Mormon religion strengths and weakness Essay

The Mormon religion was initially recognized as Church of Jesus Christ and is a restoration of the earlier church that had been found by Jesus. According to the â€Å"facts† article, there are around 14 million Mormon followers and do meet in roughly 30, 000 congregations globally. It was established by Joseph Smith in the year 1830 in USA. It teaches that Christianity is apostate and actually God had raised Joseph Smith to be a prophet in order to restore Christianity. They believe that the use of the bible is not enough to reveal what we ought to know and believe that all the revelations that were discovered by Smith were scriptures. They base their system of religion on doctrines as well as covenant books. Mormonism does teach that there was a time that God was actually a man hence, man may one day become God. It is therefore imperative to have a limelight on the strengths and weakness of the Mormon religion. According to the â€Å"Mormon religion† article, one of the weaknesses in this religion is that most of Joseph’s prophesies never come to pass. Thus most people argue that he was not really a prophet of God. In 1891, Joseph alleged that before he attains 85 years, Jesus Christ would come back. He however did not reach the age of 85 since he got murdered in the year 1844. Jesus Christ did not return. He had false prophesies. For example, he prophesied in the year 1832, that the USA civil war, that the British would be involved and it would extend globally. He also prophesied on government’s demise at Missouri because he was displeased with the government but it never came to be. Smith just revealed on what a false prophet he really was. One of its strengths is that it appears good to people who have no idea of the scriptures. They have a well organized as well as large amounts of money for backing it. They hardly teach their weird beliefs until later when one gets baptized. The religion is weak as far as scripture base is concerned. The prospective Mormons are usually persuaded to worship God and ask if Mormon’s book is really true. They are encouraged by being told that the reply will come via burning sensation coming from their bosom. However, most of them do not even bother to have a look at this book. Mormons do not follow the scriptures of their book thus rendering the religion weak. Mormon religion promotes discrimination. It teaches that the beings which fought valiantly for God had come to the earth as the whites and those who did not fight were blacks. Therefore, for many years the blacks could not be appointed as priests in the Mormon religion and worship system (Michael, 2006). Joseph Smith believed that the Negroes were inferior in the society and also believed that if the black people would be treated in the same way as others they would prove to be more productive, intelligent and prosperous. This has led to so much controversy rendering the religion to be racist. The church also advocate for polygamy. Though they may have some strange doctrines they have some strengths too as far as the religion is concerned. Members of the Mormon religion are better than other religions as far as sustaining of the marriage culture is concerned (Maggie, 2007). They usually do this through participating successfully and fully in the modern life. Approximately 77% of teenagers aged between 13 and 17 condemn fornication and support sex only for the married people (Maggie, 2007). They believe that sex before marriage is wrong and its pleasurable if saved only for marriage. The Mormon members are unlikely to have children out of wedlock (Maggie, 2007). Also their other strength is that they believe in an evidentiary faith. They believe that people can go to God and receive some answers that they need and this essentially is the ground base of religion. The weakness in this base is that, if the followers do not succeed after praying, they end up leaving the church since most of them do it for evidence purposes. According to the â€Å"advantages of Mormonism’ article, the strength of Mormonism is that it is usually open as far as history and science is concerned as compared to the conservative evangelicalism. However, most of the vital elements of this religion are not proven scientifically and their book is hard to explain. Also the Mormon religion is so much centered scientifically thus does not solve most of the theological problems. When it comes to practical religions, Mormons are better than most. They have welfare system that takes care of their fellow colleagues and do practice fellowship. Their welfare system does focus mostly on social issues, health matters and issues to do with infrastructure. The Mormon Church has a weakness since it does not make it very easy for its members to finally leave the church (Richard, 2009). It usually knows better than the members know and usually protects one against them. This is a weakness since everybody has the freedom to worship. In the US and other democratic unions one is guaranteed the freedom of religion and association. Whether or not the Mormon is a religion that can be relied on or not, that is not the main issue. The main issue is that it has both flaws as well as strengths and it is up to the people to decide whether to be involved in it or not. Works Cited Advantages of Mormonism. Mormon metaphysics and theology. (2007). Retrieved 20, May, 2010

