid volume indices in cases of oligohydramnios and polyhydramnios. Pregnant women, who are classified as having oligohydramnios by these criteria, may possibly be considered normal if a reference curve of AFI specific to gestational age were used, especially in term and post-term pregnancies. The adopted limit values indicating an alteration in the AFV are variable. For the fetal biophysical profile, the measurement of just one pocket is adopted, varying from 1 to 3 cm, and considered the lower normal limit by some authors (21,22); however, in this case, total volume would be considered decreased if the AFI were used. In fact, a RCT comparing both techniques showed an overestimation of abnormal results with AFI in post term pregnancies, increasing the number of obstetric interventions (23). These variations in classifying oligohydramnios reflect doubts regarding which percentiles best express the correlation between the decrease in AFV and poor fetal outcome. When the 50th percentile AFI was compared with that reported in a previous study (14), measurements were always higher in our study at all gestational ages by approximately 50 mm up to 28 weeks, and by 30 40 mm between 32 and 40 weeks of pregnancy. On the other hand, the current 50th percentile showed fewer variations, around 10 mm at all gestational ges, compared to the results of the indian study population (15). The importance of a curve that includes the 10th and 90th percentiles is reflected in its greater capacity to identify abnormal cases. Therefore, if the 10th percentile is used as the lower normal limit, there would be less likelihood of missing a case of real oligohydramnios. A curve that included the 2.5th and 97.5th percentiles would diagnose fewer cases of abnormal AFI, and this could result in more cases of oligohydramnios or polyhydramnios being included within the normal range. By adopting the 10th percentile of AFI as the diagnosis for oligohydramnios in our population, the values are higher than those found for the Chinese study up to 36 weeks, but similar around 40 weeks of pregnancy (14). When we compare the results of this study to previous published curves (10-17), similarities can be seen for the 50th percentile of AFT at all gestational ages. However, when comparing the 2.5th percentile, it is evident that the measurements in Moore and Cayles curve are lower up to the 35th week of pregnancy, after which they are higher than the values found in our study curve. The 97.5th percentile of the Moore and Cayle curve is slightly higher at all gestational ages except for the 41st and 42nd weeks. The lower limit of 2 standard-deviations and the mean values of the Jeng et al. (11) curve are slightly lower in relation to the present curve at corresponding gestational ages, except from the 37th to the 42nd week, when values remain higher than those in the present curve. The definition of normal AFI cannot, in itself, guarantee good perinatal outcome. For instance, a 42-week pregnancy with an AFI of 45 mm would be considered normal, but how physiological this value is and what real risk it represents are questions that still need to be fully answered. If the correlation between AFV and perinatal outcome can be established, this curve may have a broader clinical application in prenatal diagnosis and care. Moreover, the curve of the 2.5th, 10th, 50th, 90th and 97.5th percentiles of the AFI measurements shows a significant decrease according to gestational age, especially after the 32nd week. This measurement could, therefore, considered a normal reference curve for the evaluation of AFI. The results of the present study suggest that oligohydramnios after rupture of the membranes in low-risk pregnancies is associated with a nearly four-fold increased risk of operative delivery due to fetal distress. An ultrasound examination of AFI could thus identify those who may need intensified fetal surveillance during labor. The present study was performed on a selected group of women with low-risk pregnancy. As AFI is one of the parameters checked in high-risk pregnancies at our hospital, these parturients were excluded in order to make the study blind. By adding high-risk pregnancies, a much smaller sample size would be needed. The frequency of oligohydramnios in cases with intact membranes was unexpectedly high: 15% instead of 5% in the controls. Although our pregnancies were low-risk, a few showed signs of pregnancy complications on admission to the labor ward (Table I), which might explain the higher frequency of oligohydramnios in this group. Although there was a significant correlation between operative delivery due to fetal distress and oligohydramnios in cases of ruptured membrane (Table II), sensitivity was low (11%), and false-positive and negative rates were 46% and 23%, respectively. Thus the knowledge of oligohydramnios in these low-risk pregnancies did not cause any immediate action, only more intense surveillance during labor. In