Hawaiian Islands

Hawaii and Tourism â€Å"Hawaii resembles no other spot on earth† (Goshawks). Hawaii pulls in numerous sightseers every year due to Its history, topography, and diversion This state is known for its numerous islands, volcanoes, and atmosphere also. At the point when I consider Hawaii all envision is remaining on the sea shore disregarding the sea getting hit with the decent warm breeze hearing giggling and seeing grins. Since â€Å"Hawaii Is one of the most disengaged puts on Earth† It makes traveling there totally pressure and effortless, in light of the fact that you are far away from home and nothing n your brain except for having an extraordinary excursion (Inner p. ). The state was established by the Polynesians and it was additionally named by them. The word Hawaii in the Polynesian language meaner â€Å"Homeland† (Wisped). Having a name with such a ground-breaking importance says a great deal regarding the state. I think It shows that anybody could look to Hawaii as their own country. Hawaii's correspondence with Europe began when it was established by two British Explorers (Wisped). James Cook and commander assistant were assume to be looking for the Northwest Passage, and found the Hawaiian Islands on January 18, 1778 They at that point spent most of he year scanning for the Northwest Passage.When Cook had no karma, he surrendered his inquiry and turned their boat south towards the islands. Cook and Clerk showed up in Hawaii between November of 1778 and January 1779 where they arrived at Keelhaul Bay. Anticipating their appearance were a large number of energized locals. At the point when Cook chose to leave the recently discovered island he found that the locals had taken one of his boats. Cook continued to leave, anyway a couple of days after the fact came back with marines to kidnap the lord. The lord had no issues with forsaking his Island and continuous with Cook and the marines, anyway the kindred locals made an effort not to go.The perspectives of everybody immediately changed when word that a boss had been murdered, not far up the Island. â€Å"The locals assaulted and the marines discharged back with weapons and knifes. The fight possibly kept going a couple of moments however when it was finished, Cook lay dead on the beach† (south-shaft). Since the Europeans had now found the Islands It continuously developed until It turned into the fiftieth state to Join the U. S. â€Å"Hawaii's travel industry authoritatively started in 1927. That year. The principal extravagance traveler transport, the S. S. Mallow, started journeys between San Francisco and the Islands† (En p. 34).With the new boat making journeys It carried incredible new income to the islands. Be that as it may, the world changed perpetually when the Japanese bombarded the U. S. Naval force that was positioned In Pearl Harbor, Hawaii on December seventh 1941. This assault made Americans fatigued tot the Japanese and soon the Ja panese were singled out; to show that they were so faithful to America they joined to battle in World War II (Inner p. 3536). Things at long last fired searching up for Hawaii; on August 21, 1959 It was declared that Hawaii was presently a section tot the US tot America. The travel industry coming into Hawaii was at last picking back up as well (Inner p. 36).The measure of the travel industry Hawaii sees Is continually rising. As of September 2012 Hawaii has had 583,363 all out guests. Precisely one year prior in September tot 2011 Hawaii in particular and 553,187 all out guests, that is a 5. 5% change more than one year (Hawaii Tourism Authority). Numerous sightseers go to Hawaii Just in light of the historical backdrop of the islands, anyway many go for the geology too. â€Å"There are six significant islands to visit in Hawaii: Kuaka, AAU, Monomial, Lana', Mama, and Hawaii Island† (Goshawks). Regardless of which of the six partially open islands you are on; the climate is the generally the equivalent with almost no progressions all through the year.The truth that â€Å"tourists are pulled in by Hawaii's charming, bright climate† makes Hawaii such an attractive spot to relax (Inner p. 13). Hawaii just has two seasons throughout the entire year summer, which ranges from May to October, and winter, which ranges from November to April. The temperatures in the mid year extend from a low of OFF to a high of OFF; in the winter the temperatures go from a low of OFF to a high of OFF (Goshawks). Numerous individuals think about the islands as Just an island, however they are most certainly not. The Hawaiian Islands are truly highest points of volcanic mountains. The Hawaiian islands were made when bubbling magma flooded upward through very nearly 2,000 miles of splits in the floor of the Pacific Ocean† (Inner p. 8). At the point when the hot magma met the somewhat chilly water it turned out to be hard. As the years advanced this happened increasin gly more in the long run making it show up over the water as a functioning volcanic island. It took numerous years for the Hawaiian Islands to really get cut out into what it is today (Inner p. 8-9). Kuaka is probably the prettiest island to visit from Hawaii. It is one of the best five biggest islands to see and it will take your breath away.This island is utilized to film motion pictures that have significant Jungles and delightful sea shores. Likewise this island is brimming with delightful coconut trees (Inner p. 55). AAU is the nearest island to Kuaka and is the home of Pearl Harbor. This island is known for its pineapples and espresso fields (Inner p. 56-57). This island is likewise home to the â€Å"Triple Crown of Surfing competition† which is hung on the â€Å"beaches of Williwaw, Waianae Bay, Sunsets, Chukka, and other world-celebrated North Shore beaches† (Inner p. 57). This island is generally sited to see the recorded qualities that is offered here.Monomia l is the second nearest island to Kuaka and is molded like a shoe. This island is the fifth biggest island in Hawaii (Inner p. 59). This island is the best island out of all to have an apathetic excursion. It is a â€Å"great spot to go swimming or swimming or to appreciate a touring visit, total with the African wildlife† (Inner p. 60). The individuals that live on this island are never in a rush to do anything and are probably the most pleasant individuals you could ever meet (Inner p. 60). Lanai is simply the most contained island of all. It is the best island to go for harmony and quiet.The island just has two lodgings and scarcely anyplace to shop. This island just draws in visitors that need excellent clear water and to see the magnificence of the island. This island is most appropriate for enormous city vacationers (Inner . 