Banking Concept of Education: Paulo Freire Dislikes Essay

Paulo Freire severely scrutinizes the banking concept of education. He dislikes everything about the traditional teaching method, where the teachers just fill the students with information and hope the students retain it long enough to spit it back out to them on tests. He argues that students are led to â€Å"memorize mechanically† the information lectured by a teacher. He would strongly oppose the use of grades in the schooling system. Truly, students are getting graded on how well they can memorize random facts as the tests that encourage memorization of material make up a very large portion of the grading system. In his strong argument against the banking concept of education, Freire gives in a little to the opposition, as he admits, â€Å"they [students] do, it is true, have the opportunity to become collectors or cataloguers of the things they store.† I feel that this is the key to individuality in school. Freire is correct in the way that he portrays the schoolin g system. Students mostly just receive and memorize information from their teachers; thus, they never really critically think about the material. Nevertheless, the techniques that each individual student learns and masters to accomplish these demands shape his/her success later in life. I agree with Freire that, with respect to truly learning the material and retaining the knowledge for a long period of time, simple memorization is very poor. Last year, I took an AP United States History course. The material covered in the course was the same as the material I â€Å"learned† in my eighth and ninth grade United States history classes. The only difference was that this time around, we were going to study the content further in-depth, which Freire might find pleasing. Once the course got underway, I soon realized that I had to completely relearn the material, as I had completely forgotten everything I learned in the eighth and ninth grade classes. It was not because I did poorly back then, but because after the ninth grade class was over, I had no need to retain that information. I was no longer being graded on United States history, and thus, I flushed that information out of my brain to make room for new material to memorize. Once my senior year AP course began, all of the similar material seemed new to me. In Doing School, Denise Clark Pope explains a very similar phenomenon that Eve Lin experienced. â€Å"Once she took an exam, she said most of the facts she had memorize ‘emptied out of her brain.’ She was required to move on to the next assignment to keep up with the pace of the class. Taking time to reflect or to engage with the material would only slow her down and adversely affect her grades.† (Pope 155-56). Freire would oppose this. He would want students to slow down and really analyze the information thoroughly. On the other hand, I feel that in today’s fast-paced society, being able to sh ift gears so quickly is a necessary trait. I attended a medium-sized school, Saucon Valley School District, all the way up from kindergarten. With about two hundred students graduating each year, we all knew each other fairly well. However, since sixth grade, I embarked on a journey with about twenty other students. We chose to follow the path of an â€Å"honors student† taking more rigorous classes than others. We attended almost all of the same courses every day of the year and got to know each other and hang out with each other outside of school a lot more than with others in the grade. By high school, we were so closely knit that someone came up with the name, the â€Å"honors family,† and it just stuck with us ever since. The label was true though. It was like a family, as study sessions were conducted before big tests and all-nighters were pulled for group projects. We pushed each other to do better and worried when others were falling behind. Yet, just like most of the students in Doing School, we were very competitive about our grades as we strove to get the highest marks on a test or paper. I do not believe any of us went as far as Eve Lin did though, in relation to keeping her summer college class a secret just so that she had an edge on everyone else (Pope). Although it was not as extreme as in Faircrest High School, competition in the â€Å"honors family† at Saucon Valley was definitely present. Competition, motivation to succeed, and enthusiasm was amongst the â€Å"honors family.† I wish the same could be said about the rest of the grade. During my senior year, I decided to take Calculus I and II at Lehigh University, and thus, had scheduling conflicts at high school. The Honors Government and Economics class overlapped with my Calculus courses, so I needed to simply take the regular class of Government and Economics. Here, I got a glimpse of how other classmates performed in class. I interacted with many of these students in extracurricular activities and even in Physical Education, but very rarely in a core class. The desire to learn was very low in my Government and Economics class. It was not that these students were not intelligent. They just merely did not care about their grades, GPA, or class rank. Many of these students were perfectly fine with getting a C in the class. After all, a C was a passing grade. Passing was all that mattered to them. Many were fine with doing the minimum to get by just so that they could graduate high school and adventure out into the work force. The teacher seemed to realize the situation as well; she gave very little work to the class throughout the semester and based the tests off of the already-filled-in note packets she handed out regularly. Very little material was covered, even though the class lasted over ninety days. Overall, this class seemed like a complete waste of time for me. I was not coping with stress, competition, or a rigorous curriculum like I had for the rest of my classes. There was very little motivation for me to truly gain knowledge from the class as well, since I was already getting an A in the class and did not need to take time away from my other classes to study for tests. After taking the class and looking back upon it now, I realized that I can take literally nothing productive from it. It was a waste of time that did not provide me with any skills necessary or helpful for my life after schooling. Unlike the average students’ classes, the â€Å"honors family† classes gave me the necessary practice for the real world. I received so much more knowledge than others on how to succeed even with obstacles in my way. These traits and techniques on how to succeed are very similar to those Denise Clark Pope outlined in the conclusion of Doing School. Throughout high school, I gained and perfected an absolutely necessary trait of success: time management. The five students at Faircrest High School were always making the best of their time. They worked on homework during class periods and took free periods and weekends as a time to catch up with their work (Pope). Similarly, I needed to do the same if I wanted to keep up with the â€Å"honors family† work. I participated on the school soccer team in the fall, basketball team in the winter, and baseball team in the spring. The time after these extracurricular activities was insufficient to complete my work. I needed to use as much free time throughout my day as possible to complete assignments. As one might imagine, one evil coming from such a workload and extracurricular activities is stress. The students Pope researched at Faircrest all underwent stress. I, as well, was under an enormous amount of stress. Big projects seemed to always be due at the same time, and final exams were always clumped together in a two-day span. Many members of the â€Å"honors family† sacrificed their well-being through a reduced social life and poor sleeping habits in order to complete the workload. In return, we mastered the skills of coping with stress and managing out time. These skills will benefit us in the long run as we enter adulthood and the work force. Often times I did not understand why I was pushing myself to such a limit. I thought to myself that most of the students not motivated to achieve success had such an easier life. They went through school carefree and had loads of free time after school and on the weekends to hang out with friends. Nevertheless, I knew why I chose to push myself to the limits. I knew that my time to shine would come later in life and all my efforts would be worth a life full of success; the characteristics for success were instilled in me through the competit ion of grades and the workload I endured in school.

