Plug-in Hybrid vs. Pure Electric Cars Research Essay Essay Example for Free

Plug-in Hybrid vs. Pure Electric Cars Research Essay Essay This world has prospered with gasoline cars since the late eighteen hundreds and nineteen hundreds. In fact, the world we live in today cannot stand without the benefits of gasoline-powered vehicular travel. Since the modernization of travel, the public can drive cars anywhere, including other countries, cities, streets, houses, or even backyards. The mass want of private automobiles has led to more drivers, then a huge amount of pollution, and then that familiar phrase: Global Warming. This is why we need a new alternative to the combustion engine, and there are very many ways to achieve this including plug-in cars and pure electric cars. But, to fully prevent Global Warming, our economy must run on pure clean energy. Plug-in hybrid cars have their benefits, including the ability to revert to an internal combustion engine when the battery dies, but pure-electric cars are the way to go because the battery has a much larger store of electricity and electric cars do not run on harmful gasoline; they run on clean energy. The pros of hybrid plug-in cars do not match the pros that the pure-electric car boasts. Although, there are some so-called experts who disprove this theory, and say that hybrid cars are the best way to go. A pro in the mind of Philip Dunn, a hybrid car advocate, is that â€Å"at higher speeds above forty miles per hour the gas motor kicks in and gives that peppy feel so many car owners look for when driving on the highway. † Another pro is that the hybrid car can â€Å"already get one-hundred mpg on fifty-five-mile trips using cobbled-together PHEVs,† (Plug-in Hybrid Electric Vehicle) says Ben Hewitt, another advocate of hybrid cars. The hybrid vehicle also does not produce any Carbon-Dioxide from a stop, and does not produce any Carbon-Dioxide moving at less than under forty miles per hour. These pros, nonetheless, are better than a pure-gas engine, which compares with an average 21 mpg (estimation courtesy of EPA), and produces Carbon-Dioxide all of the time that it is running. But, these pros do not scratch the surface of the pure-electric car and its wonders. The cons of the plug-in car are various. The plug-in car costs â€Å"anywhere from three-thousand dollars to eight-thousand dollars more than conventional automobiles† (Watson), but these prices will go down as manufacturers start developing more hybrids and create more competition. Until there is more research, hybrids also use up the electric engine in under five-hundred uses, which leads to more money spent replacing the un-chargeable battery. Adding onto the list is the fact that hybrid cars will still use gasoline. In order to clean up Earth, hybrid plug-in cars and their problems shall not be created. Hybrid cars are also weighed down by both engines. The two engines also instigate the problem of maintaining two engines instead of one, which will make repair cost more than gas-powered cars in certain circumstances such as a car crash that damages both engines. Both pros and cons of the hybrid plug-in do not reach the level of pure electric cars. Few cons are tacked onto the pure electric car, but those few are important. Pure-electric cars cannot drive long distance road trips without being recharged. This can take up to three-and-a-half hours in some electric cars, which isn’t good for being late to work or a party. The beneficial trend toward more environmentally friendly vehicles has had the unintended effect of placing the blind and other pedestrians in danger, said Rep. Edolphus Towns (D-New York, 10th) in introducing The Pedestrian Safety Act of 2008 that would protect the blind from electric cars, which are silent. These cars are also pricy, with the Tesla Roadster reaching over one-hundred thousand dollars. These cons come with a reward, though. The pros of having a pure-electric vehicle are heavier than that of its cons. With an average of 220 mpc (miles per charge [based on EPA combined city/highway cycle]), the pure-electric car can cover the average daily driver’s commute and then some. The pure-electric Tesla Roadster can reach up to â€Å"125 mph and has a 0mph-60mph in less than 4 seconds† (Tesla Motors – Tesla Roadster). Also, whenever the brakes are used to stop, you charge the engine. Another thing is that, when stopped, the car does not consume any energy. All of this and zero-emissions boost the pure-electric car to the top of the list of daily drivers and high performance gas-guzzlers. Both types of car oust that of the gas-guzzlers on the road today. Although, to provide a cleaner and more-efficient future for Earth, humans must set aside fossil fuels and use clean electric energy, which a pure-electric car uses. The public cannot make a huge change into hybrid plug-ins and then switch to full electric power; just look at the Digital Television switch that has been postponed twice because people are too lazy to go out and get a free digital cable box. The people are slow to change, which means that in order to switch before humans destroy the world, humans must first change to pure-electric energy. If humans are ready to start the massive change to clean up Earth, those humans must first stop making a new mess. Works Cited Dunn, Philip. Hybrid Cars Pros and Cons. (2006) 4 Apr 2009 . Hewitt, Ben. Plug-in Hybrid Electric Cars: How Theyll Solve the Fuel Crunch. May 2007 4 Apr 2009 . Watson, Jerry. Hybrids pros and cons. (2005-2009) 4 Apr 2009 . http://www. teslamotors. com/performance/perf_specs. php Towns, Edolphus. Introduction of Pedestrian Safety Act of 2008, April 9th, 2008.

the business model of Apples itunes

the business model of Apples itunes Evaluate the business model of Apples itunes. In particular you should address:- 1. To what extent can the itunes business model be described as an ecosystem and what is the role of IT in enabling the collaboration between Apple, its economic partners and consumers? 2. How does itunes compare with competitors? 3. What new technologies could disrupt the current market by enabling a new form of business model? Introduction Business model in a basic sense deals with the method of doing business in order to generate revenues by which a company sustains itself in the competitive market place ( (Rappa, 2009).According to (Amberg Manuela) analysis on music industries, there are lots of media websites and companies following different business models fallen prey to file sharing tools and peer-peer networks which allow consumers to illegally copy and share the content for free. As a consequence , companies like Apple iTunes and Sony Connect have come up with internet based business models based on pay-per-download and dependent on the technology of the supplier for whom long-term customer relations are very crucial and customers are allowed to use the digital media content particularly with regard to technology of the supplier thus getting advantage and benefitting from selling hardware components because the offer of digital media content advances it. These business models replace the traditional business m odels which are generally based on selling physical media.This paper shows the fair understanding of Apple iTunes business model for its dominance over the current music market and tries to describe the business model with respect to ecosystem and compares iTunes with its key competitors in the market. The biological term ecosystem in this paper refers to the IT ecosystem. (Iansiti Richards, 2005) describes IT ecosystem as network of organizations that drives the creation, innovation and delivery of Information Technology products and services. According to (Cusumano, 2008) the term ‘Platform, is defined as â€Å" Foundation product or key technology in a system like the PC or a web enabled cell phone and should have relatively open technical interfaces and easily licensing terms in order to encourage other firms to contribute complementary product and services. So this can be accounted to an ecosystem around the platform and the platform becomes more valuable when the exter nal entities creative more innovations around it. This should cause more users to adopt the platform and more complementors to join the network. iTunes as an ecosystem Online music hit a new milestone after Apple computer,Inc.(Apple) launched the iTunes application in January 2001 follwed by launch of 1st generation iPod and 2 years later online music store in April of 2003.The two businesses, the production of MP3 players and the online music shops were initially considered as different units and after the invention of new hardware iPod these two businesses were merged. iTunes is a software designed with an intuitive and user friendly interface and iPod is an hardware designed with an eye on fashion. These two together helped Apple to enter and succeed in the music player market infact actually cross promoting the iPod hardware device. Because of their service and innovation Apple retained to grow in the online music field in a better way when compared to its key competitors like Dell, Sony and Samsung( (Li Chang). According to (Schonfeld, 2009) statistics, iTunes have now sold 6 billion songs and 10 million different tracks are now available on iTunes. iTunes is software and iPod is hardware as said by (Li Chang) are two different business units and Apple conjucts these two different products into one new business model. Using ecology to analyze this model(iPod and iTunes) it has set a nice example for ecotone between two species to drive the music industry into new ecosystem. A strong platform is apparent from the combination of both the software and the hardware. The below shows the evolution of new ecosystem with combination of two stand-alone ecosystems. ‘Most companies today inhabit ecosystemsloose networks of suppliers, distributors, and outsourcers; makers of related products or services; providers of relevant technology; and other organizations that affect, and are affected by, the