The Anti Slavery Movement In Britain in Birmingham Coursework

The Anti Slavery Movement In Britain in Birmingham - Coursework Example This is because of the fact that though Britain was one of the most influential and prosperous nations in this regard, other nations were no les behind. The practice of slave trade was rather a tricky affair and the basis of such trade was 'need'. Ships from ports such as Liverpool and Bristol used to head towards the backward African mainland laden with small goods such as spices, fabrics, arms and knives etc. things were by far petty and simple for the white man, but something that was of extreme value and demand to the African people. This is because these were some of the many things that the African were deprived of in those days given their backwardness. More often, such goods used to be of very cheap quality, for which Africa proved to be a lucrative 'dump'. As the topic of the essay ges to say, the anti slavery movement has an important association with Britain, and among these, the city of Birmingham has come to hold an important place. Most of these low quality and sub-standard goods were made in Birmingham and were popularly referred to as 'Brummagem ware'. In return for these goods, the African people had to pay the heaviest price they could have ever thought of-'themselves'. Goods were exchanged for large number of African people, who were then brought back or taken to other territories, where they were either sold of slaves or made to do hard work in the form of slaves in those territories. Many of them were captured in armed conflicts with the Europeans winning all of them given the kind of firearms they possessed in comparison to the bows and arrows, wherein the former outclassed the latter.After having been captured or being brought in as part of the trade, these people were then packed like sardines into these slave ships and were brought home to Britain in such inhuman and inhospitable conditions that many of them would perish midway. The conditions were so worse that they would not have the opportunity t o do even the commonest of other daily activities (as they were jam-packed), which resulted in the outbreak of disease. By the turn of the eighteenth century, the trade of slaves had risen to such terrific proportions that ships from Britain were now bringing back as many as 50,000 slaves every year. Those slaves who managed to survive through all the above-mentioned hardships were then sold for transportation to places such as the windies or the America to work in plantations, factories, mills etc1. The goods produced by the slaves within those regions would then come back to Britain, where they were then sold or sold in the colonies for exorbitant prices. Thu, it can be understood that the practice of slave trade profited Britain in particular, and the countries of Europe in general have benefited in huge ways by making huge profits on many trade-related fronts. On the other hand, the slaves who labored hard were made to live and work in inhospitable conditions ridden with poverty and disease. Thus, their fruits of labor were enjoyed by the people back in Britain (and Europe). Moreover, there was no sense of knowledge within the British public largely about the conditions that existed in these plantations and factories, while many just did not bother to know any2.But, as time passed by and decades rolled past, a sense of consciousness began to emerge

Explain the process for planning and evaluating work-family programs Essay

Explain the process for planning and evaluating work-family programs - Essay Example Prior understanding of the preceded discussion clearly necessitates efficient planning and evaluation of work-family programs. It is imperative to understand that children are the future of tomorrow and whos emotional, physical, and mental wellbeing depends on the care given by the parent. Planning and evaluation of work-family programs requires a survey among workers in all sectors. Information from the survey will enable the relevant bodies create a program that enables the employees who, in this case, are the parents to take care of family matters and have family time. Evaluation of such a program can be achieved through analysis of statistics in daycare and other care services. Also, the productivity of employees can be a good method to evaluate the programs (Poelmans,  2005). Better solution of the situation can be achieved through companies adopting measures to ensure better-working environment for the employees. Companies should be able to enact programs and strategies such as enough maternity leave period to allow a mother to take care of the infant. Care given to an infant is important as it is a foundation to the wellbeing of the individual concerned. Also, companies should review working conditions, hours, and workloads of the employees. Provision of a better situation would ensure parents get enough time and strength to spend and watch over their kids. Furthermore, enough rest would enhance in increased productivity of the employees with families. In conclusion, it is imperative for companies inclusive of private and public companies to review working conditions of the employees in general bearing in mind they have other responsibilities. Quick solution to the quagmire can be having a day care service in a company whereby kids to the parent employees are taken care of as they work. Having ones child close provides the peace of heart increasing