Cardiovascular Diseases

Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases

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Effective communications - Essay Example It will also help if we are cautious of the correct language usage and avoid vague terms. One style of effective communication is using diversity and common ground. We should look for the interest and purpose of the person we are talking to establish rapport. Even if you view differences of perspectives, honor that differences, incorporate it into your own for a powerful communication. There is a time that it is better to be silent when you are not sure of the relationship. For example, you should understand the topics that should be avoided in the organization, profession and even in personal relations. According to the College of Marin lecture, Chap. 1, there are barriers to communications. Sender should know the adaptability of the message to receiver and should recognize the needs, the status, and knowledge of the subject and language skills of the receiver. For instance, when someone is angry, you should listen for a while until he/she is able to express her feelings. Lack of understanding on the subject, sender cannot explain clearly what he wants and receiver does not get the message clearly. For example, an angry customer cannot explain technicalities while sales people cannot answer. Emotional interference creates a barrier, as in if someone is filled with emotions like being angry, joyful, and tearful; he may not receive the intended message and may deliberately not hear them. (w.c.

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Eval 4 - Essay Example The data collection process has various steps that require expertise in formulation and implementation and this is done best by properly trained data collectors. Regardless of the preference for defining data whether qualitative or quantitative, accurate data collection is important to ensure that the integrity of the research is maintained. Data collection by improperly trained data collectors leads to the inability to accurately answer the research questions, distorted findings therefore wasted resources, inability to validate or repeat the study, compromising decision in regard to public policy, misleading of other researchers pursuing the same or related research topic and causes harm to the participating agents. Improperly trained data collectors lead to poor results and if the results are used to support recommendations of public policy, it will cause disproportionate harm. Improperly trained data collectors will not comply to the research questions and may collect data that is not a true reflection of the natural situation. The goal of a research is to help improve a situation or come up with amicable solutions to a problem. This involves accurate data collection and carrying out a relevant data analysis through careful planning and thorough thoughts (Bedi, Bhatti , Gine, Galasso, Goldstein and Legovini, 2006). Collection of sub standard information and data implies that the evaluator will arrive at the wrong conclusion and that the wrong recommendations will be implemented. Outcome evaluation seeks to establish the effectiveness of the research, reaching at an accurate conclusion from the collected data and making recommendations. Thus if the data collected is inaccurate, the analysis and conclusion will be wrong. To overcome these problems, the evaluator is required to design the needs of the data collectors especially where there are multiple data collectors. The evaluator

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Fire Protection Systems - Research Paper Example Automatic activation can also occur in several forms, designed to a number of physical changes associated with fire. Such devices include heat detectors, smoke detectors, flame detectors, fire gas detectors and water flow detectors. Modern innovation can use cameras and computers to analyze the visual signs of fire and movement in applications inappropriate for or hostile to other detection methods (Greenman, 2003). Notifications from fire alarms to alert the occupants of the need to evacuate premises or take appropriate actions due to fire emergencies can be in audible, visible, tactile, textual or even olfactory (odorized) forms. Emergency signals are automatically intended to be distinct and understandable in order top avoid confusion with other signals. The Temporal Code 3 which chimes three times at one-second intervals, stops for one second the repeats is the most common audible in the modern fire alarm system. Other methods of audio alerts include audible textual appliances, continuous and voice evaluation. In some fire alarm systems especially in high-rise buildings, arenas and other large facilities such as hospitals where total evacuation is difficult to achieve, emergency voice alarm communication systems (EVACS) are used. This voice based system allows personnel to orderly evacuate and notify occupants in such crowded buildings. Strategically too, especially in high-rise buildings, depending on exact location of fire, different evaluation messages may be played on each floor to facilitate orderly evacuation and saving of lives (Jones, 2009). New codes and standards have enabled alarm system manufacturers to expand their systems voice evacuation capabilities to support trending requirements for mass notifications including possibility of multiple types of emergency messaging. To serve those with disabilities too, emergency communication systems have visible notification along with audio. Mass notification systems

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The Death of Socrates by Jacques-Louis David - Assignment Example The researcher states that when one looks at the painting, they can see that everyone in the composition is mournful and sorrowful except the stoic man in white drapery at the center of the artwork. Here is a man who maintains his resolve in the wake of death and decides to stick to his principles, despite being condemned to death for the same philosophy. The researcher wants this painting to be viewed at his funeral because it is a representation of strength, loyalty, and principle. The researcher intends to live his life as he always has, remaining true to himself and living by a code of practicing what the author believes in. The researcher wants people to know that he did not live life in fear, that instead of mourning, they should celebrate his life, achievements, failures, and impact on the society. Jacques-Louis’ composition is a perfect representation of the bravery and principle, with which the researcher has lived his life. The researcher not only intend on living a life of values and principle, he also intends on using this values to positively impact society, as Socrates influenced Plato.

