Economic policy and global environment Essay Example | Topics and Well Written Essays - 1500 words - 1

Economic policy and global environment - Essay Example The reduction in the government spending in 2012 has resulted in falling growth rates over the last three quarters. The shutdown of the government has greatly impacted the government spending. Though these workers will be paid their salaries retroactively, their better halves in the private sector cannot expect the same and this will lower consumption spending in the festive season. The uncertainty in the political environment is likely to affect the investments in the country, which will further result in the weaker growth. Governments Fiscal Policy: Past and Present perspective Historically, the fiscal policies, adopted by the government at state, local or federal levels, have mostly been tailwind for the economy. This implies that it has tried to boost the economy (International Monetary Fund, 2013). This has drawn references from the history that whenever the economy is in recession, the government follows an expansionary fiscal policy. This can be explained with the help of the following graph. Figure 1: Expansionary Monetary Policy (Source: Burnt Hills-Ballstan Lake, n.d.) If the government follows an expansionary policy, either by raising the level of government spending or reducing the level of the taxes, there is an outward expansion of the aggregate demand curve. This is represented by the shift of the curve from AD0 to AD1 (Burnt Hills-Ballstan Lake, n.d.). In this range of the SRAS, there is almost no effect on the rate of inflation which is measured by the price level, measured in the y-axis of the graph. The rationale working here is that during sluggish economic performance, the revenue that can be earned from taxes falls and the level of government spending has... This essay presents a comprehensive economic analysis of the effectiveness of the fiscal policy carried out by American government in 2013 year. Fiscal policy measures are the methods which are applied by the government to adjust the levels of government spending and tax rates that directly influence the growth of an economy. The fiscal policy is used in combination with the monetary policy to control the economic growth. The monetary and fiscal policies can directly affect the rate of inflation and determine whether the country will face conditions of growth or recession In designing the fiscal policies, the government has faced formidable challenges and hence, decided to reduce the level of spending. The rising age of the population, along with rising costs of health care, makes expansionary fiscal policies non-feasible in long run. The rising expenditure by the government would have soon surpassed the revenue earned by government and The analysis has revealed that the government had changed its fiscal policy from expansionary to contractionary for dealing with the recession in the present time. It has been observed that the recent federal shutdown, though for a short period, has slowed down the pace of recovery of the economy. The direct impact was the reduction of the GDP on account of the lay-off of the federal workers. The indirect impact came from the multiplier effects of the government spending cuts. The employment figures were also affected owing to the shutdown and resulted in the loss of investor confidence.

The Desert Rat-Kangaroo Essay Example | Topics and Well Written Essays - 1000 words - 179

The Desert Rat-Kangaroo - Essay Example Although the desert environment is harsh, the desert rat kangaroo had adapted to the conditions and survived in the ecosystem until interference in its natural habitat contributed majorly to its extinction. Humans were both directly and indirectly involved in the alteration of the mammal’s natural habitat by introducing herbivores such as rabbits and cattle, setting off an imbalance in the ecosystem. Fire regimes also played a key role in the destruction of the habitat (Fisher & Blomberg, 2010). Although the rat kangaroo was largely independent of water, there was increased competition for green plant with beetles. Other factors for its extinction include predation by foxes and cats. Since they were relatively small and hence vulnerable to predators, much of their self defense was in the ability to make high and quick leaps. The extinction of the desert rat kangaroo did not impact on the desert food chain significantly mainly because it was a replaceable species. More importan tly, they were not direct competitors of surface water with any other species because all their water requirements were met by the water contained in the green plants in their diet. Being herbivorous animals, their role in the ecosystem was gradually assumed by cattle as the rat kangaroo’s population diminished. However, the population of beetles, weevils and other small insects of which the rat kangaroo was a key consumer increased. The most notable difference was a decline in the number of desert fox (Fisher & Blomberg, 2010). The orangutan is a primate that depends entirely on forests for survival. Unfortunately, high illegal and legal logging and deforestation rates are contributing to its increasingly endangered status.

Case Study: Patient With Shortness Of Breath

Case Study: Patient With Shortness Of Breath Patient Identity The patient is a 54 year old female, Mrs SK who is a housewife with a BMI of 25.7kg/m2. Presenting Complaints She was brought in to the Accident and Emergency (AE) department, complaining of shortness of breath (SOB) and a productive cough. History of Presenting Complaints The patient was experiencing SOB for the past 2-3 days, and was progressively worsening on the day on admission. It was not associated with chest tightness and she was able to sleep the night before. She was also having persistent productive cough with white sputum since she was last discharged 12 days ago. Past Medical History She was diagnosed with diabetes mellitus and hypertension 8 years ago and has history of gastritis for the past 5 years. She was newly diagnosed with bronchial asthma in her last admission two weeks ago. Social History The patient is a widow since 6 years ago and is a housewife with 3 children. She stays in a factory area and has a cat at home. She is a non-smoker and a non-alcoholic. Family History Her mother and father have no known medical illness, but she has a cousin who suffers from bronchial asthma and is frequently admitted to the wards. Drug History The patient was on Salbutamol and Budesonide inhalers, 200mcg when necessary and 200mcg once at night respectively for her bronchial asthma. For her hypertension, she was on 40mg Telmisartan tablets once at night. She was also taking Gliclazide tablets, 80mg twice daily and Metformin tablets, 500mg three times a day for her diabetes mellitus. For her hypercholestrolaemia, the patient was taking Lovastatin tablets 20mg once at night. Based on the Morisky Scale, she was compliant with her medication and she had no known drug allergy. Examination Details On examination, the patient was alert and conscious. She was pink and appeared to be fairly hydrated. She was also able to speak in full sentences, and was not tachypnoeic. A Chest X-ray showed that there was a pneumonic consolidation at the right lower lobe of her lungs. Her blood pressure (BP) was 152/82mmHg, pulse rate (PR) was 109 beats per minute (bpm) and was afebrile. Her oxygen saturation (SpO2) was 96% under 3 litres of oxygen and her blood glucose was measured to be 4.7mmol/L. Investigations Upon admission, standard laboratory investigations were carried out and were obtained. From the renal function test, it was seen that the patient had a low potassium level of 2.8mmol/l and her calculated creatinine clearance was 60.0ml/min which indicated that she had mild renal impairment. The liver function test showed that she had normal liver function. The following shows the results that were out of the reference values for her haematological tests. C-Reactive Protein (CRP) 31.1 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Erythrocyte Sedimentation Rate (ESR) (0 15 mm/hr) 110 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Haemoglobin (Hb) (13.5-18 g/dl) 10.3 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Haematocrit (0.36-0.46 L/l) 0.303 à ¢Ã¢â‚¬  Ã¢â‚¬Å" Red Blood Count (RBC) (3.8-4.8 x 1012 /l) 3.45 à ¢Ã¢â‚¬  Ã¢â‚¬Å" White Cell Count (WCC) (4-11 x 109 /l) 15.1 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Neutrophil (Neutro) (2 7.5 x 109 /l) 10.57 à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ Diagnosis/Impression Patient was initially diagnosed with Acute Exacerbation of Bronchial Asthma (AEBA) secondary to an upper respiratory infection (URTI) to rule out pneumonia. However, later in the day when the chest X-ray came back, she was diagnosed with pneumonia with right parapneumonic effusion. Management Plan The patients current medication was continued and was given 3 litres of oxygen via a nasal prong (NP). She was commenced on prednisolone tablets, 30mg once a day and was given nebulised Combivent (Ipratropium 20mcg/salbutamol 100mcg), every 4 hours. Her peak expiratory flow rate (PEFR) and SpO2 was to be monitored. Antibiotics were kept in view to be started if necessary after the total white blood count results came back. Clinical Progress Upon admission, the patient was afebrile, was tolerating orally well, did not have any sorethroat but was having a non productive cough. An echocardiogram (ECG) was done and it showed that she had sinus rhythm with no ischaemic changes. As her chest x-ray showed a right lower zone consolidation, she was diagnosed with pneumonia. She was immediately commenced on 2g Ceftazidime intravenously, and then continued on 1g three times a day. She was also under nebulised combivent every 6 hours. Her metformin and gliclazide was stopped and she was started on subcutaneous 10 units of Humulin  ® three times a day and 12 units of Humulin N once at night. On Day 2 of her stay, her blood results came back and as she has low potassium levels, she was given 15mls of Mist KCl three times daily and two Slow K tablets once daily. She was still complaining of cough without sputum and was given 15mls of Benadryl (diphenhydramine) syrup three times a day. The patient did not have any major complaints on the third day and was tolerating orally well. There was no SOB seen and she had good inhaler technique. She was then taken off the nebulizer combivent and the oxygen. By day 4, the patient was comfortable, and her cough and sputum had decreased. Examination on her lungs showed that she had prolonged expiratory phase. She was stopped on the Benadryl as well as Mist KCl and Slow K. After reinforcement on the inhaler technique by the pharmacist, the patient was discharged on day 5 as she was afebrile and had minimal cough. On discharge, she was then switched back to her oral hypoglycaemics and her intravenous antibiotic was switched to oral Cefuroxime 500mg twice daily for the next 10 days. She was also given Neulin SR 250mg once at night. Table 1 shows the vital signs chart for Mrs SK throughout her hospital stay. Table 1: Vital Signs Chart Day Time BP (mmHg) PR (bpm) SpO2 Blood Glucose (mmol/l) 1 13.00 178/102 109 100% 6.9 14.00 152/82 109 98% à ¢Ã¢â‚¬  Ã¢â‚¬Å" NP 15.40 4.7 18.40 133/73 114 97% à ¢Ã¢â‚¬  Ã¢â‚¬Å" RA 21.15 6.2 23.05 151/82 119 2 03.15 143/81 106 06.00 6.3 08.30 119/67 94 100% 10.35 4.8 11.24 100/61 107 97% 15.20 112/82 100 16.30 128/70 100 6.2 22.00 3.6 23.50 118/59 66 98%à ¢Ã¢â‚¬  Ã¢â‚¬Å"3L O2 3 04.10 124/64 104 100%à ¢Ã¢â‚¬  Ã¢â‚¬Å"3L O2 06.15 8.2 09.40 100/60 96 11.50 8.5 15.30 108/67 94 17.20 7.4 20.00 121/75 86 4 04.00 110/56 62 06.00 7.9 08.00 110/70 63 4.2 16.00 105/75 91 96% 17.00 9.7 22.00 138/67 114 6.1 5 05.00 9.6 07.15 11.1 Pharmaceutical Care Issues The first care issue is to review the management of AEBA based on the British Guideline on the Management of Asthma. The dose of prednisolone should be increased to 50mg once a day for at least 5 days or until recovery. Since the patient is prescribed with theophylline on discharge, she should be counseled on the signs and symptoms of theophylline toxicity such as confusion, dizziness, diarrhoea, nausea, fatigue and headache. The second issue is regarding the choice of antibiotics for the treatment of community acquired pneumonia in this patient. A sputum full examination microscopic examination (FEME) should be requested to identify the causative microorganisms of the lung infection. If empirical treatment is to be started the preferred drugs of choice would be amoxicillin 500mg three times a day plus either erythromycin 500mg four times a day or clarithromycin 500mg twice daily. Alternative choices would be levofloxacin 500mg once daily or moxifloxacin 400mg once a day, should the patient be intolerant of the preferred regimen. Thirdly, there is no clear indication of the prescription of the diphenhydramine in the first place, as it would only suppress the patients cough, which is inappropriate. Hence it should be stopped immediately. Next, the patients updated blood cholesterol levels should be taken and the appropriate use of statins should be reviewed. As she is on long-term statin use, her liver enzymes should be monitored regularly and if is raised by three-fold, she should stop taking the Lovastatin. She should also be counseled on the symptoms of rhabdomyolysis which is related to the long term use of statins, such as unexplained muscle pain, stiffness, weakness and the darkening of urine colour. The following issue is regarding the patients diabetes management. A HbA1c test should be done to determine her glycated haemoglobin level to see how well her self-management has been. She should also be advised on diet and lifestyle to keep her diabetes under control. Lastly, as she has low red blood count, haemoglobin and haematocrit levels, it is suspected that she has anaemia. Further tests should be done to confirm this, and if it is diagnosed, she should be given ferrous supplements such as ferrous sulphate tablets 200mg twice daily. DISEASE OVERVIEW AND PHARMACOLOGICAL BASIS OF DRUG THERAPY Acute Exacerbation of Bronchial Asthma: An Overview Asthma is a chronic inflammatory disorder of the airways where many cells and cellular elements play a role. This leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the morning. These inflammatory symptoms are commonly associated with extensive but variable airflow obstruction within the lung as well as airway hyperresponsiveness and this is reversible either on its own or with treatment. 