Taxation Assignment Example | Topics and Well Written Essays - 2000 words

Taxation - Assignment Example These two systems worked independently in the past and the tax authorities maintained separate tax systems for income tax and national insurance contributions. Income tax was taxed annually in a progressive manner on individuals and corporate bodies whereby low income earners were taxed lower than high income earners (UK Government, 2012). The tax rates increased with increase in incomes of individuals. On the other hand, benefits are payments to individuals by the state. They are paid to individuals through the bank, credit union account or building societies. If one does not have any of these accounts, he/she may be paid through Post Office card account. There are various types of benefits in UK. Attendance allowance is a tax-free benefit paid to individuals of over 65 years who are mentally or physically handicapped. Two rates of up to ?71.40 are payable per week. Carer’s allowance is payable weekly in advance or every 4 or 13 weeks. Child benefit is a universal claim by pa rents for their children (BBC News, 2012). They are paid after every four weeks in normal situations and weekly for single parents. Tax credit is also paid weekly or after every four weeks, to families with children, whether the parents work or not. Disability living allowance is is a tax-free benefit payable after every 4 weeks to disabled people who have walking difficulties and who need someone to help them walk. Other types of benefits include crisis loans, council tax benefits, community grant care, child trust fund, etc. 2. Description of the proposed recommendation The proposed recommendation requires the integration of income tax with benefit systems. To achieve this, the UK tax system first needs to merge income tax and National insurance. These are two different ways in which income tax are paid in UK. Maintaining the two types of tax systems may be costly, less transparent and burdensome. Integrating the two systems will therefore bring forth an easier method of paying in come tax in UK. The integration of income tax with National insurance contribution makes it more transparent for the tax system. The progressive taxation in UK includes 20% basic rate, 40% higher rate and 50% additional rate of income tax (Mirrlees et al, 2012). If this income tax is integrated with National Insurance Contribution, the new rates may be 31%, 41% and 51% respectively. This is a more transparent mechanism which enables individuals to pay for their taxes more easily at once rather than maintaining two separate tax accounts. The second step in the integration of benefit and tax systems is the integration of the benefit system. In this case, the benefit and tax credit systems are merged together. This is a messy and complicated mix of overlapping programmes. The programmes which need to be include programmes needed to provide support for low-income families and benefits provided to give non-means-tested support for various contingencies. The former class of programmes inc ludes job-seekers allowance, income support, housing benefit, pension credit, child tax credit and council tax benefit. On the other hand, benefits for non-means-tested support for contingencies include state pension, disability allowance, carer’s allowance, winter fuel payment etc (Mirrlees et al, 2012). Because several families claim these benefits simultaneously, it is necessary to integrate the two systems into one manageable system. The recommended system

Data Communications Bluetooth Essay Example | Topics and Well Written Essays - 1000 words

Data Communications Bluetooth - Essay Example Therefore, the low transmission rate has always been a serious issue in wireless technologies and especially in case of Bluetooth it has posed serious concerns for communication scientists. However, the advancements in the areas of signal quality and strength, compression algorithms and wireless technologies have resulted in faster communications and popularity of wireless communications generally and Bluetooth technology in particular. Symmetric vs. Asymmetric & Speed There are basically two types of digital communication in Bluetooth technology; asymmetric and symmetric. In asymmetric communication, only one device transmits at a given time, whilst in symmetric communication both Bluetooth devices are transmitting information simultaneously. The technology offers different bit rates for both types of transmission. In asymmetric communication the bit rate is slightly more than 2178.1 kb/s using the Bluetooth standard 2.0, which was introduced in 2004. Symmetric communication reduces this rate to approximately 1306.9 kb/s (Huang & Larry, 2007). However, these transmission rates are not available in practical scenarios where wireless communication is affected by the distance and obstruction between communicating devices, noise in the environment, protocols being used and many other factors. The Bluetooth 2.0 Standard Bluetooth technology has considerably advanced since the introduction of 2.0 standards in 2004. Now, it is a much more reliable and robust wireless technology. â€Å"Bluetooth uses a standard 2.4 GHz frequency so that all Bluetooth-enabled devices will be compatible with each other. The only drawback of Bluetooth is that, because of its high frequency, its range is limited to 30 feet.† (Techterms,... Historically, â€Å"The word "Bluetooth" is taken from the 10th century Danish King Harald Bluetooth.