Wednesday, August 26, 2020

Commentary on Accounting Ratios Research Paper Example | Topics and Well Written Essays - 1000 words

Analysis on Accounting Ratios - Research Paper Example This implies more up to date organizations will by and large have lower ROCE when contrasted with more established organizations because of the devalued measure of its benefits. Moreover, the quantity of years that both Dairy Crest and its nearby rival have been doing business is muddled. The income of Dairy Crest is up by practically 20% in 2008, bringing about Operating Profit Margin of 6%. This outcome is comparable to its rival. Be that as it may, the improvement may have been credited by the twofold increment in Dairy Crest's other pay, of which the breakdown has not been revealed. Given the equivalent outcome, it very well may be said that the contender might be new in the market since its ROCE is path lower than that of Dairy Crest. Truth be told, the organization's Gross Margin Profit is down from 4.6% in 2007 to just 3.9% in 2008, though its rival's is 25.7%. Seeing Dairy Crest's merged salary explanation, its working expense is up by practically 21% while its income expanded uniquely by about 20%. Additionally, there might be a few contrasts in the valuing system embraced by the two organizations, which clarifies the enormous hole in the edge. The organization's Asset Turnover Ratio is somewhat better at 1.8 occasions in 2008, while its rival is at 1.9 occasions. The higher income in 2008 methods Dairy Crest is using its benefits more. Accepting its rival is new in the business, this outcome shows Dairy Crest isn't proceeding just as its rival. Apparently Dairy Crest has better control of its stocks with a drop in its Stock Turnover of 38.6 days in 2008 against 43.1 days in 2007. As food stocks are short-lived things, it is fitting not to hold them for a really long time. Dairy Crest's transition to bring its stock holding period somewhere around 10% is insightful. While its rival holds stocks 46 days in 2008, it is muddled if this is because of vulnerability in providers, as the elevated levels appear to be superfluous dependent on industry. The Current Ratio of Dairy Crest in 2008 is 1.4, an improvement from 1.0 in 2007. This shows the organization's money related position is more beneficial. Be that as it may, its rival's Current Ratio of 0.8 in 2008 appears to be dangerous, as

Saturday, August 22, 2020

The Power of Teaching Essay -- College Admissions Teaching Education

The Power of Teaching â€Å"To outfit the methods for securing information is...the most prominent advantage that can be presented upon mankind.†- - (John Quincy Adams) I have never addressed what I needed to be the point at which I grow up. From the time as a little youngster I realized that I needed to instruct. Indeed, even toward the finish of many long school days, I would get back home and play school with the local youngsters. I wanted to help other people learn and enjoyed doing as such. All things considered, to this current day I am instructing and helping other people. Directly, I mentor seventh and eighth grade girls’ b-ball. I am continually showing various techniques and procedures to help improve each individual’s game. From my past encounters I realize training is the field that I wish to seek after. I accept that the general motivation behind training is to get ready for what's to come. The world is turning out to be all the more mechanically propelled every day. Training is imperative to totally comprehend these new ideas. Instruction is the way in to a fruitful and satisfying life. The reason for existing is to give every youngster the equivalent opp...