1 Asthma is a worldwide problem as it is estimated that about 4.5% of the worlds population is affected, which amounts to 300million individuals approximately. The global prevalence of asthma varies from 1-18% of populations in countries all over the world. Asthma has three distinguishing characteristics which are airflow limitation, airway hyperresponsiveness, and bronchial inflammation. Airflow limitation is usually resolved by itself with or without treatment but for individuals with chronic asthma, inflammation may result in irreversible airflow limitation. Stimuli such as irritants or allergens may pose as triggers in airway hyperresponsiveness and bronchial inflammation is associated with eosinophils, T-lymphocytes and mast cells which cause plasma exudation, smooth muscle hypertrophy, mucous plugging and epithelial changes. It is shown that inflammation of the airways play a major role in the pathology of asthma and this starts when allergens or irritant trigger the activation of cells such as epithelial cells, macrophages, lymphocytes and mast cells. This leads to cytokine or mediator release and smooth muscle contraction resulting in cellular infiltration of eosinophils and neutrophils causing airway inflammation including oede ma, epithelial permeability or injury, mucous secretion and vascular permeability which eventually leads to airway obstruction and hyperresponsiveness. The diagnosis of asthma is based on a collection of signs and symptoms without a reasonable explanation for them and spirometry is an early test which is easy to assess if there is any airflow obstruction present and its extent. For diagnosed patients with asthma, acute exacerbations may occur and because patients with severe asthma are at increased risk of death following exacerbations, assessments of exacerbations are crucial. Clinical features of acute asthma exacerbations include severe breathlessness, tachypnoea, tachycardia, silent chest, cyanosis, or syncope. Peak Expiratory Flow (PEF) or Forced Expiratory Volume in one second (FEV1) is also used to measure the lung capacity. Oxygen saturation (SpO2) is measured using a pulse oximetry and this aids oxygen therapy as oxygen therapy is given in order to keep SpO2 levels at 94-98%. Measurements of arterial blood gases (ABG) are usually not necessary unless patients present with features of life-threatening asthma or have SpO2 of less than 92% as there may be a risk of hypercapnea if SpO2 is lower than 92%. Chest X-rays are also not recommended unless patients are suspected of pneumonia or lung consolidations, suffering from life-threatening asthma, having unsatisfactory response to treatment or if they require ventilation. Pharmacological Intervention in the management of AEBA2 Oxygen Oxygen therapy is needed most of the time as patients who are having acute asthma usually present with hypoxia as well. Hence, all patients with hypoxia who are suffering from acute severe asthma should be given oxygen and their SpO2 levels should be kept at 94-98%. ÃŽÂ ²2 agonist bronchodilators As first line therapy, high dose inhaled ÃŽÂ ²2 agonist bronchodilators are used as soon as possible as rapid relievers of bronchospasm. For patients who are unable to use inhaled therapy, intravenous ÃŽÂ ²2-agonists are used instead. ÃŽÂ ²2 agonist bronchodilators work by stimulating the ÃŽÂ ²2 adrenoceptors in the lungs, thus causing relaxation of the airways. Examples of short acting ÃŽÂ ²2-agonist are salbutamol and terbutaline, and a long acting ÃŽÂ ²2-agonist is salmeterol. Glucocorticosteroids Steroids should always be given in all cases of acute asthma. Examples of these are prednisone, prednisolone, dexamethasone, and hydrocortisone. They exert an anti-inflammatory effect by inhibiting transcription of the genes for the cytokines implicated in asthmatic inflammation and hence reduce airway hyper-responsiveness. Anti-cholinergic agents Ipratropium bromide is one of the anti-cholinergic agents that is used widely in treatment of acute exacerbations of asthma. Nebulised ipratropium bromide is used in combination with a ÃŽÂ ²2-agonist bronchodilator as treatment for patients with severe acute or life-threatening asthma. Anti-cholinergic agents work by inhibit muscarinic receptors M1 and M3 which then reduces cGMP formation and decreases smooth muscle contractility in the lungs. This eventually results in bronchodilation and reduces mucus secretion. Other therapies Other therapies include the use of magnesium sulphate. A single bolus dose of intravenous magnesium sulphate is administered to patients with acute severe asthma with previous unsatisfactory response to inhaled bronchodilator therapy or for patients who are suffering from life-threatening or near fatal asthma. It is believed that magnesium sulphate works by reducing calcium uptake by the bronchial smooth muscle cells, causing bronchodilation and also inhibits mast cells degranulation, thus reducing the release of inflammatory mediators such as histamines, and leukotrienes. EVIDENCE FOR TREATMENT OF THE CONDITION The management of asthma can be divided into two parts; acute treatment, and long term management. Management of acute asthma It has been shown that most patients suffering from acute severe asthma are hypoxaemic. Therefore it is essential that supplementary oxygen therapy be given to them.3-6 This is administered via a face mask or nasal prong with the patients SpO2 kept between 94-98%.7 Where nebulisers are needed in therapy, oxygen-driven nebulisers are favoured instead of those that are air-driven due to oxygen desaturation when driven by air alone.8-10 However, the lack of provision of supplemental oxygen should not pose as a factor in omitting nebulised therapy from administration if deemed appropriate.11 Referring to the case presented above, the patient was treated accordingly as she was immediately given supplemental oxygen and her SpO2 was maintained well above 96% throughout hospital stay. As acute asthma is associated with symptoms of bronchospasms such as wheezing and tachypnoea, the main aim of treatment is to quickly resolve these symptoms and most often, high doses of inhaled ÃŽÂ ²2 agonist bronchodilators are effective with minimum adverse effects.12-14 Salbutamol is usually the drug of choice although there is no significant differences in terms of efficacy as compared to Terbutaline. It is shown that there are no significant clinical benefits by using a non-selective ÃŽÂ ²2 agonist such as epinephrine instead of selective ÃŽÂ ²2 agonists.15 Based on a meta-analysis, it is seen that ÃŽÂ ²2 agonists administered via inhalation are more preferable and has similar efficacy with those administered intravenously in adult acute asthma.16 In ventilated patients or those in life-threatening conditions, parenteral ÃŽÂ ²2 agonists may be added to inhaled ÃŽÂ ²2 agonist treatment although there is little evidence supporting this treatment. Although a sing le bolus nebulisation may relieve most acute asthma cases, it is shown that continuous nebulised treatment of ÃŽÂ ²2 agonists is more effective in relieving acute asthma for those with unsatisfactory response to initial therapy.17, 18 Steroid therapy is always given in acute exacerbations of asthma and it is proven that it has better result if given earlier. It not only reduces mortality but it also reduces relapses and the number of hospital admissions as well.19, 20 Oral steroids given are seen to be equally as effective as parenteral treatment hence there is no need for the use of parenteral administration of steroids unless the patient is unable to tolerate orally.19 Prednisolone 40-50mg is given daily for at least five days or until recovery and this can be stopped abruptly after the patient has recovered.2 As long as the patient is on inhaled steroids, there is no need for the dose to be tapered down slowly prior to discontinuation.21 In the case presented, the patient was commenced on steroid therapy but was under-treated as she was only given prednisolone 30mg once daily for just one day. Hence, there is a need to increase the dose of prednisolone to 50mg and to continue is for at least another four days or until recovery before stopping this treatment. In hospital therapy, anticholinergic treatments are given to severe exacerbations of asthma and nebulised ipratropium bromide is always the drug of choice used in clinical settings. A combination of nebulised ipratropum bromide with a ÃŽÂ ²2 agonist bronchodilator is often given as treatment as it is proven that a combination of these two agents has a significant increase in bronchodilatation as compared to the use of a ÃŽÂ ²2 agonist alone. Hence, there is faster recovery and will reduce the length of hospital stay. However, it is also seen that anticholinergic treatment is not particularly effective and favourable for cases of mild exacerbations of asthma as well as after the patient has been stabilized, thus is not necessary in these cases.22-24 The patient in this case was seen to be having a mild exacerbation of acute asthma and hence nebulised ipratropium bromide treatment was not necessary. However, the use of nebulised Combivent, a combination of ipratropium bromide and salbutamol was justified since this patient was re-attending with a relapse and she was also suffering from pneumonia as well. Hence, there was probably a need for a quicker rate of bronchodilation as well as faster recovery for her. The use of magnesium sulphate in hospital treatment of AEBA is not widely seen, however there have been some evidence showing the bronchodilating effects of magnesium sulphate when used in adults.25 There are also studies which report that nebulised magnesium sulphate combined with a ÃŽÂ ²2 agonist shows positive outcomes and good clinical effectiveness in hospital settings.26, 27 The use of an intravenous bolus administration of magnesium sulphate is believed to promote lung function in patients who have severe asthma without harmful side effects.28 Nevertheless, there have been no studies on the repeated administrations of magnesium sulphate, though it is presumed that repeated use may lead to hypermagnesaemia, causing muscle weakness and respiratory failure. As further extensive studies need to be done to determine the most suitable route and dosing of magnesium sulphate, this treatment is reserved only for patients with acute severe asthma without satisfactory response to inha led bronchodilator therapy and patients with life-threatening of near fatal asthma. Monitoring should be carried out constantly throughout hospital stay and in acute asthma cases, monitoring of PEF is crucial. PEF readings should be measured and recorded every 30 minutes after treatment has been started. PEF should also be monitored pre- and post- nebulisation therapies as long as the patient is in hospital and until the asthma is well under control after discharge. It is seen that after hospital discharge, a relative amount of patients either experience relapse or are readmitted into the hospital with at