† The exploratory work on Bluetooth technology was initiated by mobile phone company Ericsson in 1994. Owing to its ease of use, security, availability and affordability Bluetooth technology has gained rapid fame among hardware manufacturers and the masses. The technology has now become almost a default feature in all hardware devices that supports digital communications, like laptops, PDAs, mobile phones, computer networks, etc. The major benefits offered by Bluetooth technology include: short range radio wave, inexpensiveness, availability, ease of use and configuration, high speed, multiple communication channels and security mechanisms. Sobh observes, â€Å"Bluetooth is a low cost and short range, and low power radio technology.† These benefits make the technology attractive for both personal and commercial uses, like direct and personal marketing and advertising in an area with high footfall or shopping plaza. Amor declares: â€Å"Future aspirations for Bluetooth are unstoppable because of the acceptance it has received from many big companies.† Bluetooth offers easy bridging among multiple hardware technologies and can offer quality solutions for a high-tech, fast moving world.

Strategic Management Essay Example | Topics and Well Written Essays - 1000 words - 9

Strategic Management - Essay Example stores is able to pass on the benefits of low costs in terms of onto the customer, and this policy has earned them rich benefits, especially during post war periods and recessionary times. Fundamentally this is a food and grocery store, having its own branded goods. Most of their products are their own labeled brands, and perhaps, there would only be one or two other kinds of competing brands for each kind of product. While this restricts the choice of customers regarding variety, it induces greater sale and movement of goods. Thus, the need for having a large number of tagged brands (which may not even be moving products) is obviated, and only products that sell fast are kept on pallets. Perhaps one of the distinguishing aspects regarding Aldi’s type of business is that goods are stocked in pallets, customers pick up their required items from these pallets, and load into their trolleys, which are to be compulsorily used after paying a refundable token towards use of trolley. After the pallet is empty, these are again refurbished, and the process goes on. Most of the products found are Aldi’s own labeled and branded products, and not much of other competing products or brands are found in Aldi stores. This reduces inventory carrying costs and the economic risks of having to stock a large number of brands, which may or may not sell. â€Å"The impact of using Value Chain Analysis by  is that it provides cheaper products to the consumers. In the past months, according to the Centre for Retail Studies, (2006) the cheaper products that Aldi gave the consumers impacted both the two biggest supermarkets in Australia, the Coles Myer and Woolworths. The compa nies came up with different strategies like Everyday low pricing (EDLP) and Save Everyday strategies.† (Undertake a full value chain (complementors) analysis of the Australian supermarket industry and its implications on the each of the three super market chains (Woolwoths, Coles and Aldi) 2009, para.19). The

Penny Synthesis Essay Example for Free

Penny Synthesis Essay Penny Synthesis Essay To â€Å"†¦ not ban pennies, but merely discourage their use by establishing a system†¦Ã¢â‚¬  It is because I agree with Mark Lewis of Forbes. com, that I affirm abolishing the penny, yet with some restrictions. In 2001 a United States Representative by the name of Jim Kolbe introduced a proposition to eliminate the penny (United States’ lowest denomination coin). To deeply reason as to why an individual might support this proposition, we must look at three different points of analysis. First, â€Å" How zinc manufacturing around the nation may be affected due to this decision†, Second, â€Å" What this means for the people of this country on an economical standpoint†, and Thirdly, â€Å" What are the benefits of eliminating the penny in terms of time and money†. According to Source A, since 1982 penny manufacturing has been produced from 97. 5% zinc material. Mentioned, as opposition to this bill, is Tennessee who is rich in raw zinc. Representative Kolbe’s idea is to make the nickel the country’s lowest denomination coin. Interesting enough Kolbe’s state of Arizona is rich in copper, which makes up most of the higher denominational coins. Keep in mind zinc manufacturing is not solely dependent upon penny manufacturing. The fact that this issue is being used to negate this bill is invalid because of this exact reasoning. Moreover, The proposition would gradually eliminate manufacturing instead of suddenly stopping production. This gives time for manufacturing companies to find other means of work besides the penny. It is understood from the proposition that prices would be altered rounding to the nearest nickel’s place. The study shows that if a person’s time is worth $15 an hour (which we all know it’s worth less than that, but that’s a different story) a person would be losing close to $60 per year. The penny will always be a crucial statement in our nation’s history yet we must keep our mind set on the future. In the words of Bob Dylan, â€Å" Times are a changing. † It is a better economical strategy to gradually eliminate the penny from circular use. From this reasoning I affirm Jim Kolbe’s proposition to eliminate the penny.

