Combined Pulmonary Fibrosis and Emphysema (CPFE)

Combined Pulmonary Fibrosis and Emphysema (CPFE) Ong Wei Jun Dan The Causes, Consequences and Differences Between Pulmonary Fibrosis or Emphysema Alone   Abstract Combined pulmonary fibrosis and emphysema (CPFE) is a complicated disease and untreated disease which consists of two diseases. It is difficult for respiratory therapists or respiratory physicians to differentiate between CPFE versus idiopathic pulmonary fibrosis (IPF)/emphysema alone. There is an increased recognition of the coexistence of emphysema and pulmonary fibrosis in individuals. The association of two diseases results in chronic dyspnea, upper-lobe emphysema and lower lobe fibrosis, and severely diminished diffusion of gas exchange with preserved lung volumes. CPFE is also frequently complicated by pulmonary hypertension, lung injury and even lung cancer. This causes CPFE patients to feel have a low quality of life and a low 10-year survival rate. Currently, there are no known treatments for CPFE patients with the exception of lung transplantation. Thus, clinical evaluations are needed to differentiate between chronic obstructive pulmonary disease (COPD) and pulmonary fibro sis, and to recognize that CPFE is a unique entity by looking at the difference in radiological, pathological and metabolism features in order to find better treatment for CPFE. Introduction About 11 million Americans have Chronic Pulmonary Obstructive Disease (COPD) and out of these, most are diagnosed with pulmonary emphysema. The etiology of emphysema found that 80% of cases are caused by cigarette smoking, which causes alveolar membranes to break down, creating huge alveoli (called blebs) that lesser surface area and weaker walls than normal alveoli. This causes the low perfusion of oxygen due to decrease in surface area. In addition, approximately 50,000 new cases of Idiopathic Pulmonary Fibrosis (IPF) are diagnosed each year.   IPF is a restrictive respiratory disease, and it is the most common of the idiopathic lung diseases. IPF causes thickening of the alveolar capillary membrane, which results in minimal gas exchange between the alveolar and the blood capillaries. Both diseases lead to the decreased efficacy of oxygen delivery. CPFE is a combination of both IPF and emphysema. However, it is usually treated as IPF and ignored or excluded in the diagnosis of emphysema.   COPD and pulmonary fibrosis have different pathologies, metabolic pathways and radiological characteristics, and were therefore regarded as separate entities for a very long time. However, in recent years, there is some recognition of the coexistence of pulmonary fibrosis and emphysema in patients. As such, it is very important to know the differences between CPFE versus emphysema or pulmonary fibrosis alone in order to find a treatment or prevent the patients conditions from further deteriorating. In the following years, studies had shown that CPFE patients have a coincidental occurrence of early emphysema and at later age of IPF, especially for smokers with many pack years.1   However, in recent studies there is a correlation between the occurrence of the combination between lower lobe pulmonary fibrosis and upper lobe emphysema. These two diseases have been observed coexisting in greater frequencies which are therefore called combined pulmonary fibrosis and emphysema (CPFE) and there is a need to distinguish them as distinct entities. There are some studies taking place to better understand the pathophysiology of the condition and find the possible causes of CPFE such as genetic factors or any biological metabolism pathways which may encourage its development. CPFE is normally caused by heavy smoking, exercise hypoxemia, upper lobe emphysema and lower lobe pulmonary fibrosis, unexpected lung volume and severe reduction of carbon monoxide transfer.2 Whether the combination of both emphysema and pulmonary fibrosis is a unique clinical entity still remains unknown. For some of the population in the medical community, it is a coincidental occurrence of two smoking-related diseases on one person, versus the coexistence of the similarities of COPD and lung cancer. However, many different studies have shown and suggested that interstitial lung abnormalities, which are normally caused by IPF, have are inversely related to emphysema in smokers. In fact, based on the chest X-Ray images, most patients who have many pack years with IPF do not have any signs of having emphysema. Similarly, most patients who have emphysema do not have any signs of IPF in their chest X-Ray. Hence, the combination of both pulmonary fibrosis and emphysema may be a direct result of heavy smoking or many pack years which reflects the uniqueness in individual susceptibilities. Even though medical professionals tend to use chest X-Rays for any respiratory distress, as it is inexpensive and considered a fast diagnostic tool, it is unable to properly diagnose the CPFE syndrome. Another alternative would be to use High-Resolution Chest Computed Tomography (HRCT), which is the only tool to diagnose the syndrome. The CPFE syndrome consists of heterogeneous syndromes, in which syndromes differ from one individual to another and resulting in no actual definition of the syndrome for CPFE. This makes it difficult to diagnose CPFE with the current pulmonary function test, as CPFE patient results look similar to those of patients diagnosed with pneumonia. From past research and observations, CPFE is frequently complicated with pulmonary hypertension, acute lung injury and the possibility of lung cancer, resulting in very poor prognoses. Treatments for CPFE patients with severe pulmonary hypertension have not been found and have largely proven ineffective in curing the disease apart from a wholesale lung transplant. The identification of patients with CPFE is needed due to the uniqueness and complication of the diseases history. Since CPFE has not yet attracted the attention