Use of the slit-lamp for anterior segment examination of the eye Case Study

Use of the slit-lamp for anterior segment examination of the eye - Case Study Example In my clinical placement in the Ophthalmology, I had a chance to examine a patient who presented complaining of decrease in vision. For confidentiality and ethical reasons, the identity of this patient remains undisclosed. However, this 65-year-old gentleman presented to the clinic, and when I was instructed to do a slit-lamp examination, it felt that it was an opportunity to use academic learning in practice, and I was very excited. In order to arrive at a diagnosis, I obtained these systemic medical history and family ocular history, since these are important for assessing a patient's risk factors for ocular disease. Just as with other body systems, reliable historical information allows the clinician to more appropriately direct the physical examination (Quillen, 1999).I probed into his recent complaints in terms of the onset, duration, and associated symptoms, since knowledge about these can guide me to the correct diagnosis. I asked him about his prior good and equal vision in b oth eyes. Then I asked him whether the problem were on the both eyes, and how could he not note it for last 1 year. He said that he was going on with his frequent changes in glasses, which he thought was natural at his age. While watching television, he suddenly discovered that his vision in the right eye was a lot better than the left, and when he attempted to watch TV with one eye, he was surprised to discover that with the left eye alone, the pictures were hazy. Moreover, he could see better at the periphery than at the centre. He had no pain, distortion of the sight, and no double vision. These were very suggestive and significant pieces of information since they narrow down the clinical differential diagnosis further, and helps the examiner to design the clinical examination in a better way. The suggestive better peripheral vision, differential vision between the eyes and absence of distortion, pain, and double vision led to the impression that I need to focus in the anterior s egment of the eye while conducting his examination (Age-Related Eye Disease Study Research Group, 2001). General Examination When I decided to carry out an examination, I felt that a patient with decreasing vision requires a complete examination to determine the cause of the visual decline. Therefore, I started to do a systematic examination. I performed a general examination of the eyes in good diffuse light, and I felt that it would lead me to the possible diagnosis, so later I can do a slit-lamp examination. The general examination began with the examination of the eyelids and the conjunctival sac. He was elderly and had some amount of sagging of the eyelids. On palpation, the lid margins did not demonstrate any swelling. There was no redness in the conjunctivae. The eyelashes were normal. There was no evidence of any inflammation or blepharitis in both the lid margins. In order to examine the conjunctival sac, it was necessary to expose the palpebral conjunctiva and the fornices. Due to age, his fornices were shallow. There was no crusting, follicles, conjunctival papillae, or pseudomembrane indicating chronic or acute inflammation contributing his diminished vision. I drew down his lower lid while he was asked to look towards the ceiling, and the lower fornix looked normal. This excluded any inflammation of the lower lid and swelling that can compromise vision temporarily. The upper lid was everted to examine the upper palpebral conjunc

