Potentially Inappropriate Medication at a Private Hospital

Potentially Inappropriate Medication at a Private Hospital Abstract The use of certain medications in geriatrics when potential risks outweigh the potential benefit and an effective alternative is available is called as Potentially Inappropriate medication. Because geriatrics are more sensitive towards adverse effects of medications. Beers criteria which is updated and reviewed by American Geriatric society list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. Methodology: A prospective observational study was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric patients admitted in the hospital during the study period was included. Beers Criteria 2013 were used to identify potentially inappropriate medications. Result: The prevalence of PIM use (52%) was significantly higher in study population. An avg of 10 drugs were taken by the study population. A total of 215 medications were identified as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of th eir condition (category I). 66(60%) of the study population had used more than one PIMs. 91(83%) of the PIM users had atleast one DRPs and the mean DRPs value of the PIM users were 1.59à ¯Ã¢â‚¬Å¡Ã‚ ±1.3. Conclusion: High prevalence of PIMs in the study population signifies the need of monitoring geriatric prescriptions. Key words: PIMs, Beers Criteria, Geriatrics Introduction In recent years proportion of geriatric hospital admission with comorbidity and polypharmacy has been increasing continuously (1, 2). Adverse drug events (ADRs) are the most common reason for hospital admission, but sometimes it’s not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which ends in clinical symptoms. Overall, elderly patients need greater attention to drug therapy and safety parameters (1, 3-5). Greater attention is needed for geriatric population due to age related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical care for elderly are determined on the basis of clinical trial conducted with adult population.(6) The burden of harm resulting due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are prescribed with at least one inappropriate medication and potentially preventable adverse drug reactions accounts for nearly 20% of all inpatient deaths (7). The assessment of potentially inappropriate medication (PIM) in geriatric is a challenging work and there is a need for considering many factors which influences the prescribing as well as outcome. Eight well known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study therefore aimed to investigate the prevalence of PIM use on geriatric population using Beers criteria 2012 and its association with Drug Related Problems (DRPs) . Methodology Study Site: The work entitled â€Å"A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital† was carried out in a 640 bedded private corporate hospital, South India. Study Design: Prospective –Observational study. Study Period: Nine months. Inclusion criteria: Patients above age of 65 yrs. Exclusion criteria: The patients who are unwilling to participate in the study and out patients METHOD: A regular ward rounds was carried out in all the wards of General medicine. Each patient’s medication profile was reviewed. Patients who met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical chart were recorded in customized data entry form. The prescribed drugs were evaluated and PIMs use were identified with the help of Beer’s criteria. The drugs which are identified as PIM are categorized into following: Potentially inappropriate medications /classes to avoid in geriatrics, Potentially inappropriate medications /classes to avoid in geriatrics with certain pathological condition that the listed PIM use can exacerbate Medications to be used with caution in geriatrics. ADRs associated with PIMs use were assessed. Drug interaction and ADR was monitored and reported. DRPs and Drug Risk Ratio (DRR) were calculated for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the number of DRPs in relation to how often the drug was used (DRPS/number of times used). Results and Discussion In the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were found to be prescribed with PIMs listed in Beers criteria (fig no: 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total number of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study result reveals that PIMs user are mostly males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females. The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was found to be 70.2 ±5.77. The median age for PIM users was 68.5 years. The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were frequently prescribed in the age group of 65-69 years. The social habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users. The comorbidities of the PIM users was analyzed. There were 52 (47%) suffering from hypertension and 32(29%) were suffering from DM. The results shows that most of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes. The number of drugs prescribed for the PIM users were calculated (fig no: 2). The mean number of drugs per prescription was 9.9 ±2 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the main factor for PIM use is â€Å"polypharmacy†. The number of PIM drugs per prescription in the study population was calculated (Fig no: 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using two PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.8 ±0.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM. Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categorized into three groups according to Beers criteria. (Table no: 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III. The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no: 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were frequently used PIM among their study population. Use of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no: 4). Hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use. Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no:5). The DRP among the PIM users were analyzed (fig no: . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean value of DRP in the study population was found to be 1.59 ±1.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six. The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no:5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users. As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in that 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no: 6). Drug risk ratio were calculated for the study population (table no:7). It was observed that prochlorperazine had the highest DRR (4) followed by phenobarbitone (2), digoxine (2), pentazocine (2) and duloxetine (2). The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using à ¯Ã‚ Ã‚ £2 test. On assessment of association between â€Å"number of comorbidities† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:8), the result proved that â€Å"number of comorbidies† are statistically associated with â€Å"the number of drugs† at 0.001 level of significance and â€Å"number of PIMs† at 0.05 level of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases. On assessment of association between â€Å"number of drugs† and â€Å"number of PIMs† (table no: 9), the result proved that â€Å"number of drugs† are statistically associated with â€Å"number of PIMs† at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs. On assessment of association between â€Å"number of DRPs† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:10), the result proved that â€Å"DRPs† are statistically associated with â€Å"number of PIMs† at 0.01 level of significance but not associated with â€Å"number of drugs† at 0.05 level of significance. This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs. Conclusion Our study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use. References Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002–12. Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755–65. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005; 165: 68–74. Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–9. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009; 57: 000–6 Avorn J, Shrank WH. Adverse drug reactions in elderly people: A substantial cause of preventable illness. BMJ. 2008;336:956–7 Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSd Opondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review, plos one, aug 2012, volume 7, issue 8 Biradar K; assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospital;IJPP 2012dec, vol 5,issue 4, 73-5 Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December ; 26(8): 606–15. doi:10.1177/1533317511432734 Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. J Eurger 2012 3: 326-29 Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 2013;30:561-8 Dormann H, Sonst A, Mà ¼ller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bà ¼rkle T, Maas R. Adverse drug events in older patients admitted as an emergency the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110(13): 213–9. DOI: 10.3238/arztebl.2013.0213 N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26: 697–700 Tables and figures NO. of PIM/prescription Number of patients N=110 Percentage 1 44 40 2 50 45 3 14 13 4 1 1 5 1 1 Table no:1 Number of PIM per Prescription sl no category no. of PIMs percentage 1 PIM drugs/classes to be avoid in geriatrics (category I) 195 90 2 PIM to be avoided in certain pathological condition (category II) 12 6 3 PIMs to be used with caution (category III) 8 4 Table no:2 Categories of PIM sl no Drugs No. of Patients sl no Drug No. of Patients 1 Alprazolam 57 (29%) 16 Nitrofurentoin 3(1.5%) 2 Clonazepam 17(9%) 17 Mirtazapine 2(1%) 3 Hyocyamine 10(5%) 18 Cyproheptidine 2(1%) 4 Lorazepam 10(5%) 19 Diazepam 2(1%) 5 Hydroxyzine 10(5%) 20 Piroxicam 2(1%) 6 Zolpidem 10(5%) 21 Prochloperazine 2(1%) 7 Ketorolac 10(5%) 22 Chlorphemiramine 2(1%) 8 Aceclofenac 9(4.5%) 23 Trihexylphenedine 2(1%) 9 Propoxyphene 8(4%) 24 Digoxin 2(1%) 10 Diclofenac 7(3.5%) 25 Phenobarbitone 1(0.5%) 11 Spironolactone 6(3%) 26 Naproxen 1(0.5%) 12 Prazosin 5(3%) 27 Clinidium-chlordiazepoxide 1(0.5%) 13 Clonidine 5(3%) 28 Indomethacin 1(0.5%) 14 Chlordiazepoxide 3(1.5%) 29 Metachlopramide 1(0.5%) 15 Amitriptyline 3(1.5%) 30 Pheniramine 1(0.5%) 31 Pentazocine 1(0.5%) Table no: 3 Category 1(PIM drugs/classes to be avoid in geriatrics) Sl no Drug Disease No. Patients Percentage 1 Ketorolac CHF 1 8 2 Hydroxyzine Constipation 2 17 3 Hyocyamine Constipation 3 25 4 Ketorolac PUD 2 17 5 Cyproheptidine Constipation 2 17 6 Clonazepam Frequent Fall 1 8 7 Insomnia Theophyllin 1 8 Table no: 4 Category II (PIM to be avoided in certain pathological condition) sl no Drug No of Patients percentage 1 Mirtazapine 2 30 2 Fluoxetine 1 10 3 Sertraline 1 10 4 Duloxetine 1 10 5 Escitalapram 3 40 Table no: 5 Cateegory III (PIMs to be used with caution) NO OF INTERACTION PERCENTAGE PIM-PIM 16 12 PIM- OTHER DRUGS 39 30 OTHER DRUGS 76 58 Table no:6 Categories of Drug Interactions Sl No Drug DRPs Total Drug Risk Ratio 1 PROCLORPERAZINE 8 2 4.00 2 PHENOBARBITONE 2 1 2.00 3 DIGOXIN 4 2 2.00 4 PENTAZOCINE 2 1 2.00 5 DULOXETINE 2 1 2.00 6 NAPROXEN 2 1 2.00 Table no.7 Drug Risk Ratio Sl no Varience No. of comorbidities Chi squire value P value 1 2 ≠¥ 3 1 No. of PIMs 1 5 21 13 12.76* 0.05 2 10 12 15 ≠¥ 3 7 15 12 2 No. of drugs 6-8 13 16 4 26.77* 0.001 9-11 8 25 17 ≠¥ 12 1 7 19 Table no:8 Association of no. of comorbidities with no. of drugs and PIMs . varience No. of Drugs Chi squire value P value 6-8 9-11 12-14 ≠¥15 No. of PIMs 1 16 21 4 3 21.76* 0.001 2 14 24 8 4 ≠¥ 3 2 5 5 4 Table no: 9 Association of no. drugs and no. PIMs Sl no Varience No. of DRPs Chi squire value P value 0 1 2 ≠¥3 1 No. of PIMs 1 11 21 10 2 21.76* 0.001 2 7 23 8 12 ≠¥ 3 1 4 2 9 2 No. of drugs 6-8 9 15 11 1 11.77 0.05 9-11 4 25 6 12 ≠¥ 12 6 8 3 10 Table no:10 Association of DRPs with no. of drugs and PIMs Fig no:1 Prevalence of PIMs Fig no:2 Number of Drugs Prescribed per Patient Fig no:3 Number of PIM per Prescription Fig no: 4 Adverse Drug Events and Its frequency Fig no:5 Adverse Drug Events and Its Frequency

