Disaster Management Paper 1.4 Essay Example | Topics and Well Written Essays - 500 words

Disaster Management Paper 1.4 - Essay ExampleSecurity procedures enhance security and the whole preparedness to thwart, react and notice from the underlying acts of catastrophe. Insurance program enables individuals to be put under appropriate insurance life assurance cover in case of any incident. remote actions incorporate emergency management office, fire department, police department, emergency aesculapian services, telephone companies and electricity utility. The management office entrust aids in use the victims and connecting with the families and diverse offices regarding the emergency (Collins, 2000). Moreover, it will coordinate all the operations of the rescue with all the existing parties. Fire department will aids in position off the fire within the metropolitan city thus mitigating the underlying situations. It will coordinate all the processes of fire within the city and the kind of the precautions that ought to be taken depending on the type of the fire within the city.Police department will aids in securing the scene to prevent further injuries thus bringing the situation under control. Moreover, it will keep people out of the crime scene and keeping the people at bay from the place of stroking. Emergency medical services will aids in offering immediate medication to the people affected to avoid health risks (Collins, 2000). The people involved in the accident will be given first medical attention before taking them to the hospital. The expertise will also handle the situations thereby mitigating health risk. Telephones companies will coordinate will all the operations of the involved parties thus facilitating the entire operation of rescue in time of the accident within the metropolitan

Exploring changes in futures prices - Financial Market Essay

Exploring changes in futures prices - Financial Market - Essay ExampleThis report aims at solving issues and problems related to future price changes and how best they can be used to best suit the needs of the market. Future contracts A future is contract between two parties to buy or sell a fiscal asset or instrument at a fixed future date and at a predetermined price as argued by Chandra, (2008). Futures argon traded in the exchange which acts as an intermediary between the two parties. The terms of future contracts be standardized as they indicate what is to trade, when to trade and where to trade. There are three types of protections built-in to ease credit risk in the futures. One, the daily settlement which is is usually settled in cash basis is a major protection that plays a significant role in easing credit risk. Two, margin which the balance is kept in the accounts to cover several days expenditure of potential market to market transfers. It is necessary for every trade r to understand this aspect of margin in reference to credit risk. Finally, the clearing house which guarantees transactions by insures daily settlement on market gains and losses. Forward contacts are not investments as a result it costs nothing to enter into the legitimately binding agreement. There are three ways of settling or closing out a contract. First, enter in an offsetting transaction. Two, make or pickings physical delivery of the underlying commodity. Finally, cash settlement is another aspect that should be elaborated to traders entering into any form of future contracts. Over the yield forward contracts are flexible but they have their own disadvantages. They are unregulated as no formal body regulates the players in the market and they are only designated for specific needs. History of future contracts The first standardized future to be listed in the exchange was the Chicago Board of disdain (CBOT) in the class 1848 in the United States. Other major exchanges i n U.S include New York Mercantile Exchange (1872), Chicago Mercantile Exchange (1874) and Kansas City Board of Trade (1882). In Europe futures contracts in the Exchange include London international financial futures Exchange (LIFFE) and Amsterdam, Paris, Belgium exchanges merged with LIFFE to create Euronext LIFFE. This also merged with the Lisbon telephone circuit Exchange. Types of future contracts There are two types of futures, those that provide cash settlement and those that provide physical delivery for commodity. Commodity futures such as coffee take in physical delivery on the agreed day. Stock index future contract is an example of a cash settlement contract. They are settled on cash on the basis of index number at the closing day. Treasury bond futures are settled through physical delivery of exchequer bonds. Upon maturity, they have to convert into deliverable bond. A holder of short must deliver 100 treasury bonds must mature for at least 15 years. Treasury bill futur es. Treasury bills matures after 3 months and thats when the holder delivers its face value Currency futures. Most of the currencies are traded at banks on a cash basis. Usefulness of future contrac

Obsessive Compulsive Disorder Essay Example for Free

Obsessive Compulsive Disorder EssayImagine staying away from everybody, isolating yourself invent someone you love, a family member or colleague because they seem to be sick. Imagine not being able to shake hand, kiss, or hug anybody because you ar concerned that you might get some bacteria form them. Imagine not being able to open a admittance or pressing a button in the elevator with your hand because so many people have touched it before you. Imagine if you repeatedly check if the door of your apartment is locked even though you know for sure that you have locked it and you have checked several times. These are some symptoms of an anxiety disorder known as Obsessive Compulsive Disorder (OCD) which is characterized by uncontrollable, unwanted vistas and repetitive, ritualized behaviors you feel compelled to perform.I have read about this disorder a presbyopic time ago because I noticed it with the Canadian comedian Howie Mandel. I noticed that Howie has mysophobia, so h e does not shake hands with anybody. But I didnt rec any about it as a mental illness, I thought it was just a fear that developed in his mind because of an incident that happened to him and I thought it would go away easily by facing that fear. But after watching the movie Back Form Madness, I realized that it is more mixed than what I thought it was.Glen, the photographer, was the person who got most of my attention, mainly because I am a photographer and I have done wedding photography for a art object. So I know how hard it is for a photographer to take a perfect picture and the different aspects that should be focused on while taking a picture. Having OCD would defiantly make it much harder because you will be checking so many things in the camera and will take a long time to take a picture which will cause you anxiety because the customers will be mad.In this case, I will stop shooting and I will do the cingulotomy surgery even though, as Glen said, it is very dangerous and very painful. After the surgery, Glen was hopeless because he thought that he would die without acquire cured. I cannot really talk about how I would feel because I believe that we cannot feel the whole pain of others unless we are in their shoe. But all I can say is, hope is in the horizon as the sun keeps rising every day with new opportunities to everybody.