A Tale Of Two Cities Essay Example for Free

A Tale Of Two Cities Essay We learn that the Signal man has seen very disturbing events such as the train crash and the bride dying and what is more troubling is that he seen it coming, throughout the story we see how the signal man opens up to the narrator on how he is troubled and is emphasizing how he saw a ghost but the narrator starts to doubt his new friends mind and starts to have a very patronizing attitude towards the signal man. Throughout the story the fear is spreading. Dickens also uses tactile imagery Frozen finger tracing out my spine and also Dickens uses olfactory imagery an earthly deadly smell. The relationship between the narrator and the signal man is one of trust as the signal man opens up to him on their second meeting do the signal man and the narrator linked in some way? Dickens has made the story raise some doubts about the afterlife and fate. However Bram Stoker famed for his book Dracula has created a short story that is much like The Signal Man but has a different approach to the horror genre for the first few pages are a little bit of a mysterious Draculas Guest is full of suspense the title alone raises the expectation for the reader as it does not give away the plot but creates a feeling of intrigue making the reader want to read on, this is a clever ploy Stoker has used and it was also a popular theme to use as in the middle ages and Victorian era the legends of vampires have been popular among the people of Britain and Ireland and perhaps the world. The short story contains many dark themes that create mystery and also adds to the mounting tension that is created by the title Draculas Guest Bram who is Known for his Dark stories that contain major supernaturalist elements such as Mythism and oppressive that are including as the novel The Lair of the White Worm, Bram creates the prefect atmosphere for the short stor y and for the century as the Victorian era had a thing for vampirism stories. The story begins in Munich the weather is idyllic The sun was shining brightly on Munich, and the air was full of the joyousness of the early summer is the weather too idyllic? Bram cleverly opens the story this way to lull the reader into a sense of false security a very smart move I think personally, but that all ends when still holding his hand on the handle of the carriage door is used which is very arousing and causes a lot of interest, He also uses personification a shiver in the north wind adds more dramatic effect so does the use of alliteration Sudden Storm but the line But I am sure you will not be late, here he smiled and added for you know what night is it mysterious what is the night in question? And why is it so important? The 1st paragraph creates a sense of importance for the night and adds to the mystery and we then learn the reason the maitre and coachman fears the night and also we learn the name Walpurgis Nacht which translated from German means Night of Evil this term is very important to Catholics this is the first relation to religion, later on we here Walpurgis nacht! , Stoker uses the language barrier and the fail to understand adds to the suspense and surreal aspect, later the weather changes to dark clouds drifted rapidly across the sky the atmosphere changes to a sinister dull mood. Again the language barrier is there and the personification has the desired effect the storm of snow he comes before long time also the dialogue become vague and broken creating more tension here vampirism applied mouths red with blood, we see that the protagonist seems to doubt his sanity a lot like Dickens character The Signal Man it seems he also is succumbing to his fear Paroxysm of the fear- white face perspiring, trembling Bram Stokers technique second to none he uses detailed descriptions for his characters and settings and his use of the language devices such as metaphors glistening white carpet and his alliteration Sudden Storm and lastly repetition Walpurgis nacht. Each writer Dickens and Stoker uses different methods to create a spine-chilling effect on the reader each could even be masters of horror and suspense, all the aspects that the gothic genre needs to be successful and The Signal Man and Draculas Guest where very successful in that age and successful today in the study of literature . In conclusion after close analysis of both stories I have seen that both stories are great for maintaining tension and use techniques such as alliteration, pathetic fallacy and are good to create confusion among the readers. This wining combination gives the story a kick and keeps the reader engrossed in the story. I believe that stoker is perfect for building suspense and tension while Dickens plays on the readers emotion by lulling them into a sense of security and then confuses them and then plays on their confusion. Gavin Teggart Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Miscellaneous section.

Symbolism in the Play Everyman Essay -- Papers

Symbolism in the Play Everyman The play Everyman dates back to medieval times and has affected many people throughout the centuries. Many life lessons are looked at throughout the play through symbolism, which helps the reader understand life’s lessons easier. Everyman, an allegory, had symbolism scattered throughout the entire story, which helped to better show lessons learned through life. In Everyman, symbolism is present in many characters, including Good-Deeds, Confession, and Death. In the play Everyman, Good-Deeds is symbolic through his character name, costume, and actions. Good-Deeds shows symbolism through his many charitable acts. Good-Deeds wishes to go along with Everyman on his journey before death, but he has been too weak. With being to weak Good-Deeds’ sister, Knowledge, decides to go along. This shows symbolism through his charitable acts. Good-Deeds’ costume symbolizes happiness by far and peace and perhaps was the color yellow. Good-Deeds’ actions during the play are also symbolic. Good-Deeds helps Ev... Symbolism in the Play Everyman Essay -- Papers Symbolism in the Play Everyman The play Everyman dates back to medieval times and has affected many people throughout the centuries. Many life lessons are looked at throughout the play through symbolism, which helps the reader understand life’s lessons easier. Everyman, an allegory, had symbolism scattered throughout the entire story, which helped to better show lessons learned through life. In Everyman, symbolism is present in many characters, including Good-Deeds, Confession, and Death. In the play Everyman, Good-Deeds is symbolic through his character name, costume, and actions. Good-Deeds shows symbolism through his many charitable acts. Good-Deeds wishes to go along with Everyman on his journey before death, but he has been too weak. With being to weak Good-Deeds’ sister, Knowledge, decides to go along. This shows symbolism through his charitable acts. Good-Deeds’ costume symbolizes happiness by far and peace and perhaps was the color yellow. Good-Deeds’ actions during the play are also symbolic. Good-Deeds helps Ev...

