Management of Amlodipine Influenced Gingival Overgrowth

Management of Amlodipine Influenced Gingival Overgrowth Surgical Management of Amlodipine influenced gingival overgrowth in Hypertensive patient. Abstract: Drug-influenced gingival overgrowth (DIGO) is a serious concern both for the patient and the clinician. A number of local and systemic factors such as plaque, hormonal changes, drug ingestion, heredity can cause or influence gingival overgrowth. Certain anticonvulsants, immuno-suppressive drugs and a number of calcium channel blockers have been shown to produce similar gingival overgrowths in certain susceptible patients. Amlodipine is a comparatively new calcium channel blocker may induce gingival overgrowth in case of underlying inflammatory component. A 38-year-old hypertensive female patient on amlodipine (10 mg/day, single dose orally) since eight months, sought dental attention because of the resultant gingival overgrowth. Clinical examination, Medical history and histological assessment further helped to formulate a diagnosis of DIGO. Six weeks after phase-I therapy and drug substitution, undisplaced flap surgery was performed. The patient’s gingiva seemed to be normal at six month follow-up visit, with no signs of recurrence. Key words: Gingival overgrowth, Hypertension, Amlodipine, Undisplaced flap surgery. Drug influenced gingival overgrowth. Introduction: There are many factors (causal or modifying) involved in gingival overgrowth. Plaque accumulation on teeth causes gingival inflammation and may lead to inflammatory enlargement. Gingival overgrowth can be seen in patients with familial hereditary gingival fibromatosis, pregnancy, and leukemia. DIGO is a well-documented side effect of some pharmacologic agents, including, but not limited to, calcium channel blockers (CCBs), phenytoin, and cyclosporine[1,2 ]. It can be a serious concern for patients due to the concomitant unesthetic appearance and the formation of new niches for the periopathogenic bacteria [3]. Despite the relatively high prevalence of nifedipine-influenced gingival overgrowth, [4 ] amlodipine has less frequently been reported as the potential etiologic cause of gingival overgrowth[5] .Amlodipine is a comparatively new long acting dihydropyridine calcium channel blocker that is used in the management of both hypertension and angina. Unwanted effects associated with ch ronic usage of amlodipine are few and are mainly related to vasodilation. The pharmacological effects of these drugs are specific but the clinical and histological features of the enlargement caused by the different drugs are similar. The clinical appearance of DIGO is usually characteristic, although variants are seen depending on the location of lesions, the irritants involved and the extent of inflammation. As the condition progresses, the marginal and papillary gingival overgrowth and may interfere with speech, mastication and aesthetics. In the patients with preexisting periodontitis and DIGO the deepening of periodontal pockets and associated subgingival microbiota may increase periodontal attachment and bone loss. The surgical treatment is a definitive therapy for DIGO, in absence of spontaneous regression following drug substitution and phase-I Therapy. The common surgical technique is the simple excision of the excessive gingival tissue with– external bevel gingivectomy (EBG) or internal (reverse) bevel gingivectomy (IBG). The surgical approach of undisplaced full thickness flap, in this context, is more suitable to eliminate periodontal pockets (Pocket wall) in presence of adequate attached gingiva and to improve the alveolar bone morphology. In the present report, a case of amlodipine-influenced gingival overgrowth (AIGO) has been presented wherein the AIGO was treated in the following phases: (1) substitution of the drug , (2) thorough Phase-1 therapy, (3) surgical excision of the residual gingival overgrowth and (4) maintenance and supportive therapy. Case Description: A 38-year-old female patient was referred to us with complaint of swollen and bleeding gums in the upper and lower jaw. Past medical history revealed hypertension for which the patient received amlodipine (10 mg/day, single dose orally) for the last eight months. The patient had noted a gradual and painless enlargement of the gingiva for first 4 months and then she noticed bleeding gums. A generalized fibrous gingival enlargement with edematous marginal gingiva, owing to superimposed inflammatory component, was found throughout the maxillary and mandibular gingiva (Fig. 1A,B,C,D). Presence of generalized periodontal pockets (≠¥7-8mm) and clinical attachment loss (≠¥5-6mm) was a prominent feature of gingival overgrowth indicating a vertical enlargement of gingiva. Purulent discharge and bleeding on probing were detected which were in accordance with the inflammation. Treatment: On request, patient’s physician substituted amlodipine with Beta Adrenergic blocker (Atenolol), after which, patient was recalled for through scaling and root planing. Oral hygiene instructions, chlorhexidine mouthwash 0.2% of 10ml twice a day was prescribed. At follow-up after six weeks, residual inflammatory component of the enlargement resolved(Fig-2) but the gingival overgrowth needed definitive surgical treatment. Under adequate local anesthesia (xylocaine 2%), the pocket depth was marked, (Fig-3) an internal bevel incision was taken up to the alveolar crest. (Fig-4) Crevicular and interdental incision along the base of the pocket wall was released and full thickness mucoperiosteal flap was reflected. (Fig-5) The excised mass was stored in formalin for further histopathologic investigation. Scaling, root planning and curettage were completed. Osseous resective surgery, using carbide burs, along with copious saline irrigation was done to recontour thickened bony plates, le dges and deep interdental craters. (Fig-6) Flaps were trimmed