least 15% within two weeks following discharge.29 Therefore it is essential that patient education such as proper inhaler technique, and well-documented PEF recordings with action plans depending on symptoms experienced should be instilled in order to reduce rate of relapses as well as minimize problems associated with exacerbations after discharge.30 Monitoring of the patients PEF was done consistently throughout her hospital stay and the patient was given sufficient counseling prior to discharge on her inhaler technique. However, there was no evidence that the patient was educated on self-documenting PEF recordings as well as action plans based on symptoms experienced following discharge and this should be done in this case to avoid another exacerbation of her condition. Long Term Management of Asthma The aim of management of asthma is to keep it well-controlled without the need of rescue medications, asymptomatic, no exacerbations, no hindrance to daily activities including exercise as well as normal lung function. A stepwise management approach is adopted for asthma patients and this is to acquire initial control and maintain it by stepping up treatment to improve control if necessary or stepping down treatment if there is good control over the condition to maintain the lowest step that will control the patients condition. As the patient is currently on regular preventer therapy with inhaled steroids, she is currently on step 2 of the management of asthma. There have been many studies being carried out to compare the different inhaled steroids that are being used for asthma and it is shown that beclomethasone diproprionate and budesonide are both similarly clinically effective although there may be different devices for delivery. It has also been seen that fluticasone and mometasone being administered at half the dosage of beclomethasone and budesonide shows equivalent clinical effectiveness, however there is somewhat inadequate evidence that fluticasone possesses fewer side effects and further studies need to be carried out on establishing the safety profile of mometasone.31 A new inhaled steroid has been introduced which is ciclesonide and clinical trials have shown evidence that it has more local activity than systemic and less oropharyngeal side effects as compared to the regular inhaled steroids.3 2-35 Although this seems promising, this clinical advantage is still controversial as its safety to efficacy ratio has yet to be established and compared with the conventional inhaled steroids. Inhaled steroids are recommended as preventer drug therapy for adults as they are most clinically effective in controlling asthma based on the treatment goals outlined.36-39 The frequency of dosing of inhaled steroids are generally twice daily and it is shown that there is slight clinical benefit obtained when taken twice a day than once daily, however a once daily dosing may suffice for those with milder asthma. There is also limited evidence of advantage with increased frequency of greater than twice a day.37 In addition to that, starting at higher than recommended doses have no significant effectiveness in management of mild to moderate asthma.40 Hence the recommended dosage for inhaled steroids would be 200-800mcg daily. This would be an add-on therapy to the step 1 management of using in haled short acting ÃŽÂ ²2 agonist bronchodilator as required. Based on the presented case, the patient was on budesonide 200mcg once at night prior to admission but this was immediately increased on admission and was in line with the recommended guidelines as she was continued on budesonide 400mcg twice a day together with salbutamol 200mcg as required following discharge. Other preventer therapies may be included for the patient despite inhaled steroids being the first choice of drugs for preventer therapy. These alternatives are less effective although they have shown some clinical benefit in patients who are on short acting ÃŽÂ ²2 agonists only. Chromones which act as mast cell stabilizers such as sodium cromoglicate and nedocromil sodium have shown to be beneficial in adults.41, 42 Apart from that, leukotriene receptor antagonists montelukast and zafirlukast too have clinical benefits.37, 43, 44 Theophylline also have some evidence in showing benefits in adults.36, 45 The patient in the case presented above was prescribed sustained-release theophylline on the last day of admission. Although it is another option that may be added to daily controller medications for step 2 management, there is very little evidence on the clinical efficacy of it as a long term controller. There is no reason to justify the use of theophylline in this case as the patient is responsive and can be controlled on inhaled steroids. Further more, theophylline has a narrow therapeutic index and close monitoring of plasma theophylline levels is necessary because at concentrations above 25 µg/ml, there is high risk of tachycardia and seizures may occur if concentrations exceed 35 µg/ml. CONCLUSION After reviewing the management of the patients condition throughout hospital stay, it can be concluded that SK was treated adequately based on the current guidelines and evidences attainable. She was given all necessary treatment at point of admission and there was no lacking of medications in all four days of her hospital admission. Apart from that, monitoring of her condition was carried out consistently and all data was updated, leaving no room for questioning and doubt. However, there were a few issues that came to attention which were the prescribing of several drugs that were unnecessary such as diphenhydramine and theophylline. There were little and no clear evidence that these drugs prescribed would be of benefit to the patient, and may also increase the risk of harmful effects to her as well. Alongside treatment of her acute condition, SKs controller medications were reviewed and subsequent changes were made as appropriate. Besides that, her other co-morbidities were also managed well as treatments for her hypertension and diabetes mellitus were given accordingly. PATIENT MEDICATION PROFILE PATIENT DETAILS Name S.K. Consultant Dr YKS General Practitioner Address Gender Female Weight 65kg Height 1.59m Community Pharmacist Date of Birth (Age) 54 years old Known Sensitivities NKDA Social History Widow of 6 years, Housewife, Non-smoker, Does not drink PATIENT HOSPITAL STAY Presenting complaint in primary care / reason for admission Admission date 17/04/09 Shortness of breath for the past two days, progressively Discharge Date Discharged to 21/04/09 Home worsening today and productive cough. RELEVANT MEDICAL HISTORY RELEVANT DRUG HISTORY Date Problem Description Date Medication Comments 2001 Diabetes Mellitus T. Diamicron 80mg BD 2001 Hypertension T. Metformin 500mg TDS 2004 Gastritis T. Telmisartan 40mg ON 2009 Bronchial Asthma MDI Salbutamol 200mcg PRN MDI Budesonide 200mcg ON T. Lovastatin 20mg ON RELEVANT NON DRUG TREATMENT Prescribed Medication Start Stop Clinical/Laboratory Tests Date Result 1 T. Telmisartan 40mg OD 18/04 21/04 2 T. Gliclazide 80mg BD 17/04 17/04 3 T. Metformin 500mg TDS 17/04 4 T. Lovastatin 20mg ON 17/04 19/04 5 MDI Salbutamol 200mcg 2 puffs PRN 17/04 6 MDI Budesonide 200mcg 2 puffs BD 17/04 7 T. Prednisolone 30mg OD 17/04 17/04 8 Neb. Combivent 6-hourly 17/04 19/04 9 IV Ceftazidime 2g STAT, then 1g TDS 17/04 21/04 10 S/C Humulin R 10units TDS 17/04 21/04 11 S/C Humulin N 12units ON 17/04 21/04 12 Syrup Diphenhydramine 15mls TDS 18/04 20/04 13 T. Slow K 2tabs BD 18/04 20/04 14 Mist KCl 15mls TDS 18/04 20/04 15 T. Theophylline 250mg OD 20/04 CLINCIAL MANAGEMENT Diagn

The Greatest Tunnel Ever! Essay -- Personal Narrative, essay about mys

The day had that perfect quality you always associate with childhood memories. I was eight, maybe nine, at the time of this particular memory, a small, ponytailed, freckled child with dirty legs and dirtier arms and face, full of energy and hope all children possess when looking forward to playing with other children. The sun shone through marshmallow-like clouds, and although it was only early afternoon, the tar road had started to bubble under my feet. The ponies tethered at the side of the road nickered at me in hope of an apple, but I was in too much of a hurry to oblige. Johnny, my equally dirty playmate, met me at the end of their driveway, his grin gaping where his big brother, Eddie, had accidentally knocked out his front teeth with a nine iron. "Let's check out those tunnels Eddie built last night," he demanded. The thought held no appeal for me whatsoever, but rather than show my reluctance and chance losing my only playmate, I pasted on a big grin of my own and followed him. We climbed the sloping lawn to the barn's entrance, where the doors, which were a color somewhere between grey and brown, stretched, from my viewpoint, to heaven. Johnny pulled on one door with all the strength in his puny body, but it refused to budge until I added my strength to his. Slowly, ever so slowly, it groaned a horrid sounding groan while begrudgingly swinging enough for us to squeeze through, scratching both stomachs and backsides in the process. The smell of the barn struck us a terrible blow after the air of the summer outside. The stench of horse-flesh and manure filled the air, accompanied by the smells of overly-sweet straw and pungent leather harnesses. The stenches filled our noses and pe... ...ever built!" Johnny cried. I was amazed to see his flushed face devoid of any sign of illness or relief, but full of some fanatical form of worship for the maze which had nearly killed us. "Let's go through again before supper," he demanded. "I can't," I replied, pulling stray wisps of straw from my hair. "I have to be home early today." "Well, okay, I guess," he sulked, "but tomorrow for sure. Come on, I'll race you down!" And he was off in a flash toward the ladder. I let him win, just for good measure. The sun was overly bright to my contracted pupils, but I didn't notice. I was trying to think of a reason not to go through that particular version of hell again, but a reason wouldn't come, and I knew that when tomorrow got here, that's exactly where I'd be. Maybe Johnny would even let me go first. The Greatest Tunnel Ever! Essay -- Personal Narrative, essay about mys The day had that perfect quality you always associate with childhood memories. I was eight, maybe nine, at the time of this particular memory, a small, ponytailed, freckled child with dirty legs and dirtier arms and face, full of energy and hope all children possess when looking forward to playing with other children. The sun shone through marshmallow-like clouds, and although it was only early afternoon, the tar road had started to bubble under my feet. The ponies tethered at the side of the road nickered at me in hope of an apple, but I was in too much of a hurry to oblige. Johnny, my equally dirty playmate, met me at the end of their driveway, his grin gaping where his big brother, Eddie, had accidentally knocked out his front teeth with a nine iron. "Let's check out those tunnels Eddie built last night," he demanded. The thought held no appeal for me whatsoever, but rather than show my reluctance and chance losing my only playmate, I pasted on a big grin of my own and followed him. We climbed the sloping lawn to the barn's entrance, where the doors, which were a color somewhere between grey and brown, stretched, from my viewpoint, to heaven. Johnny pulled on one door with all the strength in his puny body, but it refused to budge until I added my strength to his. Slowly, ever so slowly, it groaned a horrid sounding groan while begrudgingly swinging enough for us to squeeze through, scratching both stomachs and backsides in the process. The smell of the barn struck us a terrible blow after the air of the summer outside. The stench of horse-flesh and manure filled the air, accompanied by the smells of overly-sweet straw and pungent leather harnesses. The stenches filled our noses and pe... ...ever built!" Johnny cried. I was amazed to see his flushed face devoid of any sign of illness or relief, but full of some fanatical form of worship for the maze which had nearly killed us. "Let's go through again before supper," he demanded. "I can't," I replied, pulling stray wisps of straw from my hair. "I have to be home early today." "Well, okay, I guess," he sulked, "but tomorrow for sure. Come on, I'll race you down!" And he was off in a flash toward the ladder. I let him win, just for good measure. The sun was overly bright to my contracted pupils, but I didn't notice. I was trying to think of a reason not to go through that particular version of hell again, but a reason wouldn't come, and I knew that when tomorrow got here, that's exactly where I'd be. Maybe Johnny would even let me go first.