Filme review Movie Example | Topics and Well Written Essays - 750 words

Filme - Movie Review Example What impressed me most about the movie is that it has captured the exact economic, social, political and psychological conditions of the victims of the post world war era through showing ladies who stand in queues to get water, ruined buildings, behavior of the society when the lead character accuses the boy of stealing his bicycle etc. The visuals all point to the torn apart post war city and the dialogs of the characters further exemplify the economic situation of that era. This is evidenced when the protagonist, Antonio, tells his wife that he feels â€Å"like a man in chains† (Bicycle Thieves, 1948). This dialog right here is the epitome of the helpless situation of the working class people, that is, although they were ready to work hard for a living, they were constrained by various elements thus entailing in their jobless state and miserable life. However, on the other hand, the movie also portrays the selfless love a wife must possess towards her husband and furthermore illustrates the concepts of familial relationship and sacrifices giving them the most importance. As far as I am concerned, familial relationships are of great prominence and it is this kind of relationships and concepts that I value the most, and since the movie deftly demonstrates this, it appeals the most to me. Therefore, according to me, this was the best film I have seen as compared to other movies shown in this semester. 2) Name some of the special effects, camera techniques and camera composition used in â€Å"Citizen Kane† and how was this evidenced in the film itself? The camera techniques used in the movie â€Å"Citizen Kane† (1941), directed by Orson Wells who also performs in the title role, become evident from the scene presenting Xanadu, Kane’s old age retreat. The protagonist withdraws to this location in his old age as a symbol of his isolation from the society. The audience is first given a long shot view of the old fortress like residence wit h its gates towering over the frame. By providing such a view of his home, the audience receives a sense of Kane’s power through the overbearing view of the gate that separates the home from the rest of the world. Again, in the scene where the animals are shown, the camera pans onto the cage, again giving the viewers a sense of Kane’s power that has enabled him to create his own world, by eschewing the American way of life. Many similar cases can be seen in the movie which exemplifies the deft use of camera and angles. 3) We watched De Sica’s â€Å"Bicycle Thieves† this semester. What was so important about Italian Neorealism and how was this evidenced in the film itself? Italian Neorealism was the first post war cinematic movement that freed filmmaking from the realm of perfect worlds portrayed in the movies, thus its significance cannot be overlooked. Prior to this movement, the Italian films were greatly influenced by Hollywood movies, with which littl e could the people of Italy relate to. However, once this new trend surfaced, it transformed cinematography and boosted it into a new phase that brought to the fore movies reflecting the real life conditions of the working class people from all aspects including economic, psychological, social, moral, political etc. Bicycle Thieves evidences neorealism through the portrayal of non professional actors, natural settings and

Family of the Hearts Essay Example | Topics and Well Written Essays - 500 words - 2

Family of the Hearts - Essay Example The family is definitely one of the most important parts of the life of any person without which a person feels very lonely and sad at times. One can create the definition of a family by many different ways but the real and authentic meaning for the family is to live with people having emotions and feelings for each other. A person living with his/her family is able to enjoy life more than a person living alone. Therefore, after completing my education if I will have to decide whether I should live alone in America or with my family, I will definitely vote to live with my family. Being the first born in a family of three, I sometimes do feel the guilt of not being around my siblings to show them the right thing to do in the absence of my parents. This is so because whenever I am with them and my parents are not around, I take the full responsibility of being a parent to them. Although being away from my family is not for a bad course, I do not get that full satisfaction I usually get when being around them. Staying away from them has made realize how important my family is and that distance plays an important role in strengthening a family as a unit. Â   My extended family plays an important role just like my nuclear family. Even though being away from them too, I cannot get enough of their calls and the precious gifts they send me often. They shower me with love that rivals that of my dad, mum, and siblings. This is a clear example of how a family should be, not even friends can rival that bond created by family members.