and approximated using interrupted silk sutures. Routine post surgical instructions, a course of antibiotics and analgesics (Cap. Amoxycillin 500mg three times a day for five days and Ibufrofen 400 mg three times a day for three days) and 0.2% chlorhexidine was prescribed twice a day for fifteen days. Microscopic inspection of the gingival biopsy specimens demonstrated a connective tissue hyperplasia, acanthosis of overlying epithelium and elongated rete ridges together with inflammatory cells. Sutures were removed after 1 week. Healing was uneventful and the patient’s appearance and overall function improved considerably at six month follow up. (Fig-7) Oral hygiene instructions were given from first visit and reinforced in all subsequent visits. Discussion: Amlodipine is a second-generation dihydropyridine CCB that can cause gingival overgrowth. The prevalence of amlodipine-influenced gingival overgrowth has been shown to be between 1.7% and 3.3%[6,7]. Lafziet al.(2006) had reported rapidly developing gingival hyperplasia in patient receiving 10 mg/day of amlodipine within 2 month of onset. [8] The incidence of gingival overgrowth with nifedipine therapy has been reported to be as high as 20%, [9] and a study by Prisant (2002) [10] reported that the prevalence with the use of CCBs might be as high as 38%.Gingival overgrowth considered to be 3.3 times more common in men than in women [10] .The most common form is bacterial plaque–influenced gingival disease, which presents as gingivitis. Use of phenytoin, cyclosporine, and CCBs, as well as vitamin C deficiency, can also predispose to development of gingival overgrowth, as can hormonal shifts during pregnancy. The reason for these adverse events is not absolutely known, but mechani sms involving inflammatory and non inflammatory pathways have been suggested [11]. For example, individual sensitivity to a drug’s metabolic pathway might be a trigger [11]. Untreated gingival overgrowth might lead to bleeding, infection, abscess, ulceration, cosmetic deficiency and/or functional difficulty (eg, chewing, talking) [10]. Treatment of drug-influenced gingival overgrowth includes cessation/replacement of the drug and decreasing other risk factors with meticulous mechanical and chemical plaque control. Replacing the affecting drug with another agent is also recommended when possible[12]. In present case of DIGO patient was under treatment for hypertension since last 8 months and was prescribed tablet Amlodipin 10mg/day by her physician. Thorough SRP and replacing the Amlodipin with Atenolol was done. Drug substitution and thorough SRP did not result into regression of the enlargement. The surgical treatment is a definitive therapy for DIGO, in absence of spontaneous regression following drug substitution and phase-I Therapy. Classic gingival surgery primarily deals with the treatment of pockets – i.e., gingival sulci that are deepened due to a proliferation or an increase in bulk of gingival tissue in a coronal direction, with or without apical migration of the epithelial attachment. External bevel gingivectomy (EBG) and internal bevel gingivectomy (IBG) should be reserved for cases not responding to non surgical methods or severe cases that affect oral hygiene or functionality, or can be performed for cosmetic reasons. IBG approach has the benefit of limiting the large denuded connective tissue wound that results from the external gingivectomy, thereby minimizing postoperative pain and bleeding. It is accepted that gingival surgery (both EBG and IBG) is essentially limited to the treatment of pseudopockets. But if true pockets associated with bone defects are present then undisplaced flap surgery can be the treatment modality for the massive enlargement. The advantages of this technique are removal of pocket wall and osseous contouring simultaneously eliminating the gingival overgrowth and pocket in presence of adequate attached gingiva. In this case report undispalced flap surgery was performed for eliminating pocket and osseous contouring in presence of adequate attached gingiva. However regardless of the treatment option employed, regular maintenance and recall follow up are mandatory to achieve the long term success. Conclusion Gingival overgrowth is an overlooked but potentially harmful side effect of treatment with amlodipine and other calcium channel blockers and every physician should be aware of this, particularly if adverse oral symptoms arise during drug use. The amlodipine influenced gingival overgrowth in this case completely resolved when the patient was switched to Beta Adrenergic blocker (Atenolol) followed by surgical excision of the overgrowth. Another factor contributing to the excellent response to the therapy is the patient compliance in maintaining the oral hygiene. Lastly the patients’ documented data should be shared with the physician to gain his confidence and respect for the dental community. In addition, he will be motivated to refer patients with complains of gum swelling at a much earlier stage or in fact, advice dental consultation for improvement of oral hygiene before prescribing the list of drugs that may influence gingival overgrowth in presence of preexisting gingival inflammation. References 1

Ap Biology Lab 1 Questions