Monday, August 17, 2020

Endogenous and Exogenous Depression Symptoms, Diagnosis, Treatment

Endogenous and Exogenous Depression Symptoms, Diagnosis, Treatment Depression Types Print An Overview of Endogenous and Exogenous Depression By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial policy Nancy Schimelpfening Medically reviewed by Medically reviewed by Steven Gans, MD on December 07, 2015 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 07, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids Jamie Grill / Getty Images In This Article Table of Contents Expand Symptoms Causes Diagnosis Treatment View All Psychiatrists and researchers once categorized depression using a pair of terms derived from Latin: endogenous (meaning from within”) and exogenous (from without). These names were intended to indicate whether someone’s depression came from internal causes (such as genetics) or external causes (like a stressful or traumatic event). The old belief was that the distinction was necessary and that each type of depression had to be treated differently.?? Over the last few decades, however, research has not provided sufficient evidence in support of this theory. Today, depression formerly referred to as “endogenous” is known as major depressive disorder (MDD). The current philosophy is that the same types of treatment can be used for MDD whether it is endogenous or exogenous. However, it can still be helpful for healthcare and mental health professionals to note the differences between endogenous and exogenous causes of major depression when helping people understand the condition.??   The Most Common Types of Depression Symptoms There is considerable overlap in depression symptoms from one type to another.?? A key difference (particularly when discussing endogenous or exogenous types) can be the cause or trigger for an episode of depression rather than specific symptoms. Verywell / Joshua Seong Endogenous Depression Symptoms of endogenous depression include feelings of sadness, worthlessness, guilt, and an inability to enjoy normally pleasurable things.?? You may also notice changes in your appetite, sleep patterns, and energy levels.   If you have endogenous depression, the world may seem like a dark and sad place because thats how you feel within yourself. Exogenous Depression Exogenous depression can look and feel much like endogenous depression.?? The difference is that these symptoms come on after something happens in a persons life. For example, a person may feel persistently sad after the death of a loved one or struggle with guilt and feelings of worthlessness after losing their job. Exogenous depression can make the world seem dark and sad because of whats happening around you rather than in you. Another difference is that people with exogenous depression dont always have the physical symptoms of depression, like having trouble sleeping or change in appetite, which is common in other forms of the condition. Causes Whether depression is endogenous or exogenous, it’s almost always triggered by a life stressor. In someone who is prone to depression due to a genetic or biochemical predisposition, a significant change, life event, or trauma can serve as a trigger that causes them to develop symptoms.   Endogenous Depression People with endogenous depression often feel that their symptoms occur “for no reason”â€"at least in the sense that there is no apparent external cause. Instead, the cause is thought to be biochemical and/or genetic.?? For example, a person with a family history of mental illness may be more likely to develop depression. Can You Be Depressed for No Reason? Exogenous Depression Exogenous (or reactive) depression is triggered by an outside stressor such as the loss of a loved one, getting divorced, or losing your job.?? People who experience or witness a traumatic event may develop depression as a direct result of that exposure.   While someone with endogenous depression had an underlying predisposition that was triggered, exogenous causes can lead to symptoms of depression in someone who doesn’t have a predisposition.   How Life Stressors Can Lead to Depression Diagnosis Medical and mental health professionals use a specific set of criteria to diagnose depression. These guidelines are found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Your doctor may evaluate you for depression in the office, but they might also want you to see someone who specializes in diagnosing and treating mental illness, such as a psychiatrist.   