The Black Death and the World it Made Essay Example for Free

The vague finis and the World it Made EssayThe Black Death or The Black Plague, as it is known in history, was the worst disaster in medical history to date considering it proportionately (more than 40 percent fatality rate rate). It was so devastating in its effect that within 3 years time (1347-1350) the whole Europe was made aware of its dark presence in violate of the disadvantages of that achievement in terms of media coverage.The Plague had proven itself to be no respecter of person when it visited and touched every family from those of the highest in the ladder of society to the concluding royal families, monasteries, and farms. This medieval history is highly significant especially when looked at through the lenses of high technology twenty first century. The threat of mass killings as posed by Bio-Chemical warfare, Mad-Cow-Disease (MCD), Bird-Flu-Virus (BFV), etc., is so pertinent that a close look once again at the historic Black Plague merits anybodys concern especially those bothered by the threat. What everybody knows active this event in mans history is only mere fraction of what really occurred. precentor dug deep into what are new scientific discoveries and the aid of historical research to give a wide-angled and more panoramic vista on the realize of the flock of their day. Overview Well-known medievalist Norman Cantor relates the story of the renowned Black Death afresh with an eye of a Chronicler.In his book In the inflame of the Plague, Cantor narrates the story of the pandemic and its widespread effects with an intention, not only to retell and revive what happened during the spread of the plague, but to inform and quicken the modern lecturer of the possibility of it happening again in the same proportion that it transpired in the 14th century, or maybe exceeding the mortality rate it has incurred then, if the world be charters in diametricly to the prospect.In the Book, the Black Death was viewed from its wide-ranged eff ect (in Europes population) to its effect to families and individuals. The usual memory etched in the minds of people with regards to this medical disaster is that of muddied period where the whole population just dropping dead for reasons which no man could ever explain in rational or understandable terms. The have sex instilled, because of lack of scholarly approach to this episode in the history of medieval Europe, was the survival aspect.That all the people at that time needed to do was to retain themselves alive. Although this was part of the overall picture, this isnt complete leaving some important details untouched. Norman Cantor, on the other hand, is so keen, in that, he not only has given the overall scenario of the Plague in his book but also the important and compelling details of it. For example, he narrated the early conclusion of princess Joan of England who died at a very young age. He also tells of the death of the newly consecrated archbishop Thomas Bradwardin e of Canterbury.As told in the Book, the archbishops rather untimely death had deep ramifications especially to the improvement of religion and science. This is compelling in that it opened the eyes of the then world to all of the possibilities of how the plague was being transmitted, from serpents to cosmic dusts. The some repercussions such as, to the economy, the overall psyche of the people in their respective locale during this period is suggested by Cantor to have their lasting effect that have reached as far as to our generation now.He suggested that it might have made the world what it is in these days of technological advances. True, scholars today have keener minds in their different fields in particular the medical field. In the very first chapter, the conference of medical practitioners and specialists was used by Cantor to jumpstart the flow of his thesis on the wide-ranging effects of the plague. Many incidents come to life. Cantor talked about archimandrite Thoma s, for instance, who plays a part in the historical accounts.Thomas of Birmingham or Abbot Thomas (1349), who was then at the time of the Plague, the abbot of Halesowen, was a local resident of the town whose family was native and well-known to the place well-known enough to have named after them the city of Birmingham. The epidemics impact on the abbey managed by Thomas can be seen when he referred to the harm on the abbeys income brought about by the recent events in his petition to the bishop. In spite of all these, Abbot Thomas was fortunate and had some advantages from the other lords because the abbey and the lands in Halesowen that he was managing were generally of high quality.What is amazing of all is the argument of the author that in spite of the colossal devastation and the terrifying effects of the Plague, it had resulted in some beneficial outgrowth which created a new world of possibilities bigger than the destruction itself. Cantor asserted that, as often was the c ase in the past, the termination of the old order meant the arising of the new generation which is more scientific in its thinking. After the Black Death, there arose an intellectual revolution.There were explosions and breakthroughs in different fields artists had invented window certificate with beautiful art designs which was calculated to block the supposed airborne virus, painters responded and painted their great paintings, and the peasants that survived the Plague flourished where they started all over again in fact, they were Europes first class farmers. By and large, Black Death marked an economic change throughout Europe. It triggered what Cantor referred to as turbo-capitalism. Indeed, from ashes comes beauty.If what most of the advances in the west today were generated and can be traced back to one of the darkest of Europes history the Plague, one may say with all truthfulness that even in innate disasters where no person has the power to control, a change for the b etter might be brewing. Critique Since In the Wake of the Plague was written by Norman Cantor with the advantages of the 21st century scholarship, it has the understanding and the insights that the medieval years were primarily deprived of.The calculations of Norman Cantor are all possible and can be explained, as he had done in the Book, through scientifically proven facts especially that we have all the benefits of latest discoveries in medicine. To see the Plague through the kind of perspective that the author has narrated in his book is exactly something that one can expect from a 21st century medieval scholar. In spite of some negative feedbacks that some critics have given to the book, I will give generously my two thumbs up. The Book certainly deserves to receive a volt star category.It is written in a totally different approach than the former works on the Black Death. Cantor has endeavored to share his knowledge of the period and has given us details which otherwise cannot be known had it not been for the fact that a real historian has divulged them. Cantor turned from one motion to another(prenominal) in this book and thus able to keep those without thorough knowledge of the Plague interested till the end. Though his style of jumping from upshot to topic may be viewed by some critics to be disorderly in terms of format or arrangement, they are incidental and may be looked at as his personal style.He began with the diseases biomedical survey and presented to the some problems with the prevailing beliefs about the Black Deaths cause, its disposition and transmittance. He even went to suggest that the likely cause of death was anthrax, as in many cases the same and similar symptoms were present. Indiscriminately, the Plague hit the different classes of people in many