the present study there was a 50% increased risk of operative fetal delivery due to fetal distress in parturients with oligohydramnios and intact membranes. Teoh et al. studied 120 pregnancies as an admission study in early labor with intact membranes. The frequency of oligohydramnios (AFI < 5 cm) in their study was 22%, and operative delivery due to fetal distress frequency among these was 27%. Based on these data, a sample size of 100 would be sufficient. We chose, however, three times that size, as the low-risk status of their population was uncertain (9, 11). The pathophysiology of oligohydramnios before membrane rupture is unclear. One theory is that a reduced perfusion of the placenta causes hypovolemia in the fetus, and/or an automatic redistribution of fetal blood volume to vital organs with a resultant reduced blood supply to the kidneys. This in turn could lead to reduced production of urine, and thus reduce the volume of amniotic fluid. Bar- Hava et al. studied signs of redistribution, renal blood flow, and signs of oligohydramnios, but could find no correlation. There was no change in the renal artery pulsatility index (12, 14, 19). Oligohydramnios in labor after the rupture of membranes in a low-risk pregnancy is probably not caused by a reduced perfusion of the placenta, but is more probably caused by the loss of large amounts of amniotic fluid at the time of the rupture. One explanation for the significantly increased risk of operative delivery due to fetal distress in the group with ruptured membranes might be that there is an increased risk of the umbilical cord becoming trapped in an ad- verse position, at the time of the rupture, if a large amount of amniotic fluid is lost. Amnioinfusion may be a way to treat such cases in order to restore the volume of amniotic fluid and reduce the risk of compression of the umbilical cord, thus averting the need for operative delivery (11, 21, 23). As a conclusion of the current study, assessment of the AFV during pregnancy using the SDP appears to be more accurate than the AFI, especially the SDP evaluation has not been affected significantly with either different fetal positions or attitudes, but still we are in need for further controlled studies to compare the accuracy of the two modes of AFV assessment. Another conclusion drawn from our study is that an ultrasound examination, including measurement of AFI as an admission test for women presenting at the labor ward with ruptured membranes after an uneventful pregnancy, could help identify those with an increased risk of intrapartum fetal distress, namely those with oligohydramnios. Moreover Measuring AFI in low-risk pregnancies on admission to the labor ward might detect cases needing special surveillance. We are currently preparing a new ongoing study, as an extension to the current study, comparing the previous two parameters of AFV assessment in high risk pregnancies, and the preliminary results could confirm the previously mentioned results, but it is too early to get to a final conclusion.

Calcium Channel Blockers

Calcium Channel Blockers B. Trimble Calcium-channel blockers or calcium antagonist have several possible modes of action in hypertension. In general, these agents block the slow channel in the cell membrane and prevent calcium entry into the cell. This blocking action reduces the mechanical activity of vascular smooth muscle and leads to vasodilation. Another possible mode of action is that they block norepinephrine-mediated vasoconstriction. This may occur because alpha sympathetic vasoconstriction is produced by enhanced calcium influx into the cell. If calcium influx is decreased, then norepinephrine vasoconstriction is reduced. Another system regulated by intracellular calcium is the release of renin by the cells of the kidney. Because calcium-channel blockers inhibit renin release, the renin-angiotensin system may also be suppressed. Calcium-channel blockers prove to be useful in hypertensive patients who also have stable angina and spastic angina (Brunton, Chabner, Knollman, 2011). The vasodilation properties of calcium-channel blockers lead to a reduction in after-load, and their regional smooth muscle relaxant properties are useful in relieving coronary spasms. Calcium-channel blockers are also useful in treating patients who cannot take beta-blocking agents (Katzung, Mastes, Trevor, 2012). African-American patients may benefit more from CCBs as a first line of hypertensive treatment than others. Grapefruit products should be avoided as they interfere with normal operation of the medication. CCBs can also cause low blood glucose particularly those whose dosage is more than 60 mg daily. CCBs are mainly intended to be used for isolated systolic hypertension, and may be used in combination with other antihypertensive medications such as diuretics and ACE Inhibitors (Frank, 2008). Verapamil hydrochloride (Calan, Isoptin) is given in doses of 240-640 mg daily to control