Jeannine :: Personal Narrative Papers

Jeannine She had seen things and experienced a life that I only knew about through the movies. She acted as though she knew I would not be able to understand her, but I could see in her eyes that she hoped I could. e stood in the driveway, physically closer than we had been to each other in two weeks. Jeannine, my sister, did not stay at home too much anymore. She had dedicated her existence to her boyfriend Steven and chose to live with his family so that the two of them could be closer. My parents were supportive and open, but they would never have let their seventeen year old daughter sleep in the same bed under their roof with her nineteen-year-old boyfriend. So after countless years of tension and arguments, my sister had achieved what she had sought for years, independence from her family, but most of all from her older brother. Now standing in that driveway, our childhood playground, as I prepared for the long journey to James Madison University, we realized that the past five years of our lives had been wasted. Her constant struggles to get out of the house coupled with my harsh attempts to see that she met that goal consumed our adolescent years, the period where we needed each other the most. My parents told me that they were ready to leave, and I gave Jeannine a long hug. It was the first time in half a decade that I gave her a meaningful show of affection. I met her with the love that I had suppressed for so long, rather than the hate and loathing that was quick to my aid in the many years of confrontation that we shared. It was then, as her head rested on my chest and her arms wrapped around me, that I realized the wrongs I had done to her. All of a sudden, I did not want to leave. I had my sister back, how could I abandon her again? No one can really claim to have a perfect childhood sibling relationship, but we were still very close. At times, we could even be proud of one another. Yet, as in all sibling bonds, these good tidings never lasted. Our games of tic-tac-toe or kickball with our friends would go from friendly backyard, Little- House-on-the-Prairie type moments to screaming matches in a matter of days. Jeannine :: Personal Narrative Papers Jeannine She had seen things and experienced a life that I only knew about through the movies. She acted as though she knew I would not be able to understand her, but I could see in her eyes that she hoped I could. e stood in the driveway, physically closer than we had been to each other in two weeks. Jeannine, my sister, did not stay at home too much anymore. She had dedicated her existence to her boyfriend Steven and chose to live with his family so that the two of them could be closer. My parents were supportive and open, but they would never have let their seventeen year old daughter sleep in the same bed under their roof with her nineteen-year-old boyfriend. So after countless years of tension and arguments, my sister had achieved what she had sought for years, independence from her family, but most of all from her older brother. Now standing in that driveway, our childhood playground, as I prepared for the long journey to James Madison University, we realized that the past five years of our lives had been wasted. Her constant struggles to get out of the house coupled with my harsh attempts to see that she met that goal consumed our adolescent years, the period where we needed each other the most. My parents told me that they were ready to leave, and I gave Jeannine a long hug. It was the first time in half a decade that I gave her a meaningful show of affection. I met her with the love that I had suppressed for so long, rather than the hate and loathing that was quick to my aid in the many years of confrontation that we shared. It was then, as her head rested on my chest and her arms wrapped around me, that I realized the wrongs I had done to her. All of a sudden, I did not want to leave. I had my sister back, how could I abandon her again? No one can really claim to have a perfect childhood sibling relationship, but we were still very close. At times, we could even be proud of one another. Yet, as in all sibling bonds, these good tidings never lasted. Our games of tic-tac-toe or kickball with our friends would go from friendly backyard, Little- House-on-the-Prairie type moments to screaming matches in a matter of days.