creation and delivery of a companys own offering†¦.. as said by (Iansiti Levien, 2004) shows how business industry can be closely compared to biological ecosystem. Like every individual in the biological ecosystem every organization in the business ecosystem shares the fate of the network as a whole regardless of that members apparent strengths. Comparing this with the Apple business, iPod is not really an innovative technology by itself but the company creates a new ecotone for digital music where all the hardware(iPods) and software(iTunes) are related to it enhances its platform. According to (Koster, 2007) There is a continuous decline in the traditional sale of music sources like retail music stores and the on-going music industries ar e restructuring themselves by merging with other partners to face the loss of revenues and to adopt with the new business strategies and models in the music industry to compete with the counterparts. Even in the digital music world today, legitimate music downloading is continuously changing. Initial music sites have very strong limitations on access catalogs of music, on what could be done with the downloaded music, number of copies, time limits, where to copy. Though Apple iTunes works on this model, it is successful in negotiating a very large music catalog from the four labels from its music site. He says that one large advantage and success for Apple is because of its hardware device iPod where normally music is stored and playback. The revenues from iPods sales continue to grow after the introduction of iTunes. Though Apple had gotten permission from four majors to store their music on its website for consumers to download by promising the copyright protection authority DRM, i t is now planning to get away with DRM because they make the downloaded or recorded music very cumbersome for the consumer. This is evident from (Johnson, 2009) article on web which says By the end of the quarter all 10 million songs will be DRM free in iTunes and iTunes plus, said Phil Schiller, Apples senior vice president of worldwide product marketing. The blog witten by (Vitalari, 2009) clearly examines at the 21st century business model adopted by Apple to become successful in the market. He believes that business platforms are the root cause for cumulative business performance. Apples competitive business platforms is the main drive for innovations like community formation, mass collaboration, social networking, ecosystems, real time analytics, transparency etc. The iPhone App store was launched in July 2008 and today iTunes store is a total set of all forms of the digital media including music, games, software application, podcasts and video assets . As his explanation, the driving factors for Apple success and points out that the effective business platforms have few key ingredients:  · iPods, iphones are not just products instead they represent individual business platforms and they create an ecosystem surrounding the product which means they create a common understanding for business transactions, technical specifications, interface standards and requirements. With the iPhone this includes all of the sub-contracted manufacturers, but more importantly it includes iTunes, the app store and app developers.This results in creating a transparency which enables and facilitates hundreds of participants to collaborate asynchronously and independently.  · This leads directly to the second point, which is that the business platform then helps to generate untold business analytics for the platforms owner.This is because of the elements of the business platform are networked and generates valuable information about the product, ecosystem and participants. Apple used this analytics to fix, improve and enhance the product and finally delighting the customers.  · This in turn creates a community of practice surrounding the business platform, as the collaborators learn how to make better things. IT in enabling collaboration with partners and consumers As a cofounder of Apple, Steve Jobss vision was to create new and different products to consumers and his notion of â€Å"one person-one computer became visionary responsible for Apples reputation for innovation and mission became changing the world by bringing the computers to masses (Richard D Vohr, 1998).Apple came back with reinvention of personal computer with Macintosh in 1980 after igniting the computer industry revolution with inventing Apple II and it is commited to bring the best computing experience to all the fields starting from students, educators, professionals and consumers all around the globe with its innovative software hardware and internet offerings. This Apples mission statements indicates it focuses on innovation and personal computing experience( (Pearlson Saunders, 2009). Apple From 1987-1997 the company suffered due to some major internal problems which affected the strategic leadership and its operations but after Steve Jobss second turn as CEO, company fixed operational problems and regains its innovative leadership dramatically. Few changes like manufacturing outsourcing and improving inventory became straight forward matching Dell, the industry leader.It moved to open industry standards rather than proprietary hardware interfaces that it had maintained for 15 years and thus in a minor way Apples product strategy became more open( (West Mace, 2007).As per ( (Apple Computer, 2006) Apple derives its competitive advantage again by its innovation giving iPod as an example. Apple entered the market with iPod in 2001and by end of fourth quarter of fiscal year 2005, iPods sales gained 33% of the total revenues. The factors which are accountable to their success and uniqueness are its computers based on its own operating system, which enabled further area of innovation.Its Mac OS operating system focuses on more simplicity and seen as graphically sophisticated. (West Mace, 2007)Recent trends have seen increasing strategy convergence be tween Apple and Microsoft .For its video game business, similar to its rivals Sony and Nintendo Microsoft buys the processor but designs its own hardware and software without licensing them to others.Meanwhile ‘Zune, Microsofts music players try to compete successfully to attain equality with Apples iPod. This shows Apple pursued a vertically integrated strategy in its music business. Vertical strategy is single firms controlling the entire platform. Apple leveraging its Macintosh installed base to establish iTunes music store and building iPod business on top of that and now iPhone business shows its expansion into adjacent markets and this loyal installed base makes any company easier to branch into a related market and this becomes a lesson for the other companies and Apple aims at satisfying the costumer not just upgrading the costumers what they have today like the other companies do. When ATT decided to make offer to iTunes many other mobile industries criticized it for making too many concessions to Apple. Due to this offer ATT gets benefit from Apple in two ways , one is Apple increases the average monthly bills for the customers who switch from ATT to iPhone and the second one is it causes existing people to switch from existing carriers to ATT as its the exclusive carrier for iPhone( (The Apple iPhone:Successes and Challenges for the Mobile Industry, 2008). Digital Record Management systems are uses to encrypt the data does not allow illegal or non authorization download of music and currently there are two main formats used for protect downloading of music. One is fairplay and the other is WMA. Fairplay is Apples proprietary technology where it secure the data encrypted in AAC( Advanced Audi Coding) format. WMA is Microsofts Windows media audio video encoding platform. iPods can play only those stuff which are secured through fairplay format and Apple has refuse to lincense this fairplay to other retailers and so it is difficult for iPod users to download music from other retailers other than iTunes music store. But recently Realnetworks in US came up with a package which allows iPod users resident in US to play secures music from Realnetworkss music store Rhapsody. Apple got furious with this and accused Realnetworks of ‘Hacker tactics and Ethics and reported to investigating on that for violating the intellectual rights. If apple is capable of putting an end to such violations then the indispensability of fairplay could be established( (The iTunes music store: does competition law hold the key to closed shop?, 2004) According to insights into IDCs lifesciences by (Swenson Golden, 2005) Apple products are getting attracted by the life science researchers who actually migrated from linux and unix platforms because of the dual nature of Mac OS and its estimated historically that the life scientists have been twice or thrice more likely than the average computer user to Apples Mac platform as client computer thus representing attractive market for Apple. It has announced about its collaboration with airlines which includes Air France, Continental, Delta, United and KLM to integrate the in flight entertainment systems with iPod and taking the current entertainment provided in these airlines to a next level for better travel experience( (Apple_Partners_with_Airlines_for_iPod_Integration, 2006). Sets Apple as an interesting example for not being an open source model in its business strategies but is thought b of being a highly proprietary company from its earlier years. Now it has jumped into open sou rce and have started projects both inside and outside its corporate firewalls. Apples OS X was a open source because it was based on Darwin. Its developer website said that Apples open source projects let key developers to customize and enhance Apple software and through this open source models it allows Apple engineers to collaborate with open source community to come up with better and more reliable products (Goldman Gabriel, 2005). On September 2007, Apple and Starbucks announced their collaboration on Apple letting