regions. In the Book, there were stories of families and individuals, making the overall narrative more personal, intimate and gripping.Looking at it in a nuclear point of view, the Plague is the 14th century counterpart or equivalent of threatening nuclear war. It makes us think seriously of the global threat of nuclear billboard of some nations. If the calculations of Cantor in the book was accurate, then the threat of some renegade nations hoarding and multiplying anthrax and other biological/chemical materials are imminent and dangerous. In the Wake of the Plague is a book that can free many who until now view the Black Death through the mist of the many superstitions that primitive minds have made out of it.Cantors approach in this book is to make the past history relevant. He saw the volcanic eruption of Mad-Cow-Disease, Foot and Mouth Disease, AIDS, and the Bird-Flu Virus happened in the middle of the 14th century when the Plague ravaged Europe. The author even believes that our world today might baptistery a similar catastrophe in the near future. In a prophetic sense, the book has given us information and a warning. The threat of another pandemic is not far since the symptoms of what the medical world has been seeing in the recent outbreaks of diseases were the same signs that 14th century people had seen.Even the manner of transmission is deemed somewhat similar by the author. The author indirectly warned and indicated that if there will ever be another plague as devastating as the Black Death of the Medieval period, it will happen only through one of the possible causes which Cantor identified it will be whether brought on by inhering causes, or by bio-terrorism. Reference 1. Cantor, Norman F. 2001. In the Wake of the Plague The Black Death and the World It Made. HarperCollins Publishers

Japanese traditional game

Japanese traditional indorseJapanese traditional gameIntroductionGiven the task to innovate a Japanese traditional game, we decided to use the Two Ten Jack and create our very demand which is much simpler to be compriseed. It uses part of the Uno card and also a board with yields to be manoeuvred with a interest. In order to continuously profits the prizes, we construct the game to be in ways that a tactical maneuverer must place a bet that is either aforesaid(prenominal) act, or same color that is the taken out from the deck of cards played with. The Two Ten Jack game is played without the dealer and with localizes deducted and added which in the end, the player with the highest points balance. The conterminous page would be the manual to the game and after that would be the manual to the Two Ten Jack game. Furthermore, a comparison would be made to sight the innovation of our game being born.The Game Manual for the Two Ten JackPreliminariesThe object of two-ten- jack is to get the most points by taking pull someones legs containing positive point cards dapple avoiding tricks containing negative point cards.Two players receive six cards each from a standard 52-card deck ranking0 1 2 3 4 5 6 7 8 9 and the remaining undealt cards argon placed between the players to form the stock. Non-dealer whizs the firsttrick and winner of each trick leads to the next. Players replenish their hands between tricks by each drawing a card from the stock with the winner of the last trick drawing first. Play continues until all told of the cards in the entire deck have been played. Points are then tallied before the deck is reshuffled and dealt anew.Following, Trumping, and SpeculationIn two-ten-jack a player whitethorn lead any card and the other player must play a card of the same suit if able, or otherwise must play atrump cardif able. If a player has neither cards in the lead suit or trump, then any other card may be played. The highest trump card, or th e highest card of the lead suit if no trumps were played, takes the trickIn two-ten-jack hearts are always thetrump suit and theace of spadesis a special trump card cognise asspeculationranking above all of the hearts. Rules for playing speculation are as followsIf a trump (heart) is lead, a player may follow with speculation and must play speculation if no other trumps are held in the hand.If a spade is lead, a player may follow with speculation and must likewise play speculation if no other spades are held in the hand.If a club or diamond is lead and the other player has neither of these, speculation may be played, and must be played if no other trumps are available.A player leading speculation must declare it as either a spade or trump.Scoring and winningCards are price the following point values2, 10and Jare worth +5 each2, 10 and J are worth -5 each2, 10, J and A are worth +1 each6is worth +1 pointHence the total number of card points per deal is +5. Winner is the first player to tint 31 points.Game ManualThe number of players required to play this game is one to two players and maximum five players each roundStart by placing a single bet. separately bet is place on a number between zero to nine and four different colorsEach time six cards would be pulled out from the deckThe bet is counted with sweets.Each sweet cost RM1.Each player starts with a sweetThe bet with the same color out of the 6 cards drawn will get his moneyThe bet with the same number out of the 6 cards drawn will get win 5 sweet.The bet without same color or same number out of the 6 cards loses 1 sweet.The bet with the same color and same number walks away with Rm50The bet with same color and same number and also another same number but different color in the six card drawn from the deck walks away with Rm100Game RulesA player can only place one bet to a number and color per round.Not more than 1 player can bet at a same number and color in each round.A player has to verify his/her choi ce of bet before the opening of the six cards from the deck.ComparisonThe amount of cards used in Two Ten Jack is 52 while the game we have created uses 40.Also, the Two Ten Jack is played between players while the game we have created uses a dealer.Besides that, the Two Ten Jack is played with a system of addition and subtraction while we tried to make it compatible by placing bets instead of tricking the other players.Furthermore, the game we have created has been added with little elements of western card game like 21.

Small Scale GTL (STG Plus) Plant

Small Scale GTL (STG Plus) PlantCourse intrinsic Gas Processing engineering (ENCH 609, Winter 2017) drift TITLEGTL Syn fellate to Gasoline (STG Plus)Professor Dr. Nashaat NassarList of figures and tablesFig 1. Schematic sketch of the STG+ system (from Primus unripe Energy TM) .. (6)Fig 2. Sensitivity Analysis for case 62.5 MMSCFD (14) send back 1. Economic Indicators for invent evaluation (Detail calculation in Appendix).. (15)AppendixFig 1. Operating GTL plants on the world map The Oil Gas Year, 2015 . (21)Fig 2. example flow chart developed for the project (from Aspen plus V 7.2 Microsoft Visio 2010) (22) display panel 1 Used compounds and Values of yields for nuclear reactor 4 in the pattern . (19-20)Table 2 Economic Evaluation for case 1 10 MMSCFD ..(23)Table 3 Economic Evaluation for Case 2 62.45 MMSCFD (24)Table 4 push-down list balance of streams 1-22 for Case 1 10 MMSCFD .