60). The island Mama is â€Å"actually two latent volcanoes associated by an isthmus, or segment of land† (Inner p. 62). This island is idea l for travelers visit so they can see volcanoes. Additionally, this island has the best visit to see a whale shooting water out of its blowhole, which is totally an exceptional sight (Inner p. 64). The last significant island to visit is Hawaii itself.This is the island that gave the express its name. This island is the biggest of them all in truth â€Å"Hawaii is twice as large as different islands included together† (Inner p. 64). This island is home to a few volcanoes, remembering the most dynamic one for the whole world, Killable. Watching this spring of gushing lava eject is completely stunning, yet it is incredibly perilous. It has totally overwhelmed more than 200 homes and secured a few sea shores. The main g identify the volcanic ejections have to this island is the way that it is developing. â€Å"Its magma streams have included very nearly 600 sections of land of new land to the island's coast since 1983† (Inner p. 5). This island as I would like to think wo uld be the best island to visit because of the reality it is the most amazing island in view of its landscape. I have never been to Hawaii however from the photos I have seen I'm certain it is completely stunning. The last explanation I feel Hawaii is such an incredible place of interest is the diversion and the energy of the state. Hawaii is home to the Luau and the Hula move. Americans host gatherings with a Luau subject constantly. Luaus are â€Å"traditional local Hawaiian feasts† that are â€Å"held in nor of graduations, weddings, or a child's first birthday celebration' (Inner p. 7). The luau is currently utilized as a subject for a wide range of gatherings whether it is a birthday or Just a social affair. Americans have additionally adjusted the â€Å"flower wreaths, called leis† (Inner p. 4). The leis are the main image that is most popular in Hawaii (McCain p. 88). Regardless of whether you are in Hawaii or any state, when you see leis it consequently carrie s Hawaii to your brain. I see them laurels holding tight back view mirrors in vehicles constantly. I likewise observe this at the luau topic based gatherings. At the point when voyagers visit Hawaii here is consistently a Luau going on in light of the fact that it is such a mainstream event.Another well known occasion for vacationers to learn and encounter while at the Luau is the Hula. The Hula move was utilized during strict social affairs. â€Å"Both people figured out how to move, yet just men acted in the temples† (McCain p. 89). The move is for the most part comprised of hip and hand developments, which make up the expressions of the melody that is being played while the move is performed. Numerous individuals despite everything practice and study the Hawaiian culture and are continually making various approaches to showcase the images of the state (McCain p. 89-90). I know when I see somebody on TV doing the Hula move it carries the incredible province of Hawaii to min d.In end, the history, topography, and diversion of Hawaii are what draw in voyagers to this state. The way that the atmosphere is consistently the equivalent and that there is such a great amount of history to gain from the islands. While additionally increasing better approaches to engage is the thing that makes this state stunning. From doing this exploration on the state has Just made me need to visit the islands considerably progressively then I did previously. It has caused me to accept that Hawaii is the best get-away detect, regardless of what season. Works Cited Hawaii's Official Tourism Site. Hawaii's Official Tourism Site, 2012.

Organization (Mod 3 SLP PoM) Essay Example | Topics and Well Written Essays - 500 words

Association (Mod 3 SLP PoM) - Essay Example This article incorporates three sections for the most part featuring the significance of arranging inside a military contracting association, named Northbridge Services Group. Alongside this, it additionally incorporates the pretended by different components like work specialization, departmentalization, hierarchy of leadership, length of control and centralization or decentralization of arranging in various authoritative structures. Getting sorted out is depicted as a methodology which incorporates distinctive arranging and booking of shifted thoughts and data so as to lessen the negative effects and to improve the achievement of the arrangement or technique like rebuilding or partnership or others. The idea of getting sorted out is utilized with the goal that the arrangement or procedure gets acknowledged by all the workers in this manner improving its extent of progress (Vlasic, 2013). In this way, it is amazingly fundamental for any association, working in any fragment. In like manner, the idea of getting sorted out is likewise fundamental for a military contracting organization named Northbridge Services Group, as it offers shifted kinds of administrations like advices, trainings, operational and keen help and numerous others to governments, global partnerships and numerous others. In this way, for them, getting sorted out is very basic so as to offer their administrations suitably that may upgrade their deg ree of principles and brand esteem (Higgins and Green, 2012). Hierarchical plan is portrayed as the structure of an association. It differs starting with one association then onto the next like straightforward, progressive, lattice and numerous others. Based on the structure of the association, the jobs and obligations of the representatives are assigned. Like, the association of Northbridge Services Group involves a basic structure. In this kind of structure, most extreme degree of the choices is taken by the elevated level specialists of the association. Alongside this, gathering of employment obligations (decentralization), work specialization or occupation dissemination, solidarity of order or

The Main Classifications of Criminal Offenses