AP Biology Lab 1 Ross Lordo Introduction Questions 1. The solute potential would be -2. 48. If the concentration inside the cell is . 15 M, then would diffusion out of the cell and into the solution of . 1 M. This is due to water potential and the tendency for water to move from areas of high water potential to low water potential. 2. The turgor pressure must be equal to the water potential if there is no net diffusion.The cell and environment have reached equilibrium and the movement of water is equal on both sides. Getting Started 1. Kinetic energy is the energy an object possesses due to its motion. The difference between kinetic energy and potential energy is the kinetic energy is the energy of an object that is already in motion and potential energy is the energy possessed by an object at rest. Potential energy is stored energy, while kinetic energy is energy being exerted. 2.Temperature can affect the rate of diffusion. If the temperature is colder, the rate of diffusion is muc h slower as a result of all particles becoming closer together. If the temperature is warmer, there is much more energy present and therefore allows for the diffusion to take place at a fast rate. The distance a molecule needs to travel across the membrane can also affect the rate of diffusion. If the distance across the membrane is large, then the rate of diffusion will be much slower and vise versa. 3.A high temperature can speed up the diffusion process by providing more energy for the molecules and also for eliminating in double bonds in the phospholipid membrane. A low temperature will decline the rate of diffusion, as the particles will have less energy. The distance travelled will also affect diffusion rates. The longer the distance, the slower the diffusion is going to take place. The shorter the distance, the quicker the rate of diffusion 4. Gradients offer a pathway for molecules to go in and out of the cell.Many molecules are to big to fit through the semipermeable phosph olipid membrane and these gradients allow these large molecules to be able to cross through the cell. 5. Most cells are small because diffusion can take place at a quicker rate. The convolutions allow for more space to be able to be used in order to get molecules across the membrane. These small cells allow for materials to quickly be able to reach the cell membrane and get in or out of the cell, without having to make a long journey from an inside part of the cell. . Water will move out of the cell. The high water potential means there is little solute in the cell and more in the outside environment. In order to balance these concentrations, water moves out of the cell and creates equilibrium with the environment. 7. If saltwater is applied to a plant, the plant would shrivel up and die. This is a result of the water moving out of the cells in order to try to balance the concentration of solute compared to inside the cell.The water movement out of the cell would cause the cell to s hrink and the lack of water would eventually cause the plant to die. 8. A plant can control its turgor pressure through its central vacuole and cell wall. If a great amount of water is inside the cell, the central vacuole will take in some of the water to take some of the pressure of the cell wall. The cell wall can also eliminate water from making its way into the cell. The would cause the cell to keep expanding, but slowly eliminate its excess water.

Lacsap’s Fractions

Lacsap’s Fractions IB Math 20 Portfolio By: Lorenzo Ravani Lacsap’s Fractions Lacsap is backward for Pascal. If we use Pascal’s triangle we can identify patterns in Lacsap’s fractions. The goal of this portfolio is to ? nd an equation that describes the pattern presented in Lacsap’s fraction. This equation must determine the numerator and the denominator for every row possible. Numerator Elements of the Pascal’s triangle form multiple horizontal rows (n) and diagonal rows (r). The elements of the ? rst diagonal row (r = 1) are a linear function of the row number n. For every other row, each element is a parabolic function of n.Where r represents the element number and n represents the row number. The row numbers that represents the same sets of numbers as the numerators in Lacsap’s triangle, are the second row (r = 2) and the seventh row (r = 7). These rows are respectively the third element in the triangle, and equal to each other bec ause the triangle is symmetrical. In this portfolio we will formulate an equation for only these two rows to ? nd Lacsap’s pattern. The equation for the numerator of the second and seventh row can be represented by the equation: (1/2)n * (n+1) = Nn (r) When n represents the row number.And Nn(r) represents the numerator Therefore the numerator of the sixth row is Nn(r) = (1/2)n * (n+1) Nn(r) = (1/2)6 * (6+1) Nn(r) = (3) * (7) Nn(r) = 21 Figure 2: Lacsap’s fractions. The numbers that are underlined are the numerators. Which are the same as the elements in the second and seventh row of Pascal’s triangle. Figure 1: Pascal’s triangle. The circled sets of numbers are the same as the numerators in Lacsap’s fractions. Graphical Representation The plot of the pattern represents the relationship between numerator and row number. The graph goes up to the ninth row.The rows are represented on the x-axis, and the numerator on the y-axis. The plot forms a parabo lic curve, representing an exponential increase of the numerator compared to the row number. Let Nn be the numerator of the interior fraction of the nth row. The graph takes the shape of a parabola. The graph is parabolical and the equation is in the form: Nn = an2 + bn + c The parabola passes through the points (0,0) (1,1) and (5,15) At (0,0): 0 = 0 + 0 + c ! ! At (1,1): 1 = a + b ! ! ! At (5,15): 15 = 25a + 5b ! ! ! 15 = 25a + 5(1 – a) ! 15 = 25a + 5 – 5a ! 15 = 20a + 5 ! 10 = 20a! ! ! ! ! ! ! therefore c = 0 therefore b = 1 – a Check with other row numbers At (2,3): 3 = (1/2)n * (n+1) ! (1/2)(2) * (2+1) ! (1) * (3) ! N3 = (3) therefore a = (1/2) Hence b = (1/2) as well The equation for this graph therefore is Nn = (1/2)n2 + (1/2)n ! which simpli? es into ! Nn = (1/2)n * (n+1) Denominator The difference between the numerator and the denominator of the same fraction will be the difference between the denominator of the current fraction and the previous fraction . Ex. If you take (6/4) the difference is 2. Therefore the difference between the previous denominator of (3/2) and (6/4) is 2. ! Figure 3: Lacsap’s fractions showing differences between denominators Therefore the general statement for ? nding the denominator of the (r+1)th element in the nth row is: Dn (r) = (1/2)n * (n+1) – r ( n – r ) Where n represents the row number, r represents the the element number and Dn (r) represents the denominator. Let us use the formula we have obtained to ?nd the interior fractions in the 6th row. Finding the 6th row – First denominator ! ! ! ! ! ! ! ! ! ! ! ! – Second denominator ! ! ! ! ! ! ! ! ! ! ! ! ! denominator = 6 ( 6/2 + 1/2 ) – 1 ( 6 – 1 ) ! = 6 ( 3. 