costumers at Starbucks wirelessly browsing, previewing, buying and downloading music from iTunes music stores at Starbucks on their iPods enhancing Starbucks retail coffee experience by helping customers with discovering new music instantly (Rothman, 2007). These examples shows how Apple is spreading the digital media revolution with its technologically profound products. Apple believes in fully integrated and completely digital learning environment which makes conte nts to move from from application to another and easy to collaborate and share ideas. Integration even reduces the burden of technology challenge. So Apples IT team rather than spending time and money on how to get things working feels it worthwhile to dedicate the same on providing capabilities, innovations and resources for its institution (Everything Apple means everything just works). iTunes and Competitors: The majors competitors for Apple are Google and Microsoft Corporation and other competitors include Dell, Hewlett-Packard, Fujitsu, Samsung Electronics, Sony and Toshiba. Apple is designing software and hardware systems that delivers a greater user experience. Google is giving away operating systems to companies that license windows mobile today. Microsoft needs to think about their business models to compete in such a race where it probably has to decide whether it wants to compete in devices or operating systems and doing both is again at a risk which requires business models that are outside its core competencies( (The Apple iPhone:Successes and Challenges for the Mobile Industry, 2008). There is a partial collision between Apple and RIM in smartphone business in which Apples device is a entertainment centric whereas RIMs product is a communication centric.Though each company is growing into each others space Apple is got the advantage because infrastructure establishment would be too large for RIM and beside that RIMs image is all wrong for that instead it is much better to defend and grow its market by adding more features and types of business communications to Blackberry. Comparing it with Nokia, Nokias challenges are more about challenges. They sell hundred of millions handsets every year at low costs. But without it, Nokia will be really hard pressed to match with the iPhones user experiences. Competitors such as Diamond multimedia, with its Rio brand portable media players were successful in the market until Apple displaced them and all the credits for such a domination goes to the business model of the company by offerings users a seamless music experience by combining its iPod devices with iTunes and online iTunes store. Users were taken away by its value proposition and Apple had to negotiate deals with the major record companies to establish the worlds largest online music library, there giving the twist for the company to earn most of its revenue s by selling iPods while using the integration with the on online music store to protect itself from the competitors( (Osterwalder Yves, 2009).Smartphone users are going to increase in number in the next few years increasing in the PC functionalities supporting data services and voice and this is going to drive smartphone markets and Apple launching the iPhone which meets most of the required functionalities made it to third position in the global smartphone market in the third quarter of 2008. As there is rapid change in the technology there is introduction of new products with competitive prices, features and performance characteristics by all the competitors and out of all, mobile communication industry highly competitive with well funded and experienced competitors. For example in 2009, Nokia launched a new online media store in competition to Apple and this has resulted in price erosion which is now threatening to lessen the market share of the company( (DATAMONITOR, 2009). What new technologies could disrupt the current market by enabling a new form of business model. Apple has become the leader in the music world revolution and it justifies for its closed source system, keeping its digital music platform proprietary making it incompatible by other system by saying that it was the main reason in convincing its music labels and artists allowing them to sell their songs through iTunes assuring that those would not be pirated. But many analysts claim that that closed system was the reason for its previous failure in the computer business and Microsoft gained the masses with their open systems and now that is being seen as a gamble in this highly cometetive technology world (Williard, 2005). According to survey done by Rubicon Consulting Inc on the Apple iPhone users shows that about 43 percent of the iPhone users feels that the device would be more elegant if there is a physical change to the iPhone by adding adding a keyboard or a keypad either by making the device smaller or larger and about 40 percent of the users complain about the browser proble ms and the notably with those using Adobe flash and this shows that mobile data devices has always been segmented and its impossible for any single hardware design to please everyone. This could be an opportunity to Apple to increase its share by serving those customers by giving more importance to value propositions for their products which is again a part of business model and at the same time its an opportunity for its competitors to steal that share by addressing segments Apple failed in( (The Apple iPhone:Successes and Challenges for the Mobile Industry, 2008). Apple corporation itself has many problems but loss of competitive differentiation due to its Enterprise sytem is not counted in that because of its strong brand and its distinct operating system. For many of the other computer manufacturers cost and service are more vital for their differentiation than their products but for Apple this seems to be a unusual case says (Davenport, 1998). ‘Disruptive Business Models are emblematic of our generation. Yet they remain poorly understood, even as they transform competitive landscapes across industries (Osterwalder Yves, 2009). Conclusion: According to Sankar Dhinu, Apples senior manager of Emerging Technology, to be competitive in worlds high tech industry, one should make use of the facilities like available economic advantage of the manufacturing and distribution and Apple success goes with its interaction with dozens of trading partners , starting from resellers to distributors and OEM manufacturers which in turn helped it to form a global supply chain. Due to increased competition Apple is also facing many pressures and already working towards less limitation and freer access of digital music. Thus majors themselves are getting involved in those changes and Apples CEO Steve Jobs has called for an end to DRM because they make use of downloaded and recorded music very inconvenient and cumbersome for the consumer.( (Koster, 2007) Biblography: Amberg, M., Manuela, S. ANALYSIS OF E-BUSINESS MODELS FOR DIGITAL MEDIA . (2006). Apple Computer. The McGraw-Hill Companies, Inc. Apple_Partners_with_Airlines_for_iPod_Integration. (2006, November 14). Retrieved December 1, 2009, from www.digg.com: http://digg.com/apple/Apple_Partners_with_Airlines_for_iPod_Integration Cusumano, M. (2008). Technology Strategy and Management, The Puzzle of Apple. DATAMONITOR. (2009). Apple Inc. Company Profile. Davenport, T. H. (1998). Putting the Enterprise into the Enterprise System. Harvard Business Review OnPoint . Everything Apple means everything just works. (n.d.). Retrieved december 1, 2009, from www.images.apple.com: http://images.apple.com/education/leaders-administrators/the-apple-ecosystem.html Goldman, R., Gabriel, R. P. (2005). INNOVATION HAPPENS EVERYWHERE. In R. Goldman, R. P. Gabriel, Open source as business strategy (pp. 3-5). San Francisco: Morgan kaufmann. Iansiti, M., Levien, R. (2004). Strategy as Ecolgy. Harvard Business review. Iansiti, M., Richards, G. L. (2005). Information Technology Ecosystem Health and Performance. Johnson, B. (2009, January 6). Apple drops DRM copy protection from millions of iTunes songs. Retrieved from www.gaurdian.co.uk: http://www.guardian.co.uk/technology/2009/jan/06/apple-drops-itunes-copy-protection Koster, A. (2007). Music Industry: Toward A New Business Model? Journal of Business and Economic Research . Li, Y.-R., Chang, Y. Is the success of iPod Purely Accidental or Inevitable A Business Ecolgy Perspective. Osterwalder, A., Yves, P. (2009). Business Model Generation. Self Published. Pearlson, k. E., Saunders, C. S. (2009). Strategic management of Information Systems. In k. E. Pearlson, C. S. Saunders, Strategic management of Information Systems (p. 25). John Wiley and sons. Rappa, M. (2009). BUSINESS MODELS ON THE WEB. MANAGNG THE DIGITAL ENTERPRISE . Richard D, F., Vohr, J. (1998). APPLE COMPUTER, INC. Rothman, W. (2007, september 5). Apple partners with Starbucks for free WiFi Access to iTunes Music Store. Retrieved december 1, 2009, from www.gizmodo.com: http://gizmodo.com/296696/apple-partners-with-starbucks-for-free-wi+fi-access-to-itunes-music-store Schonfeld, E. (2009, January 6). iTunes sells 6 billions songs , and other fun stats from the Philnote. Retrieved from www.techcrunch.com: http://www.techcrunch.com/2009/01/06/itunes-sells-6-billion-songs-and-other-fun-stats-from-the-philnote/ Swenson, M., Golden, J. B. (2005). Apple and Life science research : Enabling Technologies. Life Science Insights, an IDC company. (2008). The Apple iPhone:Successes and Challenges for the Mobile Industry. (2004). The iTunes music store: does competition law hold the key to closed shop? Vitalari, N. (2009, August 10). Apple and the Rise of Competitive Business Platforms What Other Companies Must Know. Retrieved from www.wikinomics.com: http://www.wikinomics.com/blog/index.php/2009/08/10/apple-and-the-rise-of-competitive-business-platforms-what-other-companies-must-know/ West, J., Mace, M. (2007). ENTERING A MATURE INDUSTRY THROUGH INNOVATION: APPLES IPHONE STRATEGY. Williard, C. (2005). Apple worms its way into the music industry.

