September 26, 2017 Essays - Religion, Culture, Cultural Anthropology

September 26, 2017 Tuesday Diary #11 I believe that Elizabeth holding resentment on john is the proper activity. Elizabeth has an option to hold resentment since john had gone behind her back with Abigail. September 27, 2017 Wednesday Diary #12 The synopsis of act 2, Elizabeth delegate was being merciless to john delegate, john was attempting to adulate Elizabeth and afterward john was enraged at whatever point Elizabeth continued questioning him. At that point Mary warren returned to the house and told the delegate that there was 39 individuals blamed for black magic. Mary warren had revealed to Elizabeth delegate that she had spared her life today, since Elizabeth was blamed for black magic. At that point Elizabeth was going crazy since she was apprehensive she was going to get hanged on account of black magic. Elizabeth was getting annoyed with john since he wouldn't go to the courts to disclose to them that the entirety of this was a demonstration. September 29, 2017 Friday Diary #13 Abigail is an insane, manipulative young lady. I feel that john will win since man's promise against a lady's statement is bound to be progressively trustworthy at whatever point it comes to wrongdoings. John will win since he has more proof against Abigail. I think Abigail

Marketing Communication Strategy of Standard Chartered Bank Essay

Promoting Communication Strategy of Standard Chartered Bank - Essay Example The income of the bank is produced over 90% from the Middle East, Africa and Asia while the bank is United Kingdome based. (About, Standard Chartered Bank) The essential assignment of the Standard Chartered Bank was recorded in London Stock Exchange and shows up in the FTSE 100 Indexes. Till the 23rd December, 2011, the market capitalization of the Standard Chartered Bank was ?33â billion. This capitalization was qualified for the thirteenth Largest Primary Listing among all the recorded organizations in London Stock Exchange. (FTSE All-Share Index Ranking, 2012) The optional posting of the Standard Chartered Bank was handled in Hong Kong Stock Exchange and afterward National Stock Exchange (India). The significant investor of the firm was claimed by the Government of Singapore, possessed Temasek Holdings. Foundation The Standard Chartered Bank named after the merger of two unique separate banks which was working before this merger with the name of The Standard Bank, in light of Bri tish South Africa and used to be situated at The Chartered Bank of India, Australia and China too. The Bank titled Standard Chartered Bank was established in 1969 after merger of two free banks. (History, Standard Chartered Bank) History of Standard Bank: The Standard Bank was built up in Province of South Africa, Cape in 1862. It was the British bank established by the Scotsman, John Peterson. The Standard Bank was the indistinguishable in financing on advancement of the Diamond Fields at Kimberley on 1867. The system from north to new town at Johannesburg was stretched out after the revelation of gold in 1885. (History, Standard Chartered Bank) History of Chartered Bank: The Chartered Bank was established in 1853 by the Scotsman James Wilson by following the award of Royal Charter through Queen Victoria. This contract was started the absolute first branch from Mumbai, Shanghai and Kolkata in 1858, accordingly, from the Hong Kong and Singapore following one year. The Chartered Bank begin giving the cash notes of Hong Kong Dollars in 1862 with propelling of Suez Canal in 1869 and broadened the activities towards China. (History, Standard Chartered Bank) Results of Strategies fit as a fiddle of Awards Achievement The Standard Chartered Bank accomplishes numerous honors each year, which is the market acknowledgment in each district of accessible market. Winning of the honors is the acknowledgment of perfect and smoothed out procedures achievement. The planning of the systems depended on the earlier innovative work of the every district where the parts of the Standard Chartered exists. Over the span of research, the administration realizes the market pattern, necessity of the buyers just as of the corporate and institutional division. Besides, it depends available division and giving the effectively accessibility of the inventive monetary items which secured the wide scope of clients. The workers of the Standard Chartered Bank are all around qualified and special ists in industry and all around differentiated representatives. The correct preparing and advancement gives to every worker after definite perception and investigation. There is generally powerful and differentiated condition for laborers who face the new difficulties consistently with new unique. The methodology arranged by the administration of the Standard Chartered Bank for the every starting point of the engaged market independently by thinking about the way of life, religion, language and standards of the