Carribean Adventures

I am Sandra Gaskins, born in California. I have completed MBA from Anderson School of Management in 2008, did graduation in commerce streams from University of American inter Continental and schooling from Belmont Senior high school. During my MBA course, I did summer internship in American express as a Management Trainee, where my job profile was to work with the travel counselor and prepare the project report on delivery of quality services to the customers. During this program I realized my strengths, which are better communication skill, handling the queries of customers and working in teams. About my family background – my father is running a privately owned business of textiles and mother is a home maker. I have one sibling pursuing BBA. I am keen to work with the Carribean Adventures, since the profile of Travel Counselor requires the skill of customer service and ability to work under pressure and I am familiar with the workings and dealings of travel counselors as I worked in the same field during internship. I had a great learning during internship. There I learnt about the customer values, needs and what quality means to them. Along with this, I had a selling experience and learnt how to coordinate in teams, which ultimately enhanced my problem solving capabilities and all these qualities form the core in order to become the travel counselor. Apart from this, I possess a sound knowledge of geographical locations, as it was one of my hobbies to gather the information related to the diversities in the places and study the human psychology. Therefore, based on the above mentioned qualities and my sheer determination towards the work that is assigned to me, I can say that I will be the suitable candidate for this post. Â   Â  

Tasseled Wobbegong Shark Facts

Tasseled Wobbegong Shark Facts The tasseled wobbegong shark is one of the most extraordinary-looking shark species.   These animals have distinctive, branched lobes extending from their head and a flattened appearance. Although these sharks were first described over 100 years ago (1867), they are not well-known.   Tasseled Wobbegong Shark Identification Like other wobbegong sharks, tasseled wobbegongs have large heads and mouths, flattened bodies and a spotted appearance.   These sharks have 24 to 26 pairs of highly branched dermal lobes that extend from the front of the sharks head to its pectoral fins. It also has branched nasal barbels on its head.  This shark has patterns of dark lines over lighter skin, with dark spots and saddle patches.   Tasseled wobbegongs are usually thought to grow to a maximum size of about 4 feet in length, although a questionable report estimated one tasseled wobbegong shark at 12 feet. These sharks have three rows of sharp, fang-like teeth in their upper jaw and two rows of teeth in their lower jaw.   Classification: Kingdom: AnimaliaPhylum: ChordataClass: ChondrichthyesSubclass: Elasmobranchii Order: Orectolobiformes Family: Orectolobidae Genus: EucrossorhinusSpecies: dasypogon   The genus Eucrossorhinus comes from the Greek words eu (good), krossoi (tassel) and rhinos (nose). Where Do Tasseled Wobbegong Sharks Live? Tasseled wobbegong sharks live in tropical waters in the southwest Pacific Ocean off Indonesia, Australia and New Guinea. They prefer shallow waters near coral reefs, in water depths of about 6-131 feet.   Feeding: This species feeds at night upon benthic (bottom) fish and invertebrates. During the day, tasseled wobbegong sharks rest in sheltered areas, such as in caves and under ledges. Their mouths are so large, the tassseled wobbegong sharks have even been seen swallowing other sharks whole. This shark can feed on other fish that share its caves. Reproduction: The tasseled wobbegong shark is ovoviviparous, which means that the females eggs develop within her body. During this process, the young get their nourishment in the womb from the egg yolk. Pups are about 7-8 inches long when born.   Shark Attacks: Wobbegong sharks are not generally considered threatening to humans, but their ability to camouflage with their environment, combined with sharp teeth, can result in a painful bite if you come across one of these sharks.   Conservation: These sharks are listed as near threatened on the IUCN Red List, Threats include damage to and loss of their coral reef habitat and overfishing.   Not much is known about this species, but populations appear to be declining, which is another reason for their near threatened listing.   Because of their beautiful coloration and interesting appearance, these sharks are sometimes kept in aquariums. References and Further Information: Bester, C.  Tasseled Wobbegong. Florida Museum of Natural History. Accessed July 31, 2015.Campagno, L., Dando, M. and S. Fowler. 