of researchers and healthcare practitioners, there have not been many studies focused on finding the differences between pulmonary fibrosis, emphysema and CPFE. Currently, there is no consistent way to differentiate the factors, signs and syndromes when diagnosing CPFE patients from other obstructive respiratory diseases. This has resulted in many medical practitioners failing to immediately recognize CPFE in patients diagnoses. Population distribution of Emphysema, IPF and CPFE The prevalence of the disease emphysema was reported to be at about 24.5 per 1,000 in America, while the prevalence of IPF varied from 14 to 42.7 cases per 100,000. Therefore, emphysema is a more common disease as compared to IPF. However, there are no studies that account for the prevalence of CPFE. Some of the reported observations show that the proportion of patients with CPFE detected on HRCT scans range from 8% to 51% in IPF patients. On the other hand, the proportion of pulmonary fibrosis found in patients with emphysema is less than 10% using the HRCT. This variation of proportion of prevalence in CPFE may be due to the different types and complications arising from the diagnosis of emphysema when evaluated by chest X-Ray and HRCT. Patients with CPFE tend to be older men who tend to have many pack years of smoking. Previous studies have shown that there is no significant difference when varying the number of pack years against the occurrence of COPD such as emphysema and CPFE. However, patients with CPFE and those with COPD usually have a long history of smoking as compared to patients with IPF.   Many studies have reported that male have higher prevalence then female in having respiratory disease syndrome, and could be due to men tending to have more pack years as compared to females. It may also be due to the genes of men which predispose them to succumbing to COPD or CPFE. Even though both IPF and emphysema have proven to be more common in male smokers than female smokers, it does not necessarily mean that gender plays an important risk factor in the contraction of CPFE. More studies are needed to determine how gender differences affect this syndrome. Pathology pathway of CPFE Till now, there are no conclusive findings for pathogenies of CPFE. There are no clear conclusions on the development of CPFE, whether emphysema and or pulmonary fibrosis progress independently or whether there are synergistic qualities between the two. There may be some mechanisms involving cytokines, beta receptors or signaling pathways which have not been discovered. Thus, both pulmonary fibrosis and emphysema may tend to occur in genetic susceptibility individuals with from exposure to environmental factors such as smoking or occupational hazard and chemicals. Case Study of a CPFE patient (Occupational exposure) A case study journal report on a male patient aged 73 years old in 2015 gives one of the more detailed analysis of Microscopic Polyangiitis (MPA), a disease that precedes by CPFE. The patient worked as a metalworker and had 25 pack years. He was admitted to the hospital due to progressive dry coughing and he was later diagnosed with CPFE. He eventually died due to complications from CPFE, which resulted in severe pneumococcal pneumonia with acute lung injury. His arterial blood gas result was normal with a fairly abnormal range in his pulmonary function test (PFT). There were clear signs of emphysema and IPF from his CT scan and Chest X-Ray (Kyoko Gocho, 2015). MPA is a systemic necrotizing vasculitis of small vessels associated with numerous types of antibodies in particular myeloperoxidase- antineutrophil cytoplasmic antibody (MPO-ANCA). Oxidation induced by MPO-ANCA may trigger pulmonary fibrosis due to alveolar hemorrhage, resulting in pulmonary capillaritis (an inflammation of p ulmonary capillary). This causes pulmonary fibrosis as the alveolar capillary wall thickens (Kagiyama, 2015) Correlation of smoking with CPFE patients A common etiology factor for CPFE is smoking. Tobacco smoke contains 4000 chemical substances, including Kaolinite or aluminum silicate, an organic industrial material. Studies show that inhalation of this organic industrial substance will result in hyperactive macrophages, which in turn will lead to respiratory bronchiolitis and emphysema (King, 2005). Currently, there are no studies for the association of tobacco smoking resulting in IPF, other factors such as environmental factors in genetically-predisposition individuals may play a key role in resulting IPF. The association between CPFE and lung cancer may reflect the susceptibility linked to long term smoking which causes chronic smoking-induced inflammation. These were done on several other studies on the relationship between emphysemaand IPF.3,4 Pathological findings (Diagnostic Imaging) Patients who have acute respiratory distress syndrome such as COPD, pulmonary fibrosis or even CPFE, will tend to have more difficulty breathing due to the use of accessory muscles and the need to constantly supply supplemental oxygen to meet the oxygen level demanded by the body. For some of the patients, a high flow of oxygen is required (flow rate of more than 60L/min) to meet their inspiratory demand. Patients with CPFE have a confused and undetermined ventilation/ perfusion ratio due to emphysema causing low perfusion and IPF having low ventilation. This results in both ventilation of oxygen to the alveoli and perfusion of capillaries to be diminished, leading to dead space and shunt. Emphysema results in the reduction of alveoli-capillary surface membrane by forming a bleb that causes air-trapping, whereas pulmonary fibrosis scars the alveolis tissue, creating a shunt that causes ventilation of the oxygen to the alveoli to be inefficient, resulting in the patients body tissue b eing unable to get a sufficient amount of oxygen. Other remarkable syndromes found in COPD patients are chronic cough and sputum production in volume greater than one shot full