5 ) – 1 ( 5 ) ! 21 – 5 = 16 denominator = 6 ( 6/2 + 1/2 ) – 2 ( 6 – 2 ) ! = 6 ( 3. 5 ) – 2 ( 4 ) ! = 21 – 8 = 13 ! ! -Third denominator ! ! ! ! ! ! ! ! ! ! ! ! – Fourth denominator ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! – Fifth denominator ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! denominator = 6 ( 6/2 + 1/2 ) – 3 ( 6 – 3 ) ! = 6 ( 3. 5 ) – 3 ( 3 ) ! = 21 – 9 = 12 denominator = 6 ( 6/2 + 1/2 ) – 2 ( 6 – 2 ) ! = 6 ( 3. 5 ) – 2 ( 4 ) ! = 21 – 8 = 13 denominator = 6 ( 6/2 + 1/2 ) – 1 ( 6 – 1 ) ! = 6 ( 3. 5 ) – 1 ( 5 ) ! = 21 – 5 = 16 ! ! We already know from the previous investigation that the numerator is 21 for all interior fractions of the sixth row.Using these patterns, the elements of the 6th row are 1! (21/16)! (21/13)! (21/12)! (21/13)! (21/16)! 1 Finding the 7th row – First denominator ! ! ! ! ! ! ! ! ! ! ! ! – Second denominator ! ! ! ! ! ! ! ! ! ! ! ! – Third denominator ! ! ! ! ! ! ! ! ! ! ! ! – Fourth denominator ! ! ! ! ! ! ! ! ! ! ! ! ! ! denominator = 7 ( 7/2 + 1/2 ) – 1 ( 7 – 1 ) ! =7(4)–1(6) ! = 28 – 6 = 22 denominator = 7 ( 7/2 + 1/2 ) – 2 ( 7 – 2 ) ! =7(4)–2(5) ! = 28 – 10 = 18 denominator = 7 ( 7/2 + 1/2 ) – 3 ( 7 – 3 ) ! =7(4)–3(4) ! = 28 – 12 = 16 denominator = 7 ( 7/2 + 1/2 ) – 4 ( 7 – 3 ) ! =7(4)–3(4) ! = 28 – 12 = 16 ! ! ! ! ! ! Fifth denominator ! ! ! ! ! ! ! ! ! ! ! ! – Sixth denominator ! ! ! ! ! ! ! ! ! ! ! ! denominator = 7 ( 7/2 + 1/2 ) – 2 ( 7 – 2 ) ! ! =7(4)–2(5) ! ! = 28 – 10 = 18 ! ! denominator = 7 ( 7/2 + 1/2 ) – 1 ( 7 – 1 ) ! =7(4)–1(6) ! = 28 – 6 = 22 We already know from the previous investigation that the numerator is 28 for all interior fractions of the seventh row. Using these patterns, the elements of the 7th row are 1 (28/22) (28/18) (28/16) (28/16) (28/18) (28/22) 1 General Statement To ? nd a general statement we combined the two equations needed to ? nd the numerator and to ? nd the denominator. Which are (1/2)n * (n+1) to ? d the numerator and (1/2)n * (n+1) – n( r – n) to ? nd the denominator. By letting En(r) be the ( r + 1 )th element in the nth row, the general statement is: En(r) = {[ (1/2)n * (n+1) ] / [ (1/2)n * (n+1) – r( n – r) ]} Where n represents the row number and r represents the the element number. Limitations The ‘1’ at the beginning and end of each row is taken out before making calculations. Therefore the second element in each equation is now regarded as the ? rst element. Secondly, the r in the general statement should be greater than 0. Thirdly the very ? rst row of the given pattern is counted as the 1st row.Lacsap’s triangle is symmetrical like Pascal’s, therefore the elements on the left side of the line of symmetry are the same as the elements on the right side of the line of symmetry, as shown in Figure 4. Fourthly, we only formulated equations based on the second and the seventh rows in Pascal’s triangle. These rows are the only ones that have the same pattern as Lacsap’s fractions. Every other row creates either a linear equation or a different parabolic equation which doesn’t match Lacsap’s pattern. Lastly, all fractions should be kept when reduced; provided that no fractions common to the numerator and the denominator are to be cancelled. ex. 6/4 cannot be reduced to 3/2 ) Figure 4: The triangle has the same fractions on both sides. The only fractions that occur only once are the ones crossed by this line of symmetry. 1 Validity With this statement you can ? nd any fraction is Lacsap’s pattern and to prove this I will use this equation to ? nd the elements of the 9th row. The subscript represents the 9th row, and the number in parentheses represents the element number. – E9(1)!! ! – First element! ! ! ! ! ! ! ! ! ! ! ! ! – E9(2)!! ! – Second element! ! ! ! ! ! ! ! ! ! ! ! ! – E9(3)!! ! – Third element! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 1( 9 – 1) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 1( 8 ) ]} {[ 45 ] / [ 45 – 8 ]} {[ 45 ] / [ 37 ]} 45/37 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 2( 9 – 2) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 2 ( 7 ) ]} {[ 45 ] / [ 45 – 14 ]} {[ 45 ] / [ 31 ]} 45/31 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 3 ( 9 – 3) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 3( 6 ) ]} {[ 45 ] / [ 45 – 18 ]} {[ 45 ] / [ 27 ]} 45/27 E9(4)!! ! – Fourth element! ! ! ! ! ! ! ! ! ! ! ! ! – E9(4)!! ! – Fifth element! ! ! ! ! ! ! ! ! ! ! ! ! – E9(3)!! ! – Sixth element! ! ! ! ! ! ! ! ! ! ! ! ! – E9(2)!! ! – Seventh element! ! ! ! ! ! ! ! ! ! ! ! ! â₠¬â€œ E9(1)!! ! – Eighth element! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! [ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 4( 9 – 4) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 4( 5 ) ]} {[ 45 ] / [ 45 – 20 ]} {[ 45 ] / [ 25 ]} 45/25 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 4( 9 – 4) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 4( 5 ) ]} {[ 45 ] / [ 45 – 20 ]} {[ 45 ] / [ 25 ]} 45/25 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 3 ( 9 – 3) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 3( 6 ) ]} {[ 45 ] / [ 45 – 18 ]} {[ 45 ] / [ 27 ]} 45/27 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 2( 9 – 2) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 2 ( 7 ) ] } {[ 45 ] / [ 45 – 14 ]} {[ 45 ] / [ 31 ]} 45/31 {[ n( n/2 + 1/2 ) ] / [ n( n/2 + 1/2 ) – r( n – r) ]} {[ 9( 9/2 + 1/2 ) ] / [ 9( 9/2 + 1/2 ) – 1( 9 – 1) ]} {[ 9( 5 ) ] / [ 9( 5 ) – 1( 8 ) ]} {[ 45 ] / [ 45 – 8 ]} {[ 45 ] / [ 37 ]} 45/37 From these calculations, derived from the general statement the 9th row is 1 (45/37)! ! (45/31)! ! (45/27)! (45/25)! (45/25)! (45/27) (45/31)! (45/37)! ! 1 Using the general statement we have obtained from Pascal’s triangle, and following the limitations stated, we will be able to produce the elements of any given row in Lacsap’s pattern. This equation determines the numerator and the denominator for every row possible.