essential hypertension. The oral dose is almost completely absorbed from the gastrointestinal tract, and there is a large first-pass hepatic effect. Side effects include constipation, headache, flushing, peripheral edema, and AV nodal effects such as first- and second-degree heart blocks. Verapamil has significant negative inotropic effects and should not be used in patients with congestive heart failure. Verapamil applies antihypertensive results by decreasing systemic vascular resistance usually without orthostatic decreases in blood pressure or response tachycardia. Verapamil reduces arterial pressure at rest and at a given level of exercise by reducing the total peripheral resistance or afterload against which the heart works. The dosage should be titrated for the individual. The usual daily dose of sustained release verapamil, Verelan, is 240 mg daily, however, the initial dosage of 120 mg may be necessary for patients who may have an increased reaction (e.g. Elderly or small people). If adequate control is not obtained with 120 mg, the dose may be titrated in the following manner: 180-240-360-480 mg daily (Chen, et al., 2010). Nifedipine (Procardia) used for essential hypertension the dosage ranges between 10 and 20 mg given three times daily. Doses above 100 mg are not recommended (Chen, et al., 2010). The oral dose is rapidly and fully absorbed from the gastrointestinal tract, with the drug being metabolized in the liver, highly bound to plasma proteins with a half-life of approximately two hours. Nifedipine is more effective than verapamil in dilating peripheral blood vessels. Side effects include reflex tachycardias, stimulation of SA node, flushing, peripheral edema, and headache. CNS symptoms include tremors, nervousness, and mood changes (Wisloff, et al., 2012). Nifedipine and the other dihydropyridine agents (Norvasc, Caduet, Lotrel, Sular, Calan, Verelan, etc.) are more selective as vasodilators and have less cardiac depressant effect then verapamil and Diltiazem. It is recommended that short acting oral dihydropyridine not be used for hypertension due to the increased risk of myocardial infraction. Oral Nifedipine has been used in emergency treatment of severe hypertension (Chen, et al., 2010). Norvasc is a dihydropyridine; Norvasc usual dosage is 5 to 10 mg daily. Small, fragile, or elderly patients or patients with hepatic insufficiency may be started on 2.5 mg daily and titrated for response (Wisloff, et al., 2012). Diltiazem (Cardizem) dosage is between 30 and 90 mg three to four times daily. It is well absorbed by the gastrointestinal tract, with onset of action in less than 15 minutes, a peak effect in 30 minutes, and a half-life of approximately four hours. Vasodilation is limited almost exclusively to the coronary arteries. The most common side effects include AV block, dry mouth, headache, vertigo, rash, and edema (Chen, et al., 2010). Diltiazem SR is one of several preferred initial therapies for hypertensive patients with high risk of developing coronary artery disease including those with diabetes mellitus. It can be used as a monotherapy for initial management of uncomplicated hypertension with conventional tablets used three to four doses daily before meals and at bedtime. Again, elderly or smaller persons may require a lower dosage and titrate as needed for response (Frank, 2008). The algorithm for hypertension management according to The National Institute for Health and Clinical Excellence is as follows: KEY: A= ACE Inhibitor or Angiotensin II (ARB); C= Calcium Channel blocker; D= thiazide-like diuretics Step 1. Under age 55 years Over age 55 or Black person of African or Caribbean family origin of any age (C) Step 2. - (55 yrs.) Step 3. (55yrs) -Step 4. Resistant hypertension (A+C+D+ consider further diuretics OR Alpha blockers or Beta blocker) (The National Institute for Health and Clinical Excellence, 2011). References Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans: The pharmacological basis of therapeutics (12 ed.). McGraw-Hill. Chen, N., Zhon, M., Yang, M., Guo, J., Zhu, C., Yang, J.,. .. He, L. (2010, August). Calcium channel blockers versus other classes of drugs for hypertension. doi:10.1002/1465/858.CD003654.pub4 Frank, J. (2008, May). Managing hypertension using combination therapy. American Family Physician, 77(9), 1279-1286. Retrieved from American Family Physician: http://www.aafp.org/afp/2008/0501/p1279 Katzung, B., Mastes, S., Trevor, A. (2012). Basic clinical pharmacology (12 ed.). McGraw-Hill. The National Institute for Health and Clinical Excellence. (2011, May 2011). Quick reference guide. Retrieved from NICE Clinical Guidelines: http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf Wisloff, T., Selmer, R., Halvorsen, S., Fretheim, A., Novhein, O., Kristiansen, I. (2012, April 4). Choice of generic antihypertensive drugs for the primary prevention of cardiovascular diseasea cost-effectiveness analysis. doi:10.1186/1471-2261-12-26