Client Pitch Presentation Essay

Introduction The Coca- Cola Company was incorporated September 5, 1919. The company is the leading nonalcoholic beverage company. Coca-Cola offers over 500 different brands. Coca-Cola â€Å"originated as a soda fountain beverage in 1886 selling for five cents a glass† (The Coca- Cola Company, 2015) in Atlanta, Georgia. Coca-Cola puts its â€Å"â€Å"Focus on needs of our consumers, customers and franchise partners† (The Coca- Cola Company, 2015) {The Coca-Cola Company is the leading and the most popular nonalcoholic beverage (soft drink) company. Coca- Cola connects with its consumers on a level where the consumers feel comfortable with the company. Because the company has been around for so long, many customers knows what the company stands for and continue to remain loyal to the company.} Coca-Cola Brands â€Å"The Company owns or licenses and markets more than 500 nonalcoholic beverage brands, primarily sparkling beverages but also a variety of still beverages, such as waters, enhanced waters, juices and juice drinks, ready-to-drink teas and coffees, and energy and sports drinks† (Forbes, 2015). {The Coca-Cola company offers its consumers a variety of different beverages to choose from. By meeting the different tastes of consumers, the company is able to successfully satisfy customers worldwide. The different brands developed by Coca-Cola include Diet Coke, Dasani, Sprite, Fanta, and many more.} Target Market Coca-Cola’s target market includes consumers from all demographics. Men & Women Non-Alcoholic beverage drinkers Consumers of ages 10 -60. {Coca-Cola strives to target men and women of different ages, ethnicities, educational backgrounds, and locations. The company has many different brands that can satisfy the needs of customers of different demographics. The Coca-Cola brand is known world-wide so there are different brands to meet the needs of those consumers from around the world. The company targets consumers of all ages, but will focus mainly consumers between the ages of 10-60. There are different brands that meet the needs of consumers within  each age group.} Coca-Cola SWOT Analysis Strengths : Quality product, Loyal Customers, Effective Marketing Techniques Weaknesses: Most of the products are carbonated beverages, Many brands innovated are not very popular amongst consumers, Subjected to negative criticism. Opportunities: Create more healthy beverages, Create juices or beverages suitable for toddlers and babies. Threats: Competitors such as Pepsi whom are developing new brands. {Coca-Cola is the most valued company when it comes to the development of nonalcoholic beverages. Because the company has been around for so long and has sought customer feedback when engaging in making changes that relate to the products, Coca-Cola has a loyal customer base. There are some weaknesses that are associated with the company primarily only sales beverages, and there are sometimes negative criticism. There are opportunities for the company to branch out into other areas such as making food products. The threats faced by the company come from competitors.} Goals & Objectives To be the leader in the beverage industry.  To make sure that the consumers of Coca-Cola brands are aware of the company and the products that the company offers. Increase the company’s sales and revenue.  To make potential consumers around the world aware of the companies’ products and what they have to offer. {The goals and objectives of Coca-Cola are set into place in order to increase sales and revenue and to make sure that consumers are happy with the products offered by the company. The goals and objectives can be utilized to take the company to another level which will completely set it apart from other companies within the beverage industry.