The Main Classifications of Criminal Offenses In the United States, there are three essential orders of criminal offenses - lawful offenses, misdeeds, and infractions. Every grouping is recognized from one another by the earnestness of the offense and the measure of discipline for which somebody sentenced for the wrongdoing can get. What Is a Criminal Offense? Criminal offenses are additionally delegated property related misdemeanors or individual wrongdoings. Chosen authorities on the government, state, and nearby levels pass laws that build up which conduct establishes a wrongdoing and what the discipline will be for somebody who is seen as liable of those violations. What Is a Felony? Lawful offenses are the most genuine order of violations, deserving of imprisonment of over a year in jail and now and again, life in jail without any chance to appeal or the death penalty. Both property related misdemeanors and individual violations can be crimes. Murder, assault, and abducting are lawful offense violations. Furnished burglary and fantastic robbery can likewise be lawful offenses. Not exclusively can the individual who carried out the wrongdoing be accused of a lawful offense, so can any individual who supported or abetted the criminal previously or during the wrongdoing and any individual who became accomplices to the wrongdoing after it was perpetrated, for example, the individuals who help the criminal dodge catch. Most states have various orders of lawful offenses, with expanding punishments for the most genuine violations. Each class of lawful offense violations has least and most extreme condemning rules. Wrongdoings that are delegated lawful offenses include: Bothered AssaultAnimal CrueltyArsonDrug DistributionElder AbuseFelony AssaultGrand TheftKidnappingManslaughterManufacturing of drugsMurderRapeTax EvasionTreason Most states additionally order lawful offenses by capital lawful offense, trailed by first through fourth degree, contingent upon the seriousness. Albeit each state shifts while deciding the level of a lawful offense, most states with capital lawful offense characterize it as a wrongdoing, for example, murder, that meets all requirements for capital punishment or existence without the chance for further appeal. Normal first-degree lawful offenses incorporate incendiarism, assault, murder, injustice, and abducting; Second-degree lawful offenses can incorporate illegal conflagration, homicide, sedate assembling or conveyance, youngster erotic entertainment, and kid attack. Third and fourth-degree lawful offenses can incorporate erotic entertainment, automatic homicide, theft, robbery, driving impaired, and threatening behavior. Jail Sentences for Felonies Each state decides the jail sentence passed on for lawful offense wrongdoings dependent on rules controlled by the level of the wrongdoing. Class An is normally used to order the most genuine lawful offenses, for example, first-degree murder, assault, automatic bondage of a minor, grabbing in the principal degree, or different violations that are viewed as deplorable. Some Class A lawful offenses convey the hardest punishments, for example, capital punishment. Each state has its own arrangement of groupings of criminal laws. A Class B lawful offense is a grouping of wrongdoings that are extreme, yet not the most genuine of violations. Since a Class B lawful offense is a lawful offense, it conveys intense punishments, for example, a protracted jail sentence and outrageous fines. Here is a case of Texas and afterward Floridas lawful offense condemning rules. Texas Sentencing: Capital Felony:Â Death or existence without parole.First-Degree Felony: Five to 99 yearsâ incarcerationâ and up to a $10,000 fine.Second-Degree Felony:Â Two to 20 years detainment and up to a $10,000 fine.Third-Degree Felony:Â Two to 10 yearsâ incarcerationâ and up to a $10,000 fine. Florida Maximum Sentencing: Life Felony: Up to life in prisonâ incarcerationâ and up to a $15,000 fine.First-Degree Felony: Up to 30 yearsâ incarcerationâ and up to a $10,000 fine.Second-Degree Felony: Up to 15 yearsâ incarcerationâ and up to a $10,000 fine.Third-Degree Felony: Up to five yearsâ incarcerationâ and up to a $5,000 fine. What Is a Misdemeanor? Wrongdoings are violations that don't ascend to the seriousness of a crime. They are lesser violations for which the greatest sentence is a year or less in prison. The differentiation among misdeeds and lawful offenses exists in the earnestness of the wrongdoing. Exasperated attack (beating somebody with a slugging stick, for instance) is a crime, while basic battery (smacking somebody in the face) is an offense. Yet, a few violations that are generally treated as offenses in the courts can ascend to the degree of a lawful offense in specific situations. For instance, in certain states, ownership of not exactly an ounce of weed is an offense, however ownership of in excess of an ounce is viewed as ownership with goal to disseminate and is treated as a lawful offense. In like manner, a capture for driving impaired is generally a crime, yet in the event that anybody was harmed or murdered or in the event that it isn't the drivers first DUI offense, the charge can turn into a lawful offense. What Is an Infraction? Infractions are wrongdoings for which prison time is typically not a potential sentence. In some cases known as unimportant violations, infractions are regularly deserving of fines, which can be paid without going to court. Most infractions are neighborhood laws or laws went as a prevention to perilous or annoyance conduct, for example, setting speed constrains in school zones, no stopping zones, transit regulations, or hostile to clamor mandates. Infractions can likewise incorporate working a business without the best possible permit or inappropriately discarding refuse. Under certain conditions, an infraction can ascend to the degree of a progressively genuine wrongdoing. Running a stop sign may be a minor infraction, yet not halting for the sign and causing harm or injury is a progressively genuine offense. Capital Crimes Capital violations are those which are deserving of death. They are, obviously, crimes. The contrast between different classes of lawful offenses and capital lawful offenses is the way that those blamed for capital wrongdoings can take care of a definitive punishment, a mind-blowing loss.