Investigation of Thyroid Emergencies

Investigation of Thyroid Emergencies Unit 1 Thyroid Emergencies Authors: Dr. Khalid Khatib Dr. Subhal Dixit 1.0 Objectives After reading this unit, you will be able to: Enumerate thyroid diseases which will land the patient in the intensive care unit; Describe the clinical features, investigation and treatment of throid storm; Describe the clinical features, investigation and treatment of hypothyroid coma; and Describe the clinical features, investigation and treatment of obstructive symptoms due to goiter. 1.1 Introduction Thyroid emergencies comprise a miniscule fraction of patients with thyroid dysfunction, who land up hospitalized in the intensive care unit (ICU) as a consequence of their abnormal thyroid physiology or anatomy. As these conditions are infrequently encountered in the ICU, a proper understanding of the hormonal pathophysiology and varied clinical features will lead to appropriate and timely institution of hormonal and supportive treatment, ultimately rendering survival benefit to the patient. The following conditions constitute thyroid emergencies: i) thyroid storm, ii) hypothyroid coma, and iii) massive goiter causing compression of the airways and large blood vessels. 1.2 Thyroid Storm It is also known as thyroid crisis or thyrotoxic crisis and is an extreme physiological condition due to thyroid hormone excess. A very severe, life threatening and decompensated form of thyrotoxicosis, it is rare (seen in 1-2% of patients admitted for thyrotoxicosis); but mortality rates approach 10-20%. Thyroid storm may be seen even in patients who have not been diagnosed with hyperthyroidism. The male to female ratio is 1:3. Causes: i) Grave’s disease, Ã ¬i) Toxic multinodular goiter, iii) Solitary nodular goitre iv) Subacute thyroiditis v) Postpartum thyroiditis, vi) Thyrotoxicosis factitia, vii) Metastatic thyroid malignancy. Whatever the etiology of hyperthyroidism, its conversion to thyroid storm requires the addition of precipitating factors. Precipitating factors: i) Infection, ii) Trauma, iii) Surgery- of the thyroid gland or non-thyroidal, iv)Acute myocardial infarction or Acute coronary syndrome, v) Pregnancy, labor, complicated delivery vi) Burns vii) Medical illnesses- congestive heart failure, diabetic ketoacidosis, cerebrovascular accident, pulmonary thromboembolism, sepsis, viii) Stress- emotional ix) Abrupt interruption of thyroid drug therapy, x) Administration of iodine compounds or radioiodine (I131 or I123 ), xi) Others- chemotherapy for leukemia, radiation therapy to neck malignancies, aspirin overdose, organophosphate poisoning, exercise, status epilepticus and drugs (tyrosine kinase inhibitors, lithium, biological agents like interleukin 2 and interferon). Clinical features: i) Central Nervous System- apathy, agitation, delirium, confusion, paranoia, and coma. ii) Cardiovascular System- congestive heart failure, tachyarrhythmia (atrial fibrillation, supraventricular tachycardia, ventricular tachycardia and ventricular fibrillation,) sinus tachycardia, dilated cardiomyopathy, high cardiac output state, and pulmonary hypertension. iii) Gastrointestinal tract- vomiting, diarrhoea, jaundice, diffuse abdominal pain occasionally presenting as acute abdomen. iv) Respiratory system- dyspnea, tachypnea and acute respiratory failure. v) Thermoregulation- fever, hyperthermia and diaphoresis. vi) Nutrition- weight loss. vii) Renal- proteinuria, acute renal failure.viii) Electrolyte disturbances- hypercalcemia, ketoacidosis, lactic acidosis. viii) Hematology- leucocytosis, hypercoagulable state leading to thromboembolism. Some elderly patients may have very few signs of hyperthyroidism and present with stupor, apathy, coma, and congestive heart failure (apathetic thyroid storm). Diagnosis: i) It usually needs to be based on clinical judgment and treatment started even before laboratory results are available. A semiquantative scale developed by Burch and Wartofsky can be used to definitively identify patients with thyroid storm. ii) Thyroid function tests(TFT): TFTs reveal increase in free T3 and free T4 while TSH will be very low (even undetectable). iii) Other laboratory investigations: Serum bilirubin, transaminases, blood glucose levels may be increased while potassium and total cholesterol may be decreased. Treatment: Principles of treatment: i) Treat the hyperthyroid state. ii) Prevent the effects of circulating T3 and T4. iii) Treat the multiorgan dysfunction. iv) Treat the precipitating cause. i) Treat the hyperthyroid state: 1) Prevent new thyroid hormone synthesis (Thionamides) 2) Prevent new thyroid hormone release (Thionamides) 3) Prevent conversion of circulating T4 to T3 ( steroids, lithium, high dose iodine and iodinated contrast medium) Thionamides: Propylthiouracil, Carbimazole, Methimazole are used in the treatment of hyperthyroid state. Propylthiouracil (PTU): a) Dose: Loading dose- 500-1000 mg followed by a maintenance dose of 250 mg every 4-6 hours. b) It additionally prevents peripheral conversion of T4 to T3. c) It is given either orally (if patient is conscious and able to swallow) or through the nasogastric tube or rectally. d) Onset of action is rapid. e) PTU has potential for hepatotoxicity. f) Hence it is preferred now only in pregnancy, where other thionamides cannot be used. Methimazole or Carbimazole: a) Dose: 20-30 mg every 4-6 hours may even go up to 60-80 mg every 4-6 hours. b) They are preferred over PTU unless the patient is pregnant. c) They can be given orally, through the nasogastric tube, rectally, or even intravenously. Steroids: a) Hydrocortisone is used in the dose of 100 mg intravenously or intramuscularly every 6 hours and continued till the condition of the patient improves completely. b) If Dexamethasone is used, the dose is 2 mg intravenously every 6 hours. c) Doses of both the drugs need to be tapered appropriately before they are stopped. Lithium: a) Dose: 1200 mg per day in 3-4 divided doses. b) Lithium is used if thionamides are contraindicated and patient is allergic to iodine. c) Serum lithium levels are monitored to prevent toxicity. High dose Iodine: a) Lugol’s iodine or potassium iodide solution is used. b) Dose: 0.3 ml or 10 drops of Lugol’s iodine diluted to 50 ml every 8 hours, orally or through the nasogastric tube. c) Its action is due to the Wolff-Chaikoff effect leading to the suppression of thyroid hormone release and peripheral conversion of T4 to T3. d) It should be administered at least one hour after administration of thionamide drugs. e) Sodium iodide may be used intravenously (dose- 500-1000 mg), but it is not easily available as a sterile solution. Iodinated contrast solution: 0.5-1 gm every 12 hours. Cholestyramine at a dose of 4gm, 2-4 times a day orally, reduces enterohepatic circulation of thyroid hormones. In refractory cases, plasma exchange, peritoneal dialysis or hemofiltration may be used to reduce the circulating thyroid hormones. ii) Prevent the effects of circulating T3 and T4: Beta blockers: 1) They block the hyperadrenergic effects of the excessive thyroid hormones. 2) They can be used if there are no contraindications to their use (history of asthma, COPD or congestive heart failure). 3) They must be used with continous cardiac monitoring. 4) Propranolol is used most commonly at the dose of 60-80 mg, three times a day, orally or through the nasogastric tube. It may also be used intravenously at the dose of 10 mg; at the rate of 0.5-1 mg per minute till heart rate is less than 100 per minute and then continued orally as above. 5) If propranol is contraindicated, cardioselective betablockers (metoprolol, atenolol), calcium channel blockers or digoxin may be used. 6) Esmolol, an ultra short acting beta blocker, is preferred by some, as an intravenous infusion of 50-100 mcg/kg/min with a loading dose of 250-500 mcg/kg. iii) Treat the multiorgan dysfunction: 1) Manage the patient in intensive care unit. 2) Take care of ABC (airway, breathing, and circulation). 3) Respiratory support with oxygen therapy or mechanical ventilation (noninvasive or invasive) as required. 4) Resuscitation and hemodynamic support- Intravenous infusions to correct fluid and electrolyte disturbances. 5) Antipyretics- cooling mattresses and cold sponging are used along with paracetamol to reduce the raised temperature. Salicylates are avoided as they reduce thyroid hormone binding to thyroglobulin and may in fact worsen thyroid storm. 