Assessment and Development Essay Example for Free

Assessment and Development Essay 1. What is a competency? What are its characteristics? How is it different from Job Description? Competency: Competencies refer to skills or knowledge that leads to superior performance. These are formed through an individual/organization’s knowledge, skills and abilities and provide a framework for distinguishing between poor performances through to exceptional performance. Competencies can apply at organizational, individual, team, and occupational and functional levels. Competencies are individual abilities or characteristics that are key to effectiveness in work. Some examples of competencies required by the employees are: 1. Adaptability 2. Commitment 3. Creativity 4. Motivation 5. Foresight 6. Leadership 7. Independence 8. Emotional Stability 9. Analytical Reasoning and 10. Communication Skills Characteristics of Competencies ? ? ? ? ? ? Competencies are the characteristics of a manager that lead to the demonstration of skills and abilities, which result in effective performance within an organizational area. The best way to understand performance is to observe what people actually do to be successful rather than relying on assumptions pertaining to trait and intelligence. The best way to measure and predict performance is to assess whether people have key competencies. Competencies can be learnt and developed. They should be made visible/accessible. They should be linked to meaningful life outcomes that describe how people should perform in the real world 3|P a ge Common difference Competencies Job Description. Competencies †¢ †¢ †¢ †¢ †¢ Underlying characteristic of a person’s inputs. Clusters of knowledge, attitudes and skills. Generic knowledge motive, trait, social role or a skill. Personal characteristics. Set of skills, related knowledge and attributes. On the other hand, Job Description †¢ †¢ †¢ †¢ †¢ Superior performance in a given job, role or a situation. Individual’s ability to perform. Linked to superior performance on the job. Contribute to effective managerial performance. Successfully perform a task or an activity within a specific function or job. 4|P a ge 2. What are the different types of competencies? What is their relevance? 1. Behavioral Competency: Behaviors, knowledge, skills, abilities, and other characteristics that contribute to individual success in the organization ? ? ? Can apply to all (or most) jobs in an organization or be specific to a job family, career level or position For example:- teamwork and cooperation, communication Focus on the person 2. Technical or functional Competency: Specific knowledge and skills needed to be able to perform one’s job effectively ? ? ? Job specific and relate to success in a given job or job family For example:- knowledge of accounting principles, knowledge of human resource law and practice Focus on the job A trainer requires a different set of competencies than an accountant, and a teller requires a different set than a maintenance worker. If there are different levels within the same position, then each job level might also have its own set of vertically derived competencies 3. Core Competency: ? ? A core competency is defined as an internal capability that is critical to the success of business. These are organizational competencies that all individuals are expected to possess. These competencies define what the organization values the most in people. For example:- an organization might want each individual to possess teamwork, flexibility and communication skills. 5|P a ge 4. Threshold competency: ? ? The characteristics required by a jobholder to perform a job effectively are called threshold competencies. For the position of a typist it is necessary to have primary knowledge about typing, which is a threshold competency. 5. Differentiating competency: ? ? The characteristics, which differentiate superior performers from average performers, come under this category; such characteristics are not found in average performers. Knowledge of formatting is a competency that makes a typist to superior to others in performance, which is a differentiating competency. 6|P a ge 3. What is the difference between Assessment Centre and Development Centre? Differences between Assessment and Development centers Assessment centers usually ? ? ? ? ? ? ? ? ? ? ? ? ? Have a pass/fail criteria are geared towards filing a job vacancy address an immediate organizational need have fewer assessors and more participants involve line managers as assessors have less emphasis placed on self-assessment focus on what the candidate can do now are geared to meet the needs of the organization assign the role of judge to assessors place emphasis on selection with little or no developmental feedback and follow up give feedback at a later date involve the organization having control over the information obtained have very little pre-centre briefing tend to be used with external candidates. Development centers usually ? ? ? ? ? ? ? ? ? ? do not have a pass/fail criteria are geared towards developing the individual address a longer term need have a 1:1 ratio of assessor to participant do not have line managers as assessors have a greater emphasis placed on self-assessment focus on potential are geared to meet needs of the individual as well as the organization assign the role of facilitator to assessors place emphasis on developmental feedback and follow up with little or no selection function 7|P a ge ? ? ? ? give feedback immediately involve the individual having control over the information obtained have a substantial pre-centre briefing tend to be used with internal candidates 8|P a ge 4. What are the advantages and disadvantages of Assessment Centre and Development Centre? Assessment Centers: Assessment centers consist of a number of exercises designed to assess the full range of skills and personal attributes required for the job. Advantages: ? Assessment centers map the next level challenges and simulate them in exercises. This raises the validity of the assessment tool. The old way of evaluating the person based on past performance does not work many times, as the challenges of the next level are different from the challenges in the existing position. Assessment centers not only help the organization in placing the right candidate for the right job/assignment but also help in developing the participants. When participants see others handling the same exercise differently, it gives them an insight into their own performance thereby raises the credibility of the selection procedure. It appeals to the lay person’s logic and therefore is regarded as a fair means of assessment by the participants. Assessment Centers can be customized for different kinds of jobs, competencies and organizational requirements. They are far more accurate than a standard recruitment process as they allow a broader range of selection methods to be used during the process. They enable interviewers to assess existing performance as well as predict future job performance. They give the opportunity to assess and differentiate between candidates who seem very similar in terms of quality on paper. They give the candidates a better insight into the role as they are tested on exercises, which are typical for the role they have applied for. They help employers build an employer brand. Candidates who attend assessment centers which genuinely reflect the job and the organization are often impressed by that company, even if they are rejected. The cost of an assessment centre is usually cheaper compared with the potential cost of many recruitment phases and the cost of recruitment errors. 9|P a ge ? ? ? ? ? ? ? ? ? ? They are a fair process – they complement an organization’s diversity agenda and ensure that people are selected on the basis of merit alone. Disadvantages: ? ? ? ? ? Assessment Centers are very costly and time consuming. Assessment Centers requires highly skilled observers as the observers may bring in their own perceptions and biases while evaluating. Those who receive poor assessment might become de-motivated and might lose confidence in their abilities. New recruits with high expectations can feel disappointed if the assessment centre has encouraged them to believe the job or organization fits their values if, in fact, it does not. If you haven’t defined the key competencies prior to the event and a way to measure these competencies you will only be able to compare candidates on anecdotal details.