glass due to inflammation of bronchi and impairment of the mucociliary clearance, presumably due to the effects of smoking. Patients with IPF may show progressive shortness of breath, loud expiratory wheezing sounds and if the condition is worse cyanosis may appear on the patient. CPFE from previous clinical studies shows that it is similar to IPF. On close physical examination, by doing chest auscultation, it was found that more than 80% of CPFE patients will emit inspiratory dry crackles sounds due to the underlying pulmonary fibrosis. About 40 to 50% will have digit clubbing and poor capillary refill. As of now, there is no consistent definition for CPFE. However, it is very important to diagnose it early. Diagnostic criteria for CPFE include radiological findings by using either chest X-Ray or HRCT these images will appear as upper-lobe emphysema with fibrosis like blebs, lower-lobe honeycombing with subpleural reticular opacities, thick wall cystic lesions, and sometimes ground glass opacities.2 Table 1: Comparison of clinical characteristics difference between CPFE, emphysema and IPF patients group (measures of Framingham variables) CPFE IPF Emphysema p-value Sample size 22 8 17 Age (in years) Median 73.5 74 78 0.7 Range 59-96 56-89 48-86 Number of pack years Median 64 43 75 0.64 Range 20-50 30-80 15-65 Table 2: Comparison of clinical characteristics difference between CPFE, emphysema and IPF patients group (Pulmonary Function Test) CPFE IPF Emphysema p-value Vital capacity 2.52 ±0.72 2.34 ±0.86 2.85 ±0.61 0.52 Vital capcity (%) 83.1 ±22.1 68.0 ±27.7 87.0 ±12.4 0.29 FEV1 2.01 ±0.19 1.60 ±0.24 1.57 ±0.22 0.28 FEV1/FVC(%) 76.8 ±3.31 81.8 ±4.45 55.6 ±4.06 70%, this results being emphysema to be ignored or overlooked. Physician, healthcare workers and respiratory therapists should be aware of its existence. More autopsies should be recognized such as thick-walled cystic lesion and idiopathic interstitial pneumonia should be recognized as both of these can be found in CPFE patients but are seldom found in emphysema/IPF alone patients. A deeper understanding of the pathophysiology is needed for CPFE and the factors that causes the syndrome of CPFE should be explored further with more clinical studies so as to develop effective treatments or therapeutic strategies for CPFE patients. References       Hiwatari H., S. S. (1993). Pulmonary emphysema followed by pulmonary fibrosis of undetermined cause. Respiration, 60(6). Cottin V., H. N. (2005). Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. European Respiratory Journal, 26(4). Kaplan R. M. (2015). Quality of Well-being Outcomes in the National Emphysema Treatment Trial. Chest Journal, 147(2). Kagiyama C., N. T. (2015). Antineutrophil cytoplasmic antibody-positive conversion and microscopic polyangiitis development in patients with idiopathic pulmonary fibrosis. BMJ Open Respiratory Research, 2(1). Inomata M., A. M. (2013). An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features. BMC Pulmonary Medicine, 104(14). King, C. G. (2005). COPD: a dust-induced disease? Chest Journal, 128(4). Kyoko G. (2015). Microscopic polyangiitis preceded by combined pulmonary fibrosis and emphysema. Respiratory Medicine Case Reports, 10(2). Papaioannou A. I., E. A. (2016). Combined pulmonary fibrosis and emphysema: The many aspects of a cohabitation contract. Respiratory Medicine, 117(10). 9.  Ã‚   Portill K., J. M. (2011). Combined Pulmonary Fibrosis and Emphysema Syndrome: A New Phenotype within the Spectrum of Smoking-Related Interstitial Lung Disease. Pulmonary Medicine , 2012(1).

Southwestern Ohio Steel Company Essay -- Business Ohio Steel Company E

Southwestern Ohio Steel Company Southwestern Ohio Steel Limited Partnership (SOSLP) was considered to be one of the industry leaders in technology and service. SOSLP sells to approximately 500 customers, twenty five of which produces about two-thirds of the company's sales. Dan Wilson, vice president of sales at SOSLP, had recently received a letter from Matworks requesting SOSLP to provide sponsorship for an upcoming Matworks annual sales meeting. Dan needed to decide if providing sponsorship was feasible keeping in mind that Matworks had been a long standing customer of SOSLP while also knowing that gifts were no longer a custom in the steel industry.   Ã‚  Ã‚  Ã‚  Ã‚  Wilson should not offer to sponsor the annual sales meeting as this would not comply with company and industry situations.   Ã‚  Ã‚  Ã‚  Ã‚  In earlier days, ?wining and dining? the customer had been a part of the steel industry and adjusted as a cost of doing business. But recently government regulations had restricted this method of doing business and now ?buying? business was just not a part of the industry. Sponsoring the annual sales meeting does not comply with the present business ethics and SOSLP could risk hurting their image and losing respect in the marketplace. Matworks at one time had been one of SOSLP?s best customers and bought almost exclusively from the company. Over the past few years they had run into financial trouble and thus were not buying as much. They had gone from being in the top ten best cus...

George Orwells Shooting an Elephant Essay -- essays papers

George Orwells Shooting an Elephant In George Orwell's essay "Shooting An Elephant," he writes about racial prejudice. Orwell is a British officer in Burma. The author is, "for the Burmese and all against their oppressors, the British"(842). Orwell feels caught in the middle of this cultural struggle. He sympathizes with the oppressed people of India, but is treated poorly, since he is viewed as one of the oppressors. He comes to terms with the role he plays in this vicious cycle of oppression , as an imperial servant, and the influence it has on him to shoot an elephant. The Burmese people are treated as second class citizens in their own country. They are oppressed, by the British empire, that has invaded their land. Being a police officer Orwell sees ...