Whether depression is endogenous or exogenous may be determined when your doctor is asking you questions about your symptoms.For example, if you began feeling depressed after the loss of a loved one, there is a good chance your depression is reactive (exogenous).If you have experienced symptoms of depression for many years that werent triggered by a specific event, its more likely your depression is endogenous.Your provider may give you an overall diagnosis of depression rather than specifying one or the other. The process of being diagnosed with depression usually involves several key components. It often begins with you being asked questions about how you feel physically and emotionally, what your day-to-day life is like, and whether anyone in your family has a mental health condition.   Is Depression Genetic? You will also be asked questions about your diet and lifestyle, social activities, what you do for work, and any medications that you take or substances that you use. Your provider will want to know if you have people in your life you can turn to for support and whether you have been struggling to go to school, work, or participate in social activities. One of the most important questions you will be asked is whether you have ever had suicidal thoughts or attempted suicideâ€"a potential consequence of untreated depression.   DSM-5 Depression Diagnosis Major depressive disorder  (MDD) is diagnosed when someone has experienced intense sadness and/or loss of interest in their usual activities plus several other symptoms of depression (such as trouble sleeping, change in appetite or weight, and difficulty concentrating) for at least two weeks. After your discussion, your healthcare provider will carefully consider your answers and compare them to the diagnostic criteria for depression. They may ask another professional or specialist for their opinion (a consultation) or have you see another provider for further assessment. Once a diagnosis is established, the providers in charge of your care will begin working on a treatment plan. Keep in mind that the most effective treatment for you won’t necessarily be the same as what works for someone else with depression, and you may need to try more than one treatment. Sometimes, your diagnosis might change. If you don’t respond well to a treatment that usually works for depression, for instance, your doctor might want to reevaluate your symptoms to see if you have another mental illness, such as bipolar disorder. While the process of getting a diagnosis of any form of depression can take time, it is well worth it to ensure the diagnosis is accurate. Having the correct diagnosis will make it much more likely that you will find an effective treatment. How Depression Is Diagnosed Treatment In 2012, a study published in the journal Molecular Psychiatry suggested that the root cause of exogenous and endogenous depression could be found in different pathways in the brain.??   However, researchers have yet to prove that the two types respond differently to specific treatments for depression, such as medication.   Though they are instigated in different ways, both exogenous and endogenous depression ultimately lead to a biochemical imbalance in the brain. Therefore, a treatment that addresses an imbalance can be used for either type.   The first-line treatment for depression of either type is usually antidepressant medication.?? Drugs from a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are often the first choice, as they are consistently effective and well-tolerated. Medications are often paired with psychotherapy, which is more effective for some people than using only an antidepressant. People with severe or treatment-resistant depression may need other interventions to effectively manage their symptoms, such as antipsychotic medications and/or electroconvulsive therapy (ECT). The unique qualities of all types of depression are still being researched. As new information is learned and discovered, in the future, treatments may emerge that can help manage various forms of depression in different or more targeted ways. For now, it’s best to discuss your symptoms, family health history, and risk factors with your doctor or a mental health professional to determine the best treatment. The Best Online Therapy Programs