The Aims and Objectives of an Islamic Bank

The Aims and Objectives of an Islamic Bank Islamic banking is becoming increasingly popular and plays a prominent role in the financial services sector in Malaysia. According to latest statistics shown, the Muslim population of Malaysia is approximately 25 million. There is definitely a strong demand and strong growth potential in this sector. In Malaysia, the banking sector is mainly dominated by the conventional banking system whereby interest is not being prohibited. It is because the Islamic banking system is relatively new and there are insufficient regulations at present to govern them. If these obstacles are being resolved, the Islamic Banking sector will blossom given the influence of Malaysia in the international Muslim community. The primary aim of this research is to examine and understand in depth the development of Islamic banking in the world of finance. This piece of research can be divided into three sections. The first section looks at significant differences between conventional banking and Islamic banking. Products and services offered by these financial institutions will be marked to comparison. The second section looks at how the practice of Islamic banking started and how it has emerged to become a vial force in the economy. The final part of the research will focus on how the Islamic banks penetrated the Malaysian market and the challenges faced. 1.1 Structure of Dissertation This dissertation is divided into a few topics and each topic covers different areas of research. This is to give readers a clearer view of the research and make it more user-friendly. It is well thought and designed to ensure the smooth flow of the reading. The structure of the dissertation can be summarized as follows: Chapter 1: This chapter describes the aims and objectives of this research. Chapter 2: This chapter discusses the principles and fundamentals of Islamic banking Chapter 3: This chapter explains in detailed the state and scope of Islamic banking industry in Malaysia. I have also mentioned to objectives and roles the Malaysia International Islamic Financial Centre Initiatives plays in the industry. Chapter 4: Research methodologies and strategies that were being adopted for this paper was discussed. Chapter 5: I have marked two Islamic banks in Malaysia for side by side comparison. I have drawn up a table to compare their financial performance and position over the past two years. Chapter 6: I have interviewed two Islamic bankers from Malaysia. On top of that, I have also provided my personal analysis of their answers. Chapter 7: Competition and globalization of the Islamic banking industry. Moreover, I have also discussed opportunities and challenges faced in the world and in Malaysia. Chapter 8: A summary of the paper was included with recommendations and limitations to research. 2 INTRODUCTION So, what exactly is Islamic Banking? Islamic Banking is banking based on Islamic laws (Shariah). The Shariah principles are derived from the Quran and the Sunnah (sayings of Prophet Muhammad). Moreover, secondary sources of Islamic laws such as opinions collectively agreed among Shariah scholars, analogy and personal reasoning are also adopted in the rules and practices of Islamic banks (Al-Omar, 1996). The research then looks at the differences between conventional banking and Islamic banking. There governing principles of Islamic banks are: Riba Absence of interest-based transactions. Charging of interest is prohibited under Shariah principles. Money itself does not have inherent value and should not be used to create more money. Wealth can only be generated through legitimate trade and investment. Ghirar Acts of speculation are not accepted under Islamic principles. For instance, buying goods now at lower price in the hope of selling them at higher price in future. The reason being speculators make private gains at the expense of society at large. Zakat Introduction of Islamic tax for the purpose of wealth distribution so that every Muslim is guaranteed a fair standard of living. Haram It is forbidden for Islamic banks to finance activities forbidden in Islam such as prok meat and alcoholic beverage. In order to ensure that the trading activities do not contradict with Shariah principles, all Islamic banks are required to set up Shariah Committee, who acts as advisor to the banks. On the other hand, conventional banks charge interest on transactions. These interests are widely seen as price of credit. Furthermore, conventional banks focuses on elimination of risks and thus do not share any liabilities with the borrower. (Figure 1) Islamic Bank Vs Conventional Bank Based on Shariahprinciples. Based on best economic principles. Bank should not take advantage of borrower. No interest charged. Charges interest to reflect price of credit. Does not allow involvement in haramactivities such as pork meat and alcoholic beverage. Aims at maximizing profit without restrictions other than compliance with relevant regulatory frameworks. Intoduction of zakat. Non-existence of zakat. Promotes risk sharing between providers of credit and borrower. Interest is assured to providers of credit. No liabilities borne by the bank. Emphasis placed on viability and feasibility of projects. Emphasis placed on credit-worthiness of customers. Only provide guarantee for deposit account (al-wadiah). If funds placed under mudarabah accounts, customers shares profit or loss incurred by bank. Provides guarantee to all its depositors. www.learn islamicfinance.com 2.1 Fundamentals of Islamic Banking Finance Islamic commercial law is based on a few major principles. They will be discussed in detailed as follows: Musharakah (Partnership Finance) Musharakah is a contract in which the bank and the client contribute jointly to the capital of a specific project or deal to make a profit. Therefore, risks of profits and losses are being shared between these two parties according to terms and conditions stipulated in the contract. This principle exposes bank to the risks of the project, in other words protecting the interests of the community. This will prevent banks from yielding their unfair influence and sells disadvantage products to clients. Mudarabah (Trust Financing) Mudarabah is a contract in which the banks