term limits in congress :: essays research papers

THESIS:  Ã‚  Ã‚  Ã‚  Ã‚  Term limits for Congress will disrupt the balance and can make the taxpayers very unhappy. SUPPORTING DETAILS: 1)  Ã‚  Ã‚  Ã‚  Ã‚  Too many new, inexperienced members can hurt voters, as rookie legislators find it hard to navigate the bureaucracy. 2)  Ã‚  Ã‚  Ã‚  Ã‚  Term limits will force out well respected politicians. 3)  Ã‚  Ã‚  Ã‚  Ã‚  It will take away the voters’ right to choose their politicians. 4)  Ã‚  Ã‚  Ã‚  Ã‚  Long term politicians will have â€Å"good behavior† in order to ensure their reelection. 5)  Ã‚  Ã‚  Ã‚  Ã‚  The more experienced the politician, the better they will handle the peoples’ affairs. There were many things that I had to go through to complete this assignment. As with anything that you do, you will need to work hard to overcome obstacles, some which may be more difficult than others. Everyone has their own way of dealing with dilemmas. This assignment was a definite dilemma for me. Politics is by far the worst subject for me. I tend to get very lost when it comes to this. This is definitely an area I need to work on. I had to read many articles in order to form an opinion on this matter. Even after all the reading I still had trouble deciding on a side to take. I had to question myself many times to get the right take on it for myself. It was difficult but it seems that I have managed to come up with a good argument. Questioning is a great strategy for me to use. This has helped me out very much in this particular assignment. The argument could have really gone either way, but questioning myself helped make the decision much easier. Brainstorming or listing is another helpful tool that everyone should use. This has helped me form my supporting details. It is easier to sit down and rack your brain and list all the points than it is to just free-write all your ideas. Free-writing can sometimes be a jumbled mess.

Planning Document

PLANNING DOCUMENT Planning Document HRM 517 – Managing Human Resource Projects Planning Document Construct a project charter to revamp the compensation and benefits package. The overall goal and strategy of the XYZ Company is to align its total compensation and benefits plan to the financial and operational results of the Corporation and the Business Unit.Alignment of variable compensation to performance is essential to ensure that the supervisory team and identified sole contributors share in the prosperity of the Company when our goals and objectives are exceeded and does not expect or receive variable compensation in those years where failed to meet our key business targets It is essential that each participant in the Supervisory Variable Compensation Plan (SVCP) has a clear understanding of the plan, understands the parameters and guidelines by which SVCP is paid and that a key component is utilizing â€Å"ACTUAL† overall financial and operational year end results.T he Supervisory Variable Compensation Plan (SVRP) is designed to establish the participation, criteria and the process by where variable compensation will or will not be paid out to those individuals who have been identified as participants in the plan and have made a contribution to the financial and operational results of the Business Unit. The following guidelines have been defined to assure that the SVRP is administered fairly and within the parameters required to protect the financial integrity of the Corporation. 1.SVRP payout is based on actual fiscal year financial and operational performance. 2. SVRP will be paid out on an annual basis. 3. Actual payouts are based on individual performance to defined objectives and targets from each qualified participant. 4. Objectives and targets will be established for each participant prior to the beginning of each fiscal year. Objectives and targets will be weighted based on importance. 5. Objectives and targets can be adjusted during th e year to reflect changing Business Unit performance or priorities. 6.A mid-year performance review with each participant with their respective manager is required and performance to date against objectives and targets should be reviewed. Mid- year reviews are to be documented and placed in the participants personnel file with a copy to the participant. 7. SVRP payouts will only be paid to participants who are on staff at fiscal year-end. 8. SVRP payouts are paid on final results achieved for each objective using the weighting established for each target. 9. All payouts will require the approval of two levels of management.In order to qualify for a payout under the Supervisory Variable Compensation Plan the following criteria must be met: 1. Eligibility – Identified first level supervisors, managers and individual contributors in the business units. Eligibility to participate in the plan will start after a 90 day probationary period for new hires. 2. Managers must have been i n the position a minimum of 6 months and performing at a â€Å"fully satisfactory† level. 3. All managers must have a completed Job Performance Evaluations (JPE) for their respective teams.Copies of the JPE must be on file with a copy sent to Human Resources. 4. Meet or exceed performance objectives and targets established at the beginning of the fiscal year. 5. Managers who are on an hourly rate will not qualify for the Supervisory Variable Compensation Plan. 6. For managers who do not have a full year of service will have the SVCP will be pro-rated for the year. SVCP Timeline: ? October 1, 2012 – Business Unit Objectives established ? November 1, 2012 – Individual Performance Plans developed ? May 2013 – Mid Year reviews ? November 2013 – Year End Final Results November 2013 – Final SVCP Calculations completed and submitted for approval ? December 2013 – SVCP payouts [pic] Incentive Plan Calculation Participants will have the opport unity to earn an SVRP payout of 20% of their base salary. The payout will be based on the participant’s performance to their individual objectives and the weighting assigned to each objective. [pic] Design a communication plan for the project. The project's communication plan will consist of the reasons why XYZ Company should revamp their compensation and benefits plan.The purpose of the change will help with productivity as well as seeking more customers within each business unit. It is important that all stakeholders understand why the company should make changes to enhance the business. The managers will see this change as a plus for them since it will include giving them a bonus based on productivity