(25-26)Table 5 Mass balance of streams 1-22 for Case 2 62.45 MMSCFD .. (27-28)AbstractThe worlds energy demand is growing exponentially and to meet this demand, bringing new supply sources to the market is extremely critical. Natural gas resources atomic number 18 plentiful, geographically diverse and currently overly the cleanest burning dodo give the sack. Gas to Liquids (GTL) is a chemic act that transforms subjective gas or other gaseous hydro coulombs into towering quality liquid products that would otherwise be produced from naive oil Shell Global. GTL creates an additional opportunity to monetize a countrys resource of rude(a) gas by turning them into mellow quality liquid force come knocked out(p)s. GTL products argon colorless and odorless hydrocarbons with very low level of impurities.The purpose of this project is to simulate a small scale GTL (STG Plus) plant that transposes 10 MMSCFD of rich-methane natural gas into 672 gun barrel/day of gasoline. The first step of the STG Plus mould is called move reforming and it consists of the reaction betw een the methane in the natural gas with abundant water. The second step of the growth is the reaction between the hydrogen, and the carbon monoxide producing methanol. The methanol thus formed pass on be converted to dimethyl ether (DME) and finally, the DME impart be dehydrated, producing gasoline. The project lead also highlight the difference between two major GTL technologies Fischer Tropsch and STG Plus. An economic evaluation was conducted to check the viability of this process and at 10 MMSCFD conversion of methane the project proves to be economically profitable, with an NPV value of $14.66M at 10% discount rate. It was also determined that if the merchandise of gasoline increases to over 4,100BBL/day, the profitability of this project will increase significantly.1.0. Introduction 1.1. GTL Technology and the WorldGasoline to Liquid (GTL) is a technology that converts natural gas or other gaseous hydrocarbons into high quality liquid products like gasoline or diesel moto r fuel, otherwise produced from unsmooth oil . GTL products are colorless and odorless hydrocarbons with very low level of impurities. Refineries can also use GTL to convert some of their gaseous hydrocarbon waste products into valuable fuel oil which can be used to generate income.The worlds first commercial GTL plant was opened by Shell in Bintulu, Malaysia in 1993. In 2011, the largest GTL plant, Pearl GTL was opened in Qatar Shell Global. Figure 1 in the Appendix shows all operating GTL plants and their turn backing locations on the world map.1.2. GTL OriginIn 1920s, when Germany found itself short of petroleum but with ample reserves of coal, GTL and Coal-to-Liquids (CTL) technologies were pioneered using a process known as Fischer-Tropsch (F-T) discount (Heng et al. 2004). Methanol-to-gasoline (MTG), Mobils synthetic gasoline process, establish on the transformation of methanol to hydrocarbons using zeolite accelerator pedals, was the first major synfuel process developmen t in half a deoxycytidine monophosphate since the development of the Fischer-Tropsch process (Frerich J. Keil, 1998).1.3. Gas-to-Liquid (GTL) technologyGas to Liquids (GTL) is a refinery process that converts gas or other gaseous hydrocarbons into products with longer carbon chains. Gasoline and diesel fuel are classic examples. Gases with a high concentration of methane are transformed into liquid synthetic fuels chase two methods direct transformation using processes without the front man of catalysts that convert methane to methanol or by using syngas as a midway product, such as in the Fischer Tropsch, Syngas to Gasoline Plus and Mobil processes.This project will focus on designing a small scale Syngas to Gasoline (STG) plus plant that uses methane rich natural gas as render and converts it to high quality gasoline and other products.2.0. Syngas-to-Gasoline plus (STG+) processSTG+ process was derived from the MTG (Methanol-to-Gasoline) process, which was developed by Mobil in the 1970s. This technology directly converts natural gas-derived syngas into drop-in gasoline and jet fuel through a catalytic thermo-chemical single-loop process that minimizes complexity, improves product quality and yield. The plus in STG+ stands for the alternate end products yielded by the process.The STG+ technology is currently operating by Primus commons Energy company in Hillsborough, New Jersey at pre-commercial scale with a production of 100,000 gallons (approximately) of distinct quality gasoline per year from natural gas with surpassed performance of the STG+ system and catalyst and 720 hours of continuous operation. The STG+ process consists of the following operating steps in one continuous process loop. It comprises of Syngas generation by move reforming method, four fixed bed reactors in series and a two phase separator.Figure 1 Schematic sketch of the STG+ system (from Primus Green Energy TM)2.1. Syngas Generation by go reforming methodThe first step in the S TG+ process is to convert the natural gas feed into syngas or deductive reasoning gas which is an intermediate gas feed for many dissimilar petrochemical processes. This processing basically removes contaminants, such as mercaptans, sulfides, mercury and any others that can compromise the conglomerate catalysts performance that are used in the STG+ reactors before it is fed to the syngas generation unit. Either partial oxidation or steam reforming processes are used for syngas production.Steam reforming process is widely used to generate syngas for feedstock in different petrochemical processes. A mixture of hydrogen, carbon monoxide, carbon dioxide, and unconverted methane and steam are formed when methane reacts with steam in the presence of a catalyst such as Nickel or Rhodium at high temperature (800-1000 C), high pressure (20-40 bars) and steam-to-carbon ratio variable between 1.8 and 4 in the steam reforming process which is highly endothermic in nature (Mbodji et al., 201 2).The possible reactions areThe steam methane reforming reaction (SMR)CH4 + H2O CO + 3H2 H = +206 kJ mol-1 (strongly endothermic).. (1)The water-gas shift (WGS)CO + H2O carbon dioxide + H2 H = -41 kJ mol-1 (moderately exothermic) . (2)The product from the reformer depends on the operating pressure temperature, composition of the feed gas, and the proportion of steam fed to the reactor. The thermodynamics and kinetics of the reaction within the reformer decides the amount of carbon monoxide in the final product from the steam reformer (Larminie Dicks, 2000).2.2. Reactor 1 (Methanol Synthesis) outward-developing compressors are used to compress the syngas from reforming unit which enters the reactor 1 containing copper zinc as catalyst and the following reaction occurs.2H2 + CO CH3OH H = -92 kJ mol-1 .. (3) callable to the exothermic nature of the reactions, low temperatures favor conversion to methanol and pre- pepperinessing of the reactant gas and heating of the boiler feed water are done by this special heat. The position of the equilibrium depends on the pressure and temperature. The methanol formation is favored by increase in pressure.2.3. Reactor 2 (Dimethyl Ether (DME) Synthesis)After the crude methanol from reactor 1 is preheated, vaporized and then superheated between 300-320oC in a series of heat exchangers, it is then sent to the dimethyl ether (DME) reactor containing a dehydration catalyst (alumina) where methanol is partially dehydrated to an equilibrium mixture of DME, water and methanol which is a reversible and exothermic reaction.2CH3OH CH3OCH3 + H2O . (4)2.4. Reactor 3 (Gasoline Synthesis)In reactor 3, in presence of catalyst the product gas from reactor 2 converts to hydrocarbons including paraffins (alkanes), aromatics, naphthene (cycloalkanes) and olefins (alkenes), mostly from C6 to C10.2.5. Reactor 4 (Gasoline Treatment) To have high octane enumerate for synthetic gasoline and desirable volumetric properties, the product from reactor 3 is treated in reactor 4 to reduce the durene (tetra methylbenzene), Iso durene and tri methylbenzene components which have high freezing points.2.6. SeparatorFinally, in the reactor 4 two or three phase separation is done to obtain synthetic gasoline comprised of paraffins, aromatics and naphthene, non-condensed gas and water. The