} Customer Loyalty The company will provide its’ consumers with a quality experience when utilizing the products. The Company will build customer loyalty by continuing to be innovative in creating the different brands that fit the needs of their consumers. The company offers its consumers Coke Rewards that allow them to gain savings for the products. {When it comes to customer loyalty, it is important that companies make sure that they maintain the brand image. According to the course text, â€Å"A strong brand community results in a more loyal, committed customer base† (Kotler & Keller, 2011). Another way for the company to promote customer loyalty is to make sure that the products are available to the consumers at a reasonable price. It is also important to make sure that the products are easily accessible to consumers in all locations where the products are being sold. By offering opportunities for consumers to save, the company is able to build gain loyal companies because they can see that the company does care about their finances.} Competitors Coca- Cola’s competitors include other companies that produce nonalcoholic beverages, the main one being Pepsico, Inc. Pepsico is the 2nd most popular soft drink company. Like Coca- Cola, this company also have beverages that are offered within a number of restaurants and stores. Nestle is another competitor that offers beverages. Although this company has drinks, it also has some food products that are available to consumers. With Nestle having water as one of its’ brands, it poses competition to Coca-Cola. Branding Strategy Coca-Cola manages its brand by â€Å"constantly striving to improve their products, services, and marketing† (Kotler & Keller, 2011). â€Å"Focus on needs of our consumers, customers and franchise partners† (The Coca- Cola Company, 2015) â€Å"Get out into the market and listen, observe and learn† (The Coca- Cola Company, 2015) â€Å"Possess a world view† (The Coca- Cola Company, 2015) â€Å"Focus on execution in the marketplace every day† (The Coca- Cola Company, 2015) â€Å"Be insatiably curious† (The Coca- Cola Company, 2015) Coca-Cola has formed partnerships with restaurants and stores where the company’s products can be offered to consumers. Communications Methods  Advertising- Coca-Cola uses the TV, internet, newspapers, magazines, and other sources to advertise their product. Company Website- Coca-Cola’s company website provides consumers with information about the products that the company offers. The website also allows for the consumers to be involved in the activities that the company  works on in order to have an effect on the environment. Print Ad ~Open up to new possibilities with Coca- Cola! Conclusion Coca-Cola is the leading nonalcoholic beverage producer. The company builds on customer loyalty by keeping their customers involved and informed. The company’s programs and The company’s IMC will allow for the company to reach an even larger customer base which will lead to the continuing of the company’s success. Coca- Cola’s brand image and loyal customers will help in their ability to face the encounters of the company’s competiton. By analyzing the company’s strengths, weaknesses, opportunities, and threats, Coca-Cola will be able to make necessary changes and continue using successful strategies that have allowed them to be the number one soft drink company! References Coca- Cola Company (2015). Mission, Vision, & Values. Retrieved February 18, 2015 from http://www.coca-colacompany.com/our-company/mission-vision-values. Forbes (2015). Coca Cola. Retrieved March 7, 2015 from http://www.forbes.com/companies/coca-cola/. Kotler, P., & Keller, K. (2011). Marketing Management, 14th Edition. [VitalSource Bookshelf version]. Strategic Management (2015). SWOT Analysis of Coca Cola. Retrieved March 8, 2015 from http://www.strategicmanagementinsight.com/swot-analyses/coca-cola-swot-analysis.html.