An overview of atrial fibrillation

An overview of atrial fibrillation Section1: Atrial fibrillation (AF) is a condition when the heart does not beat to its normal speeds or rhythm, often it beats faster than it should. This irregularity leads to an increased risk of stroke and death. The pump function of the heart deteriorates as a result of the un-coordination (due to uncoordinated excitation of muscles). The net result of impaired pump action is the upper chambers of the heart contract randomly and at times too quick for the heart to relax before it can contract again effectively. At the junction of the pulmonary veins in the left atrial musculature, abnormal impulses fire which override the heart natural pace maker. There are 3 major classifications for AF: Paroxysmal AF- lasts from 30 seconds to 7days Persistent AF- longer the 7days Permanent AF- AF that fails to terminate using cardioversion, or is terminated but relapses within 24hours. If there are no obvious cause and all investigations are normal, this is known as lone AF. Lone AF tends to occur in Paroxysmal cases. Otherwise the most common causes are ischaemic heart disease hypertension mitral stenosis hyperthyroidism Other causes which arent as common are can be classified into 3 sub catagories; Cardiac: Rheumatic heart disease, Sick sinus syndrome, Pre-excitation syndromes (such as Wolff-Parkinson-White syndrome) and heart failure. Less commonly, congenital heart disease, atrial myxoma , atrial septal defect, pericardial disease, and cardiomyopathy. Non-cardiac: Drugs (e.g. bronchodilators/thyroxine), Electrolyte depletion infection, Pulmonary embolism, Lung cancer Diabetes. Lifestyle: Obesity, high caffeine or alcohol intake1. A fast pulse (often >140bpm) which may or may not be irregular is the most common symptom of AF however it is also accompanied by tiredness, breathlessness, dizziness, angina1, syncope, reduced exercise tolerance, or polyuria2. The decreased efficacy of the pumping of the heart may result in the reduction of blood pressure. AF is diagnosed by the use of an ECG and is characterised by the absence of consistent P waves and presence of fibrillation. The method of management of suffers of AF has two main strategies, either by the control the arrhythmia aspect of the condition or by the tachycardia side of the condition. Rhythm controlling drugs include flecainide (and other similar drugs), beta-blockers (particularly sotalol), and amiodarone. Rate controlling drugs such as beta-blockers bisoprolol atenolol or the calcium channel blockers verapamil ordiltiazem. Thrombolytic and antiplatelet drugs are also used to manage the thromboembolic risk. There are non pharmacological ways to manage AF, the most common being cardioversion. Aspirin inhibits cycloxygenase from producing thromboxane A2 which is responsible for platelet activation and thus aggregation Diltiazem of use in AF for its affects on calcium channels on the heart. The blocking of calcium channels reduces excitability of cardiac muscle and hence decreasing fibrillations it also decreases the force of contraction Atenolol is a beta receptor blocker(a classII), it decreases the effects of the sympathetic drive to the heart, such that the neurotransmitters adrenaline and noradrenaline are competitively blocked. Thus the levels of cAMP decrease. cAMP mediates many events in the heart:decreases stability in resting potentials (phase 4) of nodal tissue(AVN conduction SAN firing). In nodal tissue(myocytes) a decrease in cAMP reduces Ca2+ entry thus action potentials take longer, it also causes repolarisation to longer i.e. increasing the refractory period Amiodarone has all four classes of activity (of Vaughan Williams system MAKE APPENDIX) however its main method of action is its class III mechanism. By the blocking potassium channels the potassium efflux in an action potential is blocked, thus action potentials duration is a prolonged refractory period (causing a region of unidirectional block remain refractory for longer effectively having a bi directional block)3 Verapamil a non selective calcium channel blocker (classIV), by reducing the Ca2+ into the cell through L-type channels in the nodal tissue (SAN AVN) depolarization takes longer as does the refractory period causing slower AVN conduction. Reduces tachycardic impulse from AVN to the ventricles and also AVN re-entrant rhythms. Phase 2 is limited in nodal tissue (myocytes and purkinje fibres) reduces triggered automaticity4. Warfarin inhibits the effective synthesis of biologically