Sunday, May 24, 2020

Financial Globalization And The Financial Crisis - 1274 Words

The term financial globalization can be defined as the integration of various financial markets of countries across the world. In other terms, it means the mobility of finance across various countries without encountering any barrier. Therefore, financial liberation is not sufficient enough parameter for globalization. Financial globalization advocates for development of a single currency worldwide currency that can be regulated and managed by a single global monetary institution. The first era of unrestricted financial globalization took place in late 1860s. During this time, it is argued that London played the role of the heartbeat of all of financial undertaking. This time frame is classified as the early stage of development of global financial and markets (Eichengreen Bordo 202). That time frame was characterized by a sequence of banking challenges as a result of poor financial management, speculation; unrestricted borrowing poorly controlled banking systems and non-disclosure of financial data in the banking industry. Interestingly, Keynes (171) views the financial the first era financial crisis under the perception as London having the ability to serve the whole world in terms of financial assets only through a phone a call. The history of global financial industry progress in the world war time frame, 1919 to 1939, had no anything to be happy about either; besides it greatly threatened by the collapse of stock market in the early 1930s, proceeded by the GreatShow MoreRelatedGlobalization Of Financial Markets And The Global Crisis2182 Words   |  9 PagesGlobalisation of Financial Markets and the Global Crisis The financial markets are increasingly and highly interconnected, which means that the regulation of the financial services is becoming globalised as well, since most of the bigger firms operate all over the globe, the standardization of the regulation is a very common practice nowadays, making very difficult especially for developing countries keep up with the regulation. The financial crisis of 2008 was one of the most devastating and longestRead MoreThe Globalization Of The World Economies Is A Direct Result Of Globalization1309 Words   |  6 PagesOver the past few decades, particularly during the 2000s, financial markets around the globe have become increasingly interconnected (Shmukler, 2004). This mounting integration of the world economies is a direct result of globalization. Particularly, the globalization of financial markets is characterized by substantial cross-national flows of capital and the development of a large foreign exchange market. Every day around the world, banks and stockbrokers transfer vast amounts of money across countryRead MoreThe World s Economy Was Devastated1732 Words   |  7 Pagestelecommunications, the world saw rise to globalization. Globalization is process of integration of the world’s views, products, ideas and culture. 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Globalization 441. Professor1277 Words   |  6 Pages2016 Globalization 441 Professor Garclon Final Exam In this paper you will understand the shift of the development to the globalization project. In doing so you will learn what â€Å"globalization† means as a project and as a process and why it is described as being in crisis. Next you will learn about the financial and farming dimensions of the problems confronting the globalization project. With that you will thirdly learn about how global warming presents multiple challenges to globalization. I willRead MoreThe Economic Globalization Of India935 Words   |  4 Pages Economic Globalization has swept across the world since the end of WWII. Slowly but surely all the nations across the world have been impacted by Economic Globalization. India for example, has been one of the countries that has been recently hit by the storm, and India’s economy can be seen to still be shooting up. In my paper I will be discussing the Economic Globalization of India, the roots of the globalization to occur, the effects it had and the negative effects it had. Effects such as foreignRead MoreArticle Analysis: On the Contradictions of the New International Financial Architecture: Another Procrustean Bed for Emerging Markets?1404 Words   |  6 PagesSummary: what is a main concept in the case or article? The main concept of the article is to explain why the New International Financial Architecture (NIFA) was created and who is being benefited from this approach. The discussion begins with an examination of the power structures of the global political economy by focusing on the continued dominance of the USA. The article presents the contradictory relations between USA and global finance will be explored so as to shed more critical lightRead MoreHow Failures in Financial Engineering Influenced the Recent Financial Crisis1303 Words   |  6 PagesIn this paper, an analysis of how the failures in financial engineering and Corporate Governance have been closely related with the recent Global Financial Crisis is carried out. The Real Estate Bubble in 2006 leaded to the Subprime Mortgage Crisis in 2007 which expanded from the United States to the whole world generating the biggest financial crisis since the Great Depression of the 1930s. There are multiple factors that originate a crisis like this, and will be explained and analysed laterRead MoreGlobalization and Its Meaning Broadly Speaking, the Term ‘Globalization’ Means Integration of Economies and Societies Through Cross Country Flows of Information, Ideas, Technologies, Goods, Services, Capital,1074 Words   |  5 PagesGlobalization and its Meaning Broadly speaking, the term ‘globalization’ means integration of economies and societies through cross country flows of information, ideas, technologies, goods, services, capital, finance and people. Cross border integration can have several dimensions – cultural, social, political and economic. In fact, some people fear cultural and social integration even more than economic integration. The fear of â€Å"cultural hegemony† haunts many. Limiting ourselves to economicRead MoreFinancial Deregulation and Capital Control1283 Words   |  5 Pagesï » ¿Financial deregulation and capital control The financial markets for a long time were regulated following the aftershocks of the global recession which affected several economies across the globe. It was until the 1980s that the federal government passed the Deregulation and Monetary Act which was aimed at providing deregulation for the financial institutions. This gave the banks the flexibility to compete and extend their services at a much easier and faster way in a very competitive market and