Music Festival Co-Founders Hold Pitch Competition

Music Festival Co-Founders Hold Pitch Competition by: Naomi Nishihara on June 20, 2016 | 0 Comments Comments 132 Views June 20, 2016Evan Ehrenberg pitches Xperii to judges at RECESS Final in LAOne email gave two guys a chance to pursue their dream of a music festival start-up. Now theyre helping college students realize their dreams, too, with a pitch competition they describe as a March Madness of college â€Å"Shark Tank† competitions — mixed with music.RECESS began when co-founders Deuce Thevenow and Jack Shannon were Indiana University students. They were really into electronic dance music, and their dream was to host concerts on college campuses. They took a big step toward realizing that dream the day Thevenow, on a whim, emailed Mark Cuban, the billionaire owner of the NBAs Dallas Mavericks and a judge on the ABC show Shark Tank.To Thevenows  surprise, Cuban responded, and became their first investor.With Cuban’s backing, RECESS has been hosting con certs since 2010. Now they’re partners with Southwest Airlines, Fiverr, and more, and Thevenow says  they’ve worked with just about every major dance music artist.FROM MUSIC FESTIVAL TO MUSIC-AND-IDEAS FESTIVAL  Still, Thevenow says,  they wanted to do something bigger. Specifically, they wanted to help college students turn their ideas into reality, just as Mark Cuban did for them. So in 2013, RECESS evolved from a music festival to a music-and-ideas festival, and a national pitch competition for college students was born.There are three stages to the competition that span several months: campus qualifiers, regional semifinals, and then the final competition. The most recent round began in April and ended this month (June). RECESS travels to college campuses and holds small competitions where teams of students are able to pitch their business ideas to VCs and investors. Judges pick winners who advance to the regional semifinals, and three winners from each regio n go on to the final competition.The semifinal and final competitions are held at concert venues, and after the pitch sessions, RECESS hosts a free concert.  This year, 10 student teams were flown to Los Angeles on an all-expenses-paid trip to compete in the final.â€Å"We don’t take anything, we don’t take any equity, we just wanted to develop a platform to help them,† Thevenow says. â€Å"We were in their shoes once and we got lucky. This is just our way to give back.†THIS YEARS WINNING TEAM  IS TRYING TO SOLVE A BIG PROBLEM  This year’s winning team is Xperii, a health-tech start-up founded by Evan Ehrenberg, an MIT PhD student, and Cynthia Chen, an undergraduate who is currently on leave from Brown University.Ehrenberg and Chen collaborated on research for several years before they started Xperii together. One day, while working together at MIT, Ehrenberg went to check a flier he had posted, seeking subjects of a research study he was con ducting.  Ã¢â‚¬Å"(Cynthia) saw me checking my research fliers, and she asked what else we did to find people,† Ehrenberg says. â€Å"I said that was it, and she thought there must be a better way, like an AirBnB or an Uber for this stuff. The next day she sketched out the entire idea for Xperii.†The problem they’re trying to solve is a big one. Each year, millions of people are needed to participate in scientific studies, Ehrenberg says, but it’s difficult for researchers and study participants to find each other. Eighty-six percent  of clinical trials have to be extended if they can’t find participants fast enough, costing the U.S. clinical trial industry billions of dollars each year, and possibly delaying the development of life-saving treatments.Xperii is an app that connects researchers and study participants quickly. People who want to be paid to participate can use the app to find nearby on-going studies that they qualify for.  Ã¢â‚¬Å"W e did some interviews and found that people and researchers were both really interested (in the app),† Ehrenberg says. â€Å"After that it was obvious. We had to make this.† Page 1 of 212 »

Malcolm X Biography - Free Essay Example

Sample details Pages: 2 Words: 576 Downloads: 6 Date added: 2019/03/26 Category History Essay Level High school Topics: Malcolm X Essay Did you like this example? He was born May 19th, 1925 in Omaha, Nebraska Malcolm X (originally Malcolm Little)s father, a baptist minister, was an activist but he was killed when Malcolm was 6 years old, making the family poor. His mother went mad and was placed in an asylum, and siblings and him were sent to foster homes He quits formal education when told he would be a carpenter and not a lawyer in 8th grade. He was sent a juvenile detention home in Michigan but soon was moved to the Roxbury section of Boston to live with his half-sister Ella, from his fathers previous marriage. Don’t waste time! Our writers will create an original "Malcolm X Biography" essay for you Create order During his teenage years, he dealt drugs, was a hustler, and was the leader of a gang of thieves in Roxbury and Harlem (NY) He was in prison for robbery from 1946 to 1952, which lead him to convert himself, and join the Nation Of Islam his brother Reginald was also a member and was one of the reason Malcolm decided to convert- they had been in prison together in 1948. The Nation Of Islam was a movement for African-Americans that combined elements of black nationalism and Islam He quit eating pork, smoking and gambling to be in this Nation all those were part of the requirements to be a member. All members had to replace their last name with X, it was a custom among the Nation of Islam followers who considered their last name to have originated from white slaveholders He met Elijah Muhammad (leader of the Nation Of Islam) in Chicago (1952), who inspired him to organize temples for the Nations in New York, Philadelphia, Boston and other cities in the Southern US, and he created the Nations newspaper: Muhammad Speaks Contrary to other activists who wanted African-American rights to be equal to white rights, Malcolm X argued that blacks were naturally superior to whites Malcolm became the minister of one of the temples that he founded himself: Temple No. 11 in Boston. He was later promoted to be the minister at Temple No. 7 in Harlem Elijah Muhammad appointed Malcolm X as the National Representative of the Nation of Islam. This meant that Malcolm was the most important person in the Nation, right after Elijah Malcolm spoke at many universities including Harvard and Oxford around the major phase of the civil rights movement: 1955 1965 1963 deep tensions between Malcolm and Elijah Muhammad ovec the political direction of the Nation Malcolm brought bad publicity to the Nation with a controversial comment about President John F. Kennedy, so was ordered by Elijah to do a period of silence for 90 days they then became estranged Malcolm left the Nation in 1964 He made a pilgrimage to Mecca,, and converted himself again to Sunni Islam, and adopting the Muslim el-Hajj Malik el-Shabazz and stopped believing in the separatist ways of the Nation In 1965, he founded the Organization of Afro-American Unity, moving from civil rights to human rights Malcolm received open death threats and violence due to the hostility between him the Nation He was assassinated on February 21st 1965 while giving a lecture in the Audubon ballroom in Harlem 3 members of the Nation of Islam were convicted for it Impact on Society: Malcolm X was a standout amongst the most huge figures inside the American dark patriot development. A significant number of the thoughts he explained, similar to race pride and self-protection, ended up ideological pillars of the Black Power development that rose during the 1960s and 70s.