6) Treat hypertension. 7) Treat delirium and agitation by sedation with haloperidol and benzodiazepines. 8) Provide nutritional support with adequate dextrose infusions and vitamin (especially thiamine) supplementation. 9) Treat the tachyarrythmias with antiarrythmic drugs if patient is hemo- dynamically stable or by electrical cardioversion if unstable. Treat congestive heart failure with diuretics and ACE inhibitors. iv) Treat the precipitating cause: 1) Search and treat the focus of infection. 2) Use broad spectrum antibiotics on empiric basis as appropriate. 3) Send urine and blood cultures. 4) Treat trauma, diabetic ketoacidosis, myocardial infarction and other precipitating factors as per usual principles. Once thyroid storm has been treated the hyperthyroid state should be treated definitively with antithyroid drugs, radioiodine or thyroidectomy. 1.3 Hypothyroid coma It is also known as myxedema coma or myxedematous coma and is due to very severe, untreated hypothyroidism manifesting with reduced temperature and altered mental status. It is an emergency to be treated in an ICU and has high mortality, but fortunately it is rare. Typically the patient is an elderly female with history of hypothyroidism with or without adequate treatment, who may have stopped treatment, or may have suffered an intercurrent stressful situation (infection). Occasionally coma may be the first presentation of hypothyroidism. Rarely hypothyroid coma may be seen in young females, some of whom may be pregnant. Precipitating factors: i) Burns, ii) Trauma, iii) Surgery, iv) Severe infection- pulmonary or urinary tract infection, sepsis, v) Low ambient temperature, vi) Cardiac diseases- myocardial infarction, congestive heart failure, vii) Cerebrovascular accident viii) Labour, ix) Anesthesia x) Drugs- neuroleptics, sedatives (benzodiazepines), xi) Intake of large amounts of liquids, xii) Seizures, xiii) Gastrointestinal bleeding. Some of the common causes of hypothyroidism are: i) Chronic autoimmune thyroiditis, ii) Thyroidectomy (total or partial), iii) Graves disease treated with radioiodine, iv) Secondary hypothyroidism- hypopituitarism, v) Drugs- amiodarone, lithium. Clinical features: i) Hypothermia- is usually severe with temperature approximately 26.70C (800F). Rarely, temperature may even reach 210C. In some cases, temperature may be normal in the presence of infection. ii) Altered mental status- may present as disorientation, depression, paranoia, hallucination, cerebellar signs, amnesia, disturbed memory, abnormal EEG findings, seizures, status epilepticus, stupor, obtundation or coma. iii) Cardiovascular system- abnormalities present as bradycardia, prolonged QT interval, varying degrees of AV block, ventricular arrhythmias (torsades de pointes), pericardial effusion, reduced cardiac output or shock. iv) Respiratory system- disturbances present as hypoventilation and hypercarbia or respiratory failure requiring mechanical ventilation. v) Renal and electrolyte disturbances- manifests as hyponatremia, edema, retention of urine or rarely renal failure. vi) Gastrointestinal- manifestations are constipation, paralytic ileus, ascites, gastropare sis, and gastrointestinal bleeding. vii) Hematological- problems are coagulopathy due to vonWillebrand syndrome and reduction of coagulation factors, DIC (disseminated intravascular coagulation), granulocytopenia and microcytic or macrocytic anemia. viii) General- manifestations of hypothyroidism like macroglossia, ptosis, generalized skin swelling or cool dry skin, periorbital edema, obesity and depressed deep tendon reflexes. Diagnosis: i) It should be suspected clinically. ii) TSH is raised in most cases. It may rarely be normal in pituitary causes of hypothyroidism. Severe systemic illness and drugs (inotropes, steroids) used to treat the associated systemic illness will cause blunting of the TSH elevation. iii) T3 and T4 levels are low. iv) Hyponatremia, hypoglycemia, hypoxia, respiratory acidosis, hypercapnia, hypercholesterolemia and elevated LDH and serum creatinine kinase levels may be present. Treatment: Principles of treatment: i) Thyroid hormone supplementation. ii) Steroids. iii) Correction of fluid and electrolyte disturbances. iv) Treatment of precipitating cause. i) Thyroid hormone supplementation: a) Supplementation with L-thyroxine with or without addition of liothyronine. b) Therapy is preferably intravenous. c) There is no consensus on the best therapeutic regime. d) Dose of L-thyroxine- High dose (300-400mcg on day 1 and then 50-100 mcg/day on subsequent days) is preferred by some. Though tolerated by young patients, it may cause sudden cardiac death in the elderly. Hence a lower dose is preferred (100mcg on day 1 and then 50-100mcg on subsequent days). e) Liothyronine- at a dose of 10-25 mcg (bolus), intravenously and then 10 mcg intravenously every 4 hours for the first 24 hours and every 6 hours over the next 48 hours and then oral therapy with L-thyroxine (50-100 mcg daily), as feasible. Initial therapy with liothyronine may be preferred, as it has better bioavailability and peripheral conversion of T4 to T3 is impaired in hypothyroid coma. Care should be taken during liothyronine therapy as excess T3 may increase mortality. f) Combi ned T4+T3 approach: to avoid above complications, a combined approach with L-thyroxine and liothyronine is advised as shown in Table no. 1. Table No. 1 Combined L-thyroxine and liothyronine therapy ii) Steroids: a) Hydrocortisone at a dose of 50-100 mg intravenously every 6 hours, is preferred. b) It is required to treat the associated adrenal insufficiency. iii) Correction of associated fluid, electrolyte and other disturbances: a) Maintain airway and provide mechanical ventilation if necessary. b) Hyponatremia- is a frequent occurrence and needs correction by restricting water intake or by intravenous infusion of isotonic saline (if serum sodium is less than 120). If hyponatremia is more severe, infusion of 3% NS is used very carefully. Occasionally, Conivaptan may be used in patients with euvolemic or hypervolemic hyponatremia. c) Hypothermia- is treated with passive and gradual heating with blankets and air warmers. iv) Treatment of precipitating cause: a) Appropriate antibiotics (broad- spectrum) are started for bacterial infections. b) Diuretics are used to treat volume overload and pulmonary edema. c) Intravenous glucose is used in the presence of hypoglycemia d) Inotropes are used if shock is present while digoxin is used with care for congestive heart failure. 1.4 Airway and vascular obstruction due to goitre Gross enlargement of the thyroid gland, especially substernal and intrathoracic extension, causes compression of the airway and the great vessels at the thoracic inlet. Sometimes massive hemorrhage inside a thyroid nodule, malignant thyroid disease, metastasis to thyroid gland and Reiter’s thyroiditis may cause compressive symptoms. Symptoms and signs: i) Dyspnea- usually chronic with acute or subacute exacerbations, ii) Stridor, dysphonia, iii) Dysphagia, choking, iv) Fullness and pressure in neck, v) Superior vena cava syndrome- causing facial edema, cyanosis and venous engorgement of face and arms, vi) Esophageal varices, vii) Phrenic or laryngeal nerve paralysis, viii) Horner’s syndrome, ix) Chylothorax, and x) Sleep apnea. Treatment: a) Continous positive airway pressure (CPAP) application or intubation and mechanical ventilation for maintaining patency of the airways and to treat respiratory distress. b) In a few cases where intubation is not possible, emergency tracheostomy may be required. c) Surgery to relieve the obstruction in the form of thyroidectomy and associated sternotomy, if required. d) Radioiodine and percutaneous laser ablation may be preferred in some patients. 1.5 Let us sum it up Thyroid storm occurs in hyperthyroid patients in the presence of precipitating circumstances leading to a hyperadrenergic condition which is fatal unless treated with care. It is treated with thionamides, beta blockers and correction of abnormal organ function. Hypothyroid coma usually presents in the winter months, in elderly females, in the presence of a precipitating cause. The patient has profound hypothermia and altered mental status or coma. It is treated with supplementation of thyroid hormones and treatment of the associated multiorgan dysfunction. Obstruction of the airway and blood vessels in the neck by an enlarged thyroid gland is very rare.