non-condensed gas is recycled back to the feed stream for reactor 1 and water is recycled back to the Steam Reformer (Syngas Generation Unit).3.0. Why STG+?The previous group answerable for GTL used the conventional GTL technology called Fisher Tropsh (FT) in their manakin process. Fischer-Tropsch (FT), which is a technology developed in early 1920s, converts gas into liquid hydrocarbons mainly diesel through a very complex process. While there have been significant improvements on the efficiency and technology of the Fisher-Tropsch process, the industry is in an urgent pauperization of new technologies capable of converting as much gas as pos sible into liquid fuels in a cheaper and more efficiently manner. As consequence, we decided to go for for our project the novel process called STG+ developed by Primus Energy. The main product of STG+ is gasoline as opposed to diesel. Since the most demanded liquid fuel in Canada, peculiarly in Alberta, is gas, we decided non use FT or any new technology producing diesel. STG+ has numerous advantages over the conventional GTL techniques such as bring low operating and peachy costs, higher production, better product quality and faster delivery times. The rival technology of STG+ is ExxonMobils MTG process. However, ExxonMobils MTG process has a greater environmental stupor and it is not very cost-effective. STG+ process was designed to correct some inefficiencies in the ExxonMobil process . The main correction is the integration of the reactors in a single-loop that increases the production and yields a higher quality of the gasoline with a less environmental impact A key exam ple is integration of the reactors in the STG+ process.4.0. Project Design/ salutary example4.1. Flowchart DescriptionThe lists of components that are considered in the simulation for the STG+ process and the yields in mass base for the one-quarter reactor (Keil, 2012) are shown in the Appendix (Table 1). The flow chart developed for the STG+ process is shown in the fig. 2 of Appendix.A brief explanation of the flowchart will be done now. First, our feedstock is basically the natural gas. For simplification purposes, our feed of natural gas is basically methane. Another feedstock that this process will have is fresh water. The water will be heated in a heat exchanger (HE-01) and will be mixed with the methane to enter the first reactor (R-01). In this reactor, carbon monoxide, carbon dioxide and hydrogen will be produced, as explained above. The fractional conversion in the first reaction is 83.4% of the methane, the limiting reactant. The conversion in the second reaction is 6% of the carbon monoxide (Choudhary et al, 1992). The exit stream of the reactor R-01 is cooled in a heat exchanger (HE-02), enters a compressor (CP-01) to increase the pressure for the second reaction process and, finally, enters another heat exchanger (HE-03) to adjust the temperature for the ideal temperature in reactor R-02. The operating conditions of this reactor are 69 bar and 380C (Wood et al, 2012). In it, basically, the syngas will be consumed to form methanol. The fractional conversion of this reaction is 63.7% of carbon monoxide (Lebarbier et al, 2012).The exit stream of reactor R-02 will pass through a heat exchanger (HE-04) to adjust the temperature of the mixture to enter reactor R-03. The methanol will form dimethyl ether (DME) and water. The operating conditions of this reactor are 12 bar and 325C (Wood et al, 2012). The fractional conversion of the methanol for this process is 76% (Kasaie et al, 2010).The stream that comes out of reactor R-03 passes through a heat ex changer (HE-05) to reduce its temperature and then enters a liquid-vapor flash vas (FV-01). The dimethyl ether along with the non-polar components will come out in the gas stream, while the water will come out in the substructure or liquid stream, which can be sent to the outflowing treatment plant. The gas stream will pass through a compressor (CP-02) and then through a heat exchanger (HE-06) to adjust the temperature and pressure for the fourth reaction process in reactor R-04. Basically, in this reactor, the dimethyl ether will be dehydrated in order to break down its molecule into -C2H4- radicals, which will be combined to form bigger molecules, as explained above. Since the reaction process is complex and the number of reactions is big, the stoichiometry of the process will be very complicated. at that placefore, this paper precisely shows the yield in mass basis of each component formed in reactor R-04 (yield per unit mass of total feed of components that are not listed a s inerts) (Aspentech Support Technology, 2001). Since only the dimethyl ether (DME) is a reactant in reactor R-04, all of the other compounds that enter reactor R-04 are considered inerts.The exit stream of reactor R-04 will pass through a compressor (CP-03) and through a heat exchanger (HE-07) to adjust the pressure and temperature for the last flash vessel (FV-02). This flash vessel is a liquid-liquid-vapor separator that will separate on the top the gas and lightest products. The middle liquid stream will be the gasoline formed (main stream) and the bottom liquid stream will be the water that was formed in the reactor R-04 and must be removed. The gas stream can be exchange to an industry that processes gas phase hydrocarbons, while the water removed can be sent to the effluent treatment plant.4.2. Thermodynamic Model and Simulation ConsiderationsThe simulation of the STG+ process was developed in the software Aspen Plus version 7.2. In our simulation, we chose the GRAYSON model , because it was developed for systems consisting of hydrocarbons, such as carbon dioxide and hydrogen sulfide. This method should return good results for temperatures in the range of 60F to 800F and pressures up to 3000 psia (Aspentech Support Technology, 2001). Since our process contains hydrogen and all the temperatures of the streams are within this temperature range, we can use the GRAYSON model (Aspentech Support Technology, 2001).The first three reactors (R-01, R-02 and R-03) were modeled in Aspen Plus as RSTOIC reactors since only fractional conversions and stoichiometry were considered for them. The last reactor (R-04) was modeled as an RYIELD reactor. In this model, the excitant data that is required consists of the outlet temperature and pressure of the reactor, as intimately as the yield values for the components that are products of the reaction process.4.3. Assumptions adopted in the simulation Natural gas feed consists only of methaneWe used only flash drums to perf orm the separation of the components after the reactions.The gasoline yields only consist of paraffins, olefins, aromatics and cyclic hydrocarbons from C2 to C11.Fractional conversions and stoichiometry are only considered for the first three reactors and no kinetic parameters for the reaction processes and catalyst deactivation are considered cod to lack of data.Even though the STG+ process is hearty known for the loop which defines the efficiency of the process, due to lack of data on fractional conversions for C2-C11 compounds, we restricted our simulation till gasoline production and planned to wander our product (Gasoline and Natural Gas) to the other parties who are in charge of any post treatment required.Since we are not including the durene/Isodurene in our output, the Gasoline treatment reactor is not considered.5.0. Economic EvaluationIn order to evaluate the economics of the project, a cash flow analysis is made based on the following considerationsOur business model consider buying treated natural gas to be used as both feedstock and fuel gas (we dont pay royalties because we are not producing it), paying for electrical energy consumption and revenues come from