Essay about My Sociological Perspective - 803 Words

Sociology is a part of everyday life. People experience sociological changes when they get married, get a new job, or get discriminated against. All of these things can alter a person’s perspective on a group of people or even the world. Since the beginning of this class, I have personally endured several sociological changes in my life. I recently started a new job. I’m meeting new and wonderful people and I no longer dread having to go to work. I have also begun setting plans for my wedding to the one girl who I know will make everyday better than the one before. But, perhaps the one instance that has affected me the most and the deepest was when my parents got a divorce. This is something that occurred over ten years ago but it†¦show more content†¦If there was anything that I valued as a child, it was the togetherness of my mother and father. Due to the fact that my father was now on his own and trying to raise three children (my older brother from my father’s first marriage), he had to take a different position at his work. Although he was getting a raise it wasn’t necessarily a good thing. He had to start working the night shift so he could get the raise. He didn’t really have a choice in the matter and because of this new change, I began to lose valuable time with him as well. It was now up to my brother to watch over us at night and make sure we got to bed on time. If there was any trouble or and problems in general, my brother would call my grandmother. For three years my dad worked that job and every night he would stay up after he got home to see us. He would make my sister and I breakfast and make we were off to school on time. This meant the world to me because no matter what he always made time for us. Now, it will soon be my turn to make the same vows my parents once did. However, I will not make the same mistakes that they did. After seeing what divorce did to my family, I will never even utter that word when I have my own. My children will never experience the pain and agony and shear despair that I had to go through. Although it has been ten years, I still hurt. WhenShow MoreRelatedEssay on The Sociological Imagination1389 Words   |  6 PagesMy personal condensed definition of â€Å"the sociological imagination† is that it is the idea one should be aware of the societal structures around themselves, and how those structures can influence a person and vice-versa. In addition, I think that having a â€Å"sociological imagination† also involves a deep appreciation for the importance of society and culture. 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Dengue Case Study free essay sample

Introduction Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas. Dengue haemorrhagic fever (DHF), a potentially lethal complication, was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian countries and has become a leading cause of hospitalization and death among children in the region. There are four distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that virus but confers only partial and transient protection against subsequent infection by the other three viruses. There is good evidence that sequential infection increases the risk of developing DHF. The incidence of dengue has grown dramatically around the world in recent decades. Some 2. 5 billion people – two fifths of the worlds population – are now at risk from dengue. WHO currently estimates there may be 50 million dengue infections worldwide every year. The spread of dengue is attributed to expanding geographic distribution of the four dengue viruses and their mosquito vectors, the most important of which is the predominantly urban species Aedes aegypti. A rapid rise in urban mosquito populations is bringing ever greater numbers of people into contact with this vector, especially in areas that are favourable for mosquito breeding, e. g. where household water storage is common and where solid waste disposal services are inadequate. Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After virus incubation for eight to 10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission, but the role of this in sustaining transmission of the virus to humans has not yet been defined. Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time that they have a fever; Aedes mosquitoes may acquire the virus when they feed on an individual during this period. Some studies have shown that monkeys in some parts of the world play a similar role in transmission. Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. The clinical features of dengue fever vary according to the age of the patient. Infants and young children may have a fever with rash. Older children and adults may have either a mild fever or the classical incapacitating disease with abrupt onset and high fever, severe headache, pain behind the eyes, muscle and joint pains, and rash. Dengue haemorrhagic fever (DHF) is a potentially deadly complication that is characterized by high fever, often with enlargement of the liver, and in severe cases circulatory failure. The illness often begins with a sudden rise in temperature accompanied by facial flush and other flu-like symptoms. The fever usually continues for two to seven days and can be as high as 41 °C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patients condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock and die within 12 to 24 hours, or quickly recover following appropriate medical treatment. There is no specific treatment for dengue fever. For DHF, medical care by physicians and nurses experienced with the effects and progression of the complicating haemorrhagic fever can frequently save lives decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patients circulating fluid volume is the central feature of DHF care. At present, the only method of controlling or preventing dengue virus transmission is to combat the vector mosquitoes. Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal and improved water storage practices, including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes. The application of appropriate insecticides to larval habitats, particularly those that are useful in households, e. g. water storage vessels, prevents mosquito breeding for several weeks but must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success. During outbreaks, emergency vector control measures can also include broad application of insecticides as space sprays using portable or truck-mounted machines or even aircraft. However, the mosquito-killing effect is transient, variable in its effectiveness because the aerosol droplets may not penetrate indoors to microhabitats where adult mosquitoes are sequestered, and the procedure is costly and operationally difficult. Regular monitoring of the vectors susceptibility to widely used insecticides is necessary to ensure the appropriate choice of chemicals. Active monitoring and surveillance of the natural mosquito population should accompany control efforts to determine programme effectiveness. Anatomy and Physiology Blood Components * Plasma is a straw-colored liquid portion of the blood in which the cells and platelets are suspened. It makes up approximately 50-55% of a blood sample. It consist of water (approximately 92%), amino acids, proteins, carbohydrates, lipids, vitamins, hormones, electrolytes and cellular wastes. Serum is essentially the same as plasma, only it has no fibrinogen and clotting factors. If whole blood is allowed to clot and the clot will be removed. Blood cells, along with platelets, comprise the remaining portion of the blood sample. The blood volume is approximately 8 percent of the total body weight. * Erythrocytes, or red blood cells (RBCs), transport oxygen (O2) and carbon dioxide (CO2) in the blood. Erythrocytes contain the protein hemoglobin to which both O2 and CO2 attach. * Mature erythrocytes lack a n ucleus and most cellular organelles, thereby maximizing the cells volume and thus its ability to carry hemoglobin and to transport O2. * Erythrocytes are shaped like flattened donuts with a depressed center (rather than a donut hole). Their flattened shape maximizes surface area for the exchange of O2 and CO2 and allows flexibility that permits their passage through narrow capillaries. * Hemoglobin contains a protein portion, called globin, and nonprotein heme groups. Globin consists of four polypeptide chains, each of which contains a heme group. The heme group is a red pigment that contains a single iron atom surrounded by a ring of nitrogen-containing carbon rings. One oxygen atom attaches to the iron of each heme group, allowing a single hemoglobin molecule to carry four oxygen atoms. Each erythrocyte contains about 250 million hemoglobin molecules. Oxyhemoglobin (HbO2) forms in the lungs when erythrocytes are exposed to oxygen as they pass through the lungs. Deoxyhemoglobin (Hb) forms when oxygen detaches form the iron and diffuses into surrounding tissues. * Carbaminohemoglobin (HbCO2) forms when CO2 attaches to amino acids of the globin part of the hemoglobin molecule. About 25 percent of the CO2 transporte d from tissues to lungs is in this form. * Carbonic anhydrase, an enzyme in erythrocytes, converts CO2 and H2O in the blood plasma to H+ and HCO3? About 65% of the CO2 collected from tissues travels in the blood plasma as HCO3?. Because they lack cellular organelles and thus physiology to maintain them, erythrocytes survive for only about 120 days. * Leukocytes, or white blood cells (WBCs) has three types: * Granulocytes constitute 60-80% of the total number of leukocytes. They contain granules in their cytoplasm and act as phagocytes. The three types of granulocytes are neutrophils, eosinophils and basophils which are also referred as polymorphonuclear leukocytes. * Neutrophils are the most plenty of the granulocytes (55-70%). They act as a phagocytes that are less mature than a fully developed neutrophil. A shift to the left describes the increase in immature neutrophils resulting from activation of the bone marrow to produce white blood cells in response to infectious processes. As the bands mature, the nucleus becomes segmented and develops into neutrophils, which is why neutropils are often referred to as â€Å"segs†. Neutrophils are the first type of phagocytic cell to arrive at the site of invasion, drawn by chemicals released by damaged tissue and invading organism * Eosinophils accounts for 1% to 4% of the total number of circulatory leukocytes. They are also phagocytes but they are not efficient in this role compare to the neutrophils. They have the ability to engulf antigen-antibody complexes from allergic responses. They also have the ability to protect the individual from parasitic infections * Basophils (0. 5%-1% of all leukocytes) contain histamine, heparin and serotonin. These are similar to the mast cell activity seen in allergic and inflammatory reactions. Basophils have limited phagocytic activity. * Monocytes account for 2%-3% of circulating leukocytes and are large phagocytic cells produced in the bone marrow. Once they leave the circulation, they reside in tissues to become macrophages. Macrophages are responsible for removing dead and senescent cells as well as having the ability to engulf microorganisms. * Lymphocytes account for 20%-40% of circulating leukocytes. They originate primarily from the lymph nodes and also from the bone marrow. There are three types of lymphocytes: T-lymphocytes,B-lymphocytes and NK cells or mull cells. * Thrombocytes or platelets. Many of platelets are present in circulat ion. The spleen contains the remainder of platelets. Approximately 20,000 to 40,000 new platelets per cubic millimetre of blood are produced each day. The life span of platelets is approximately 10days. * `The major functions of platelets are to maintain homeostasis and coagulation. They have the ability to plug breaks in blood vessels and therefore are able to maintain the integrity of these vesssels * Platelets also release thromboplastin (factor 111) necessary for the conversion of prothrombin to thrombin, which is the first step of coagulation. Demographic Profile Name Address Age Sex Date of Birth Place of Birth Nationality Religion Civil Status Educational Attainment Father Occupation Mother Occupation OTHER Admitting Diagnosis: Acute Tonsilopharyngitis T/C Dengue Fever Syndrome Principal Diagnosis: Dengue Hemorrhagic Fever Attending Physician: Hospital Admitted: Date/Time Admitted: Date/Time Discharged: History of Present Illness According to the significant other, one day prior to admission the patient suffered fever with a temperature of 39. 