provides all the capital required whilst the partner contributes in terms of skills, experiences and efforts. The bank receives a pre-determined share of profits as agreed by both parties upon commencement of the project. The major difference between mudarabah and musharakah is that in this case, the bank bears all financial loss whilst the client goes unrewarded. Therefore, it is also the banks responsibilities to assess the feasibility and viability of the project. As such, it is vital for the bank to have a good and credible credit system to evaluate all its exposures on these projects. In short, this principle encourages individuals to participate in financial activities It also gives individuals without sufficient resources an opportunity and platform to prove themselves in the society. Murabaha (Cost-plus Financing) Murabaha is a contract in which the banks informs their client about the acquisition price of certain goods and products and sells them with a margin. It requires the bank to declare an honest price of acquisition. It is one of the most common principles adopted in Islamic banking system to promote interest-free transactions. It is widely practiced in asset financing and both commodity import and export. Bai-Muajjal (Deferred Payment Sale) It is a contract in which the seller sells a certain goods or products to the buyer at an agreed fixed price to be paid later at a specific date by the buyer. In short, it is a sale on credit. The bank merely acts as the financier by deferring the receipt of the sale price of goods it sells. Ijara (Leasing) In this case, the bank buys capital equipment or property and leases it out under instalment to clients. Similar to conventional leasing, the client has the option to purchase the goods at the end of the lease period. The fact that there is real good to be financed means that it is Shariah compliant. A very common product adopting this principle is Islamic mortgage whereby the buyer buys the property on an instalment basis. Qard Hassan Islamic teachings promote brotherhood amongst Muslims. Qard Hassan is seen as a gratuitous loan that helps fellow Muslims who need financial assistance. It can be defined as a loan to be repaid at a later date without incurring any interests. According to Rob (1992), Islamic banks may raise funds through sale of shares to public and main deposit accounts. Therefore, the bank has a responsibility to lend a helping hand to those in desperate situation without taking of their advantaged position. 2.2 Compatibility of Islamic Banking with Conventional Banking Islamic banking system has very similar features to conventional banking except that Islamic banks operate in compliant to Shariah laws and principles. Both banking systems have common features and common products. The main differences being prohibition of interests being incurred and sharing of profits and losses between banks and their clients (Abdur Rahim, 2009). They have the same objectives except interpretation of interest. Islamic banks fall into realms of the economic world as well. They try to ensure all their operations comply with Shariah laws yet at the same time conform to rules set by international bodies such as International Accounting Standards Board and Audit Practices Board. This is to ensure they remain relevant to the society and at the same time conform to their religious principles. Islamic banks sell products such as mortgages, savings accounts, insurance which is also sold by all conventional banks across the world. According to Nienhaus (1995), Islamic banks offer facilities more or less the same as conventional banks, in compliance with the welfare principles of Islam. 3 LITERATURE REVIEW A literature review is a process in which published articles or information are studied as part of the research for the preparation of a dissertation. For the purpose of this project, I have gathered information from books and articles from various sources. I have studied the concept of Islamic banking, having limited understanding about this topic previously. Further, I have also included discussion about the development of Islamic banking in the world, and in particular, Malaysia. This paper allows readers to have a good grasp of Islamic banking in general. It gives readers the opportunity to study about Islamic banking in greater detail when the interest of this industry gathering strong momentum. This is of particular importance because Islamic banking has a huge impact of the world economy because of the strong influence of the oil-rich Gulf States. 3.1 Introduction Since a few decades ago, Islamic banking has emerged as a new reality in the world economy. Its philosophies and principles are however, not new, having been outlined in the Holy Quran and the Sunnah of Prophet Muhammad (p.b.u.h.) more than 1,400 years ago. The emergence of Islamic banking is often related to the revival of Islam and the desire of Muslims to live all aspects of their live in accordance with the teachings of Islam (Siddiqi, 1983). This chapter provides a brief overview of how Islamic Banking was introduced in the World and how it penetrated the Malaysian market. Islamic banking today has proven to be a popular and reliable financial system in the world. It is widely seen as a viable alternative to the conventional banking system over last 3 decades. Islamic banking was described by scholars as wishful thinking when the idea was first mooted almost thirty years ago (Iqbal and Philip, 2006). Many conferences and discussions were carried out at that time to work on the finer details of this system. Several blueprints were drafted by Islamic scholars from all over the world to ensure a detailed system is created. The first international conference on Islamic Economics was organized by Kings Abdul Aziz University in Makkah marked an important milestone in the history of Islamic banking (Iqbal, 2005). Financial gurus, economic experts and Islamic leaders were invited to present their view and opinions. Following this, the first Islamic bank, Dubai Islamic Bank (DIB) was established in the United Arab Emirates in 1975. Since its formation, it has established itself as the leader in the industry and has won several accolades internationally. In 2009, it recorded net profit of  £200 million with assets worth over  £14 billion. Islamic banking has gained tremendous momentum and has been growing rapidly over the years. Islamic banks now offer products in various areas such as banking, insurance, mortgage and asset management with annual growth of 10% for many years. 