MegaCities Essay Essay

Mega Cities are cities that have a population of more than 8 million and are characterised by the challenges they face, including issues involving the informal economy, unemployment, poor sanitation and shelter. These issues are largely prominent in these cities due to rapid urban growth and a lack of resources. In many cases action has been taken by national governments and non-governmental organisations (NGO’s) to combat and reduce the impact of these issues, however In order for these strategies to be effective they need to fit 3 primary criteria, the solution must be community based, cost effective and sustainable economically and environmentally. Strategies such as micro financing.. Etc. have been adopted to resolve these challenged. A primary challenge facing many mega cities is the population’s heavy reliance on the informal economy as a means of income. The informal economy is a sector of unregulated work and with this comes high unemployment rates and a lack of jobs to support the ever-increasing population. Jobs in the informal economy are particularly prominent in Dhaka, Bangladesh, where 65% of all jobs are found in this sector. Jobs in the informal economy pose a threat to mega cities and their population as workers are not protected and are open to exploitation (e.g. Child labour) and people employed informally pay no tax (e.g. Street vendors, rickshaw drivers) leading to a reduction in the governments revenue. A number of strategies have been undertaken in order to transform informal work into the formal economy, including Micro financing. Micro financing involves NGO’s giving out small loans (approximately $US200), which provide people with money to formalise their business. There are a number of NGO’s that undertake this strategy, including Opportunity International, which is an Australian charity, operating in manila, targeting particularly impoverished communities. Access to these loans is based on a persons standing in the community and once the business begins to sustain itself loans must be repaid. The outcome of this process is a formalised business, which then contributes to government  beneficially by providing it with revenue. This strategy to combat the prominence of the informal economy has been particularly successful, adheres to the three evaluation criteria and provides users with lifetime skills and an income, which could potentially improve their living standards/quality of life. Another challenge faced by a large majority of mega cities is access to shelter, due to population growth in mega cities being too extreme for sufficient supply of housing. This in turn leads to the creation of informal housing, such as squatter settlements, which are generally formed on unoccupied unwanted land, such as next to rail lines or sewerage systems. Informal housing is extremely prominent in developing countries such as India, where 500,000 people live on the pavement in Kolkata with at least 4 million more living in squatter settlements; as well as 1 million people living in cemeteries in Cairo, and  ¼ of the Philippines population residing in slums. This informal housing creates a number of problems for its residents and government; it lacks basic services (sewerage, electricity, water), leading to unsanitary living conditions. There is a lack of tenure, which is the legal right to occupy land, which stops residents from wanting to improve property, insecurity for people and also extremely high crime rates particularly in the Favelas of Rio de Janiero where the police are unable to patrol, due to extreme gang violence. NGO’s and governments have undertaken strategies to improve the issue of lack of access to shelter, including the Kolkata Bustee Improvement Project, a joint initiative between government and non-government organisations. This is a site and service program meaning that the project takes an existing site and provides it with necessary services, such as sanitation, electricity etc. This program in turn reduces the cost burden on local government and creates jobs by incorporating the local community into the work. This movement has tried to stop India’s slum clearance policy, which frees up NGO’s to be able to assist the extreme urban poor. This movement has proved to be extremely successful in improving the shelter situation in Kolkata as it improves the living standard of squatter settlement dwellers, provides jobs and skills to the local community (therefore adding to the formal not informal economy) and also allows NGO’s to be able to assist the poor as they were previously  restricted by government policies. Another benefit is that it is cost effective because it aims to improve existing settlements and creates tenure. Access to sanitation is another key challenge faced by many Mega Cities that is, providing safe food and drinking water and sewerage management. Due to increasing populations, inadequate and ancient sewerage systems and also lack of access to fresh water many Mega Cities face sanitation issues. This issue is particularly prominent in cities such as Manila, where only 11% of people have access to a sewerage system, Karachi at 20% and Dhaka at 18% of the population. Water Borne diseases are particularly prominent in megacities, such as Cholera, Dysentery and Typhoid. Furthermore the disposal of solid waste in Mega cities has lead to issues involving contamination of groundwater and creating Vernon, this is common of Jakarta where only  ¼ of all rubbish gets collected. To combat the issue of sanitation, local governments and NGO’s have established very effective, low-tech strategies, such as the Pour Flush Toilet. This initiative is a relatively cheap response to the needs of unplanned urban settlements in mega cities. A pour flush toilet has a water seal that avoids the problems associated with odour and insects. However its effectiveness is limited by the fact that the system is not suitable in cities where the groundwater table is close to the surface, which is the case in many mega cities, including Mumbai and Kolkata in India and Dhaka in Bangladesh. Also, pour flush toilets can produce substantial quantities of heavily contaminated wastewater which can require substantial downstream infrastructure to avoid severe environmental and public health problems. Despite the disadvantages of this strategy it has proved to be a very successful short term solution to the issue of sanitation and is widely used in Mega Cities around the world, due to the fact that they are simple to use and can be kept clean fairly easily. Mega Cities face many challenges; largely due to their high population increase rate. They therefore need to develop a number of solutions and strategies to combat these prominent issues, such as the informal economy, access to shelter and access to sanitation. If action is not taken to confront these issues they will only become more consequential, leading to more deaths and further environmental and land degradation. Governments and  NGO’s continually need to create strategies to solve these issues and their efforts so far have proved to be extremely beneficial in improving the quality of life of residents of Mega cities, as they fit the three primary criteria needed for solutions to be effective.