5 Centigrade accompanied by productive cough able to expectorate yellowish non-blood tinged sputum. The patient was given Ibuprofen (Dolan) 250mg/ml to be taken every 4 hours but it didn’t relieve the patient. It was then followed up with Paracetamol 250mg/5ml with the same frequency. Few hours prior to admission, the patient still had a persistent fever which prompts the significant other to consult the present institution and through assessment, it was then advised that the patient should be admitted for further examination and management. History of Past Illness Through interview to the significant other, the patient was said to be completely immunized. The patient hasn’t been hospitalized for the past 7 years due to any accident or illnesses. The patient was said to be living in a concrete house but with a poor environment sanitation such as presence of garbages and stagnant water. Head to Toe Assessment BODY PART| FINDINGS| Skull| ? proportional to the size of the body, round, with prominences in the frontal area anteriorly ; the occipital area posteriorly, symmetrical in all planes, gently curved| Scalp/Hair| ? scalp is white, clean, free from masses, lumps, nits, dandruff ; lesions, with no areas of tenderness upon palpation; hair is black, evenly distributed ; covers the whole scalp, thick ; shiny| Face| ? oblong shaped, symmetrical, smooth ; no involuntary muscle movements| Eyes/Vision| ? yes are parallel ; evenly placed, symmetrical, nonprotruding, with scant amount of secretions, both eyes black ; clear; sclera is white ; clear; eyebrows are black, symmetrical, thick, can raise both symmetrically ; without difficulty, evenly distributed ; parallel with each other; eyelashes are evenly distributed ; turned outward; upper eyelids cover a small portion of the iris, cornea ; the sclera when the eyes are open, when the eyes are closed the lids meet completely , symmetrical ; the color is the same as the surrounding skin; lid margins are clear, without scaling or secretions; lower palpebral conjunctiva are shiny, moist, transparent ; salmon pink in color; iris are proportional to the size of the eye, round ; symmetrical; pupils are from pinpoint to almost the size of the iris, round, symmetrical, constricts with increasing light ; accommodation; able to move eyes in full range of directions| Ears/Hearing| ? ears are parallel, symmetrical, proportional to the size of the head, bean-shaped, helix is in line with the outer canthus of the eye, skin is the same color as the surrounding area ; clean; ear canal ispinkish, clean, with scant amount of cerumen ; a few cilia; able to hear whisper spoken 2 feet away | Nose| ? nose is in midline, symmetrical, patent; internal nares are clean, dark pink with few cilia| Mouth/Lips| ? lips are pinkish, symmetrical, lip margin is well-defined, mooth ; moist; gums are pinkish, smooth, moist, no swelling, n o retraction, no discharge; no dental caries; tongue is pinkish, slightly rough on top, smooth along the lateral margins, moist, shiny ; freely movable; cheeks are pinkish, moist ; smooth; frenulum is in midline, straight ; thin; soft palate is pinkish, smooth ; moist; hard palate is slightly pinkish; uvula is at the center, symmetrical ; freely movable| Neck| ? proportional to the size of the body ; head, symmetrical ; straight, no palpable lumps, masses or areas of tenderness| Thorax and Lungs| ? chest contour is symmetrical, spine is straight, no lumps, no masses, no tender areas, with clear breath sounds| Heart| ? no abnormal pulsations, pulsations are palpable ; visible in apical area| Breast| ? symmetrical, pinkish nipples, no cracks ; discharges, uniform in skin color, smooth ; intact, no lumps, masses ; tenderness| Abdomen| ? bdominal skin is unblemished, no scars, color is uniform with the body color, abdomen is rounded with symmetric movements caused by respiration; umbili cus is concave| Upper Extremities| ? symmetrical, with visible veins, fine hair evenly distributed, warm, dry ; elastic upon palpation, with area of tenderness on the left arm; palms are pinkish, warm, soft ; elastic; nails are transparent, smooth ; convex with light pink nail beds ; white translucent tips; 5 fingers in each hand; both shoulders, arms, elbows, hands ; wrists can be moved in different range of motion with relative ease; marks of petechial rashes| Lower Extremities| ? kin is smooth, fine hair is evenly distributed, absence of varicose veins, muscles symmetrical, length symmetrical, 5 toes in each foot, sole ; dorsal surface is smooth with pink nail beds ; white translucent tips; both legs, knees, ankles, ; toes can be moved in different range of motion with relative ease| Pathophysiology Predisposing factor Tropical areas Stimulates WBC Bite from mosquito (Aedes Aegypti) Virus enters circulation (Chikungunya Virus)) Virus disseminated to blood Precipitating factor Poo r environmental sanitation Mosquito carrying dengue virus Thermostat change Fever, flash skin and chills Stimulates hypothalamus Release of pyrogen IgG