Subliminal Advertising and Modern Day Brainwashing

The advertising industry, a prominent andpowerful industry, engages in deceptive subliminal advertising which most us are unaware of. By bypassing our unconscious mind using subliminal techniques, advertisers tap into the vulnerabilities surrounding our unconscious mind, manipulating and controlling us in many ways. Since the 1940 s subliminal advertising blossomed until now, when you can find subliminals in every major advertisement and magazine cover. Legislation against the advertisers has had no effect in curbing the use of subliminals. In this Information Age, it seems people are no longer in control of the people. The ones in control are the ones with knowledge (as usual). In this case, the advertisers have it; you don t. Until†¦show more content†¦Despite the lack of conventional scientific evidence, I believe there exists a consciousness that lies outside of our normal awareness. Although I will later provide evidence, the paper assumes the existence of such a phenom enon. Introduction What is your favorite ad on TV or in a magazine? Why do you like it? Is it the dry humor? Or the dramatic irony? Advertisers use subliminal techniques to put hidden messages into their ads. By now, your subconscious mind has a full load of them, each expertly targeted by the advertisers. Although the exact consequences are unknown, one can guess it is like being brainwashed every time you see an ad. Heaving Breasts Do advertisers really put subliminal messages on their ads? Let s explore this topic. Go to the vending machine and buy a can of Diet Cokeâ„ ¢. The can looks pretty ordinary--script letters on white bubbles floating on a silver can. Turn your attention now to the passion red glass on the lower left and hold the can arm s-length away from you. Do you see them now? Almost everyone I have shown the can to readily perceived the sexual image. 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Disney Disney And Mental Illness - 1216 Words

Disney and Mental Illness It is well known that children are very easily influenced by what they see in the world, especially in the media. Disney has undoubtedly monopolized the hearts and brains of children all around tihe world, so they have an extreme amount of power in the way they portray things. Whether it be the way they portray gender, families, or mental illness, these portrayals affect their audience on a deep psychological level. The way that mental illness is portrayed is a lot harder to detect than some other topics like gender and families, but they are just as damaging. Disney needs to strive to portray mental illness as something that is genuinely human rather than something that is evil. While it s obvious that Disney needs to adjust their view of mental illness, this goal isn’t something that can be changed overnight. Disney has taken the concept of mental illness and turned it into something to define someone by. The sheer amount of mental illness referenced in Disney movies is somewhat shocking. In a study by Andrea Lawson and Gregory Fouts it was discovered that, â€Å"Combining principal and minor characters, a total of 85% of Disney animated films contained references to characters with mental illness†(Fouts). Disney is also very complex in the way that they portray certain mental illnesses, they take any character that is supposed to be misunderstood and slap on a mental illness, â€Å"Disney seems to be saving that madness is a label that society uses whenShow MoreRelatedThe Correlation Between Disney Movies and Poor Body Image in Young Women1406 Words   |  6 PagesDisney was named the worlds second top media company in the US for the year 2 004. They have produced over 44 â€Å"classics† and are one of the most recognized names in animated film (Peterson).We expose young girls to these animated films at a very young age, yet doing so does not seem to be good for these children. 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Notes On Disability And Empowerment - 1170 Words

Ademola Adeshina Disability and Empowerment This essay will discuss the term - learning disability or (learning difficulties – a term sometimes used interchangeably) and some possible causes. The nature and role of advocacy as a part of the empowerment process will also be considered. All these will be done in relation to Kelly – a person with Down’s syndrome as a case study. It will explain the progress made with Kelly by her support workers and how these can be further developed to ensure a more independent and meaningful life. According to Paul Williams, ‘Learning Difficulty’ cannot be defined (social work with People with Learning Difficulties). Arriving at a generally acceptable definition of learning disability is a difficult†¦show more content†¦The medical model sees learning disability as a condition that needs to be cure in order for disabled people to live a ‘normal’ life. The model sees the disabled people as the problem not the society. In contrast, the social model argues disability to be the result of the way society is organised. According to this model, the society disabled people by way of discrimination and barriers to allow equal participation. With regards to Kelly, we can conclude she has experienced the two models of learning disability. She has a condition known as Down’s syndrome, a genetic condition caused by the presence of an extra chromosome 21 in the body cells. This condition is neither a disease nor an ailment (Down’s Syndrome As sociation UK). Down Syndrome, like Autism, Asperger, Tourette syndrome and Dyslexia are some of the many types of learning disabilities in the UK. In an attempt to explain the level of Kelly’s disability, an in-depth explanation of the various levels of learning disabilities will now be examined. These can be grouped into four categories; Mild, Moderate, Severe and Profound. Mild – people with mild learning disability are usually able to engage in conversation, they may be able to perform some basic activities on their own, they may need support to understand