Wednesday, May 13, 2020

Cognitive Styles And Their Impact On Learning - 1145 Words

Introduction Dr. Seuss once said â€Å"It is better to know how to learn than to just know†. The debate over cognitive styles and their impact on learning has been prevalent for over 50 years and is still being researched today. Cognitive styles, also referred to as learning styles, can be defined as â€Å"information processing habits† (Kollofel, 2012) and are believed to be much like traits of personality in that they remain stable and unchanged over time (Klitmoller, 2015). There are three different types of learning styles including visual, auditory/verbal, and kinesthetic. A kinesthetic learner may prefer demonstrations and more hands-on approaches in order to process information. The most prevalent and debated learning styles are visual and verbal. A visual learner is someone who learns through pictures or diagrams while a verbal learner may learn best through discussions and talking out problems. According to Kollofel (2012), there are two different types of visu al learners, those who learn best through spatial imagery and those who learn best through pictures or object imagery. Learning styles in schools are largely debated because it is often difficult for instructors to meet every student’s learning needs. Increasing numbers of students mean that there will be more preferred learning styles. According to Romanelli, Bird, and Ryan (2009), learning styles vary by culture so one form of instruction that may work in America may not necessarily work in Eastern cultures. OneShow MoreRelatedThe Theoretical Framework For My Research Is Adult Learning Theory Essay1607 Words   |  7 PagesTheoretical Framework The theoretical framework for my research is adult learning theory incorporates the basic concepts of behavioral change and experience in learning. â€Å"Emerging theories of adult learning are based on the unique characteristics of adults as learners† (Knowles, 1970, section 1, para 1). There are two categories with respect to the theory of adult learning: how an adult processes knowledge, which in turn produces change for the individual, and how an adult processes knowledge toRead MoreThe Classroom Learning Theories And Models1454 Words   |  6 Pagesopportunity to influence learning for children and adults in the classroom learning theories and models are used to tactfully engage the participants. The learning theories implemented are similar for both school aged children and adults. Regardless of the age of the student that is involved in learning, the system used to accomplish the learning is associated with seeing, hearing, listening, and some instances hands- on pra ctice. Therefore, children that are learning new concepts are very similarRead MoreLearning Styles As A Student s Learning1454 Words   |  6 Pageswhat methods of teaching and learning work most effectively for them. They often choose from a list of learning styles, either from a quiz that they find online or by evaluating the effectiveness of the ways their teachers present information to them. The more common learning styles are visual learning, auditory learning, and kinesthetic, or hands-on, learning (Workman). There are other explanations as to why humans learn the way they do, such as brain-based learning or dual coding. The questionRead MorePhysical and Social Factors That Influences Growth and Development882 Words   |  4 PagesIn a normal child, progress within the different domains varies, as in the toddler who walks late but speaks in sentences early. Overview Genetic factors, environmental influences and psychological factors and disease can affect both a childs cognitive development and physical growth. This is why parents, doctors and teachers should routinely assess childrens patterns of development throughout the years so the children can reach certain developmental milestones they are expected to achieve. GeneticRead MoreWhy Learning Theories And Learning Styles Is Important For Your Career Essay1435 Words   |  6 Pagesunderstanding of learning theories and learning styles is important for your career in nursing? In this essay, I will start by discussing the four main aspects of learning theories and how having an understanding of these will help me in my nursing career. I will also be identifying my own strongest and weakest learning style and how having an understanding of this will enhance my practice as a learning disability nurse. In my understanding, a learning style is your own way of learning, and who youRead MoreLife Factors Affecting A Person s Life For The Better Or Worse982 Words   |  4 Pages Life factors can have a significant impact and effect on a person s life for the better or worse. My smart measure score was 72 percent out of hundred. Time being the most reasonable concern scoring on 50 percent. Due to my other commitments being a wife and mother these responsibilities affects my studies and time but not in a bad way. Following with 65 percent, Skills 70 percent, Place 75 percent, and at 100 percent is the Reason. Especially this semester being a fast-trackedRead MoreSample Resume : Customer Service Essay1398 Words   |  6 Pagesat all times (Larkin). The course objectives are: 1. Identify the company’s customer service principles. 2. Explain customer service language and the importance of using it when speaking with customers. 3. Demonstrate a consistent, professional style when talking with customers. 4. Prepare the employees to manage demanding customers and difficult circumstances (â€Å"Customer Service Training,†n.d.). The Main Topics with subtopics are: 1. Define excellent customer service. †¢ What does excellent serviceRead MoreTheory Analysis: Health Promotion Teaching Plan1109 Words   |  5 Pages Health promotion teaching Plan for principles of health promotion for students. Assessment of learning needs - The knowledge needs to be reduced to practical and condensed themes so that it can be easily remembered and applied. Differentiated learning will be employed so that assessment will occur in differentiated style according to specific personality, level, style of learning etc. K knowledge level -a their knowledge level is excellent, particularly since students have recently receivedRead MoreInfancy and Early Childhood Development Essay1157 Words   |  5 Pagesquite similar to a blank video tape. During infancy the child records everything he or she sees and hears. The things that are recorded are stored for later use in life. The way that people behave with the infant as an individual and a family greatly impacts the development of the infant. It is for this reason that it is extremely important to raise children properly the first time around and to provide a safe and caring environment. After an infant is born the brain begins to go through developmentalRead MoreTypes of Cognitive Strategies1083 Words   |  4 Pagesfour types of cognitive strategies. Pintrich, Johnson, Weinstein and Mayer indicate that rehearsal strategy is commonly used for individuals involved with beginner or introduction level learning. The elaboration and organistional strategies are for covering more complex and detailed information. [as cited in C.-Y. Chen Pedersen, 2012, pg. 364]. Another type of strategy is a metacognitive strategy, this is how somebody understands and controls him or herself in the process of learning. After this