adheres to the platelet (initiates destruction of the platelet) Decrease clotting function thrombocytopenia Possible for bleeding rashes, melena, abdominal pain, low hgb, low hct and low rbc) stimulates intense inflammatory response Related Treatment Drug Infomation| Contraindications| Side Effects/ Adverse Effects| Nursing Intervention| Generic Name: ParacetamolDoctor’s Order: 250mg/5ml5ml p. o. every 4 hoursClassification: Anti-pyreticIndication: Treatment for feverDrug Action:Decrease fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation| Contraindicated with allergy to acetaminophenUse cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Side Effects Stimulation Drowsiness Abdominal painAdvers e Effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5-8g/day are ingested daily for several weeks or when doses of 4g/day are ingested for 1 year GI: Hepatic toxicity and failure, jaundice GU: Acute renal failure, renal tubular necrosis Hematologic: Methemoglobinemia- cyanosis, hemolytic anemia- hematuria, anuria, neutropenia, leukopenia, pancytopenia, thrombocytopenia and hypoglycaemia Hypersensitivity: Rash, fever| Consideration * Assess for the temperature of the patient before giving the medication and during the peak level of the drug. Avoid using multiple preparations containing acetaminophen * Discontinue drug if hypersensitivity reactions occur. * Treatment for overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measure may be necessary. Education * Do not exceed recommended dose; do not take for longer than 10 days. * Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days. * Warn patient that high doses or unsupervised long term use can cause liver damage. * Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns. | Drug Infomation| Contraindications| Side Effects/ Adverse Effects| Nursing Intervention| Generic Name: AmpicillinDoctor’s Order: Ampicillin 500mg IVClassification: PenicillinIndication: Active against: Streptococci, non penicillinase producing staphylococci, Listeria, Pneumococci, Enterococci, Haemophilus influenza, E. coli, Enterobacter, Klebsiella, Proteus mirabilis, Neisseria meningitides, N. gonorrhea, Shigella, SalmonellaDrug Action:Binds to bacterial cell wall, resulting in cell death| Contraindicated with allergy. | Side Effects: diarrhea, nausea and vomiting, rashesAdverse Effects: Seizure| Consideration * Monitor intake and output. * Assess food tolerance. Observe patient for signs and symptoms of Anaphylaxis( rash, pruritus, laryngeal edema, and wheezing) * Assess skin for â€Å"ampicillin rash†, normal allergic, dull red, macular or maculopapular, mildly pruritus. * Obtain a history before initiating therapy to determine previous use and reactions to penicill ins and cephalosphorins. Education * Instruct the patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. * Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus or mucus. | Date| Shift| Bot. #| Kind of Solution| Volume| Drops| CC hr| Time Started| 8/11/2011| 2-10| 1| PLR| 1L| | | 4:40pm| 8/12/2011| 6-2| 2| PLR| 1L| | | 8:05pm| 8/12/2011| 2-10| 3| D5 0. 3 Nacl| 1L| | | 9pm| Laboratory Result Hematology For a Complete Blood Count (CBC), specimens of venous blood are taken, it includes hemoglobin and hematocrit measurements, erythrocyte (RBC) count, leukocyte (WBC) count, red blood cell (RBC) indices, and a differential white cell count. The CBC is a basic screening test and one of the most frequently ordered blood tests. | 08/11/2011 2:54pm| 08/12/2011 10:46am| 08/13/201105:29 pm| Normal Values| WBC| 3. 6| 4. 0| 2. 3| 5. 0 – 10. 0 X 10 g/L| DIFFERENTIAL COUNT| * NEUTROPHIL| 0. 66| 0. 27| 0. 34| 0. 40 – 0. 60| * LYMPHOCYTES| 0. 23| 0. 59| 0. 60| 0. 20 – 0. 40| * MONOCYTES| 0. 10| 0. 12| 0. 03| 0. 02 0. 08| * EOSINOPHILS| 0. 01| 0. 01| 0. 02| 0. 1 – 0. 03| * BASOPHILS| 0. 00| 0. 01| 0. 01| 0 – 0. 02| HEMOGLOBIN | 125| 135| 131| 140 – 175 g/L| HEMATROCRIT| 0. 37| 0. 40| 0. 39| 0. 42 – 0. 48| RBC| 4. 61| 4. 96| 4. 82| 5. 5 – 6. 5 X10 12/L| MCU| 81| 81| 80| 88 – 96| MCH| 27. 2| 27. 2| 27. 2| 27 – 33 pg| MCHC| 338| 337 | 338| 300 – 360 g/L| RDW| 11. 8| 11. 7| 11. 7| 12. 7 – 22. 7 %| PLATELET| 140| 142| 145| 150 – 450 X 10 g/L| MPV| 4. 74| 4. 6| 4. 6| 4. 5 – 7. 5 Fl| Urinalysis Urine tests include tests for specific gravity, pH and the presence of abnormal constituents such as glucose, ketones, protein, and occult blood. 8/11/2011 3:44 PM Urinalysis Macroscopic| | Chemical| | Color:Transparency:Microscopic:RBC:PUS Cells:BacteriaEpithelial CellsMucus ThreadsCrystalsAmorphous UratesAmorphous PhosphatesAmorphous BiuratesCalcium oxalate CastPUS CastCoarse Granular Cast:Fine Granular Cast:Remarks| YellowClearMicroscopic0 – 2 / HPF0 – 2 / HPFFewFewFewFew| SpecificPHNitrate: Protein:Glucose:ketone:Urobilinogen:Bilirubin:Leukocytes:Blood:Yeast Cells:Pregnancy:Micral Test:Others:| 1. 0156. 5NegativeNegativeNegativeNegativeNormalNegativeNegativeNegat ive| Serology Description| Result| Dengue NS: Ag| Negative| Dengue Blot| IgG| Negative| IgM| Negative| Recommendations * Boost immune system through eating rich in vitamin C foods and nutritious well-balance diet. * Increase oral fluid intake. * Call the physician and report any untoward signs and symptoms such as bleeding. Cover water drums and water pails at all times to prevent mosquitoes from breeding. * Replace water in flower vases once a week. * Clean all water containers once a week. Scrub the sid es well to remove eggs of mosquitoes sticking to the sides. * Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes. * Old tires used as roof support should be punctured or cut to avoid accumulation of water. * Collect and dispose all unusable tin cans, jars, bottles and other items that can collect and hold water * Preventive Measures: (CLEAN). Accdg to DOH. Chemically treated mosquito nets Larvae eating fish Environmental clean up Anti mosquito soap/lotion Neem trees/eucalyptus tree