gasoline and natural gas sales.Two years for construction and 20 years of operations.340 days of production per year.Analysis in constant American dollars of January 2017, exchange rate of 1.30 CAD to USD.Annual non-fuel operating and maintenance cost equal to 3.6% (Haro P. et al ,2013) of total capital expenditures.Corporate income tax rate equal to 28%. electricity consumption, fuel gas required, flow rates (feed and products) from the simulation model.Current monetary values for gasoline, natural gas and electricity in Alberta, taken from Alberta Energy websites.Capital Cost Allowance (CCA) with a half year rule is considered for tax calculation purpose according to Alberta legislation. displace rate 10%.Capital expenditure (CAPEX) for syngas generation is estimated using figures for a known plant (Yang Ogden, 2005) and the following equation to take into account the different capacities. . (5)Where,Cx = capital cost for a plant of size x (Sx), Cb = capital cost of the known plant of size b (Sb).CAPEX related to the STG+ process itself is estimated based on the ratio given by Primus Green Energy (company proprietary of the STG+ technology) that syngas generation typically represents 60% of total capital cost for commercial-scale plant and the STG+ process itself represents the other 40%.Two scales are considered 10 MMSCFD of natural gas in the feed for comparison purpose with the previous years group and 62.5 MMSCFD of natural gas in the feed to evaluate the influence of the scale on the economic indicators.The economic indicators of the project are summarized in the following table commit Gas Flow rates (MMSCFD)1062.5Net Present Value NPV 10% (million $)14.66371.86Internal Rate of Return IRR12.12%22.87%Profit to Investment Ratio PIR0.140.97Breakeven price f or Gasoline (CAD/L)0.910.62Table 1 Economic Indicators for project evaluation (Detail calculation in Appendix)Finally, a sensitivity analysis is made to see the influence of different variables natural gas price, electricity price, gasoline price and capital cost on the NPV of the project. For these, all variables are changed +10% and -10% and the NPV are calculated. Results shown in the fig. 2 correspond to the case with 62.5 MMSCFD in the feed. However, it is the same trend in both casesFigure 2 Sensitivity Analysis for case 62.5 MMSCFDIt can be concluded that the project is economically feasible and the variable that impact the most the economics of the project is the gasoline price.6.0. RecommendationsWe recommend considering the fractional conversions for C2-C11 compounds in reactor 1 to have a better picture of STG+ with its close loop process.A thorough composition analysis for gasoline in the fourth reactor gives more realistic results.There is much scope to extend our work by adding gasoline treatment and distillation column (instead of flash drum for more efficient separation) with proper chemical reactions and stoichiometric fractional conversions and kinetics to improve the market value of our product.There is possibility for considering more components in the feed gas till C5-C6.In our model, due to lack of data, we focused on chemical reactions and stoichiometric fractional conversions. There is scope for more efficient designing by working on catalyst cycle life.7.0. ConclusionThe 21st century is witnessing the establishment of a new global business based on natural gas processing. As a consequence, the gas-to-liquids (GTL) industry is becoming increasingly important as it is getting more difficult to find and extract new oil reserves as well as the presence of more environmental restraints. This is why we decided to apply the new STG+ process technology in our project to demonstrate its efficiency in the conversion of methane to gasoline. As pr eviously stated, we decided to differ from the previous group process, mainly because its technology is old and their product is diesel as opposed to STG+ process which is a novel technology and its product being gasoline, which is more demanded in Canada. We chose to do the simulation of a small scale GTL plant that processes 10 MMSCFD of methane, producing 672 bbld, which resulted in an economically viable process. The economic indicators showed that, by increasing the production of gasoline, the profit would increase significantly (proven with the case 0f 62.5 MMSCFD). In conclusion, STG+ might be indeed prospered and profitable in Alberta if there is a reliable source of natural gas and good market conditions. 8.0. ReferencesAlberta energy website.http//www.energy.alberta.ca/NaturalGas/1316.asp. Accessed on March 16th, 2017.Alberta energy website.http//www.energy.alberta.ca/Electricity/679.asp. Accessed on March 16th, 2017.Aspentech Support Technology, Inc. Aspen Physical Prope rty System 11.1 Cambridge, MA, September 2001.Choudhary V. R., Rajput A. M., Prabhakar B Low temperature oxidative conversion of methane to syngas over NiO-CaO catalyst Chemical engineering Division National Chemical Laboratory, India, May 1992.Haro P, Trippe F, Stahl R, Henrich E. Bio-syngas to gasoline and olefins via DME A comprehensive Techno-economic assessment Apple Energy 2013 volume 108 page no. 54-65.Heng H.C., Idrus. S The proximo of gas to liquids as a gas monetization option diary of Natural Gas Chemistry 13, 2004 pages 63-70.http//www.albertagasprices.com/index.aspx?fuel=C . Accessed on March 16th, 2017.Kasaie M., Sohrabi M. energizing Study on Methanol Dehydration to Dimethyl Ether Applying Clinoptilolite Zeolite as the Reaction Catalyst Chemical Engineering Department, Amirkabir University of Technology, Tehran, Iran, January 2010.Keil, Frerich J. Methanol-to-hydrocarbons process technology Department of Chemical Engineering, practiced University of Hamburg-Harburg , Hamburg, Germany, July 1998 page 49.Larminie, James, Dicks, Andrew Fuel Cell Systems Explained West Sussex, U.K. John Wiley Sons 2000.Lebarbier V. M., Dagle R. A., Kovarik L., Adarme J. A. L., King D. L., Palo D. R. Synthesis of methanol and dimethyl ether from syngas over Pd/ZnO/Al2O3 catalysts Richland, USA, June 2012.Mbodji M., Commenge J.M., Falk L., Di Marco, Rossignol F., Prost L., Valentin S., Joly R., Del-Gallo P. Steam methane reforming reaction process intensification by using a milli structured reactor Experimental setup and model validation for global kinetic reaction rate estimation, Chemical Engineering Journal, vol. 207-208, pages 871-884.Primus Green Energy website (http//primusge.wpengine.com/press-room/white-papers/), Accessed in March 2017.Shell Global Website (http//www.shell.com/energy-and-innovation/natural-gas/gas-to-liquids.htm), Accessed March 05, 2017.Wood, David A., Nwaoha C., Towler, Brian F Gas-to-liquids (GTL) A review of an industry offering several routes for monetizing natural gas Journal of Natural Gas Science and Engineering, Volume 9, November 2012.Yang, Christopher Ogden, Joan M. (2005).Analyzing Natural Gas Based Hydrogen Infrastructure Optimizing Transitions from Distributed to Centralized H2 Production Institute of Transportation Studies UC Davis.9.0. Appendix portion in Aspen PlusComponent nameFormulaMass yieldMETHANEMethaneCH4-METHANOLMethanolCH4O-COCarbon monoxideCO-CO2Carbon dioxideCO2-H2OWaterH2O-ETHERDimethyl etherC2H6O-H2HydrogenH2-OCTANEn-OctaneC8H183.582HEXANEn-HexaneC6H142.702HEPTANEn-HeptaneC7H163.142NONANEn-NonaneC9H204.022DECANEn-DecaneC10H224.462N-C11n-UndecaneC11H2424.602N-C5n-PentaneC5H1236.078OXYGENOxygenO247.549ETHANEEthaneC2H64.901PROPANEPropaneC3H845.691N-BUTANEn-ButaneC4H1069.321ISOC4IsobutaneC4H10101.615ISOC52-Methyl-butaneC5H1275.269ISOC62-Methyl-pentaneC6H1434.921ISOC72,2-DimethylpentaneC7H163.137ISOC82,2-DimethylhexaneC8H181.690ISOC92-MethyloctaneC9H200.491ISOC102-MethylnonaneC10H2237.092ARO MC6BenzeneC6H64.024AROMC7o-XyleneC8H1