Wednesday, May 6, 2020

High School Educational System in Contrast Free Essays

Name: Lily High School Educational System in Contrast between Canada and China With the development of a progressive and civilized society, education becomes a greater priority. In separate countries, there are distinct differences in the systems and methods by which education is practiced. The Canadian secondary school educational system is different from the Chinese education system in four main areas: the subjects offered for study, requirements for graduation, the authority of the teachers and the physical aspects of the institutions. We will write a custom essay sample on High School Educational System in Contrast or any similar topic only for you Order Now The first obvious difference in the education system between Canada and China is in the subjects that are offered for study. In China, there are two systems for students to choose in high school: a departmental system consisting of liberal arts and science. The students who choose liberal arts will study Mandarin, English, History, Mathematics, Politics, and Geography. For those who choose science, the preferred courses will be Chinese, English, Mathematics, Biology, Physics and Chemistry. According to BC Ministry of Education (2008), in Canada, there are two ways for students to choose: required and elective courses. For instance, required courses are planning, language arts, mathematics, fine arts and applied skills, social studies, science and physical education and are offered as the students only choices. Furthermore, elective courses have more flexible options. Surely, choosing any courses that interest students is important, as long as their electives are over twenty eight cre dits. The second difference between China and Canada is in the requirements for graduation. In China, students have to take college entrance examinations, which are the most important academic exams in China. In addition, students will receive placings that are arranged from the higher to the lower grades. The marks they get will influence whether they are able to graduate, to repeat the courses or to leave school and enter the workforce as only partially skilled. Conversely, in Canada, the requirements for graduation are easier than they are for students in China. Students in Canada are required to obtain just forty eight credits from the required courses, twenty eight credits from the elective courses, as well as four credits from graduation transitions (BC Ministry of Education, 2008)2. Other noticeable differences between Canada and China involve issues of the authority possessed by teachers. In China, teachers are like parents, in contrast, teachers are more like friends or mentors in Canada. Chinese teachers always emphasize the importance of rote learning and the value of marks. However, Canadian teachers give students more freedom and offer the opportunity to develop their interests. Furthermore, Chinese teachers are much stricter than Canadian teachers. Sometimes, a teacher in China can punish a student by assaulting them, which is due to the fact that teachers in China are held as being above question, while by law. Canadian teachers are not allowed to physically attack their students in any way. (Farran, S. , 2009)3 The final distinct area of difference between Canada and China is the physical aspects of the learning environments. For instance, the sizes of the classes in China usually are composed of approximately sixty people, but classes in Canada normally are a maximum of about thirty people. Statutory holidays are different, too. Chinese students are free from January to February for one month to celebrate Spring Festival and in July and August for two months because of the extremely hot weather. Canadian students are free during a part of December to celebrate Christmas during Winter Break, and this holiday is usually about three weeks without school. In China, students have to go to school in the evening to study; however, Canadian students have the choice of taking extra classes or tuition, but this is optional. In conclusion, the subjects offered for study, the requirements for graduation, the authority of the teachers and the physical aspects of the institutions are the main contrasts between the Canadian and the Chinese secondary school educational systems. Education is an essential component of a successful and potentially prosperous life, and a definitive part of the core competency of a nation. Therefore, how to form a more innovative yet completely effective system of education requires constant exploration, development and implementation of methods that maintain high standards and improve to the highest quality for the students of the world’s future. Reference: 1 BC Ministry of Education (2008). At a Glance Requirements – What You Need to Graduate. Retrieved 2012, from BC Ministry of Education 2 BC Ministry of Education (2008). At a Glance Requirements – What You Need to Graduate. Retrieved 2012, from BC Ministry of Education 3Farran, S. (2009). CAN HIGH SCHOOL GRADES BE TRUSTED?. MacLean’s, 122(44), 92-96 How to cite High School Educational System in Contrast, Essay examples