within their business unit. The compensation plan will allow room for hourly and salaried managers to receive incentive pay and this will also help them during performance review for advancement opportunities.The communication plan will include email, conference calls, meetin gs, and voice calls to push our compensation plan and get the information out to the managers. Furthermore; we will hold monthly training sessions for all managers to ensure they are receiving the correct information and training to be successful with this plan. Finally; we will have a Q session which will allow everyone to bring their issues and questions to the table every month.These sessions will help the stakeholders understand what concerns the managers may have or what they may need assistance with to obtain their goals. Define the scope of the project. In order for the plan to be a success there are a few things each business will have to focus on. One of the important factors include errors, if employees are making consistent errors at the customer sites this will cause issues with XYZ Company and the customer. As a team, all will have to determine if all the objectives have been met to include error free installations, and A1 customer service.As a company we have to do it right the first time because there is not guarantee that we will have a second time to correct it. Another important factor is safety, we have to maintain a minimum amount of preventable accidents on a monthly basis. To ensure that we are remaining in compliance, we will have to enforce our safety policy and place sanctions on those who are violating the company policies. Create a work breakdown structure including numbered components. Submit your WBS by creating a table inside your assignment. |Level |WBSCode |Element Name | |1 |1 |Compensation/Benefits Plan | |2 |1. 1 |Initiate Compensation Plan | |3 |1. 1. 1 |Evaluation & Make Recommendations | |3 |1. 1. |Develop Plan | |3 |1. 1. 3 |Present Compensation Plan to Stakeholders | |3 |1. 1. 4 |Stakeholders Review Plan | |3 |1. 1. 5 |Compensation Planned Approved | |2 |1. |Plan for next steps | |3 |1. 2. 1 |Create Scope Statement | |3 |1. 2. 2 |Organize and Select Compensation Team | |3 |1. 2. 3 |Compensation Team Meeting | |3 |1. . 4 |Develop Compensation Plan | |3 |1. 2. 5 |Submit Compensation Plan to Stakeholders | |3 |1. 2. 6 |Milestone: Compensation Plan Approval | |2 |1. 3 |Execution Plan |

Natural disaster risk assessment and risk management

Disasters have occurred in the world over for many years. They have occurred both in MDCs and LDCs. These disasters have either been caused by human forces or natural forces or interaction of both natural and human forces. When they occur they cause serious challenges and consequences to the economies of affected areas or countries. It’s estimated that the world looses over 750 dollars annually as a result of disaster. In most cases, the phenomenon that triggers disasters is beyond human control. In general the loses that causes natural disasters are largely a function of human factors which are human decisions, human actions and human choices or sometimes lack of these. Before I go into specifying a specific human disaster threat, it is important to exactly know what a disaster is or what it means. A disaster means misfortunes or calamities. It can also be termed as an incident of great harm and distress. It’s a serious disruption of functions of society causing widespread human, material or environmental loses that exceed the ability of the affected society to cope using its own resources. In this case, I am going to specifically dwell on earthquake as a natural disaster and its threats. Earthquake is a tremor caused by the disturbance of the earth surface. When it happens it causes great destruction economically, socially and even psychologically to the people living around. Because earthquakes are natural disasters, human have no control over them and this can explain why naturally occurring disasters have serious impact on human society. They only leave human beings with the option of reducing their impacts when they occur. As I have mentioned before, disaster is a result of human force, natural force or a combination of both; management for these disasters have been put in place. Disaster management simply is a body of policy and administrative decisions and operational activities which pertain to various stages of a disaster at all levels. So disaster management body has to come up with personnel and facilities dealing with earthquakes. The personnel includes both the administrative, individuals and community actions who try to minimize loss of lives or/and damage of facilities. This they do through disaster preparedness includes efforts for effective rescue of people involved in the earthquake disaster, relief and also rehabilitation and reconstruction of destroyed materials like buildings. The administration, individuals and community also engage in disaster mitigation which encompasses all measures to reduce the impact the earthquake disaster phenomenon by improving the community’s ability o withstand the impact of the earthquake. This they do through the prevention, preparedness and real response of earthquake disaster during or after which includes relief, rehabilitation and reconstruction. Earthquake disaster will definitely leave behind vulnerable people who are prone to it again incase it occurs again. To be vulnerable is to live with a likelihood that one will suffer from hazardous events. In the society, some people are more vulnerable than others. The nearness to hazardous places the more the consequence one will face. Earlier, earthquake disasters have established that natural hazards are a cause of vulnerability to disasters. People who live or work in certain areas are prone to disasters that may occur to such areas. This means that humans living or working in certain areas make themselves vulnerable to earthquakes disaster, for example if they live in areas of volcanic activities then they are prone to earthquakes or earth movements respectively. Vulnerability is simply reduced to zero by people not living in affected areas. Scientists, technologists and engineers have attempted to predict hazardous events and development of technologies that can enable human structures to withstand earthquakes. The assumption has been that events are acts of nature that cannot be prevented but rather there are possibilities of reducing their consequences. As a result of this, technologies and materials for building and construction for example have been developed so that they can withstand earthquakes or earth movements. In spite of many games in the scientific and technological process to control vulnerability to earthquake disasters people continue to be injured, die and loss of property. One reason for this is because many earthquake disasters predictions and other mitigative technology are costly and individuals and communities are either unwilling or unable to afford them. The costs tend to set criteria for deciding on what mitigation methods to use under various circumstances.   