active forms of the vitamin K-dependent clotting factors: II, VII, IX and X, as well as some regulatory proteins. Flecainide a class1c sodium channel blocker.There is decreased diastolic excitability and Phase 0 (depolarization) takes longer as does the refractory period together causing slower conductions4. Propafenone is a class1c sodium channel blocker.There is decreased diastolic excitability and Phase 0 (depolarization) takes longer as does the refractory period together causing slower conductions4. Digoxin is a K+/Na+ ATPase inhibitor which leads to an increase in the intracellular concentration of sodium this stimulates of sodium-calcium exchange as a result there is an increase in the intracellular concentration of calcium causing stronger less frequent contractions. Cardioversion may be tried in some people with AF. The heart is given a controlled electric shock to try to restore a normal rhythm1. Catheter ablation is a procedure that very carefully destroysthe diseased area of your heart and interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated1. A pacemaker may be fitted alternatively to drug treatment when it is not appropriate of failing1. Section 2: AF is the most common rhytm disorder of the heart with up to 500,000 sufferes in the UK1. In the UK over 46,000new cases of AF are diagnosed each year5. The incidences increase with age, with a higher incidence in men, when data is adjusted for age6. AF is uncommon in the young unless there is an existing heart disorder. At 50-59years of age, the prevalence is around 0.5%. At 80-89years of age, the prevalence is around 9%. Section 3: AF is a significantly increases the chance of stroke and emboli. The decision to use antithrombotic therapy involves a complex balancing of risks, benefits, and costs. The probabilities of stroke, bleeding complications, and death; the associated costs of all treatment options and outcomes; and the quality of life associated with treatment and disability. These have shown that warfarin therapy is generally cost-effective and often cost-saving. However, the economic value of antithrombotic therapy in terms of cost-effectiveness is most strongly influenced by 2 factors: stroke risk and perceived quality of life. The cost-effectiveness models indicate that warfarin can be cost-effective or, indeed, cost-saving for a wide variety of patients with AF, provided that it is prescribed appropriately based upon stroke risks7 In patients at high risk of stroke, anticoagulation is most cost effective, but not for those at low risk of stroke8. Aspirin 75mgx28 Â £1.66, Aspirin 300mgx28 Â £0.55, Warfarin 1mgx28 Â £1.10, Warfarin 3mgx28 Â £1.15, Warfarin 5mgx28 Â £1.21, Atenolol 25mgx28 Â £0.82, Diltiazem MR 60 mgx84 Â £3.52, Diltiazem MR 60 mgx56 (or over 70yrs), verapamil 40mgx80 Â £1.55. Section 4: Symptoms should be monitored; often AF has no symptoms, however you should look for the common presenting symptoms (stated in section 1). Tests: Heart Rate- Should be done when treating with rate lowering drugs Electrocardiography- every 12months blood electrolytes, urea and creatinine- 1-2 weeks after initiation, and 1-2 weeks after reaching the maintenance dose, then every 6 months. For Beta-blockers, digoxin, amiodarone Monitor blood pressure Liver function tests- every 6months for amiodarone Thyroid function test- when using amiodarone eye examinations- annual eye examinations. Plasma levels- for digoxin, shortly after initiation or after a dose increaee. 0.7and 2.0nanograms per millilitre Drugs to reduce the risk of thromboembolism (warfarin, aspirin and clopidogrel) The target INR for oral anti coagulants is 2-3 usually 2.5. Patients should be considered for warfarin use if risk is perceived to be medium or high according to nice (see appendix)9. It is important that INR be measured daily or alternate days at initiation of treatment. Then at longer intervals depending on dose response up to 12 weeks10. Note the importance of increased monitoring as drugs are added to the regimen, pre-adjustment to warfrin are sometimes necessary e.g. decreasing dose by one or two thirds before initiation of amiodarone1. Section 5: Although systematic reviews have shown that aspirin reduces the rate of stroke by 25%8 The Atrial Fibrillation, Aspirin Anticoagulation Study demonstrated a reduction of strokes by 64% per year with warfarin (INR 2.8-4.2), compared with placebo, a 3.5% per year reduction. A non-significant reduction in stroke was seen with aspirin 75mg8. Where warfarin is contraindicated or patient requests