Is NAFTA That Great? :: Essays Papers

Before I get into the details of the North American Free Trade Agreement (NAFTA) that took effect on January 1, 1994 I want to call attention to what it is that makes this an interesting topic to me. On that date I was only eleven and was completely oblivious to what the agreement incorporated. My entire family comes from a Mexican heritage so NAFTA was definitely a topic of conversation at the dinner table. All I really understood was that its implementation would hopefully stimulate the Mexican economy and improve its trade relationship with the United States and the rest of the World. Well now I am twenty-one and in the ten years since NAFTA has been implement I have heard relatively nothing about the benefits of the agreement. Therefore, I began to wonder why is it that I have heard nothing? In this research paper, I plan to not only help people better understand what NAFTA was trying to accomplish but also evaluate its overall effects. Did NAFTA accomplish what it said it would or has it accomplished nothing in the last ten years? Overview of NAFTA Three of the main issues that I would like to talk about later in this paper have to do with the peso crisis, the political turmoil that happened in 1994, and the many problems that exist on the US-Mexico borders. However, before I dive into those three areas I would first like to give an overview of NAFTA itself and its â€Å"effects.† I put effects in quotations because as I researched the agreement I quickly found out that many of the things that NAFTA claimed to accomplish either would have happened regardless or did not really happen at all. The North American Free Trade Agreement, as mentioned earlier, was implemented on January 1, 1994. Its main goal was to basically phase out almost all of the restrictions on trade and investment flows between the United States, Canada, and Mexico. What is important to mention is that NAFTA mainly concentrated on the US-Mexico problem seeing that the Canada-United States Free Trade Agreement had been implement a couple years before NAFTA was introduced.

The French Revolution :: European Europe History

The French Revolution Thesis: The French Revolution was a crucial event in Western History, and possibly the single most crucial influence on British intellectual, philosophical, and political life in the nineteenth century. The French Revolution was a crucial event in Western History, and possibly the single most crucial influence on British intellectual, philosophical, and political life in the nineteenth century. It presented itself as a triumph in its early stages but later proved to be a revolution of senseless revenge. With a mob composed of mainly animals, like Madame Defarge, the French Revolution is one of the most barbaric periods recorded in history. The French Revolution began in 1789 when the States General met May 5. June the seventeenth the National Assembly was declared. Then a gang of angry, mistreated peasants stormed the Bastille and murdered numerous aristocrats. As a precaution, Louis XVI and the Royal Family were removed from Versailles to Paris. The King attempted, but failed, to flee Paris for Varennes in June 1791; he was captured. The Legislative Assembly sat from October 1791 until September 1792, when, in the face of the advance of allied armies, it was replaced by the National Convention, and the National Convention proclaimed the Republic. The King was brought to trial, found guilty, and executed on January 21, 1793. In February, war was declared against Britain, Holland and Spain. The Revolution heightened. After the execution of the King, the Committee of Public Safety and the Revolutionary Tribunal were created. The most horrific time was still to come. The reign of terror, during which the ruling faction ruthlessly exterminated all potential enemies, began in September and lasted until the fall of Robesoierre on July 27. During the last six weeks of the terror, nearly fourteen hundred people were murdered in the guillotine. On October 16, Marie Antoinette was executed, and many others followed her. The revolution began to invade people's lives deeper and deeper. In November of 1793, the worship of God was abolished and the cult of Reason took its place. Battle followed battle; the Revolution raged on devouring everyone in its path. Things finally came to a halt when Napoleon Buoneparte became Emperor on May of 1804.

Health Campaign Essay

Health Campaign three on diabetes serves to implement change in population health. The main focus of this presentation is on recommendations for implementing and assessing the change in population. The presentation is to discuss the various recommended implementations to improve the health of diabetic population by addressing the social, economic and cultural factors. The paper also recommends different approaches in place for the diabetic population such as the programs, policies, laws, and environmental aspects for assessing the health and wellness of the target population. The paper addresses several challenges related to improving the health of the diabetic patients by examining the global implications, environmental factors and disease prevention. Finally the paper summarizes the epidemiology and other data models used by the managers for decision making and to anticipate future trends. Mass media campaigns are the treatments based on mass media channels to present subjects abou t the physical activity to big and undefined audience. These campaigns are presented to enhance awareness and knowledge of the gains of the physical activity, and beliefs about the physical activity, alter physical activity behavior in diabetic populations. The subject matter can be channelized via as newspaper, brochures, manuals, radio, television, and websites or in a combination. Social support networks for diabetes using internet and mobile applications. Social support networks uses mobile applications for diabetes such as M-health for the daily monitoring and self-management of diabetes (Chomutare, et al., 2013). Economic factors include awareness of the direct medical cost and indirect medical cost for diabetic management is important for the population. Direct medical cost which is the average medical expenditures among people diagnosed with diabetes is twice as higher than the people without diabetes. Indirect cost is more than 69 billion which includes the cost for disability, work loss, and premature death (Center for Disease Control and Prevention, 2012). Building cross cultural relationships by one to one  interaction connects each other in a culturally diverse community. Building relationship with people from different cultures including the minority population is the key in building diverse community that are powerful enough to achieve the goals. Bringing quality of health care into culturally diverse community by sturdy and caring relationships based on the trust, understanding and shared goals (Noll, 2012). National Diabetes Education Program (NDEP) works with partners to reduce the burden of diabetes and to prevent or delay the onset of type-2 diabetes and its complications using proven approaches. National Diabetes Prevention Program partnerships with community organizations, insurers, health care organizations, employers and governmental agencies. The National Program to Eliminate Diabetes Related Disparities in vulnerable population assist community partners in planning, organizing, developing, implementing and evaluating community based interventions to decrease the incidence of diabetes. National Public Health Institution on Diabetes and Women’s Health enhances approaches to improve access and quality of care for women with gestational diabetes. Road to Health is designed for African American and Hispanics at risk for type-2 diabetes, which is a community outreach program reinforcing the prevention or delay of diabetes. Laws on nutritional labels provide information on carbohydrate counting and helps to compare foods and to make better choices. Food labels can be essential tool for diabetic meal planning (Center for Disease Control and Prevention, 2012). Environmental and policy approaches are planned to promote opportunities, provide support, and reminds people to be more physically active. Enhanced spaces for physical activity involves an attempt to change the existing environment to create physical activities, such changes include making walking trails, promoting exercise facilities, and providing access to existing nearby facilities. Environmental modification for creating walkable communities, increases physical activity levels by development of adequate trails, sidewalks, pedestrian spaces to bike, jog, and walk. The land use policies and practices involve the efforts of planning and health care professionals to change the physical environment of urban area to support physical activities. The land use policies should support improvement of ecofriendly spaces, increased sense of community, and increased consumer choices for places to reduce stress. Transportation and travel policies will facilitates walking, bicycling and use of public  transportation. Also, increased parking cost will promote the use of public transportation (Center for Disease Control and Prevention, 2012). The global rise in the non-communicable disease presents a tremendous challenge in public and private health care sectors. With complex and variable determinants of health non-communicable disease like diabetes is estimated to increase the global burden of disease and death rates. Diabetes accounts for more than fifteen percentage of National Health care Budgets, and almost triple the health care resources. Many of the countries have improved the health care infrastructure which is fragmented, but still it remains inadequately funded and non-operational. Environmental challenges include the lack of exercise, obesity, rapid Westernization of low and middle income countries and changes in diet habits (Tjota, et al., 2011). Encouraging public awareness about healthy diet, and promoting physical activity facilitates to overcome the challenges. Another challenge is the inadequate workforce in the public health sector, lack of adequate training on the disease prevention and health care promotion. Finally there is no enough evidence-based research materials to support the public health care for disease prevention and health care promotion. Translating Research Into Action for Diabetes (TRIAD) is a conceptual model that uses Donabedian’s paradigm to draw the relationships among various factors such as the system factors, process of care and health care outcome. The model is used for decision making in diabetes treatments, identify barriers and better care outcomes for the people with diabetes. This model is launched by Center for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Kidney Diseases (NIDDK). TRIAD model is a cohort study in which the system factors include structure of the health care system, disease management steps, referral care and management, payment services and incentives, cost-containment steps and use of information system. In the process of care the model uses HbA1c testing, lipid testing, retinal examinations, micro albuminuria testing, annual foot examinations, and prescription of aspirin. The health outcome expectations include the glycemic control, blood pressure control, utilization and cost control, management of health status and symptoms, that includes cardiovascular disease, renal disease, retinopathy, and cholesterol control (Translating Disease Into Action for Diabetes Fact Sheet, 2011). Conclusion Diabetes has become an epidemic that continues to rise and become the seventh leading cause of death among the population. Federal, state, and local agencies have placed various surveillance systems and recommends to assess how diabetes affect the community and the specific targeted population. Diabetes as a public health issue is aligned with the nationally identified health objective of Healthy People 2010 and continues to address the issue with improved methods of prevention and control of the disease. The presentation recommended implementation of the campaign for diabetes based on the social, economic, and cultural factors. It also revealed the various approaches taken by policy makers, department of law, various diabetes programs, and environmental aspects involved. The presentation assessed various challenges in improving the population health. Finally the presentation summarized the TRIAD model used by the managers for decision making purposes and to anticipate the future nee ds. Reference Centers for Disease Control and Prevention. (2012). Diabetes Health Resource. Retrieved from http://cdc.gov/diabetes/status/us/index.htm. Chomutare, T., Tatara, N., Ã…rsand, E., & Hartvigsen, G. (2013). Designing a diabetes mobile application with social network support. Studies In Health Technology And Informatics, 18858-64. Noll, K. E. (2012). Cultural diabetes. (Order No. 1519974, University of Denver). ProQuest Dissertations and Theses, 86. Retrieved from http://search.proquest.com/docview/1112475764?accountid=458. Tjota, M. Y., Kozak, B. M., Chang, E. M., Wu, V. L., & Close, K. L. (2011). Journal of Diabetes NEWS. Journal Of Diabetes, 3(3), 174-181. doi:10.1111/j.1753-0407.2011.00140.x Translating Disease Into Action for Diabetes Fact Sheet. (2011). Diabetes Public Health Resource. Retrieved from http://www.cdc.gov/diabetes/projects/research.htm.