3.2 History of Islamic Banking in Malaysia Islamic banking industry in Malaysia is growing at a moderate pace. It is a unique market because Islamic banks in Malaysia are allowed to operate in parallel to conventional banks (interest-based). The multi-ethnic population of Malaysia makes the entire change of financial system to follow the Shariah system not viable. Government of Malaysia opted for gradual way of introducing Islamic banking by allowing conventional banks to sell Islamic banking products and services such as sukuk (Arif, 1989). The dual banking system has been recognised by both West and East leaders and it is seen to be the model of the future. In fact, many central bankers have visited Malaysia to see the effectiveness of this dual system first hand. Furthermore, this dual system also eliminates the wrong concept of general public that Islamic banking products are sold exclusively to Muslims. The history of Islamic banking industry goes back to as far as 1963, when the foresighted government set up the Lembaga Tabung Haji also known as the Pilgrims Management and Fund Board. It was set-up primarily to encourage Muslims in the country to save up on their income in order to perform pilgrimage in Mecca (Kamarulzaman Bhupalan, 1983). Besides, the fund was also created to provide a platform for participation in the economic and investment activities. Based on the success of the Lembaga Tabung Haji, coupled with the consultation of Shariah experts and economic gurus, government then proceeded to set up the first ever Islamic Bank in 1983. Setting up of Bank Islam Berhad Malaysia (BIMB) marked a milestone in the banking industry. It proved to be hugely popular because over half the Malaysian population are Islam followers. What followed through was the listing of the bank in the stock exchange of Malaysia in the early 1990s. As of today, the bank has 100 braches located all ove r Malaysia. With the fairytale of BIMB, central bank decided to allow commercial banks and merchant banks to offer Islamic banking products under the Islamic Banking Scheme. It was not long after that the central bank set up the National Shariah Advisory Council to oversee all issues pertaining to Islamic Banking. Due to the economic liberalisation, central bank finally grants licenses to foreign Islamic banks to operate in Malaysia in 2004. Al-Rahji Bank and Kuwait Finance House took full advantage of this ruling and step foot into the Malaysian banking industry. The last count of Islamic banks operating in Malaysia stood at 21. 3.3 Scope of Islamic Banking in Malaysia Islamic Banking started out as mere deposit taking and lending facility has since transformed into all aspects of banking, money and capital market operations. In Malaysia, the central bank is in favour of a dual banking system, whereby Islamic banks are allowed to co-exist with conventional banks. It is at the consumers choice to select which services they prefer that cater to their needs. This is in stark contrast with the scenario in Iran and Pakistan, where conventional banking system is abolished completely to make way for Islamic banking. They claim to be devoid of conventional interest based financial transactions. Today, the Malaysian Islamic banking sector is blossoming as reflected in the extensive distribution networks comprising 152 full-fledged Islamic banking branches. The ability of these Islamic banks to offer competitive products with attractive and innovative features has attracted both Muslim and non-Muslim population in the country. This has also spurred non banking institutions such as savings institutions to introduce Shariah compliance product to appeal to a wider consumer base. According to Association of Islamic Banking Institutions Malaysia, there are 21 Islamic banks who have subscribed to their membership. The list of Islamic banks is provided as follows: Affin Islamic Bank Berhad Alliance Islamic Bank Berhad Al-Rajhi Banking Investment Corporation Berhad AmIslamic Bank Berhad Asian Finance Bank Berhad Bank Islam Malaysia Bank Berhad Bank Kerjasama Rakyat Malaysia Bank Berhad Bank Muamalat Malaysia Bank Berhad Bank Simpanan Malaysia Berhad CIMB Islamic Bank Berhad EONCAP Islamic Bank Berhad Hong Leong Islamic Bank Berhad HSBC Amanah Malaysia Berhad Kuwait Finance House (Malaysia) Berhad Maybank Islamic Bank Berhad OCBC Al-Amin Bank Berhad PT Bank Muamalat Indonesia Public Islamic Bank Berhad RHB Islamic Bank Berhad Standard Chartered Saadiq Berhad Unicorn International Islamic Bank Berhad As evident from the list above, there are 21 banks offering Islamic products in the Malaysian market. Confidence is clearly shown on the Malaysian market with international banking powerhouse presence such as Standard Chartered group and Kuwait Finance House. The Governor of Central Bank Malaysia recently declared the central banks intention to lure larger overseas banks to provided services that comply with Muslim tenets. As a sweetener to any potential deal, the central bank has raised foreign ownership limits at local Islamic banks and insurance companies to 70%. Rising oil wealth has turned the Islamic banking into an industry with assets with $1 trillion in assets globally. The central bank is doing its utmost, implementing initiatives to explore this relatively untapped market. In addition to the changes in foreign ownership limits, the central bank is also offering tax breaks for Islamic products and has relaxed rules for Islamic banks to trade in foreign currencies (Aziz, 2006). This is seen as a major breakthrough because the foreign currencies dealing is tightly regulated due to the impact Malaysian market suffered in the 1997 Asian Financial Crisis. In July 2010, Khazanah, Malaysia sovereign wealth fund made its debut in Singapore debt market issuing sukuk or Islamic bonds worth $1.5 billion, three times the size of Singapore sukuk market until now. This further strengthened the Malaysian government efforts to promote Islamic banking products both domestically and internationally.