not to initiate therapy, it has been found that a combination of antiplatelets (aspirin and clopidogrel) was associated with a significant reduction in major vascular events compared with aspirin alone. The number of people that would need to be treated with aspirin plus clopidogrel for 3.6years to prevent one vascular event was 421. According to a meta-analysis the combination of both aspirin and warfrin yielded no significant reduction in stroke rates and had increased side effects8. No mortality difference was found between rhythm control and rate control. Although for people older than 65years of age or those with coronary artery disease, a significant difference was found in favour of rate control in terms of all-cause mortality. Studies showed significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two groupsa.Incidence of ischaemic stroke, bleeding and systemic embolism was similar in the two groups, but certain malignant dysrhythmias were significantly more likely to occur in the rhythm control groupa. No cognitive decline was seen with the use of rhythm controlling drugs. Quality of life scores were similar in both groups. Therefore it is recommended that rate control, is used as it is less costly11. IA, IC and III drugs are effective in maintaining sinus rhythm but increased adverse effects. Class IA drugs may increase mortality. Calcium antagonists versus digoxin Seven studies found no difference in average heart rate between calcium antagonists verapamil or diltiazem and digoxin either at rest or during periods of normal daily activity. Studies have found calcium antagonists resulted in a lower heart rate during exercise, compared with digoxin2. Beta-blockers versus digoxin Three studies found no difference in average heart rate between digoxin and beta blockers while at rest or during periods of normal daily activity. However, the beta blockers atenolol and labetalol controlled heart rate during exercise more effectively than digoxin did2. Beta-blockers versus calcium antagonists One crossover study found no difference between the calcium antagonist diltiazem and the beta-blocker atenolol in terms of either the mean heart rate over 24 hours or during exercise2. Beta-blockers with digoxin versus beta-blockers One crossover study found no statistically significant differences in heart rate during periods of exercise. Some studies found the beta-blocker atenolol used in combination with digoxin to be associated with a lower heart rate over 24 hours than atenolol alone2. Calcium antagonists with digoxin versus calcium antagonists Four crossover studies found that calcium antagonists diltiazem or verapamil used in combination with Digoxin to be more effective in controlling heart rate over 24 hours, as well as during periods of exercise, than either diltiazem or verapamil alone2. Section 6: Many people whom suffer from AF suffer no symptoms, some have been diagnosed incidentally1. It is in these patients that concordance is a particular issue. Education as to the risks and complications of the condition are necessary to achieve optimum concordance. It is important that patients are aware the side effects (SE) as well as the dosage regimen. Many of the dugs used in the management of AF have common and serious side effects which patients should be trained to spot. Interactions and side effects of note. Further information can be derived from the British National Formulary (BNF) and a comprehensive analysis available in the most current Stockleys drug interaction. Classes of drugs have been mentioned although this does not mean that the entire class will interact Amiodarone Interactions: Anti-arrhythmic (rate and rhythm modulating), Antibiotics, Anti coagulants, Tricyclic antidepressants, mizolastine, thyroid hormones, diuretics and phenytoin10. it is of note that due to its long half life amiodarone may still interact several months after treatment is stopped particularly relevant in the switching over of treatments. Amiodarone reduces the clearance of warfarin, prolonging prothrombin times (PTs) and elevating international normalized ratios (INRs). To avoid bleeding complications, the patient being put on amiodarone must have their current dosage of warfarin reduced by at least one-third and PT and INR closely monitored until they are stabilized15. Although routine eye examinations should occur to asses the ocular effects of amiodarone, if a patient experiences any visual impairment the treatment should be stopped10. Patients should be aware for the signs of thyroid