Lithium Side Effects, Toxicity, and Monitoring Tests

Lithium Side Effects, Toxicity, and Monitoring Tests Bipolar Disorder Treatment Medications Print What You Need to Know to Safely Take Lithium By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Updated on December 09, 2019 JGI / Jamie Grill / Getty Images More in Bipolar Disorder Treatment Medications Symptoms Diagnosis In This Article Table of Contents Expand Possible Side Effects Acute and Chronic Toxicity Drug Interactions Monitoring Tests Coping Strategies View All Back To Top Lithium is a mood stabilizer that can be helpful with bipolar disorder and other conditions but is well known for causing side effects and toxicity. That said, when tests are performed regularly to monitor levels, and people are familiar with the proper use of the drug, it can be very effective in controlling moods. What do you need to know to use lithium safely? Lithium was the first mood stabilizer medication used for bipolar disorder, having been first used for the treatment of the inflammatory condition gout. We are just starting to learn the mechanism by which this medication works at a biological level. Possible Side Effects As with many medications, lithium can come with a number of side effects, both short term and long term and both mild and serious. The most common side effects of lithium tend to be more annoying than dangerous. These include:?? Increased thirstFrequent urinationNauseaDiarrheaTremor (a tremor which is made worse by attempting delicate hand movements.Weight gain: Lithium is well known for its role in weight gain. On average, people tend to gain 13.5 pounds on the medication, but roughly 20 percent of people gain more than this. A 2016 study found that the medication Metformin may be of benefit in reducing or preventing weight gain for some people on lithium therapy.Swelling (edema)Hair loss Organs most affected (and which should be monitored) include the: Kidneys: Most of the time kidney dysfunction is mild, though sometimes this can be progressive.Thyroid: Lithium can affect thyroid function in many ways. It can cause hypothyroidism, a goiter, or autoimmune thyroiditis. Lithium therapy has also been linked with hyperthyroidism in some people.Parathyroid: Parathyroid dysfunction has been recognized more recently as a side effect of lithium use. More serious side effects include: Kidney dysfunctionNephrogenic diabetes insipidus: Nephrogenic diabetes insipidus is a condition in which the kidneys are unable to concentrate the urine resulting in excess urination (polyuria) and excess thirst (polydipsia).Cognitive dysfunction:  The exact role that lithium plays in cognitive functioning is difficult to study due to the presence of the mood disorder as well as possibly hypothyroidism. A 2017 study did find that lithium had a significant impact on psychomotor speed, though it did not appear to have an impact on attention.?? Its effect on memory, intellectual abilities, and executive functioning is still unclear. Acute and Chronic Toxicity Lithium toxicity can take different forms and includes acute, chronic and acute on chronic toxicity. Early signs of lithium toxicity include diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination. More severe symptoms include ataxia (failure or irregularity of muscle action), giddiness, tinnitus (ringing in the ears), blurred vision, and a large output of dilute urine. Severe lithium toxicity is a medical emergency that can result in encephalopathy and cardiac arrhythmias.?? Drug Interactions There are several drugs which can result in increased lithium levels in the blood. These include:?? Non-steroidal anti-inflammatory drugs such as Advil (ibuprofen) and Aleve (naproxen.)Diuretics (water pills.)Angiotensin-converting enzyme inhibitors (ACE inhibitors) such as Vasotec (enalapril) and Prinivil (lisinopril.)Angiotensin II receptor antagonists (ARBs) such as Diovan (valsartan) and Cozaar (losartan.) There are many more possible drug interactions with lithium and its important to talk to your doctor before starting any new medication or if you discontinue a medication you are taking. Caffeine and theophylline, in contrast, can result in lower lithium levels. Monitoring Tests During Lithium Therapy Blood tests are monitored both before a person begins lithium therapy, and periodically for the duration  that the medication is taken. Monitoring Lithium Levels Before treatment is started, tests are ordered to assess both kidney function and thyroid function. Lithium is excreted from the body by the kidneys, so if the kidneys are malfunctioning to any degree, levels of lithium can build up in the blood.?? Lithium levels should be monitored after treatment has begun, and then after every dosage change. Blood levels are often done 5 days after a dosage change as it takes some time for the levels to stabilize. Levels should also be checked if any new medications are added or discontinued, as many medications interact with lithium.?? Lithium has a very narrow therapeutic window which means that the level of the drug needed to have a therapeutic effect is very close, and sometimes even overlaps, with that which causes toxicity. The therapeutic level of lithium is usually between 0.8 and 1.1 mmol/L, though some people may need a level anywhere from 0.5 to 1.2 mmol/L to be therapeutic??. Levels toward the higher side are sometimes needed to control mania. Toxicity begins at around 1.5 mmol/L. Initial symptoms of toxicity often include a significant worsening of the tremor, nausea, diarrhea, and blurry vision. As levels get higher, symptoms of being unsteady, slurred speech, muscle twitches and weakness, and confusion appear. A level of 2.0 mmol/L is a medical emergency and immediate care is needed. Symptoms can include severe neurological signs such as delirium and unconsciousness. Heart arrhythmias may also occur, which if, untreated, can be fatal. Thyroid Tests: Its important to note that anyone diagnosed with bipolar disorder should have thyroid tests monitored frequently even if not on lithium since abnormal levels of thyroid hormones can cause symptoms that mimic (or precipitate) both mania and depression. Thyroid levels should be tested at least every 6 months. Calcium Levels: A serum calcium level should be checked yearly as lithium may cause hypoparathyroidism. Kidney Tests: A BUN and creatinine (kidney function tests) should be drawn at the beginning of treatment, regularly during treatment, and if any symptoms of kidney disease become evident. Other Tests: Other tests such as blood chemistries and an EKG may be needed depending on many factors. Coping With Side Effects and Toxicity There are several ways in which the risk of side effects and toxicity can be reduced. One is to minimize the dose so that blood levels are on the lower side of the therapeutic window. Timing of the dose may also be helpful. Certainly, monitoring of blood levels is important on a regular basis as well as if any new symptoms should arise. In some cases, medications can be used to reduce the symptoms of side effects. The Bottom Line Lithium can be an excellent drug for people with bipolar disorder and is thought to be the drug of choice for elderly people with bipolar disorder. It has been found to decrease the rate of suicide, a significant risk among people with the condition. Careful monitoring of levels is critical to reducing the potential for toxicity and its consequences. Side effects are common, and many of these are more annoying than dangerous. Careful monitoring of lab tests (and cardiac function especially in the elderly) is needed due to the risk of kidney dysfunction, and thyroid and hypothyroid side effects. With monitoring, however, and a careful understanding of the early symptoms of toxicity, many people have been able to enjoy the benefits of this medication without significant risks. Understanding Your Bipolar Treatment Plan