Public Opinion and policy Essay

In Public Opinion: Democratic Ideals, Democratic Practice, Rosalee Clawson and Zoe Oxley interpret public opinion as an individual’s beliefs and preferences in regards to all governmental matters and policies.(424) These individual ideas collectively are viewed as the overall populations opinions summarized and can be reflected by a poll. By collecting these opinions through the polling process, lawmakers are likely to take these opinions into consideration when creating and/or regulating a policy. In 1824 The Harrisburg Pennsylvanian newspaper conducted one such poll where the readers were asked to return a postcard with their opinion about the presidential candidates; Andrew Jackson or John Quincy Adams. Jackson won the poll as well as the eventual election.(Franklin) This style of opinion polling has increased over the years and evolved into a more refined and accurate representation of the public. For instance, instead of submitting an untraceable, anonymous postcard, peop le are instead asked to submit a survey and are required to submit some personal information, which will remain anonymous, in order to prevent the chance of someone submitting more than one survey. Due to the availability of the telephones and the internet, we are able to survey a larger and more diverse group of citizens which will allow for more accurate results. As voters, we are able to have some control over who represents our opinions as well as who we believe will make decisions that are truly for the betterment of the people and society. By understanding the five linkage models established by Norman Luttbeg (Robert & Kent, 20-21) we are able to see how public opinion can sway the formulation of a public policy. 1. The Rational-Activist Model assumes that all voting citizens are level-headed, informed, involved and politically active individuals. This model presents the idea that if representatives do not make decisions to satisfy the demands of the people, then the people will replace that representative. This model is the least likely to be apparent since the majority of the public does not keep close tabs on political actions. The largest flaw with this model is that we are assuming all voters are educated and rational about a particular issue and/or candidate. 2. The Political Parties Model takes place when an individual has an overall agreement with the ideals of an individual party. Citizens identify with a party whose overall attitude and beliefs mesh with their own. A major flaw within this model is the idea that representatives feel  pressured to take actions that are for the betterment of the party but not always for the individual citizen. 3. The Interest Groups Model establishes that the public can express their opinions to lawmakers by forming a group who will advocate for a collective cause. The groups place pressure on the lawmakers and parties electorally by rallying behind those that will publicly promote them. As well as monetarily by donating funds to those individuals and/or parties. By understanding this particular model we are able to see the likelihood of one group being more represented than another in society. This would create strife among the people as the group who is the least wealthy would be more likely to be underrepresented even though that group could contain a more accurate representation of the overall public opinion. 4. The Delegate Model maintains that a representative is elected based on the candidates values but not necessarily their stance on the issues. This model varies from the Rational Activist model in that it places more responsibility on the candidate to follow the opinions of the constituency or face being replaced and not place the responsibility on the public to educate themselves. While the Delegate Model and the Rational Activist Model are very similar the key difference is in noting that this model places more pressure on a candidate to follow their constituency’s ideas even if the candidate believes that other options would be in the best interest of the constituents. 5. The Sharing Model speaks on the idea that a representative will act on their own belief that may not be in complete alignment with their constituency but due to the unlikelihood that the lawmaker will go directly against their constituency they are still placing public opinion in their favor. This model overwhelmingly displays that a representatives values and character may come more into consideration with a voter than that representatives stance on a particular issue. (WK 2008) When we say population we are referring to a large mass of people that represent the summation of a geographical area. (Robert & Kent, 28) Population can be that of a country, state, city or even a university leading to extremely large groups of people that would take too much time to poll individually. Within any given population we take samples, collect data from a subdivision of a population in an effort to estimate the overall opinions of the collective group. Within these subsets of populations the results may not be a completely accurate reflection of the overall population. Religion,  race and income are factors that can greatly sway the outcome but most instances are unintentional. (US History) A biased sample is where there has been a methodical selection of the participants in an effort to achieve a planned outcome. An unintentional occurrence might take place with a telephone sampling. The University of Texas at Austin elaborated on this bias in regards to telephone sampling. For instance, if the amount of people who are without phones, or those who simply don’t answer the phone are not considered this can greatly skew the results. Truly random samplings are where the participants are participating solely due to chance and where every varying subset of citizens h as an equal chance to be selected. (Rosalee & Zoe, 29-30) A sample will very rarely get the exact percentages as it is highly likely that they will miss a group of people since the entire population is not participating and we are taking smaller groups to represent the entirety. The confidence level is a mathematical probability measure that tells us how reliable our data is in terms of accuracy. We keep this probability to a manageable number by keeping the number of individuals polled low. Polls are kept to less than 1,000 respondents due to the margin of error as well as the fact that the accuracy improves only marginally with larger samples. (Robert & Kent 30) The 1936 poll conducted by Literacy Digest proclaimed that the Republican candidate was likely to be the overwhelming winner of the Presidential election when in actuality it was Franklin Delano Roosevelt that won the bid for President. Seeing as how this poll was conducted at a time where the majority of people were dealing with the aftermath of the stock market crash and the subsequent great depression we can infer that the majority of the people polled were people who had the funds to subscribe to a weekly magazine, owned a telephone and possibly an automobile. The Republican candidate was proje cted to be the winner most likely due to the affluent Republican participants of the survey. During this same election George Gallup’s American Institute of Public Opinion did project the winner to be Franklin Delano Roosevelt, which placed the Gallup poll into the spotlight. It is believed that the Gallup poll was able to accurately predict the outcome due to their preference of using a smaller and more diverse sample. (Polling the Nations) Ideologies are the beliefs of an individual about the various social, cultural, political and economic operations within a society. An individual forms opinions based on their beliefs, life experience, genetics and many factors that as a whole make up their political ideology. (Rosalee & Zoe, p62) The liberal ideology is based on the beliefs that government intervention in economic matters, as well as a basic belief in the equality of the people. While a conservatives ideology is based on the beliefs that there should be minimal government intervention in all matters, as well as an emphasis on tradition and individual responsibility. (Robert & Kent, p72-73) There are five main influences that will affect how a person develops their ideology; family, gender, religion, ethnicity, and/or region. All of these influences will combine, influencing the opinions and beliefs of the citizen. Since a person develops opinions based on the experiences and knowledge they have developed over the course of their lives, there can be instances where a person can completely flip-flop on their original ideals as time progresses and while this is highly unlikely it is still possible.