dysfunction (signs and symptoms of which included in appendix 1) Warfarin interactions: Alcohol, amiodarone, propafenone, analgesics, antibiotics, antidepressants, antiepileptics, thyroid hormones, ulcer healing drugs, lipid regulating drugs, hormones, corticosteroids Warfarin levels are easily effected by changes in diet, major changes in diet should be done in consultation with healthcare professional, commonly eaten foods that are known to interact with warfarin are cranberry, grapefruit and vitamin K rich foods16. bleed or bruise easily. Also, if you bleed, the bleeding may not stop as quickly as normally. For example, you may have: bleeding gums; nosebleeds; prolonged bleeding from cuts; blood in the urine. Beta blocker interactions: Antiarrhythmics (rhythm and rate modulating), antibiotics, antidepressants, mizolastine, antipsychotics and diuretics. Beta blockers should be avoided in people with asthma, or with chronic obstructive pulmonary disease13, Beta-blockers should not be stopped suddenly unless absolutely necessary; there is a risk of rebound in the condition13. Doses are titrated for patients and are gradually increased10. Digoxin interactions: Antiarrhythmics (rate and rhythm modulating), diuretics, anti biotics and anti epileptics. Signs and symptoms of digoxin toxicity are important to report promptly. Digoxin toxicity may cause drowsy, dizzy, and affect your vision, disorientation, confusion, headach or disyurbed vision14. Flecainde interactions: Antiarrhythmics (rate and rhythm modulating), antidepressants, antihistamines, antipsychotics, diuretics and tolterodine Roughly 1% of the general population and 10% of asthma suffers are allergic to aspirin12. Each drug has the potential for interaction with other medication and even food. Self help advice In order to minimise the risk of stroke and heart attacks it is important for patient to receive practical advise on diet as this will impact on blood cholesterol levels, weight management and blood pressure it is of particular importance when the patient is diabetic. Important components in a healthy diet are low fat and salt intakes, with an emphasis on complex carbohydrates found in vegetables. Advice on the sources of esstential fatty acids should be given (for example nuts and oily fish). Smoking cessation counseling and Nicotine replacement therapy should be offered, discussing the statistical significance smoking alone contributes to the Cardio vascular events. Section 7: Pharmacists have contact at various stages along a patients treatment. A specialist PCT pharmacist may manage patients, prescribe, review and monitior. A community pharmacist should attempt medicine use reviews and prepare to make interventions on prescriptions when appropriate. Clinical pharmacists are involved in monitoring and providing guidance on protocols and current evidence. In the future there will be an increased scope for pharmacists to play a larger role when full patient records become available, full clinical reviews may be conducted taking into account the persons history (familial, drug, treatment, condition) and make appropriate interventions and recommendations according to the most current evidence. Section 8: In order for the condition and the services to run effectively is necessary to run audits regularly. This will ensure the national standards are met. Nice guideline audit criteria: All people presenting to primary or secondary care with a hypertension, heart failure, diabetes made or stroke and noted to have an irregular pulse to be offered an ECG and any new diagnosis of AF recorded2. All AF patients in whom a rate-control or rhythm-control strategy is initiated to have their involvement in choosing a treatment strategy recorded2. All patients who are prescribed digoxin as initial monotherapy for rate control to have the reason for this prescription recorded where it is not obvious (e.g. sedentary patient presence of contraindication to alternative agents)2. All patients should be assessed for risk of stroke/thromboembolism and given thromboprophylaxis according to the stroke risk and have this assessment and any antithrombotic therapy recorded2. It is important for pharmacists to keep uodate and maintaining a high levels of competenacy. Advice should be evidence based and current. There are regular updates produced by nice NICE and the Guidelines for atrial fibriliation are a good source of information. Section 9: the National Service Framework for coronary heart disease has a chapter pertains to AF. Arrhythmias are of