The Policies of Harry S. Truman

Many presidents have faced domestic and international problems, but it is a challenge not to know about them until you become the president of the United States, that is what happened to the 33rd President of the United States Harry S. Truman At the time of Roosevelt’s death, Truman was Vice-President for only 82 days and he faced more challenges in domestic and foreign affairs than any other U. S. president did at the time, yet he manages to steer this country in the right direction. Truman knew nothing about the Manhattan Project, and the atomic bomb. When Truman took the reins unexpectedly, (April 12, 1945) he was forced to deal with keeping a nation together and winning the greatest war history had ever seen. The first issue of foreign policy that Truman confronted was the decision to use nuclear weapons against Japan. No decision of his presidency has drawn so much criticism as the dropping of atomic bombs on Hiroshima (6 August 1945) and Nagasaki (9 August). The question is whether he could have done anything else—that is, whether he could have delayed use of the bombs by opting for a demonstration of their immense power or refused to employ what General Dwight D. Eisenhower described many years after its employment as an inhuman weapon. The Charter of the United Nations was signed in June 26, 1945 in San Francisco by Truman and ratified by the Senate in October 24, 1945. Originally ratified by 51 countries, currently 192 countries have ratified the charter. The Charter of the United Nations is by far the largest peace keeping Organization treaty it ever existed to date. Truman as a vision of a wilsonian he is, he wouldn’t let Wilson’s idea revived into the Truman straightforward he is to let this idea die again. The Proclamation 2695 (July 4, 1946) served as the culmination of American colonialism in the Philippines and proclaimed the absolute independence of the Filipino people as the United States withdraws and surrendered all rights of possession, supervision, jurisdiction, control or sovereignty. It was supposed that the United States relinquished control over the islands in 1944 but with the war on the Pacific the United States Senate decided to delay by two years. Now from this point forward the Unites States recognized the new independent state of the Philippines and the Unites States relinquish any control over the new created state. The nations of Europe were ravaged after WWII. Poor countries were susceptible to Communism. Truman’s announce Congress the change in policy by the means of the Truman Doctrine (12 March 1947), which promised United States support to countries threatened by Communism. It stated that totalitarian governments undermined the foundations of international peace, and thus were a threat to the United States. It was used in Greece and Turkey after the communists tried to take over, and a revolution erupted, the United States supplied the anti-Communist forces with money and arms. This policy was the adoption of containment as official U. S. policy. The Inter-American Treaty of Reciprocal Assistance (or commonly known as the Rio Treaty), was signed in Sept. 2, 1947 in Rio de Janeiro (hence the name Rio Treaty) and ratified by the United States Senate in 1947. Originally ratified by all 22 American republics which are Argentina, Bahamas, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United States, Uruguay, and Venezuela. Under the treaty, an armed attack or threat of aggression against a signatory nation, whether by a member nation or by some other power, will be considered an attack against all. This treaty puts a defensive alliance of the Western Hemisphere nations, and this agreement was a move toward a multilateral approach to the Monroe Doctrine and the most important inter-American agreement to this day. This treaty also puts the groundwork for the formation the Organization of American States (OAS) a few years later in Colombia. The Marshall Plan (June 5, 1947), Truman proposed the Marshall Plan to sponsor reconstruction in Europe. The Marshall Plan passed in 1947, right after the Czechoslovakian Communist revolution. Congress appropriated $5. 8 billion for the first fifteenth months, and contemplated further spending. The Marshall Plan included most of the nations of Western Europe: Austria, Belgium, Denmark, France, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Sweden, Turkey, and the United Kingdom. (Switzerland signed the convention creating an organization for the plan, but refused to accept funds. ) Congress included (National) China in Marshall Plan appropriations. The National Security Act (July 26, 1947) mandated a major reorganization of the foreign policy and military establishments of the U. S. Government. The act created many of the institutions that Presidents found useful when formulating and implementing foreign policy, including the National Security Council (NSC). The Council itself included the President, Vice President, Secretary of State, Secretary of Defense, and other members (such as the Director of the Central Intelligence Agency), who met at the White House to discuss both long-term problems and more immediate national security crises. Truman never went and didn’t take importance in these meetings until the Korea War in 1950 when Truman took the seriousness of the conflict and began to form part of these meetings. The General Agreement on Tariffs and Trade (October 30, 1947) set the basic rules under which open a nondiscriminatory free trade policy in which it can take place. This treaty meant to reduce trade barriers among the 23 countries signatory nations. The GATT sought to create an institutional framework within which international trade could be conducted as stable and predictable as possible. The Charter of the Organization of American States (April 30, 1948) was signed by 21 nations (this are the same nations that signed the Rio treaty except for the Bahamas delegation) of the western hemisphere at the conclusion of the ninth Pan-American Conference in Bogota, Colombia which reconstituted the Pan-American Union to the Organization of American States in which they reaffirmed its commitment as when they signed the Rio treaty â€Å"to achieve an order of peace and justice, to promote their solidarity, to strengthen their collaboration, and to defend their sovereignty, their territorial integrity, and their independence. The Truman administration hoped that the Organization would eventually assume the mounting responsibilities for solving hemispheric problems, but the U. S. would always play the dominant role. The provisional government of the state of Israel proclaims the new state of Israel (May 14, 1948). On that same date the United States, president Truman acknowledges and recognized the provisional Jewish government as de facto authority of the new Jewish state (de jure recognition was extended on January 31). The U. S. delegates to the U. N. and top ranking State Department officials were angered that Truman released his recognition statement to the press without notifying them first. The Berlin Airlift (June 27, 1948-May 12, 1949) was the greatest humanitarian and aviation event in history. Since the Allies had never negotiated a deal to guarantee supply of the sectors deep within the Soviet-occupied zone. The commander of the American occupation zone in Germany, General Lucius D. Clay, proposed sending a large armored column driving peacefully, as a moral right, down the autobahn across the Soviet zone to West Berlin, with instructions to defend itself if it were stopped or attacked. Truman, however, following the consensus in Washington, believed this would entail an unacceptable risk of war. He approved a plan to supply the blockaded city by air. On June 25, the Allies initiated the Berlin Airlift, a campaign that delivered food and other supplies, such as coal, using military airplanes on a massive scale. Nothing remotely like it had ever been attempted before, and no other nation had the capability, either logistically or materially, to have accomplished it. The airlift worked; ground access was again granted on May 11, 1949. The airlift continued for several months after that. The Berlin Airlift was one of Truman's great foreign policy successes as president; it significantly aided his election campaign in 1948. The Genocide Treaty it was signed December 12, 1948 it went in force in 1951 but the U. S. ratification came November 23, 1988. Although it took four decades to ratify the treaty, this international agreement made genocide an international crime during both war and peace. The North Atlantic Treaty (4 April 1949), which assured military assistance, resolved the economic and political near-chaos of Europe after World War II. These measures would, he believed, preserve democracy in Western Europe and thereby help preserve the freedom of the United States. The North Atlantic Treaty Organization (NATO) comprised the United States, Belgium, the Netherlands, Luxembourg, France, Britain, Canada, Italy, Portugal, Denmark, Norway, and Iceland; Greece and Turkey joined in 1952, West Germany in 1955, and Spain in 1982. The situation in the Pacific was not much better than that in Europe. In the Potsdam Conference in Germany and in the Cairo Conference, it was agreed that Korea would become a free and independent nation once the war is over. However, after V-J Day, the Soviet government was quick to establish a Communist regime. The United States under the Truman administration helped Korea setup a democratic government on the Southern Part of the peninsula. North Koreans crossed the border in full force (June 25, 1950). The UN, presented with its first real conflict, acted quickly, partly because the Soviet representative had walked out a few days earlier in protest of Communist China's lack of representation (it was represented by Nationalist China). War was declared on the aggressors by the United Nations. Although all nations contributed, it was mostly the United States fighting the war. The war lasted for about three years until an armistice was signed splitting Korea again along the 38th parallel. Macarthur stated to President Truman that the Chinese wouldn’t enter the war and this conflict would be over by Christmas. That was the most erroneous statement that Gen. Macarthur said to president Truman because since Gen. Macarthur was anxious to wrap up the war he ordered American and other U. N. troops to press on to the Yalu River and since the communist Chinese didn’t want that buffer zone gone they enter in force. In doing this, he ignored the warnings of the Communist Chinese as well as a directive by military planners in Washington to send only South Korean troops into the provinces bordering China. Macarthur never thought that the Communist Chinese were going to invade North Korea, but since it happen he wanted authorization for a full scale invasion of China and bring the Chinese Nationalist to fight in Korea and in weak positions of Communist mainland China, but since Truman didn’t wanted WWIII it refused Macarthur plan. Macarthur frustrated started to say its plans publicly without Washington’s authorization and for insubordination; Truman fired Macarthur on the grounds that Macarthur wasn’t the Commander in Chief. Puerto Rican nationalists Griselio Torresola and Oscar Collazo attempted to assassinate Truman at Blair House (November 1, 1950). This put and important question mark the relationship between the United States and Puerto Rico and since Truman understood that, he allowed a plebiscite in Puerto Rico to determine its future relationship with the United States. As for the Torresola, he was shot a White House policeman, Leslie Coffelt, before expiring himself and Collazo as a co-conspirator in a felony that turned into homicide was guilty of murder and sentence to death in 1952, but Truman changed it to life in prison. This attack could well be implemented since the gunfight was over a dozen feet of his bed and since he was curious went to the window to see until a passerby shout to Truman to take cover. The Tripartite Security Treaty (Anzus Treaty) was signed September 1. 