( Pelin, Erik, Jackie†¦) For instance, a person who grew up in an affluential conservative household may find as they get older and more independent that their view of the world is vastly different from that of their families. This can also lead to strife amongst families in instances where there is an obvious divide on the ideals. A person who is witness to the exchange of ideas between the opposing sides is likely to be influenced by the attitudes and opinions of the peop le while also comparing those individuals’ ideals to their behaviors, character, and reliability. Conservatives and Liberals have very different ideological standpoints and many Americans tend to lean towards one or the other in regards to their personal beliefs toward public policy making and governing styles. However, it has been discovered that the majority of the present American public do not identify themselves as adhering to one strict ideology but instead place themselves somewhere in the middle. (Robert & Kent, p83) Conservatives have the highest percentage of individuals who are strict ideologues. (Gallup-a) But there are many individuals from either side that can be uncompromising  in their ideals and take their truth as the one and only truth. In understanding a person’s chosen ideology we are faced with an interesting fact; that while most people tend to identify themselves as conservative, the overall majority of the public tends to vote more liberally. (John, 2014) Conservatives are ideologically defined by their strict adherence to traditional values and practices as well as their support for little to no governmental regulation and their emphasis on individual citizens taking personal responsibility. Liberals are alternatively defined by their belief that the government should be active in the regulation of the people in order to protect the citizens from the possibility of unequal and discriminatory actions. (Rosalee & Zoe, p134) Liberals are also recognized by their beliefs in the overall equality of citizens, protection of liberties and progressive thinking that is based on the idea that there is overall an essential goodness to the mass populous. While there are vast differences between these opposing sides , it is possible to see how a person may agree with a conservative view of government while simultaneously believing in the humanist attributes of the liberal view. Individuals will usually develop an allegiance to a particular party (typically Democrat or Republican, though many other political parties have emerged), or will categorize themselves as being an independent of a specific party affiliation. An individual’s party identification gives us a better idea on how that person will vote in elections as people tend to follow their elected party’s specific views on an issue as well as electorally support a political leader of the party, but that is not always the case. Party identification has been described as being a psychological identification, or being the way an individual has come to their current attitudes towards public policy by way of their individual life experience, that will continue to influence how new information is processed. (Thomas & Geoffrey) If we were to question an individual’s likelihood to remain a steady voter for one particular party, the Michigan Model theory will give us such a theory to go on as this model emphasizes an individual’s party attachment is  predominately stable. One noticeable flaw in this theory is if a party were to change their stance on an issue that overwhelmingly goes against the beliefs or ideals of the individual, the voter may then vote against the party if not possibly switch parties altogether. But this is unlikely as the voter is more likely to respond to the performances of their elected representatives than to their ideologies alone. (Harold, David, Marianne & Paul) By looking at the present day Republican Party we are able to see they are typically very conservative in their views, which may be why more and more religious people vote in accordance with this party. The Republican party favors towards older, affluent and white males while the Democratic party tends to be more diverse. The Democratic Party contains a very diverse group of people and is weighted in the areas of women, race and sexual orientation. (Gallup-b) The majority of younger Americans also identifies with the Democratic Party. By seeing the makeup of these parties we can deduce that it is likely the Democrats are representative of a â€Å"new school† wave that is pushing for a more liberalistic approach. (Adam, 2014) The presidential approval rating is one of the main political opinion polls taken and focused on by the media. This ranking shows whether the public generally approves or disapproves of the job performance of the person holding America’s highest office. In studying the inconsistent falls and climbs of the approval rating there have been certain trends believed to be the cause of some high points during a presidential term. (Rosalee & Zoe, 109) The honeymoon effect is the first trend that will take place during the days after a President takes office. This effect refers to the initial phase after the swearing in of the president into the office. Since this man is entering office with a clean sheet, and has recently come off of an approval high as evidenced by his election, people are more likely to be optimistic towards actions taken by the president. Eventually there will come a time where a problem is encountered and the president’s plan of action will no doubtedly ups et a cluster of people. After this point there can be varying reasons for the day-to-day rising and falling of the approval rating. (Robert & Kent, 120) In some instances a presidents rating can climb when the nation has been confronted with a foreign event that involves America and possibly a crisis for the American people. This idea is referred to as the rally round the flag effect. Robert Erikson and Kent Tedin write in American Public Opinion (121) this effect is likely to occur due to the desire of the American people to feel united behind a leader. One of the most accurate examples of this would be the attitude of the American people after the attacks that took place on 9/11 and the subsequent skyrocketing in the approval ratings for President George W. Bush. Upon deeper evaluation of this occurrence: when there is more of a relative calming of the people and the effects of war, both financially as well as the casualties incurred, the approval ratings are then subject to drop, one could say when â€Å"reality† sets in. (Rosalee & Zoe, 111) The final source for the possible explanations behind drastic increases and decreases in a presidential approval rating is the state of the economy. An economy that is poorly performing will likely result in low approval ratings for the President and a prosperous economy to increase the approval rating. According to Kevin Hoover in his article â€Å"Phillips Curve†, during a low economic point there will be higher rates of unemployment and inflation. These two factors can have a substantial and negative impact on an individual’s livelihood. President Obama was elected during a time of economic strife due to many factors including a housing market crash as well as the weighing cost of the â€Å"War on Terror†. Even though Obama was not in the Presidential office during the onset of the war, nor was he to blame for the inevitable housing market crash, his approval rating suffered due to the onset of these events aftereffects. Bibliography Robert S. Erikson and Kent L. Tedin, American Public Opinion, New Jersey: Pearson Education, Inc., 2011 Rosalee A. Clawson and Zoe M. Oxley, Public Opinion: Democratic Ideals, Democratic Practice. Washington D.C., 2013 The University of Texas at Austin. â€Å"Biased Sampling and Extrapolation.† Last modified August 28, 2012. https://www.ma.utexas.edu/users/mks/statmistakes/biasedsampling.html Pelin Kesebir, Erik Phillips, Jackie Anson, Tom Pyszczynski, Matt Motyl, â€Å"Ideological Consistency across the Political Spectrum: Liberals are More Consistent but Conservatives Become More Consistent When Coping with Existential Threat† (February 11, 2013). http://ssrn.com/abstract=2215306 John Sides, â€Å"Why Most Conservatives are Secretly Liberals,† The Washington Post, March 6, 2014. http://www.washingtonpost.com/blogs/monkey-cage/wp/2014/03/06/why-most-conservatives-are-secretly-liberals/ Gallup-a. â€Å"Conservatives Remain the Largest Ideological Group in U.S.† Last modified January 12, 2012. http://www.gallup.com/poll/152021/conservatives-remain-largest-ideological-group.aspx Gallup-b. â€Å"Democrats Racially Diverse; Republicans Mostly White† Last modified February 8, 2013 http://www.gallup.com/poll/160373/democrats-racially-diverse-republicans-mostly-white.aspx US History. â€Å"American Political Attitudes and Participation: What Factors Shape Political Attitudes?† Last modified January, 2013. http://www.ushistory.org/gov/4b.asp Christopher Ellis and James A. Stimson, â€Å"Pathways to Ideology in American Politics: the Operational-Symbolic â€Å"Paradox† Revisited† http://www.unc.edu/~jstimson/Working_Papers_files/Pathways.pdf Harold D. Clarke, David Sanders, Marianne C. Stewart and Paul Whitely, â€Å"The Dynamics of Party Identification,† in Political Choice in Britain, edited by Harold D. Clarke (Oxford: Oxford University Press, 2004), 185-186. https://www.essex.ac.uk/bes/bookfiles/Sanders-ch06.pdf Franklin & Marshall College. â€Å"The First Political Poll.† Last modified June 18, 2002. http://www.fandm.edu/politics/politically-uncorrected-column/2002-politically-uncorrected/the-first-political-poll WK, Ph.D. Candidate, â€Å"The Role of Salience on the Relationship between Public Policy and Public Opinion† (Paper prepared for DC AAPOR Student Paper Competition, December 12, 2008) http://www.dc-aapor.org/documents/spc08wk.pdf