Monday, May 4, 2020

Polymorphism Adversely Responding to ACE †MyAssignmenthelp.com

Question: Discuss about the Polymorphism Adversely Responding to ACE. Answer: Introducrion: Mr. Tim Hewson is a 61 yr. old male patient who stays in Mawson. He is suffering from Hypertension, ischemic Heart Disease and Gastro esophageal Reflux (GERD). He has a history of ischemic stroke that happened 6 months ago, is a widow with no children and lives alone. Hypertension is characterized by chronic elevated BP. GERD is a condition where the esophageal sphincter is abnormal leading to presentation of heartburn and regurgitation. Ischemic heart disease presents with basically angina due to coronary insufficiency (Marie Visvikis-Siest, 2018). He is under the following treatment; Lisinopril 20mg, Frusemide 40mg, Aspirin 150mg, Cymbalta 60mg nocte, panadol 1g PRN, Ibuprofen 400mg TDS, Nexlum 40mg, Coloxyl and Senna 2 tablets. Lisinopril is an ACE inhibitor and is used to manage hypertension (Wu, Yang, Chang Wei, 2016). Frusemide is a diuretic and is used to treat hypertension and heart disease. Aspirin is used in the treatment of pain and inflammation that may result due to th e ischemic heart disease. Nexlum (esomeprazole) is used in treatment of reflux and heartburn by reducing acid production. Ibuprofen is an NSAID and work to relieve pain and inflammation, symptoms of heart disease (Packer, Anker, Butler, Filippatos Zannad, 2017). Cymbacta is an antidepressant that can be used to treat chronic pain. Panadol is used to relieve mild pains such as headaches that may result due to high blood pressure (Maumus, 2018)Coloxyl and senna are laxatives that softens stool hence facilitating gastric emptying hence relieving symptoms of reflux. Mr. Tims symptoms are persisting and he is also suffering adverse reaction due to treatment. It seems Jim has not been completely compliant to the medication and the general measures advised in regards to his condition. As a community health nurse, I would request Tim to explain to me his eating habits and drug taking frequency. In regards to GERD, Tim ought to be aware that he should use a big pillow while sleeping and he should not sleep immediately after eating (Scarpellini, Ang, Pauwels, Santis, Vanuytsel Tack, 2016). He should also avoid acidic meals. Failure to comply to the measure leads to worsening symptoms. During assessment of the conditions, the cues expected; pain on the chest, headaches, edema, complaints of heartburn and reflux. The information required is having prior knowledge about the conditions, precipitating factors, management and general measures of prevention in the community. As a community health nurse, I will be planned to carry out a physical exam and come out with priority nursing care plan. The next focus will be on the health education (Sacks, Alva, Magalona Vesel, 2015). I will educate Tim on the measures in attaining comfort and pain free and how to minimize complications. Due to the continued use of NSAIDs, the symptoms of GERD are persistent. Tim is also thought to be taking meals just before bed time and high acidic meals. This is the reason for persistent symptoms. Due to the chronic use of Ibuprofen, this has increased the hypertension symptoms and heart disease. Asprin increases of the risk of gastrointestinal bleeding in cases where GERD has led to ulceration. Esomeprazole acts after a long period of time up to 4 days. During this period, the symptoms of reflux and heartburn are persistent. Lisinopril in its action it can worsen the symptoms of heart disease such as chest pain and cough. It also worsens the headache that may be present sin ce the patient is suffering from hypertension. The main reason for taking a community visit is to be able to reach patients who are unable to visit a facility. In the community, one I able to diagnose it as one, identify the common problem hence making a community diagnosis. The goal of the visit is to evaluate the nursing interventions for Tim and assess the need for re planning. Prior to this visit one has to be aware of the history of Tim, the treatment regime and the patient centered management. In the assessment, I would assess the vital signs to ensure whether they are within normal ranges. I would monitor the symptoms and check if they are resolving or fluctuating and consult the subjective concept of the patient. I will also assess the occupational adjustments and adaptation as far as his condition is concerned. Tims symptoms are worsening and this may led to complications. I would recommend him to visit a physician for a checkup and reconsider more tests, hospitalization and change of medications. References Marie, P. Y., Visvikis-Siest, S. (2018). Do we need diagnostic strategies enhanced with genetic information for ischemic heart disease?. Maumus, M. (2018). Solving Americas Prescription Epidemic: Pathophysiology, Ethics, Chronic Pain, and Addiction. In Clinical Approaches to Hospital Medicine (pp. 181-200). Packer, M., Anker, S. D., Butler, J., Filippatos, G., Zannad, F. (2017). Effects of sodium-glucose cotransporter 2 inhibitors for the treatment of patients with heart failure: proposal of a novel mechanism of action. JAMA cardiology, 2(9), 1025-1029. Sacks, E., Alva, S., Magalona, S., Vesel, L. (2015). Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana. Human resources for health, 13(1), 81. Scarpellini, E., Ang, D., Pauwels, A., De Santis, A., Vanuytsel, T., Tack, J. (2016). Management of refractory typical GERD symptoms. Nature Reviews Gastroenterology and Hepatology, 13(5), 281.Springer, Cham. Wu, S. J., Yang, Y. H., Chang, H. W., Wei, C. C. (2016). Pharmarcogenetic Mechanism of ACE I/D Polymorphism Adversely Responding to ACE Inhibitors in Regulating the ACE Promoter Activity in Neurons. Alzheimer's Dementia: The Journal of the Alzheimer's Association, 12(7), P856.