2005. Sharks of the World. Princeton University Press. 368pp.Compagno, L.J.V., 1984. Eucrossorhinus  dasypogon   (Bleeker, 1867).  FAO Species Catalogue. Vol. 4. Sharks of the world. An annotated and illustrated catalogue of shark species known to date. Part 1 - Hexanchiformes to Lamniformes. FAO Fish. Synop. 125(4/1):1-249. Rome: FAO.  In  FishBase. Accessed July 31, 2015. International Shark Attack File. 2015.  Florida Museum of Natural History. Accessed July 31, 2015. Pillans, R. (SSG Australia Oceania Regional Workshop, March 2003) 2003.  Eucrossorhinus dasypogon. The IUCN Red List of Threatened Species. Version 2015.2.   Scales, H. Pictures: Shark Swallows Another Shark Whole. National Geographic. Accessed July 31, 2015.

Free Essays on The First Native Americans

The First Americans Throughout time our ancestors have always been the race that we have descended from. To this day scientists and philosophers still don’t grasp the true revelation, of who owns the past. The controversies of the Kennewick man very well define some of our many questions about the actual origin of the 9300 year old skeleton. The remains are an ongoing battle with the American anthropologists and the NAGPRA. And archeologists may never know the biological evidence of linkage between us and the Kennewick man. The origin of the human remains is still not known to this day, although archeologists believe to be of a Caucasoid descent. Originally the Kennewick man was thought to be a fur –trader or pioneer. Obtained though a CAT scan and was thought to be dated from 9000 to 4500 years ago. The NAGPRA claims that these remains are from a Paleo-Indian tribe and believes that they should preserve and keep the remains. The only problem with this claim is that this tribe is a fairly new tribe and with radiocarbon dating the facts just don’t match. Controversy surrounds the whole situation of the Kennewick man, the remains, the origin, and the possessions is all being fought over. Since this skeleton was found on land that the Native American Graves Protection and Repatriation Act. The Committee also believes that the remains are closely related or are one of a Paleo-Indian Tribe. For many archaeologist the find of these remains are huge, mainly because a huge portion of the skeleton was found. This piece could very well tell us the many things we still have to learn about our early ancestors. Native Americans believe that there is a close ancestral relationship between the Kennewick man and a modern tribe. The tribe has been around for many years, but not more that 4500 years ago. The radio carbon dating on the fossil dated back to about 9300 years ago this would throw this theory in the water. T... Free Essays on The First Native Americans Free Essays on The First Native Americans The First Americans Throughout time our ancestors have always been the race that we have descended from. To this day scientists and philosophers still don’t grasp the true revelation, of who owns the past. The controversies of the Kennewick man very well define some of our many questions about the actual origin of the 9300 year old skeleton. The remains are an ongoing battle with the American anthropologists and the NAGPRA. And archeologists may never know the biological evidence of linkage between us and the Kennewick man. The origin of the human remains is still not known to this day, although archeologists believe to be of a Caucasoid descent. Originally the Kennewick man was thought to be a fur –trader or pioneer. Obtained though a CAT scan and was thought to be dated from 9000 to 4500 years ago. The NAGPRA claims that these remains are from a Paleo-Indian tribe and believes that they should preserve and keep the remains. The only problem with this claim is that this tribe is a fairly new tribe and with radiocarbon dating the facts just don’t match. Controversy surrounds the whole situation of the Kennewick man, the remains, the origin, and the possessions is all being fought over. Since this skeleton was found on land that the Native American Graves Protection and Repatriation Act. The Committee also believes that the remains are closely related or are one of a Paleo-Indian Tribe. For many archaeologist the find of these remains are huge, mainly because a huge portion of the skeleton was found. This piece could very well tell us the many things we still have to learn about our early ancestors. Native Americans believe that there is a close ancestral relationship between the Kennewick man and a modern tribe. The tribe has been around for many years, but not more that 4500 years ago. The radio carbon dating on the fossil dated back to about 9300 years ago this would throw this theory in the water. T...