Key Issues and Handling of Organisation-Free-Samples for Students

Questions: Disucss about the Importance and Role that Better Organisational Behaviour Plays In the Development of Business. Answers: Introduction The report elucidates the importance and role that better organisational behaviour plays in the development of business. In this particular report the case study of Ken Pvt Ltd. has been given which deals with Dogma International and promised the client to provide 10 years newspaper in digitisation format in 2 months. But the agreement was not maintained. After 2 months only 2 years paper were digitised that too with the poor image quality that highly disappointed the client (Kitchin, 2017). On analysing there were various mistakes that have been found which is discussed within the report along with the solution to this challenge. The hindrances and help have been discussed along with the key concepts in relation to organisational behaviour followed by the issues that happened in the case and concluded with the recommendations by giving suggestions to the organisation so that mistakes are not repeated in the future. Identification of key issues Ken private limited is situated in Texas, United States and was established in the year 1991. The main motive of the company is to outsource the knowledge and rendering the technological services. The information is provided to the client in an effective and cost-efficient manner. The company deals in the fabrication service and knowledge service. In the fabrication services the information digitization takes place using XML, mark-up services, setting up the image, conversion of data, creating the technological services to develop services and translation of services. The knowledge services involves within the tact to expand the content, improvement of vocabulary, taxonomy, hyperlinking the important links and marking it up, indexing the content and designing the abstract and undergoing the other editorial services (Walumbwa, Hartnell Misati, 2017). The technological area focuses on the designing, implementation, integrity and deployment to the author, managing and distributing cont ent to the client. The company is renowned enough for its outstanding performance. The company has opened the outlets in America, Europe and Asia where around 5000 employees are employed and net worth that the company holds is $90 million as per the year 2004 (Ken Group, 2015). The case demonstrates that Ken Private limited got the big project to work on the Genesis Times; the Genesis Digitization project wants Ken to create the project for their client Dogma International. Dogma International demanded for digitized newspapers covering the 150 years. Ken assured the client to present the digitisation of 10 years in the 2 months. Due to the occurrence of certain issues the promise was not fulfilled by Ken in the given time duration and Dogma International gave the warning to Ken that in case if the Company is not able to meet the commitment then company might take back the order and revoke the contract. This created the situation of panic for Ken and working gets faster along with the monitoring where the company is lacking and to repair the patches thereby finding out the root cause of the discrepancies. On analysis the study key issues and challenges appeared are that basically there was lack of communication among the staff. The project manager Sharma distributed the work into 2 sections on of them was Indian section dealing with development of technology and then passing it to the Philippines so that they can start working upon the digitisation process. The Philippines section was divided in 5 departments and each section has 1 head that report to the project manager. The issue was that Philippine section was facing the challenge in using the technologies designed by the Indian section and the staffs are not supporting eth project manager as well (Pandey, Breslin Broadus, 2017). When Sharma, called up the meeting no one uttered a single word and neither anybody raised some sought of query at the time meeting. The project manager gets to know about the actual issues when the 2 departments were having their mutual talks and were sharing the complaints with each other. The technolog ies designed were too high then the level of understanding of Philippines section and they were neither briefed about the technology nor were the employees given training to handle the technology and input the data within the designed digital format. Whereas the Indian section claims that the Philippines section are not patient enough to wait for the technology and the employees are not aware enough about the correct usage of technology that has been invented. This cause delay in working and making the client dissatisfied (Morgan, 2015). Describing the issues in context of organisational behaviour concept The organisation comprises of collectiveness of the human being working on the different departments but focusing on the single vision and moving forward in the similar direction. The organisation is an ever changing unit where dynamism takes place and the human resource should be made resistant to these challenges and takes it as the opportunity to create wonders (Goller Harteis, 2017). Organisational behaviour is the combination of human resources from