So according to this view, although vulnerability is a cost, vulnerability reduction is itself costly. As I mentioned before, disaster does not choose specific people and the nearer one gets to it or lives near it the more vulnerable he or she becomes. Earthquakes disasters do not choose the poor or the rich but it affects anyone or everyone. So earthquake or earth movement disasters impose a varied number of consequences on the humans, animals, physical and environmental aspects. These consequences can be in view of the time period of a disaster that is either short term, mid term or long term. To UNECLAC, effects of disasters are short term consequences of disaster that comprise of direct damage,, indirect damages and secondary effect. Impacts comprise of economic, social, psychological and environmental impacts. These are mainly long term consequences of disasters. The worst case scenario that determines the degree of risk is whereby disaster occurs because people who are vulnerable simply do not know when the disaster may occur, what protection measures to take and these coupled with negative attitudes towards use of certain measures. This increases human suffering from disastrous situation. A good example here is a case where by simple earth tremors or movements occur frequently leaving   people with a normal assumption that such have been happening and that have never had effect on them. This will definitely make everyone to take such scenarios for granted not knowing that one day the tremor can turn out to be an earthquake. When it turns to be earthquake, it will find everyone unaware and hence will end up affecting the majority. The fact that disaster can happen anywhere and anytime, everyone should be prepared. Earthquakes disasters are categorized as either simple, Meagre or complex. What one society can look at as a simple earthquake disaster can be perceived as complex earthquake disaster by another society. Some disasters are also seen as rapid while others seen as slow. I may say that most earthquakes disasters can be considered as initially slow or creeping because mostly they begin as earth movement or tremors before ending up as earthquakes which are considered to being rapid. Earthquakes are as a result of natural forces or an interaction of human and natural hence they are beyond human control thus the society should be prepared on how they can be mitigated however much costly it may be. People should also be prepared because of the damages the earth quakes cause whether partial or complete destructions of physical infrastructure like buildings, people, communication networks, machineries, etc.   They can be indirect damages that the damage to the flow of goods and services that can neither be produced nor distributed when a disaster occurs. Indirect damages are of four folds namely; increased population costs, increased damages, loss of corporate incomes and unexpected expenditures. In conclusion, earthquake disasters neither belong to the rich or poor but to everyone. This means it can affect everyone as long as one lives on the earth’s surface. References www.redcross.com

Victorian Literature: Anglo-American Feminism, French Feminism

ssignment Title: ‘Compare and Assess at least two of the following approaches in feminist theory, with illustration from two of the Victorian texts you have studied: Anglo-American feminism; French Feminism; Socialist or Marxist Feminism; feminist approaches influenced by Foucault. ‘ ‘I declare that this is my own work and that I have followed the code of academic good conduct and have sought, where necessary, advice and guidance in the proper presentation of my work. ‘ Signature: Date: Compare and Assess at least two of the following approaches in feminist theory, with illustration from two of the Victorian texts you have studied: Anglo-American Feminism; French Feminism; Socialist or Marxist Feminism; Feminist Approaches influenced by Foucault. ‘ Feminist theory like psychoanalytic theory is relatively modern in its creation. The immergence of feminist literary theories can be linked to the out break of female political uprising in the early nineteenth century. The French Revolution marked the beginning of a fight for the obtaining of women's rights to power and equality in society. Elaine Showalter comments that the ideological socially acceptable view of Victorian women as a whole can be seen as ‘†¦ prescribed a woman who would be a Perfect Lady, an Angel in the House, contently submissive to men, but strong in inner purity and religiosity, queen in her own realm of the Home. (Victorian Women's Poets, Page 13) Feminist theory is segregated into separate view points of feminism as a whole; French Feminism analyses literature from a perspective of a psychoanalytic view, drawing upon the work of Lacan to highlight view points. It helps to analyse the ways in which women are positioned in society in the text and how they can be perceived to be repressed. Marxist Feminism takes its inspiration from how the women can be perceived to be oppressed in literature. American feminism analyses literature from a textual expressive view point. All feminist out looks have their issues which provide flaws into their argument. ‘To be sure, most feminist thinkers today assume that nurture, at the very least, qualifies nature. Recently, however, a number of poststructuralist theorists – deploying both male and female signatures – have claimed that there is no gendered â€Å"reality,† that the concepts of â€Å"man† and â€Å"woman† are, as some would put it, â€Å"always already† fictive since human identity is itself a tenuous, textually produced epiphenomenon. ‘ (No Man's Land. Pagexv). Wuthering Heights by Emily Bronti provided feminist critics with a canvas of a examples of marginally autobiographical Victorian gynocentrism. The production of text from a woman, looking at the emphasis placed on the female place in the history of the text, the structural placing of women and the thematic view