Triple Vessel Ischemic Heart Disease Treatment Case Nursing Essay

Triple Vessel Ischemic Heart Disease word Case Nursing EssayMr. MS is a 58-year-old Malay male who was previously diagnosed with hypertension, gout and triple vessel ischaemic heart unhealthiness. He offset presented with bureau painfulness in March 2010 where he was diagnosed with ischaemic heart dis order. He was unable to complete an exercise stress test and an angiogram done in Hospital Sultanah Aminah found him to have triple vessel disease. He was told angioplasty was not possible collectible to the severity of the blocks and was counseled for CABG but he was not keen. Meanwhile, he has had angina attacks 2 to 3 times per week every week since his initial diagnosis for the last 3 months, unremarkably relieved by sublingual GTN and was currently admitted for the 4th time for chest pain not relieved by GTN. ECG done 2 hours after aggression of chest pain showed ST economic crisis of 2mm at leads I, aVL, V3 V6 and left axis loss with no Q waves. Trop T was positive (2 .75 ng/ml) at 4 hours after onset and other cardiac enzymes were also raised signifi ejecttly. He was diagnosed with NSTEMI and treated with aspirin 300mg, IV morphine 2.5 mg, sublingual GTN 3 tablets and subcutaneous clexane 60mg BD for 3 days as well as continuing his current medicament regime of simvastatin, metoprolol, cardiprin, ISDN, amlodipine and GTN. interest admission, he was well in the ward with no recurrence of chest pain and did not pose any new complaints. He was dis forethoughtd after 3 days of inpatient treatment with instructions to attend his follow-up appointment at the cardio clinic in HSAJB on the 16th of June 2010 to make an appointment for surgery. Following this episode of chest pain, which he says is the worst so far, he is now quite keen for CABG.2) clinical HISTORYChief ComplaintChest pain for 1 day. account statement of Present IllnessMr. MS is a 58-year-old Malay male who was previously diagnosed with gout, hypertension and ischemic heart disease with triple vessel disease. He was awoken from sleep at about 10pm due to a central chest pain of fast onset. He described the character of the pain as crushing in nature and radiated to his tell apart. This episode of chest pain was the most severe since he was set-back diagnosed with ischemic heart disease. The pain was associated with profuse sweating, body weakness and was not relieved by rest. However, it was relieved by sublingual GTN, of which he has a yield of. His discomfort was made worst by exertion so he lay in bed to recover. Despite this, he had other episode of chest pain 30 minutes later. He took the sublingual GTN again but this time, the pain did not resolve. He was then brought to the emergency department of Hospital Batu Pahat by his son.This is Mr. MSs fourth admission for chest pain since March 2010. Since his diagnosis of ischemic heart disease in March, he has experience angina attacks two to tierce times per week, especially on exertion such as when strain ing while passing motion. During these attacks, he uses sublingual GTN to relieve his symptoms and normally feels much break down after that. He only comes to the hospital when GTN does not work to relieve his symptoms.Systemic ReviewMr. MS does not experience symptoms such as palpitations, dizziness, headache, nausea, vomiting, orthopnoea, paroxysmal nocturnal dyspnoea, epigastric pain, shortness of breath, fever, and had no syncopal episodes. He also does not have loss of appetite or loss of weight. intestine and urinary habits ar normal. His sleep has not been affected until this current episode whereby he was awoken by the chest pain.Past Medical HistoryMr. MS was diagnosed with hypertension 6 long time ago when he had an episode of headache. He has been on medical specialty since and was on regular follow-up with KK Rengit. He was diagnosed with gout 5 years ago when he had a left big toe swelling which resolved after some medication. He is not on long term medication for g out. Mr. MS was admitted for the first time 5 years ago in 2005 when he had bilateral renal calculi. He was subsequently referred to Hospital Sultanah Aminah for further management of this line of work and it has since resolved and does not have follow-up anymore.Mr. MS was diagnosed with ischemic heart disease in March 2010 when he presented with chest pain for the first time. Following his recovery, he underwent a stress test in Hospital Batu Pahat but according to him, was unable to complete the procedure due to chest discomfort. He was referred to the cardiology building block in Hospital Sultanah Aminah for further management where an angiogram was performed and he was told to have triple vessel disease. He was also told that angioplasty was not possible due to the severity of the blocks. He was recommended to have Coronary Artery Bypass Grafting (CABG) but as of yet, no appointment has been made as he was still unsure of termination through with the procedure. Following thi s episode of chest pain, Mr. MS has decided that going for the CABG is the only thing that will keep him alive.His current medications include contraceptive pill Simvastatin 20mg ODTab Metoprolol 75mg BDTab Cardiprin 100mg ODTab Isosorbide Dinitrate (ISDN) 5mg TDSTab Amlodipine 10mg ODSublingual Glyceryl Trinitrate (GTN) PRNHe is compliant to his medication regime.Mr. MS is not known to have diabetes or hyper lipoidemia. He also does not have any known food or drug allergies.Family HistoryMr. MS is the 3rd of 9 siblings. His father had hypertension and passed away a long time ago due to unknown causes. His mother and other siblings argon healthy. None of them have hypertension, diabetes, ischemic heart disease or malignancy.Social HistoryHe lives in a kampung in Rengit with his wife and 5 children. Mr. MS does not smoke nor consume alcohol. He works in a palm oil plantation. The distance from his house to Hospital Batu Pahat is about half an hour. On further enquiry, Mr. MS says tha t the cost of the CABG is about RM1000, which he can afford.3) FINDINGS ON CLINICAL EXAMINATION(Mr. MS was examined by me 9 hours after onset of chest pain)Mr. MS was alert, conscious, and communicative. He was not in obvious pain or respiratory distress. He was lying down comfortably on his bed. in that respect were no tendon xanthomata, xanthelasma, pallor, corneal arcus or pedal edema. His JVP was not raised. His clinical parameters areBlood Pressure 158/94 mmHgHeart Rate 94 beats per minute. Regular rhythmRespiratory Rate 20 breaths per minuteTemperature 37CSpO2 97% under room airOn scrutiny of the precordium, the apex beat was located at the 5th intercostal space on the midclavicular line and was normal in character. Parasternal heave was not felt and in that location were no thrills. First and second heart sounds were heard. There were no murmurs or added heart sounds.On examination of the chest, there was no deformity and chest amplification was equal on both sides. P ercussion and tactile vocal fremitus was normal and equal on both sides. On auscultation, vesicular breath sounds were heard end-to-end all lung fields with good air entry. There was no wheezing or crepitations heard.On examination of the abdomen, it was soft and non-tender. There were no masses felt. Bowel sounds were heard and normal.4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONINGProvisional diagnosingAcute myocardial infarction with underlying triple vessel ischemic heart disease and hypertensionWith a history of diagnosed triple vessel ischemic heart disease with multiple episodes of angina attacks since the initial diagnosis, it is highly likely that Mr. MS is presenting with an crisp coronary particular and this should be a priority until proven otherwise. This is evidenced by the presentation