different culture following various traditions. The organisation should treat all the culture and tradition equally and to create harmony there is a need to develop the organisational culture need to be developed and every person employed need to respect it and abide by that culture. The organisational behaviour is the conduct that has been carried out within the workplace. In the organisational behaviour the employees working is analysed and bonding gets created and the group of humans come together to support the facts and they co llectively work for achievement of the goal which lead to simultaneous development of organisation along with the employees thereby ensuring the common growth (Tsang, 2017). There are various challenges that the organisation faces. Comparing these issues with that of the Ken Private ltd. the key concept of organisation and reason for delay could be realised and wise step could be initiated to repair these challenges and adopt it as the opportunity to ensure development (Johns, 2017). The organisational challenges that occur in Ken Pvt. Ltd. are quoted as under: Managerial challenges: The managerial challenge is faced at the management level, as per the case study even the manager is in dilemma as the situation is not clear and even on holding the meeting no one spoke out a single word, no complaint came out and later on the heads of department complaint mutually that manger will favour the technical side only and blame the Philippines section (Tafti, Mahmoudsalehi Amiri, 2017). Also there is the major cause of workforce diversity that is also the cause of problem; the organisation has been divided into the Indian section and Philippines Section. The education and behaviour of the people differs and that cause the understanding issues and conflict arises. Most of the time small thing rise to get big and converts into the disputes (Kashyap, 2017). Work Place Issues and Challenges: When more than two people come together for the common cause there is likely to have the mismatch in choice and disagreements might take place, these are known as the workplace issues and challenges (Cartwright, 2017). The issue that took place in most of the workplace are employee privacy, employee right which is most common issue and for that the legal actions could be opted as well, unionism is another issues and this could be quoted in the context of Ken the 2 sections have been distributed but later on there arouse the cold war and silent fight among the employees. The expectations of employees are also the factor that causes issues they need the hike, motivation and job satisfaction, also the need and level of motivation differs from person to person (Brett, 2017). Organisational challenge: The above challenges at the end affect the progress of the organisation only. The case study also faces the organisational problems, in the clients project there is the occurrence of quality issues. The total quality management is not maintained and in the era where quality consciousness is given high priority the organisation and the employees need to maintain the high quality. This is because of conflict arising among the employees and the gap of understanding. Lack of knowledge among the employees is also one of the reasons (Potential project, 2017). The employees are not able to handle the technology that has been designed and neither the training of advancement has been given. Adaptability does not arrive only with accepting the challenge but also by learning to use it in the effective manner. Another measure that always makes the difference is ethical behaviour of the peers, superior and subordinate. Half of the things get back to place when the situat ions are ethically handled with maturity (Shah, Irani Sharif, 2017). How the issues help or hinder the delivery of project to client As per the case study the issues hindered the project of the client but in other way round helped the manager to learn a lot of lessons from every issues that arises. The manager gains the experience to solve out the situations and deal with the sad employees and handling the angry client as well. The hindrances that occurred while delivering the project was that first of all the committed work was not offered to the client (Tagove, 2017). The promise was made that 10 years newspaper digitisation will be delivered within 2 months whereas the actual delivery was of 2 years newspaper digitisation that is not even quarter of the commitment accomplished. Also the brief project was not as per the standard quality causing high dissatisfaction among the client. The final warning was given to Ken to deliver the assured work with the high quality and completely digitised within the next 2 month. These 2 months could be considered as the help in delivering the better project as in the first ch ance the mistakes came up and the reasons were figured out that were becoming the cause of causing the mistakes (Campos-Melady, Smith, Meyers Godley, 2017). The COO Saiyumn Savarker was called upon to analyse the situation and undertake the evaluation technique to understand the actual situation that is prevailing and what wrong is happening in the process that is causing barrier in the process. On reviewing the situation and having word with project manager Sharma, Savarker was driven deep to know what the actual issue that the organisation and its employees are facing. As the employees made the countless efforts and advanced technology was created and the other team wisely and patiently adopted the technology after handling lot of hectic. The Quality assurance department also assured that quality given was 99.95% accurate and appropriate headlines, sub-headlines, by-lines, images and captions have been quoted (Dunn et al, 2017). When the issue is discussed with Dogma it was figur ed out that the manager did not consulted the Dogma International for once that what actually the