951 and came in force April 29, 1952. This Treaty, signed a few years after WWII, it was designed to send a signal to Communist China and the Soviet Union that Western-oriented countries were determined to stop new aggressive moves in the Pacific. The U. S. -Japanese Security Treaty (San Francisco Treaty) was signed September 8, 1951 by 49 nations and came in force April 28, 1952 in which the United States agreed to assume primary responsibility for the conventional defens e of a disarmed Japan and an exclusive role in providing nuclear deterrence. Japan would have renounce the ability to declare war and its military would be for peacekeeping forces and ensured the formal return of independence at the expense of large military presence in the country and also ensured that any attack against Japan, the United States makes responsible of any protection and retaliation in the name of the Japanese Diet. The Immigration and Nationality Act (McCarran-Walter Act) (June 27, 1952) upheld the national origins quota system established by the Immigration Act of 1924, reinforcing this controversial system of immigrant selection. It also ended Asian exclusion from immigrating to the United States and introduced a system of preferences based on skill sets and family reunification. Plus this Act expanded the United States definition to Guam, Commonwealth of Northern Mariana Islands in addition to Puerto Rico and U. S. Virgin Islands which is used currently. At the basis of the Act was the continuation and codification of the National Origins Quota System. It revised the 1924 system to allow for national quotas at a rate of one-sixth of one percent of each nationality's population in the United States in 1920. As a result, 85 percent of the 154,277 visas available annually were allotted to individuals of northern and western European lineage. The Act continued the practice of not including countries in the Western Hemisphere in the quota system, though it did introduce new length of residency requirements to qualify for quota-free entry. There were other positive changes to the implementation of immigration policy in the 1952 Act. One was the creation of a system of preferences which served to help American consuls abroad prioritize visa applicants in countries with heavily oversubscribed quotas. Under the preference system, individuals with special skills or families already resident in the United States received precedence, a policy still in use today. Moreover, the Act gave non-quota status to alien husbands of American citizens (wives had been entering outside of the quota system for several years by 1952) and created a labor certification system, designed to prevent new immigrants from becoming unwanted competition for American laborers. Truman vetoed the McCarran-Walter Act because he regarded the bill as â€Å"un-American† and discriminatory. Truman’s veto was overridden by a vote of 278 to113 in the House, and 57 to 26 in the Senate. Parts of the McCarran-Walter Act remain in place today, but much of it was overturned by the Immigration and Nationality Services Act of 1965. These reversals in foreign policy, from isolation to world power, established Truman's reputation as one of the nation's greatest presidents. Which helped placed an economic foundation to struggling nations of Western Europe and Northeast Asia. Truman's domestic policies as president took far less of his time, and proved far less successful, than his foreign policies. Here also he dealt with three major issues: The administration of the modern American presidency, a legislative program known as the Fair Deal, and Republican accusations of internal subversion and corruption. He managed well with two of these domestic matters. The Executive Order 9599 (August 18, 1945) Provides assistance to expand production and continued stabilization of the national economy during the transition from war to peace, and for the orderly modification of wartime controls over prices, wages, materials, and facilities. The Executive Order 9635 (September 29, 1945) Organizes the Navy Department, defines what is the Naval Establishment as well it defines the duties of the Chief Naval Operations and declare that the Marine Corps and the Coast Guard are part of the Naval Establishment. The Executive Order 9646 (October 25, 1945) Rearranges the Coat of Arms, Seal and Flag of the President of The United States to accommodate the newest incorporated states into the Union. The War Brides Act (December 28, 1945) relaxes the immigration regulations to allow foreign born spouses and children of U. S. military personnel to settle in the United States. The Employment Act (Murray Act) (February 20, 1946) stimulates the economy following WWII, creating agencies in Congress and in the executive branch to focus on the problems of the depression and inflation. The Executive Order 9728 (May 21, 1946) Truman seized most of the nation's bituminous coal mines so that the secretary of the interior could negotiate a contract with mineworkers. As authority, EO 9728 had cited, among other things, the War Labor Disputes Act. The Hobbs Acts (Anti-Racketeering Act) (July 3, 1946). This made it unlawful to interfere with interstate commerce by robbery or extortion and reined labor unions ability to enforce the interests of their constituents within the boundaries of the law. The Federal Tort Claims Act (August 2, 1946) enabled private citizens to sue the government when a federal employee harms a third party or private property by committing an international tort or by negligence. The Supreme Court later barred military personnel from suing the federal government for injuries suffered while performing their jobs. The Taft-Hartley Act (June 23, 1947), was designed to amend much of the National Labor Relations Act of 1935 (the Wagner Act) and discontinued parts of the Federal Anti-Injunction Act of 1932. It limit the power of unions from contributing to political campaigns, It forbids jurisdictional strikes and secondary boycotts, It permits union shops only after a majority of the employees vote for them, It declares all closed shops illegal and the president is allow to appoint a board of inquiry to investigate unions when he believes a strike would endanger the health and safety, and obtain an 80-day injunction to stop the strike. Even president Truman was against this and vetoes it but it was overridden. The Presidential Succession Act (July 18, 1947) corrected the weaknesses in the line of presidential succession as outlined in the original Constitution. The Water Pollution Control Act (June 30, 1948) extended the reach of the federal government by establishing cooperative arrangements with states for grants, research, and technical assistance. This Act addressed the nation’s water-quality problems by attempting to establish a cooperative relationship between the federal and state governments. This legislative piece since it was far ahead of its time, he decided to turn this legislation into an Executive Order at the same time running the risk of being overturn by another Executive Order but it worked, it is Executive Order 9981 (July 26, 1948) that provided integration of the armed forces and establishes equal treatment and opportunity in the armed services. The Navajo-Hopi Rehabilitation Act (April19, 1950) attempted to improve conditions in one of the most impoverished areas of the United States; this Act funded the construction of roads, schools, and other developments on the Navajo and Hopi reservations. The Internal Security Act (McCarran Act) (September 23, 1950) established the Subversive Activities Control Board, aimed at stopping communist subversion in the United States, calling for the registration of all known communist organizations and individuals in the United States. The Celler-Kefauver Act (December, 29 1950) prohibited certain types of mergers between firms in the same industry, the Celler-Kefauver Act led companies to form conglomerates made up of companies in unrelated industries. The Celler-Kefauver Act of 1950 amended the Clayton Act by closing a loophole that allowed companies to avoid antitrust suits by acquiring assets (rather than stock) of another company. The Twenty-Second Amendment was ratified February 27, 1951 and it was certified in record breaking time of March 1, 1951. Shortly after Franklin Roosevelt’s unprecedented fourth term as president, the twenty-second Amendment was adopted to established presidential limits to two (2) terms. The Executive Order 10340 (April 8 1952) Truman directed Secretary of Commerce Charles Sawyer to seize the mills to ensure their production to support the war efforts just hours before a scheduled strike. Since the Taft-Hartley Act passed in Congress the Supreme Court goes in emergency session in the case of Youngstown Sheet & Tube Co. v. Sawyer (Secretary of Commerce) in a 6 to 3 decision on Youngstown Sheet and Tube Co. v. Sawyer declared the seizure unconstitutional. The Court held that Truman could have used the Taft-Hartley Act to delay the strike, but Truman disliked the law too much to use it. In Supreme Court appointments, Truman wasn’t cautious choosing the Supreme Court Justices because significantly all four were friends of the dear president and all four were more political background rather than judicial. Justice Harold Burton in 1945, Chief Justice Fred Vinson in 1946, and Justices Sherman Minton and Tom Clark in 1949 – generally shared his views regarding the judiciary. Burton and Minton had served with Truman in the Senate; Vinson and Clark had served in Truman's Cabinet (the former as Treasury Secretary and the latter as Attorney General). Vinson, Truman's choice as Chief Justice, was a favorite poker-playing companion of the President, who hoped that his friend's political skills would help restore harmony to what had become an increasingly contentious and divided Court. But the Vinson Court continued to be plagued by internal conflicts. Justice Hugo Black's commitment to judicial activism in defense of civil liberties and the Bill of Rights clashed with Justice Felix Frankfurter's belief in judicial restraint and deference to legislative authority. Philosophical differences were aggravated by personal animosities on the Court, most notably between Black and Justice Robert H. Jackson. Much to a surprise the American people thought that president Truman was an outsider and it was, he knew nothing about the atomic bomb (was investigating large expenditures in Oak Valley, Tennessee but didn’t knew for what purpose it was) and he ordered the release of the weapons in Japan, send troops to the Korea conflict although it resulted in a stalemate. Recognized two countries (Pakistan and Israel) and helped another country to became independent (Philippines), Signed the UN charter, authorized the Berlin Airlift, it’s a founding of the OAS, authorized a plebiscite to the people of Puerto Rico to determined the future of relations with the U. S. saved Greece and Turkey from Communist rule. Although he could do better in domestic policy, but from being only 82 days as Vice-president knowing nothing about policy and saving the world from catastrophe, that is an exceptional President if you ask me, he is truly the Prince of Foreign Policy. Works Cited S. Avi-Yonah, Reuven. U. S Laws, Acts, and Treaties. Library Edition. Vol. 2. Pasadena, California: Salem Press, 2003. Print. United States. National Archives and Records Administration. Proclamation 2695-Independence of the Philippines. 4 July 1946. 10 April 2009. . United States. Department of State. Kennan and Containment, 1947. September 1997. 9 April 2009. . United States. Department of State. National Security Act of 1947. September 1997. 8 April 2009. < http://www. state. gov/r/pa/ho/time/cwr/17603. htm>. United States. Department of State. Background Notes: United Nations. September 1997. 4 April 2009. < http://www. state. gov/www/background_notes/united_nations_0997_bgn. html>. United States. Department of State. The Immigration and Nationality Act of 1952 (The McCarran-Walter Act). September 1997. 9 April 2009. < http://www. state. gov/r/pa/ho/time/cwr/87719. htm>. United States. The White House, Executive Office of the President. National Security Council History. 2 April 2009. 9 April 2009. < http://www. whitehouse. ov/administration/eop/nsc/history/>. The Harry S. Truman Library and Museum. Exec. Order No. 9599, 3 C. F. R. 3 (1945). 2 April 2009. 9 April 2009. < http://www. trumanlibrary. org/executiveorders/index. php? pid=368&st=&st1>. The Harry S. Truman Library and Museum. Exec. Order No. 9635, 3 C. F. R. 3 (1945). 2 April 2009. 9 April 2009. < http://www. trumanlibrary. org/executiveorders/index. php? pid=350&st=9635&st1>. The Harry S. Truman Library and Museum. Exec. Order No. 9646, 3 C. F. R. 3 (1945). 2 April 2009. 9 April 2009. The Harry S. Truman Library and Museum. Exec. Order No. 9728, 3 C. F. R. 3 (1946). 2 April 2009. 9April 2009. < http://www. trumanlibrary. org/executiveorders/index. php? pid=459&st=9728&st1>. The Harry S. Truman Library and Museum. Exec. Order No . 9981, 3 C. F. R. 3 (1948). 2 April 2009. 9 April 2009. The Harry S. Truman Library and Museum. Exec. Order No . 10340, 3 C. F. R. 3(1952). 2 April 2009. 9 April 2009. The University of Texas Digital Library Services Division. The Presidential Timeline of the Twentieth Century. 1 April 2009. 7 April 2009.