of central, crushing chest pain of sudden onset that radiated to the neck and associated with profuse sweating and body weakness which is classical of a myocardial infarction . Mr. MS will collect immediate investigations such as an electrocardiogram and cardiac enzymes to differentiate the acute coronary syndromes so that the appropriate management may be instituted for him e.g. if he has an ST-segment elevation myocardial infarction (STEMI), he will require myocardium-saving thrombolytic therapy to disrupt the ischemic event. As Mr. MS did not present with features such as acute shortness of breath, loss of consciousness and severe palpitations, it seems that he does not have complications of acute myocardial infarction but these developments should be watched out for throughout his admission as complications may arise later.Differential DiagnosisPulmonary embolismPulmonary embolism is a possibility that can be considered when a patient presents with an acute chest pain that is accompanied by shortness of breath, hemoptysis, tachypnea, fever and even cyanosis and collapse in severe cases. Furthermore, the chest pain is of a pleuritic nature, of which it is worsened on breathing, and a pleural rub can be heard on auscultation of the chest. However, Mr. MS did not present in such a way. At the same time, Mr. MS did not have try factors such as a deep vein thrombosis, prolonged immobilization or recent surgery. It is still highly likely that Mr. MS has suffered an acute myocardial infarction, and an ECG would help to differentiate between the two as pulmonary embolism might show the classic S1Q3T3 pattern of right axis deviation or right bundle branch block. Either way, the diagnosis should be made quickly so treatment may be instituted before his peg down becomes worse or complications develop.Aortic dissectionAortic dissection presents as an acute onset chest pain that is tearing in nature, and often radiates to the back. It is often confused with myocardial infarction due to its presentation but differences include the pretermit of profuse sweating, signs of heart pump dysfunction and a normal ECG. Risk factors are usually un controlled hypertension, connective tissue disorders or chest trauma. Mr. MS has hypertension, but is under control, and does not have the other risk factors. A diagnosis of myocardial infarction should be the priority as thrombolytic therapy is vital, but if there is any reason to doubt that diagnosis, then further investigations should be performed.5) IDENTIFY AND grade THE PROBLEMS1. Acute chest painMr. MS has acute chest pain with features very suggestive of a classical picture of myocardial infarction as he presents with crushing central chest pain that radiates to the neck and associated with profuse sweating and weakness. Given that he is known to have triple vessel ischemic heart disease and that he has suffered some(prenominal) angina attacks since his initial diagnosis, it is highly likely that he is having an acute myocardial infarction. Without further a due, he take an electrocardiogram (ECG) and cardiac enzymes tested to distinguish between the different acute coron ary syndromes so that the appropriate treatment protocols may be initiated for him as before long as possible to disrupt the ongoing ischemia. As Mr. MS is having severe chest pain that may overstimulate his sympathetic system and cause further ischemia, he will require immediate supportive therapy such as effective pain medication and oxygen therapy.2. Triple vessel ischemic heart disease awaiting CABGMr. MS was diagnosed with triple vessel ischemic heart disease when he first presented with chest pain in March 2010 and has since experienced many episodes of angina. Given his diagnosis and disease pattern, he is at a very high risk of developing a severe acute coronary event that may prove fatal if the infarction is too extensive or if complications develop. As percutaneous revascularization with a stent or balloon was not possible for him, he will require a CABG to both relieve his symptoms and reduce his mortality risks in the long term. He was unsure of going ahead with the fe at previously, therefore no appointment date was given for surgery. However, now that he has changed his mind, every effort should be made by both the doctors in charge of him here in Hospital Batu Pahat and in the cardiology unit of Hospital Sultanah Aminah to arrange for his surgery as soon as possible, given the circumstances of his condition.3. Compliance to medicationMr. MS is on several medications for his triple vessel ischemic heart disease and will require revascularization surgery soon in order to ebb his mortality risks. However, waiting for a CABG in the government setting may take some time, even under dire circumstances due to the nature of the system. Therefore, it is extremely crucial that Mr. MS is compliant to his medication regime while awaiting a CABG to prevent another episode of infarction. He should be counseled to fully understand this and the situation of his ischemic heart disease. It is also the responsibility of his doctors to ensure that he is taking th e right combination of medications with the aim to prevent another acute cardiac event. Meanwhile, a sufficient supply of sublingual GTN should be provided for Mr. MS in cases of angina attacks at home. He should come to the hospital at once if GTN fails to relieve his symptoms.4. Regular screening for comorbid diseasesMr. MS has not been diagnosed with diabetes or hyperlipidemia previously but these diseases are strong risk factors for the long term implications of his ischemic heart disease. Therefore, Mr. MS should be screened regularly e.g. twice yearly during his follow-up appointments. Early detection of diabetes is necessary so that treatment can start as soon as detected in order to prevent his ischemic heart disease from becoming worst than it already is. As for his lipid control, if his lipid profile is found to be outside the normal limits, the dosage of his medication can be increased as necessary. Following his CABG, he will film to maintain a healthy lifestyle of a g ood, well-balanced, low-salt and low-fat diet and regular exercise within his limits.6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS1. Electrocardiogram (ECG)To tang for any changes that may indicate an ongoing ischemic event, such as ST elevation or depression and T wave inversion in order to support the diagnosis of an acute myocardial infarction so appropriate treatment can be started. Differentiation of ST segment elevation or depression is also crucial in initiating treatment as thrombolytic therapy is only indicated for ST-elevation myocardial infarction.Results ECG on admission (2 hours after onset) shows sinus rhythm with ST depression at leads I, aVL, V3 V6 with left axis deviation. T wave was present and normal.Interpretation The ST depression in the leads above indicate an ischemic event at the anterolateral sections of the heart. The lack of ST elevation concludes a diagnosis of either unstable angina or NSTEMI, depending on the levels of cardiac enzymes. There is no sign of old infarction.2. Cardiac EnzymesTo behavior for elevated levels of cardiac enzymes such as troponin T, creatinine kinase (CK), lactate dehydrogenase (LDH) and aspartate transaminase (AST) that will indicate myocardium ischemia and necrosis. If elevated, a diagnosis of NSTEMI can be made in accordance with the ECG changes. However, cardiac enzymes when done too early after onset may not show any rise in levels 1. This does not mean that necrosis has not taken place and the test should be repeated once more at 6 hours after onset 1.Results Troponin T (4 hours after onset) 2.75ng/ml (12 hours after onset) (60 hours after onset) Normal Range (U/L)CK 997 263