of women in the text. Sandra Gilbert and Susan Gubar argue that women writers such as Emily Bronti had been trapped into the roles that society has manipulated, as they were trapped against the patriarchal view of the angel of the house. However even thought there is a desire for this view to be usurped, Bronte still curtails herself to society's expectations by debilitating and eventually killing off of the strong rebellious charcter of Catherine, emphasising her own fear of what the female form in which she was writing. Gilbert and Gubar's reading of Wuthering Heights classes it as a ‘A bible of Hell. ‘ (Gilbert, S & Gubar, S. Mad woman in the attic) The classification of Wuthering heights as a living hell is created in type by the Byronic hero of Heathcliff. Although Gilbert and Gubar look into the curtailment of women being confined to the house, trapped into submission by domesticity, Wuthering Heights provides Catherine with her own sense of control where she can break social confinements. Yet Catherine chooses to be confined by domesticity and social patriarchy by marrying Edgar Linton. Bronte does however portray the confusion Catherine feels in making her choice between what she desires and what is socially expected; You love Mr Edgar because he is handsome, and young, and cheerful, and rich and loves you. The last, however, goes for nothing – You would love him without that, probably, and with it, you wouldn't, unless he possessed the four former attractions. ‘ (Wuthering Heights, Page 119)Through the use of the second generation Cathy, Bronte allows the correction from cultural to natural choice to be made via the successful relationship between Cathy and Hareton. Kristeva comments on the text ‘presses the linguistic sign to its limits, the semiotic is fluid, plural, a kind of pleasurable creative excess over precise meaning and it takes sadistic delight in destroying or negating such signs. ‘ (Literary Theory: an introduction). The dual nature of narration in the novel serves thematic purposes, in that both provide commentary on the role of women in society. The feminist nature of the novel can be seen through Lockwood's comments on the success of Nelly's narrative story telling. Bronte manipulates the Victorian view that women have innate frailty and makes a parody out if the view by portraying Catherine's illness as a strength in which she is manipulating those around her through Nelly's perception; ‘I wasted no condolences on miss, nor any expostulations on my mistress, not did I pay attention to the sighs of my master, who yearned to hear his lady's name, since he might not hear her voice. ‘ (Wuthering Heights, Page 158) Catherine's subsequent illness shows itself in the form of a disillusioned madness. Bronte's use of this madness is to offer clarity to the social structure that the very cultural expectations of Catherine are the things that cause the feared wild nature to develop; ‘This feather was picked up from the heath, the bird was shot – we saw its nest in the winter, full of little skeletons. Heathcliff set a trap over it, and the old ones dare not come. I made him promise he'd never shoot a lapwing, after that, and he didn't. Yes, here are more! Did he shoot my lapwings, Nelly? Are they red, any of them? Let me look. (Wuthering Heights, Page 160) Gilbert and Gubar view Catherine's imprisonment in Thrushcross Grange as the reason for her being trapped into a feminine madness; ‘Imprisonment leads to madness, solipsism, paralysis †¦ Starvation – both in the modern sense of malnutrition and the archaic Miltonic sense of freezing (‘to starve in ice') – leads to weakness, immobility and death. (Rylance, Page 253) Catherine's embracing of Victorian societal views that kept her from being with Heathcliff. Included in these views are the expectations of women. It is important to note because the awareness of social standing and gender in this example prevent true love prevailing. Bronte also argues that Catherine's inability to resist social ambition is reflective of the oppressive power of the social structure of the Victorian society. Bronte feminises Lockwood by giving him the typically female characteristic of frailty, according to Beth Newman ‘Lockwood's supine passivity (he is bed ridden during most of her narrative) suggests that he is in the â€Å"feminine† position with respect to Nelly's controlling gaze. (Gender, Narration and Gaze in Wuthering Heights, Page 1034). Emily Bronte portrays Hareton as a model man who does not fear women but does not repress them either, this is marked through his not hiding away from Cathy's advances; â€Å"Helene Cixous has written that the Medusa who has terrorized the male subject, looked at â€Å"straight on,† is actually â€Å"beautiful†¦ and †¦ Laughing† Bronte has uncannily anticipated Cixous's analysis of the masculine fear of the woman's gaze in suggesting that Hareton, alone among the male characters in the novel, is able to laugh back. (Gender, Narration and Gaze in Wuthering Heights, Page 1037). The splitting and fragmentation of Catherine's feminine desire through the lack of a stable identity, she is Catherine Earnshaw, Catherine Heathcliff and Catherine Linton at the same time. The theme of heaven and hell is prevalent most through Heath cliff's representation as a satanic wild figure that should be feared. Bronte links Heathcliff to the wildness of nature through his name; he becomes one with the heath surrounding the heights. Catherine expresses her own desire to be associated with Heathcliff through â€Å"If I were in Heaven, Nelly, I should be extremely miserable. ‘ ‘Because you are not fit to go there,' I answered. ‘All sinners would be miserable in heaven. ‘†¦ ‘I was only going to say that heaven did not seem to be my home; and it broke my heart with weeping to come back to earth; and the angels were so angry that they flung me out, into the middle of the heath on the top of Wuthering Heights, where I woke sobbing for joy. ‘ (Wuthering Heights, Page 121) Bronte uses the binary opposition to emphasise Catherine's ideal of Heaven being Heathcliff. Yet due to the confinement of social expectation Catherine turns her back on Heaven and places herself in the Hell that is Thrushcross Grange causing a fragmented version of herself to become her existence. Kristeva comments on Wuthering Heights lack of ability to have a simplistic narrative form, there is a use of multiple genres to create the complex binary oppositions. The use of the re-emergence of the choice between patriarchy and desire through Cathy has the object