Sg Cowen

9-402-028 REV: JANUARY 19, 2006 THOMAS DELONG VINEETA VIJAYARAGHAVAN SG Cowen: New Recruits We are who we recruit. — SG Cowen professional Chip Rae, director of recruiting at SG Cowen, looked out the conference room window at the falling flakes and wondered how fast the snow was accumulating. Most of the firm’s bankers had come in from Connecticut or Westchester to participate in the Super Saturday recruiting event, and he knew they were anxious to get home before the weather deteriorated and made travel dangerous. The interviews had finished at noon, and the candidates from various graduate schools had left for their flights right away.Now, the bankers were eating lunch, discussing interview results and making decisions. They were sitting in â€Å"Giants Stadium,† the bank’s largest conference room, and Rae had set the tables up in a U-shape so that he could stand in the front and still communicate with all 30 bankers. He posted placards with all the cand idate names on the bulletin board and moved them around as they came up for discussion. The hiring meeting had moved rapidly through a number of candidates. The decision makers had agreed on candidates who were firm â€Å"yeses† and some other clear â€Å"nos. † Now was the tricky part: there were four candidates still left.Each person had some strong support among their interviewers but had also raised some questions. To reach the ideal class size after factoring in expected yield, Rae wanted to give out only two more offers. Investment Banking Industry in 2001 Consolidation in the investment banking industry was widespread, as major firms bought small banks, bought retail brokers, and considered partnering with commercial banks. Mergers and acquisitions (M&A) and equities remained the highest-margin businesses but also very volatile, as deal volume and initial public offering (IPO) issuances could dry up very quickly in a downturn.In a down market, fixed incomeâ€⠄¢s more stable revenue stream was especially welcome. Integrated banking groups such as Citigroup or JP Morgan Chase were sometimes able to win investment banking business away from the traditional bulge-bracket firms because of their ability to offer loans and other commercial banking capabilities. Some strategists believed the lending business was the ________________________________________________________________________________________________________________ Professor Thomas DeLong and Research Associate Vineeta Vijayaraghavan prepared this case.HBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. Copyright  © 2002 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-545-7685, write Harvard Business School Publishing, Boston, MA 02163, or go to http://www. hbsp. harvard. edu.No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permission of Harvard Business School. 402-028 SG Cowen: New Recruits wave of the future, while others targeted the custody business. The custody business, which involved holding and processing the buying and selling of securities for investors, was a low-risk fee-based business that was considered mundane but offered regular opportunities for interaction and service to potential clients.Several investment banks reported declining profits, and some laid off staff to cut costs. The biggest expense on Wall Street was compensation costs, averaging 50% of revenue. 1 In the prosperous years on Wall Street in the late 1990s, some firms had salary and bonus costs upwards of 60%, since firms signed multiyear contracts promising fixed bonus payouts to keep tale nt and also signed separate profit-sharing agreements with individual business groups to prevent them from spinning out on their own.Investment banks were also under increased scrutiny from regulators and the public, who were concerned about conflict of interest. Many new equity issues, especially in technology, had been supported by research analysts, particularly at the firms that had executed the IPOs. This loyalty to the banking clients came at the expense of the investors who followed analyst recommendations and bought stock in companies that often continued to decline. Firms were now developing better guidelines for keeping research teams independent from bankers and their clients.Investment banks fought for talent with firms in venture capital, private equity, hedge funds, consulting, and, for the last few years, tech companies. Banks were reassured to see students return to the fold, as they exhibited much more interest in established brand-name companies for secure jobs. Ho wever, the interest level had gone from one extreme to the other. Where banks had once feared they were only seeing second-tier candidates, now they had recruiting yields much higher than expected and struggled with how to handle all the new recruits as business slowed down.SG Cowen SG Cowen was born when Societe Generale purchased Cowen and Company in July 1998. Societe Generale was an international bank based in France, founded in 1864, nationalized in 1945, and privatized in 1987. By 2000, it was one of the world’s largest banks, with assets of over $430 billion as of December 2000. Like many European banks, it wanted a foothold in investment banking in the United States. Many of these banks had tried to create a beachhead in the U. S. but had not succeeded.Societe Generale had flirted with buying one of the CHARM banks for the past five years and decided Cowen was the best match culturally. 2 By 2000, Societe Generale’s $600 million purchase of Cowen had started to pay off: SG Cowen went from an operating loss of $75 million in 1999 to an operating profit of $34 million the following year. Cowen began business as a bond brokerage house in 1918 and grew into a firm known for top-tier research and strong equity sales and trading capabilities. It was now also focused on building up its investment banking and M&A advisory services.The new entity SG Cowen, numbering 1,500 professionals, planned to remain a boutique-sized firm but had access to the parent firm’s balance sheet. SG Cowen’s investment bankers focused on emerging growth companies in two volatile but highly profitable areas, health care and technology. This focused approach to banking depended on deep knowledge collected through its equity research team, highly regarded for its coverage of both 1 The Economist, August 4, 2001. 2 CHARM banks was the Wall Street nickname for this set of boutique banks: Cowen, Hambrecht & Quist, Alex Brown,Robertson Stephens, and Montgomery S ecurities. 2 SG Cowen: New Recruits 402-028 health care and technology. Kim Fennebresque, president and CEO of SG Cowen, often described research as the â€Å"edge of a wedge† that created inroads with new clients. The firm had strong roots in Boston but had now opened several other offices, as far apart as San Francisco, Dallas, and London. This raised concerns about making sure employees in smaller offices were not isolated and also that they had full knowledge of and access to the resources of the global firm.As the firm grew, there were concerns that groups should make sure there were frequent interactions and that people should know about one another’s deals and proposals and make sure they coordinated their client activity. Fennebresque believed that SG Cowen should continue to grow geographically but stay industry focused: â€Å"We will, under all circumstances, remain an emerging growth investment bank. Our geographical reach will extend to Europe, Asia, and o ther parts of the world, but we will not stray from that focused sectoral agenda.We have in our midst, and will continue to attract, the highest-quality professionals who believe in that business model. † The Hiring Process Like most firms on Wall Street, SG Cowen made hiring decisions in the early winter and spring of each year to fill a new class of associates who would begin that summer. Some associates had previously been employed by SG Cowen as analysts and were promoted to first-year associate at the end of their third year with the firm without going to business school. Other associates started out as interns in the summer between their first and second year of business school and subsequently were offered full-time employment at the end of their internship commencing the following summer. The hiring process for new outside associate hires began in the fall, when SG Cowen would make company presentations at its â€Å"core business schools,† where it participated in the on-campus recruiting programs. These schools were NYU, Chicago, Columbia, Cornell, Emory, USC, Washington University, Notre Dame, and Berkeley.SG Cowen would also accept resumes from students at noncore schools, where it was not participating in the on-campus program. Often SG Cowen professionals would conduct â€Å"informational interviews† with students in the office in advance of official first-round interviews. These interviews, which were not part of the formal process, were a chance for SG Cowen to gauge how serious and enthusiastic the candidates were and a chance for candidates to learn more about the firm and the industry before the interview in which they would be actually evaluated.Rae assigned team captains to every school at which SG Cowen recruited on campus so that students had a constant and familiar point of contact. Ideally, these team captains were banking professionals and not human resource professionals, and as often as possible, Rae would try to match up alumni with their own school. Gregg Schoenberg was team captain at the Johnson School of Business at Cornell, the school that currently provided SG Cowen’s highest recruiting yield. Schoenberg had joined the firm in August 1998 and now worked in the Equity Capital Markets Group.He became actively involved in recruiting at Cornell upon joining for two reasons. First was that he believed SG Cowen would benefit from the high quality of candidates at Cornell. Second was that he wanted to make it easier for Cornell grads to obtain investment banking positions on Wall Street. Schoenberg averred: In the bull market years, the Goldman’s of the world would back up the recruiting truck to places like Harvard and invite slews of students to climb aboard.It was tougher for us because 3 Analysts were recruited from Babson, Colby, Columbia, Georgetown, Harvard, New York University, University of Pennsylvania, Tulane, Vanderbilt, Massachusetts Institute of Technology, and Ya le. 3 402-028 SG Cowen: New Recruits we didn’t have the alumni base in New York. We came down here on our own nickel and really pounded the pavement. But you can turn a negative into a positive. Because Cornell students who do want to do banking have to show more initiative and be more focused, generally this makes them great hires.When Schoenberg had been hired, Cornell was not a core school, and Schoenberg described SG Cowen at the time as â€Å"so-so receptive† to people from noncore schools, mostly because the lack of an on-campus round made for disproportionate hassles to pin bankers down to do interviews and set up individual interview times in the middle of a regular workday. Coming from a nontraditional background in politics, Schoenberg felt SG Cowen’s interest in him really gained momentum once they knew he had been called back for second rounds at Lazard Freres.When Schoenberg recruited for SG Cowen, he said he always told candidates, â€Å"It doesnà ¢â‚¬â„¢t matter what you did before, what matters is that you have demonstrated a pattern of success. † But he also said candidates had to be realistic about their â€Å"fit,† as he himself was. â€Å"I couldn’t outmodel a former Morgan Stanley analyst,† he said. He moved to Equity Capital Markets from M&A within his first few months because â€Å"it played to my interests in the markets and my personality. † People need to be fast learners, he said, because â€Å"Wall Street doesn’t have the patience to allow someone to develop slowly. Rae’s Strategy Schoenberg’s advocacy for making Cornell a core school converged perfectly with Rae’s new strategy for choosing core business schools. â€Å"We used to go to the top 10,† Rae said, â€Å"but at some of the top schools we were getting people in the middle of the class. † Paying more attention to the next 15 schools in the top 25 was Rae’s new strategy. R ae, who graduated from Amos Tuck School of Business at Dartmouth, had originally been a banker himself at JP Morgan before moving into recruiting positions there and at Merrill, Smith Barney, and then SG