MEDIA TECHNOLOGIES Essay Example | Topics and Well Written Essays - 2000 words

MEDIA TECHNOLOGIES - Essay Example As per Carlyle (1830), development of printing press was the first step towards the modern era of media. McLuhan has introduced the term â€Å"Media† along with other terms like â€Å"The Global Village† and the â€Å"Age of Information† which gained high popularity. In 1965 his famous book â€Å"Understanding Media: The Extension of Man† was published. Soon he was called the most important thinker after Newton, Darwin, Pavlov and few more. With the further development in technology, media has made constant evolution and has improved itself to fit best into the society. McLuhan has called media as an extension of man. (Griscom, n.d. â€Å"McLuhan’s message†). The chart given above indicates that with passage of time, some vital changes took place in the media industry. These changes are more influenced by the changes that are taking place in the field of technology and also in the society. One of such revolutionary change was brought by the development of the internet. Internet introduced speed in media. The present era of media is known as digital media due to influence of internet in each and every aspect. In the year 1964, Rand Corporation, created a communication network which had several nodes and each node was capable of originating, passing and receiving message. In 1967 Britains National Physical Laboratory succeeded in developing the first test network. This was just the beginning of a new era. With passage of time, more and more such networks came into existence. Many agencies came forward and actively participated in developing their own network. By the end of the 20th century, six basic internet domains developed. These domains got segregated by separate abbreviations for representing their address such as â€Å"gov†, which was for government; â€Å"mil†, which was for military; â€Å"edu†, which was for education; â€Å"com†, which was for commercial; â€Å"org†, which was for organisation and

Econometrics Essay Example | Topics and Well Written Essays - 2000 words - 2

Econometrics - Essay Example velopment to fulfill international expectations, high excellent of job and items, up-to-date engineering, consumer as well as environmental responsibility and robust networks in conducting company operations. More importantly, the competition of Thai market, particularly SMEs, has usually relied in low-cost job and normal resource advantages as opposed to technological capability or qualified human investment capital. Many models of growth along with development suppose that end result is generated with a two component, CobbDouglas specification for your aggregate production function using physical capital and work or Man capital adjusted labor helping as inputs. The CobbDouglas specification could be the only linearly homogenous production function that has a constant elasticity of substitution in which each factor’s Share of income is constant over time. Since this latter implication with the CobbDouglas specs is considered consistent with among stylized information of development, that this shares involving income accruing to help capital along with labor are relatively constant over time most researchers have not questioned the application of a CobbDouglas production function to check questions involving growth along with development. The linear homogeneity along with constant elasticity of alternative properties with the CobbDouglas specification also can explain this popularity with this functional style (Duffy & Papageorgiou 2000, p. 1). In all forms of production of one good with multiple factors, the formulation is presented as. Y represents the total production, L represents labor input, K represents the capital input, and A represents the total output by the factory. Regression evaluation generates the equation to spell it out the statistical relationship between more than one predictor variables along with the response varying. The p-value for every term checks the null hypothesis, which the coefficient is equal to zero (no effect). A low p-value