of; ‘articulating the mother-child relation as a site for both affirm the archaic force of the pre-oedipal, which although repressed is thus also preserved. Both affirm the fluid, polymorphous perverse status of libidinal drives and both evoke a series of sites of bodily pleasure capable of resisting the demands of the symbolic order. ‘ (Jacques Lacan; A feminist Introduction, Page 149) ‘Thus, although Wuthering Heights ends in cosy domesticity, the gaps in its enunciation express a feminist resistance to the patriarchal order in which its story partially acquiesces: for the narrative undercuts the condition of its own telling even while implicating them in specular economy that fetishizes and appropriates women. ‘ (Gender, Narration and Gaze in Wuthering Heights, Page 1039) Christina Rossetti's Goblin Market expresses the frustrations from enforced female passivity, articulating bitterness about being the second sex, and the limitations on female potential; this is evident through out the poem, culminating as two women become what Victorian patriarchy predetermines, wives and mothers. Goblin Market shows women in social relations, in market economies in literary history and women in sexual economics. Elizabeth Helsinger explains that Goblin Market is ‘A feminist utopia based on sisterhood against male domination and ‘the male' market or a legitimating of separate spheres? Victorian studies, 1991). Goblin Market allows Rossetti the opportunity to escape the archaic patriarchy and create a fantasy realm. Rossetti allows Lizzie and Laura an insight into the male commodities of male utopia that is the market place, and how to successfully regain equal control. ‘This is a morally nonsense poem, which puts religious myth and sexual temptation into a market economy which is endlessly unstable. ‘ (Victorian Women's Poets, Page 138). Rossetti's creation of sisterly solidarity gives a feminine outlook; ‘Hug me, kiss me, suck my juices Squeezed from goblin fruits for you, Goblin pulp and Goblin Dew. Eat me, drink me, love me; For your sake I have braved the glen And had to do with goblin merchant men. ‘ (A Choice of Christina Rossetti's verse, Page 16). ‘The sexual suggestiveness of ‘Goblin Market' has undoubtedly made it a compelling work for feminist readers concerned with what constitutes a distinctly female imagination. ‘ (‘A Music of Thine own. ‘ Victorian Womens Poets, Page 50). â€Å"Goblin Market', the title poem of Christina Rossetti's first volume, is the questioning feminine discourse it masks. ‘ (‘A Music of Thine own': Womens Poetry. Victorian Womens Poets, Page 49) Rossetti's representation of sexuality is not in the names or images she finds but in the structure of the whole poem with its repeated tasting. ‘ (‘A Music of Thine own': Womens Poetry. Victorian Womens Poets, Page 49) In many respects Goblin Market is directly contradictory to many nineteenth century views about the role of the woman poet. Mary Ann Stoddart, 1842, defines the sphere of the poetess as: â€Å"All that is beautiful in form, delicate in sentiment, graceful in action will form the peculiar province of the gentle powers of women†. Goblin Market can be said to have none of these qualities. This metrical indulgence, gives Goblin Market a sensual art for art's sake, which is usually reserved for male poets, making this offering to the public by a poetess incompatible with Victorian notions of female poetic beauty Laura performs a familiar role in literary history – that of the fallen Eve. She relinquishes herself to the sexual temptation offered by the evil goblin men. Her sin is compounded by prostitution in selling a lock of her hair in return for the fruits. This can be viewed as an act of rape; the goblins cut her hair for payment, when, at the time, a woman's hair was a somewhat sacred thing. The fallen woman is a common figure in literature, however, because she comes from the creative mind of a female poet the representation comes to have a few problems in its interpretation. Yet still, Laura receives her salvation, from her sin of eating the fruit, through the self-sacrificing actions of her sister. Lizzie plays the male role of redemption. While Rossetti can be viewed in opposition to the Victorian ideals of female creativity, there is an inherent conservatism in her work that creates problems with the idea of her being a truly radical or feminist writer. Unlike the other Pre-Raphaelite poets, Rossetti does not embrace atheism, but rather adheres to a strict Anglo-Catholic faith â€Å"Goblin Market' is Christina Rossetti's most remarkable long poem. She was also a writer of consummate lyrics. What can be called the feminine discourse which respondes to the aesthetics of expression and repression overflow and barrier, in ‘Goblin Market', is also at work in her short poems. ‘ (‘A music of thine own':Womens Poetry, Victorian Womens Poets, Page 54). Through both of the texts analyzed it is important to notice that as Showalter states that it is in fact, â€Å"female imagination' cannot be treated by literary historians as a romantic or Freudian abstraction. It is the product of a delicate network of influences operating in a time, and it must be analyzed as it expresses itself, in language and in a fixed arrangement of words on a page, a form that itself is subject to a network of influences and conventions, including the operations of the marketplace. ‘ (Victorian Women's Poets, Page 12) Both Emily Bronte and Christina Rossetti were classed as typically romantic Victorian women's writers. However this view is highly problematic as both women try to break the curtailments of Victorian archaic patriarchy in their work, constantly testing and pushing the boundaries of female authorship; ‘Romance fiction deals above all with the doubts and delights of heterosexuality, an institution which feminism has seen as problematic from the start. In thinking about this ‘problem' I myself have found the psychoanalytic framework most useful since it suggests that the acquisition of gendered subjectivity is a process, a movement towards the social ‘self' , fraught with conflicts and never fully achieved. Moreover, psychoanalysis takes the question of pleasure seriously, both in its relation to gender and in its understanding of fictions as fantasies, as the explorations and productions of desires which may be excess of the socially possible or acceptable. It gives us ways into the discussion of popular culture which can avoid the traps of moralism or dictatorship. ‘ (Romance Fiction, Female sexuality and class. Page 142)