Cowen.His previous employers were giants on the top 10 campuses, with huge recruiting budgets, recognized brand names, and, most importantly, much larger hiring needs, which meant that they received immediate student interest. At schools such as Emory and USC, SG Cowen could be a relatively bigger player and attract more attention from the best students. There was resistance initially from senior management, as this was viewed as going downstream. But Rae said, â€Å"Senior managers eventually saw the wisdom. We were hiring at the top of the class, and these students also tended to be more loyal.We were not missing much by not going to the top schools. † At each of the core schools, Rae scheduled a company presentation in advance of the interview dates. At the presentation, R ae guided the team captains to make sure they answered four questions quickly: who are we, what do we do, what distinguishes us from competitors, and what are the next steps. SG Cowen promoted the advantages of a boutique firm, arguing that there was less bureaucracy than at larger banks, that people could move much faster in their careers than at other banks, where they would be hired and promoted lockstep as part of a large class.Team captains talked about the advantages of small deal teams, which allowed for more exposure to clients, more responsibilities, and more entrepreneurship. Rae encouraged team captains to make a very short formal presentation and then allow a substantial amount of time to informally talk and answer questions. At schools like NYU, SG Cowen would be represented by an MD, who made the presentation, and then perhaps 20 alumni who could then have fairly substantial interaction with the expected 100 students who would show up.Some team captains like Schoenberg would tell students they could call him or come and see him (at their own expense) for informational interviews. This would help self-select students who really wanted to be prepared for first-round interviews by knowing more about the firm and also establishing a 4 SG Cowen: New Recruits 402-028 relationship with him. However, he admitted there was a fine line between helping students who were self-starters and giving them unfair advantage in the process. Some team captains put in a lot of time and effort, while some put in less.SG Cowen did not directly compensate or reward bankers for being involved in recruiting activities, but recruiting was included on the performance reviews leading to year-end bonuses. On-Campus Round At every core school, SG Cowen had two or three schedules comprising at least one open one, whereby students signed up based on interest, and the rest closed, whereby SG Cowen selected among previously submitted resumes. Rae said, â€Å"In the past, I’ ve found as many good people on the open as the closed list. † In the first rounds, interviewers tried to focus on which of these candidates could make it through Super Saturday.Schoenberg said, â€Å"When I go up to interview, I’m tough on candidates because I don’t want to embarrass myself later on by endorsing weak candidates. † Interviewers knew they would be held liable for the quality of candidates they brought back for Super Saturday, and their own reputation was diminished if they wasted the time of senior bankers at the firm interviewing candidates at Super Saturday who were clearly not appropriate. At the same time, Schoenberg said, â€Å"When I see people who are prepared and have the eagerness, I fight very hard for them. †While some bankers were especially tough, others were especially easy and wanted to be generous in their assessments of all the candidates. Rae said, â€Å"This is where you see the beauty of writing comments down. â €  At the end of a day of first-round interviews, the two or three people who had been interviewing would discuss whom they had seen. Rae tried to make detailed notes on resumes or on the evaluation sheets he had created, and he encouraged the bankers to do the same so they could recollect specific details about each candidate (see Exhibit 1 for a sample of Rae’s notes from past interviews).Most often there were two schedules, which would amount to 24 candidates. They would then try to narrow the list to six candidates and quickly have a second round, even that same night, on campus in order to cut half and invite the other half to Super Saturday. Rae said the firm usually wanted associates or senior associates to conduct first-round interviews: â€Å"We’re not aggressive about sending our most senior people out; we want to downstream the identification of talent and upstream the responsibility of closing on offers to senior people. Rae felt that often the senior-m ost people were removed from day-to-day concerns and tended not to be as demanding about the basic skills an associate needed, whereas those just a few years ahead of a firstyear associate would be much more rigorous about assessing skills. He made sure senior bankers would be at Super Saturday, however, to judge whether potential associates also had the makings of a good long-term banker. In Rae’s view, long-term success did not come from building models, it came from loving the work, loving to teach and sell, and loving the hunt.The successful bankers had to feel the excitement of serving clients and the excitement of competing at the highest level. In this first round, he also instructed interviewers to test for culture fit. This could be as simple as asking someone whose work and education experience was entirely in the Midwest, â€Å"Are you comfortable living and working in New York? † Rae said, â€Å"Sometimes they might be a diamond in the rough and they can m ake the transition, but cultural fit is important. † Other bankers at SG Cowen agreed. One banker, Ryan Daws, pointed out, â€Å"It’s mportant having Chip in the process because there are only so many personality types in the world, and he’s seen a lot more than we have. † Daws said, â€Å"HR at every bank has to earn credibility with bankers, but when you have someone like Chip who used to be a banker, it makes it easier. † He also said, â€Å"Certain types 5 402-028 SG Cowen: New Recruits fail to succeed once they get here, which colors the interviewing process. † For Daws, alarm signals went off when people did not dress appropriately, or when they asked questions like, â€Å"Are the hours really as bad as they say? He acknowledged there was some ego involved on the interviewing side. â€Å"No one’s ever as good as I thought I was,† he joked. Super Saturday Super Saturday in fact began on Friday afternoon, when candidates ar rived from their various schools and convened with many of the interviewers for dinner and cocktails in the wine cellar of an elegant midtown restaurant. Fennebresque spoke at dinner, and, because he was a great speaker and because it was rare to get the attention of a CEO during recruiting, candidates were usually visibly impressed.On Saturday morning, interviews began at nine, and each interviewer and each candidate had five half-hour sessions with short breaks. Rae tried to keep these interviews moving and spent a lot of time gently tapping and then firmly knocking on bankers’ doors when they lost track of time. Super Saturday was exhausting for the interviewers as well as the interviewees, and Rae wanted to make sure the bankers saved some energy for the collective decision making. Thirty candidates had attended, which meant Rae had commandeered 30 bankers to come to Super Saturday.Rae said, â€Å"They’re giving up a Saturday, and they want to get out of here as f ast as they can. But they get to make the decisions, and that brings them in here every year. † Rae estimated from previous years that he should make 20 offers if his target was 15 acceptances. There were already eight hires from the summer associate program, and seven third-year analysts were being promoted, so this would achieve his objective of a full associate class of 30. Successful candidates received offers to join investment banking.Those who accepted returned for an orientation in April to meet with the banking groups that interested them most. By the time the training program started, each new associate was assigned to a group. The hiring meeting started as the bankers ate their lunch. The bankers usually felt very confident that they could whip through the list of candidates quickly, as they often assumed that others would have shared their view on the interviews they conducted. Bankers were always surprised at these meetings to find out how strong the disagreement could be.One managing director might be turned off by a candidate for â€Å"being too salesy, I thought he was trying to snow me,† and that same candidate could have appealed to another director for having â€Å"great attitude, eager to contribute. † Rae had to figure out how to let everyone weigh in and then build consensus around a decision. Building a Culture through Hiring Rae said, â€Å"I try to get people to act and behave like a firm. † He wanted to make sure bankers were not overly partial to candidates from their own alma maters and also that bankers did not hire people who would only succeed in their own group.At the same time he wanted to make sure that bankers did not relax standards and hire a candidate whom they thought of as â€Å"good enough for the firm† but â€Å"not good enough for my group. † Sometimes he would try to push a banker to a conclusion by saying, â€Å"If you could only take one new associate to the CEO’s of fice with you, which one would it be? † Or at the other extreme, â€Å"If I can’t place her, she’s going to be yours, how do you feel about that? † 6 SG Cowen: New Recruits 402-028 One HR manager at SG Cowen commented:People on Wall Street are too hard on people who took some time to figure out what they want to do. But look at Kim Fennebresque, our CEO. He started out as a lawyer, and he’s been incredibly successful in banking. But when people are hiring, they don’t think of that. Personally, I think anyone who tells you in an interview that they wanted to be an investment banker since age 12 has led an incredibly dull life. Fennebresque said, â€Å"We want to make sure people who are attracted to a place like this understand what this is. We want to ferret out people who love technology, who love emerging growth. Making the firm more visible to both potential clients and potential employees was one reason Fennebresque agreed to frequent ap pearances on CNBC and business segments on other news shows. â€Å"So many people come to Wall Street for the wrong reasons,† he said. â€Å"They’re dazzled by dough and dazzled by stature. People should figure out what they like to do, it matters even more than what they’re good at. I was perfectly good at law, but I sat in that law library at night and I thought the librarian was the Marquis de Sade torturing me.If you don’t like what you’re doing, even if you’re good at it, eventually you and God are going to figure it out. † Fennebresque spoke fondly of having started out in banking at First Boston in the 1980s during the firm’s heyday and in close view of the rise of Joe Perella and Bruce Wasserstein. Fennebresque said, â€Å"I used to believe culture was an overrated Harvard buzzword,† but First Boston made him realize how much culture mattered. â€Å"We were young punks trying to elbow in on the big boys, and it worked,† he said proudly. He was trying to bring some of that dynamism to SG Cowen.Because the investment bankers had all been hired from different firms to build SG Cowen’s banking platform, Fennebresque often used the metaphor of Ellis Island to exhort his bankers to come together and create a unified new culture. He also wanted to make sure they felt they had the support they needed to get their work done, and Fennebresque tried to give bankers as much autonomy and decisionmaking power as possible. Fennebresque’s involvement in recruiting events and his visibility with new and young employees stemmed from this desire to provide support. â€Å"The most important clients are inside, not outside. I really believe that,† he said.Hiring Criteria Rae tried to formalize the criteria by using grid sheets for the bankers to fill out and having them vote and make a case on behalf of their candidate. There were definitely bankers who resisted any kind of â€Å"sc ience† in this process. Bill Buchanan, HBS ‘86, was head of Equity Capital Markets and had also come to SG Cowen from First Boston, like Fennebresque. â€Å"The type of person who does well here doesn’t want to be told what to do. He or she is far less regimented. This is not the Navy. We want the self-starter. † Buchanan said he did put a lot of stock in resumes: â€Å"It makes a big difference if they have been an entrepreneur. Most important, though, he hired for fit. He was even known to change the structure for fit, in that he had created jobs for people he thought SG Cowen should hire. As Buchanan put it, â€Å"We can stretch for personality, and we can stretch for sparkle. † Especially in ECM, Buchanan said, â€Å"The human element, especially our creativity and energy, is why a company chooses us as financial advisor in the first place, especially on commoditized products. We’re very hands on and high touch. We’re not the volu me leader, but we are a service leader. † 7 402-028 SG Cowen: New Recruits Candidates for HiringThe bankers assembled had assigned almost all the magnetic placards representing the applicants into decision groups. They had two spots remaining and four people in the â€Å"maybe† category from whom to choose. 