requirements are and they are performing the activities as per their method. The help portion that Dogma stated is that the text portion was good and satisfied as per the quality defined but the images were not of the appropriate quality. The images are first thing that the customer notices and get attracted with it. The client was of the view that no one from the contacted company ever contacted them to know the specifications or deal with something to get clarification upon the things. When the same is communicated by Savarker to the project manager Sharma they come up with the reply that they never thought of it and it was not in their knowledge that they should consult the client once a while detailing the concerned with the progress that is taking place and what all amendments does they require. Finally the company was aware about total issues and challenges that occur and complete ly understood the specification that the client require, also now they have the idea that conformation from the client should be timely taken so that the confusion and assumptions are avoided (Burke, 2017). After the hindrance if discussing upon the help portion the complete project made the situation clear and gave each and every person of the organisation dealing with this project about the lot of learning. The handling of technical things, adopting of new things, organisational environment, relations with peers, subordinates and superior are clarified and its importance is learned by the employees and manager as well. The manager learn to handle the stressful situation along with dealing with the client and how the project should be handled, what are the primary things that need to be kept in mind and that are basic to be known and practiced (Conroy et al, 2017). Recommendations After analysing the case study and learning about the whole situations there are certain recommendations that could be made so that better learning could be developed. First of all there is the need to appropriately learn about the organisational structure. The manager should firstly understand about the organisation and what specification does the company carries. The organisational culture has to be studied so that the knowledge regarding internal environment is gained and fighting out with the external environment become easier. When the manager is aware about the internal structure and capability of the company then decision making related to the external environment ease up and manager could smartly deal with the market area and chose those deals that are beneficial for the company after evaluating all the aspects of business, its budget, capacity to take risk, being creative and innovative, ability to adopt new technology and many more things are attached while developing the k nowledge of organisational behaviour (Miterev, Turner Mancini, 2017). When the project was handed over to Ken by Dogma International the foremost mistake that the project manager Sharma did was not clarifying the specifications and directly started working upon it and bifurcating the departments. When the sections were made the cooperation started lacking. The Indian section was designing the technology which was far advanced and the Philippine section was not able to handle those technologies and formats. Both the sections had to sit back and talk upon the issues that have occurred so that clearance is made and they could understand the actual problem all the department is facing. They chose to talk among each other instead of interacting with each other. Even the cooperation with the manager was not there. This depicts that organisational structure and management was not adequate and this completely affected the organisational behaviour (Stanley, Matthews Davidson, 2017). On get ting the warning from client the COO scrutinized the situation and communicated with related parties and came to know about the real reason and then the situation was brought under control. Therefore the manager needs to clear out the specification first and accordingly the responsibility is distributed as per the competencies. Timely meeting should be held to check the progress and discuss the issues if any so that they could be resolved early and employment relations also get maintained that is essential for the growth of organisation and the employees (Johnson, 2017). Conclusion Hence, it could be conclude from the above report that organisational behaviour carries an utmost importance in the regulation and success of business. Due to the lack of management the organisation was not able to achieve the required objective. As happened in the case study between Ken and Dogma International. The client company was not asked the requirements nor were they made to have a check over the project only final submission was made without any prior draft been submitted as a sample. On calling the COO from India to Philippine the expert took a look and made out the way to learn things. Though many issues were created but the employees as well as the managers get to learn from the mistakes and paid attention over the points which were lacking so that the mistakes are not repeated in future. References Brett, J., Brett, J. (2017). Intercultural challenges in managing workplace conflicta call for research.Cross Cultural Strategic Management. Burke, W. W. (2017).Organization change: Theory and practice. Sage Publications. Campos-Melady, M., Smith, J. E., Meyers, R. J., Godley, S. H., Godley, M. D. (2017). The effect of therapists adherence and competence in delivering the adolescent community reinforcement approach on client outcomes.Psychology of Addictive Behaviors,31(1), 117. Cartwright, S. (2017). 7 Workplace well-being: responsibilities, challenges and future directions.A Research Agenda for Human Resource Management, 114. Conroy, S., Henle, C. A., Shore, L., Stelman, S. (2017). 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