great importance Cardiac arrhythmia affects more than 700,000 people in England and is consistently in the top ten reasons for hospital admission, using up significant AE time and bed days. AFis the most common arrhythmia, affects up to 1% of the population (rising to 4% in the over 65s) and absorbs almost 1% of the entire budget of the NHS to the NHS16. Of the three quality requirements there are two relevant in AF. Quality requirement one: patient support. People with arrhythmias receive timely and high-quality support and information, based on assessment of their needs16. Markers of good practice People with arrhythmias receive a formal assessment of their support needs and those at significantly increased risk of anxiety, depression or a poor quality of life receive appropriate care16. People with long-term conditions receive support in managing their illness from a named arrhythmia care co-ordinator16. Good quality, timely information about arrhythmic conditions is given by appropriately trained staff16. Quality requirement two: diagnosis and treatment. People presenting with arrhythmias, in both emergency and elective settings, receive timely assessment by an appropriate clinician to ensure accurate diagnosis and effective treatment and rehabilitation16. Markers of Good Practice Initial Treatment All patients receive a hard copy of the ECG documenting their arrhythmia and a copy is placed in their records. Patients who survive out-of-hospital cardiac arrest and patients presenting with pre-excited AF are assessed by a heart rhythm specialist prior to hospital discharge. The following patients are assessed urgently by a heart rhythm specialist: Patients with syncope or any other symptom(s) suggestive of an arrhythmia and a personal history of structural heart disease or a family history of premature sudden death Patients with recurrent syncope associated with palpitations Patients with syncope and pre-excitation Patients with documented 3rd degree AV block (not associated with acute MI) Patients with recurrent syncope in whom a life-threatening cause has not been excluded Patients with documented ventricular tachycardia The following patients are referred to a heart rhythm specialist: Patients with a presumed diagnosis of ventricular tachycardia Patients with Wolff-Parkinson-White (WPW) syndrome or asymptomatic pre-excitation Patients with symptomatic regular recurrent supraventricular tachycardia which is unsuccessfully treated with one type of medication or who would prefer not to take long-term medication Patients with recurrent atrial flutter Patients with symptomatic AF despite optimal medical therapy First degree relatives of victims of sudden cardiac death who died below the age of 40 years Patients with recurrent unexplained falls Markers of Good Practice Ongoing Treatment Mechanisms are in place for urgent referral of patients with sustained or compromising arrhythmias for prioritisation of appropriate treatment. Implantable cardioverter defibrillators (ICDs) are considered in patients presenting with life-threatening ventricular arrhythmias and in those without demonstrable arrhythmia but identified as being at high risk. Catheter ablation is considered as the treatment of choice in patients presenting with sustained supraventricular tachycardia (SVT) other than AF, and cardioversion of recent onset AF is considered as early as is clinically safe. Where further hospital treatment is not recommended, a care plan is agreed between the patient, GP and the arrhythmia care team, including follow up and support as required. Management of long term conditions and elderly also have a priority in the governments plans and frameworks for the future. Section 10: Emphasis should be on patient centered care, projects such as near patient testing for warfarin have proved to be effective at managing patients and their potential complications. Primary care workers such as GPs PCT pharmacist should screen at risk patients. They shall be involved in the management of there condition frequently monitor patients. If required a referral can be made on lifestyle issues to manage the risk of stroke, e.g. if lipids are elevated may want to refer to a dietitian. Community pharmacists have a role in conduction medicines use reviews and be prepared to make inventions in prescribing, regimen concordance and side effect management/referral. It is of utmost importance that the specialist (cardiologist) makes clear recommendation and maintains communications with their counterparts in primary care.