4 Natalya Godlewska Natalya Godlewska was an MBA student at Cornell and had earned an undergraduate degree in finance at an eastern European university. As an undergraduate, she had been the student with the highest grade point average (GPA) in the finance department, and she went on to serve as a graduate teaching assistant in the finance program at Cornell’s business school.She was originally from Poland and had moved to the U. S. at the age of 22. She spoke fluent Russian, Polish, and German and some French. Prior to business school, she had worked for four years for CommScan, a company that developed M&A modeling software used by many major Wall Street fir ms. She had gone to the SG Cowen presentation at Cornell, called the bankers she had met to have informational interviews, and then had been one of the top candidates from Cornell sent on to Super Saturday.At Super Saturday, her interviews had mostly gone well, although there was some hesitation from two interviewers. Everyone was uniformly impressed with her finance background, her analytical knowledge, and her understanding of the financial markets. When one of the bankers had telephoned her references, her previous supervisor had responded positively about Godlewska’s skills and also commented, â€Å"This is the person I would want to bring to a tough negotiation. † She seemed very determined, ambitious, and ready to work hard.But one associate and one managing director each expressed strong reservations for different reasons. The associate felt that Godlewska might not be a good culture fit with the other associates and that she had seemed stiff and uncomfortable d uring small talk at the opening of the interview and also at dinner the night before. The managing director felt that some bankers might lose patience with Godlewska’s less-thanperfect English and that this would affect her ability to work smoothly with her managers. Other people on her interview schedule spoke up in her defense.Associates should be made to deal with people with different backgrounds, and it was all too easy to use â€Å"culture† as an excuse. One banker said he thought Godlewska would be a hit with clients because she was a go-getter and radiated positive energy and a â€Å"can-do attitude. † He said that though it might be an issue with impatient bankers on her team, her language skill would definitely not be an issue with clients because â€Å"most of our clients think Wall Street types speak too fast anyway. † Martin Street Martin Street was a second-year Wharton MBA who had previously served four years in the military.He had no busin ess experience, but he had substantial leadership experience, most notably having led a rescue operation in war-torn Bosnia. He was president of his section at Wharton and also of the Running Club, having completed two marathons and one triathlon in the past year. All of his interviewers agreed that he came across as a dynamic personality and that he was confident and articulate. SG Cowen came to Wharton toward the middle of the recruiting period, so as one banker said, â€Å"People either really want SG Cowen, or they didn’t get offers from other firms. Street had told them he was taking several finance courses, but SG Cowen was not allowed to ask him about his grades because that was forbidden under Wharton recruiting rules. Cowen had difficulty scheduling Street for Super Saturday because he was always involved in recruiting events at other firms. He had said that he liked smaller firms and liked SG Cowen’s areas of specialization, but they still were 4 Note: These candidates are composites of many candidates and are not meant to describe any actual candidate. 8 SG Cowen: New Recruits 402-028 nsure what the likelihood was that Street would accept the offer if it was extended. They were also wary of whether he would play firms against one another in terms of wanting additional time to interview and consider offers, which might prevent SG Cowen from being able to fill that slot with another top-choice candidate. One professional in recruiting said, â€Å"If a person doesn’t sign and accept the offer letter right away, we’ve made a mistake. † Ken Goldstein Ken Goldstein was a second-year MBA at Berkeley who had previously worked at PricewaterhouseCoopers for five years.He had quickly risen to be a manager at PWC, managing multiple audit teams simultaneously, drawing up budgets and pricing for projects, making presentations to win business, and resolving technical accounting issues for clients. When SG Cowen called his refere nce at PWC, he confirmed, â€Å"Ken’s performance appraisals put him in the top 5% of the firm. † Everyone who had interviewed Goldstein liked him and thought he would represent SG Cowen well. In fact, when Rae looked over the written comments on all the evaluation forms, they were uniformly positive.Why hadn’t Goldstein been an immediate â€Å"yes,† why was he one of the â€Å"maybes† that warranted this discussion? One banker said, â€Å"I can tell you what everyone’s afraid to say. Ken is married and has two sons, a newborn and a two-year-old. Whatever he did at PWC, we can’t tell at this stage of his life whether he really will be willing to work 24/7 like the rest of the associates. † One of the senior associates said, â€Å"It’s hard on the other first years if we make allowances for Ken to pick up his kids at daycare or not work on a weekend when his wife’s away.None of the first years expect to have a lif e, so what happens when they see Ken having a life? † Some interviewers said Goldstein had openly talked about his intention to be able to balance a family with being a banker. One of his interviewers said, â€Å"I commend him for trying, but I break promises to my kids all the time, to take them to the first day of school, to get home for a game. † Another banker said, â€Å"It’s weird to say this, because we always say we’re looking for maturity, but I almost think Ken’s too mature. If he were on my team, I wonder if he would do what I tell him to do, or if he’ll dislike taking orders.He’s used to having a lot of responsibility and being in charge. † Andy Sanchez Andy Sanchez was a second-year MBA at the University of Southern California and had completed his undergraduate degree in economics at UCLA. Sanchez had found early success as an entrepreneur, having started his own business during his first year of college, a Kaplans tyle tutoring business to prepare students in Los Angeles for high school achievement tests and the SATs in both English and Spanish. After college, he ran the business full time for three years and then continued to run it while he enrolled in business school.Last year, his business had served 4,000 students at an average price of $500 per course, resulting in $2 million in revenue and clearing $400,000 in profits divided between himself and an equity provider. Sanchez’s interviewers all found him enthusiastic and personable. He had talked to a lot of people at SG Cowen and had stopped into the New York office to have informational interviews or talk to other associates on several occasions when he was in the city for other meetings. He always sent follow-up e-mails and notes to everyone he spoke to, was friendly to the other candidates at Super Saturday, and was great at making people relax.He was well informed about the firm, telephoned other alumni from USC to talk to the m about their banking experiences, and seemed as though he had been reading up on investment banking, speaking very cogently about recent landmark deals in some of his interviews. When asked whether he was sure he wanted to leave his business, he said he was ready for new challenges and that his younger brother was going to run it in his absence. The biggest concern interviewers had with Sanchez was from his resume, which listed a 2. 8 for his undergraduate GPA.When asked about his business school GPA, Sanchez had said it was a 3. 1. At a time when most schools including USC had a fair amount of grade inflation, SG Cowen bankers were 9 402-028 SG Cowen: New Recruits concerned that he had had so many â€Å"Cs† on his record over the years. â€Å"We’re not looking for rocket scientists, but a 2. 8 really sticks out,† one banker said. Sanchez had pointed out to one of his interviewers that his SATs and GMATs were quite high and that his low grades only reflected th e amount of work he was putting into running his business.Rae looked over the other resumes of the Super Saturday candidates, and Sanchez had a very competitive SAT score and one of the highest GMAT scores. Sanchez had told one of his interviewers, â€Å"There was a lot of demand for our services, so we got excited and grew the business pretty fast, and I also needed to make enough money to put myself through school and then put my two brothers through school. Unfortunately, that left me little time for studying. † Decision Time The bankers were having a hard time deciding among the four candidates, and they were running out of energy. The snow was coming down faster, and most f the food was gone, the bankers now going back to the buffet for a second sandwich or some lukewarm pasta. They had made good progress, but choosing these last two candidates was not turning out to be an easy task. Rae remembered Fennebresque’s admonition to make the hiring process â€Å"our mo st important priority. † One banker spoke up, â€Å"Chip, let’s keep this meeting moving. The roads look bad, and it’s my anniversary tonight. If I don’t get home soon, I’m in deep trouble. † 10 SG Cowen: New Recruits Exhibit 1 402-028 Sample Pages from Rae’s Evaluation Book (Prior Candidates) Candidate: Bill Berry Bill BerryLarry Larry Fromkin,Vice President, Health Care Linda Conway, Managing Director, Technology Daniel Jones, Associate Technology Lynn Smith Carl Havens, Vice President, Technology Gloria Watson, Associate, Barr Devlin K. C. *K. C. 11 402-028 SG Cowen: New Recruits Exhibit 1 (continued) Candidate: Damon Sam Sam Damon Vijaya Vijaya Parbhu, Managing Director, M&A Aaron Solomon, Associate, Technology Sam Chung/Lewis Anderson, Associates, Technology M&A Lynn Smith Tom Tedlow, Director, Technology Danny Lewis, Director, Technology 12 SG Cowen: New Recruits 402-028 Exhibit 1 (continued) Candidate: William XuWilliam Xu Ken K en Arendt, Associate, Technology Samantha Adams/Lewis Anderson, Associates, Technology M&A Charlotte Williams, Managing Director, Equity Private Placements Lynn Smith Michael Brennan, Associate, Barr Devlin Cal Pava, Managing Director, Technology with maturity 13 402-028 SG Cowen: New Recruits Exhibit 1 (continued) CSara Wicher Wicher andidate: Sara Mitch Mitch Madison, Director, Technology Sam Downing, Managing Director, Equity Private Placem ents Daniela Galvin, Associate, Technology Lynn Smith Bill Friedan, Associate, Technology Darrell Rawlins, Managing Director, TechnologySource: Company. 14 SG Cowen: New Recruits Exhibit 2 402-028 Associate Evaluation Form SG Cowen Investment Banking Division Associate Evaluation Form CANDIDATE: SCHOOL: EVALUATOR: DATE: GROUP INTEREST: OUTSTANDING GOOD FAIR UNSATISFACTORY COMMITMENT TO FIRM JUDGMENT/MATURITY INTERPERSONAL SKILLS Impact/Presence Communication Skills LEADERSHIP Initiative Motivation TECHNICAL SKILLS Creativity Modeling Accountin g/Finance Prioritizing WORK ETHIC Team Player Flexibility/Versatility Motivation OVERALL RATING COMMENTS: RECOMMENDATION(CIRCLE ONE): HIRE DON’T HIRE Source: Company. 15