Social Media In Marketing Communication

Social Media In Marketing Communication The technologies and tools people use to communicate online are referred to collectively as social media (Scott, 2010 ). Social media is not understood in terms of the different technologies and tools but, rather how those technologies and tools allow you to communicate directly with people or intended recipient. The term social media represents media that users can easily participate in, contribute to (Karjaluota, 2008), communicate with and congregate to have fun with friends and community (Scott, 2010 ). Social Media is an emerging phenomenon of recent times. Social media is a group of new kinds of online media embodied participation, openness, conversation, community and connectedness as unique characteristics (Mayfield, 2008). Boyd (2008) refers social media is an umbrella term that refers to the set of tools, services, and applications that allow people to interact with others using network technologies. Social media encompasses groupware, online communities, peer -to-peer and media-sharing technologies, and networked gaming. Mayfield (2008) explain social media is all about being human like sharing ideas, cooperating and collaborating to create art, thinking and commerce, vigorous debate and discourse, finding people who might be good friends, allies and lovers, which our species has built since several civilisation. He further adds social media is becoming popular so quickly, not because its great shiny, speedy new technology, but because it lets us be ourselves. People can find information, inspiration, communities and collaborators faster than ever before. New ideas, services, business models and technologies emerge and evolve at fast speed in social media. According to Scott (2010) social media ; .provides the way people share ideas, content, thoughts and relationships online. Social Media differ from so-called mainstream media in that anyone can create, comment on, and add to social media content. Social media can take the form of text, audio, video, images, and communities (Scott, 2010 , p. 38). Social media is also known as user generated media (Mangold Faulds, 2009). User creates a network among friends, families, celebrities, and those who share common characteristics etc. that has built strong user base among different social media forms. It is becoming popular day by day due to its unique characteristics such as socialising, participating, freedom of expression, engaging, interactivity and easily accessible at fraction of cost. The main important features of social media is to keep in touch with friend, communicate with friend and share memories of good and bad experience through notes, post, blogs, video sharing and photo sharing etc. Social media is sometimes referred to as social software or social computing or computer-mediated communication (Boyd, 2008). In next section, social medias characteristic is explained. Characteristic of Social Media: The power of social media is rooted in its ability to connect people across time and space. The way these tools are used alters plethora of practices, including communication, collaboration, information dissemination, and social organisation (Benkler, 2006; Castells, 1996; Rheingold, 2002). Social media has affected how people interact with one another and, thus, it has the potential to alter how society is organised though they are simply the messengers, social media tools are revered for their potential to connect people( (Shriky, 2008; Tapscott Williams, 2006; Weinberger, 2008). Social media provides power to communicate one to literally hundreds or thousands of other people quickly and with relatively little effort. Participation and making connections are common characteristics among social media platforms. Part of this is informed by the notion of a flat community, in which all parties engage in open dialogue. Influence and credibility are prized in this arena, as the users reputation can often be a key motivator for one to remain active in the dialogue (Karjaluota, 2008). Some of the common characteristics of Social Media identified by Mayfield (2008) are; Participation, social media encourages contributions and feedback from everyone who is interested. It blurs the line between media and audience. Openness, most social media services are open to feedback and participation. They encourage voting, comments and the sharing information. There are rarely any barriers to accessing and making use of content-password -protected content is frowned on. Conversation, whereas traditional media is about broadcast and in contrast social media is better seen as a two -way conversation. Community, social media allows communities to form quickly and communicate effectively. Communities share common interests, such as a love of photography, a political issue or a favourite TV show. Connectedness, most kinds of social media thrive on their connectedness, making use of links to other sites, resources and people. Common Forms of Social Media: There are various tools and format are in practice in the forms of social media. The commonly used or basic forms of social media (Karjaluota, 2008; Mayfield, 2008; Scott, 2010 ; Mangold Faulds, 2009) are; Social Networking Sites (SNS) are virtual communities that allow users to build personal profile, connect with friends, and cultivate a community of friends and to share information, content and communication. Some appeal to broad groups (i.e. Facebook) whereas others are built around particular niches and demographics (i.e. LinkedIn). The common SNS are Facebook, MySpace, Bebo, LinkedIn, Faceparty etc. Blogs are personal web sites written by somebody who is passionate about a topic, which provide a means to share that passion with the world and to foster an active community of readers who provide comments on the feature posts. Perhaps it is the best known form of social media, blogs are online journals, with entries appearing with most recent first. Blogs are vary widely in nature, but tend to be popular as they often provide an unvarnished, insider perspective on a particular topic. For example, user sponsored blogs (unofficial Apple Weblog, Cnet.com) and company -sponsored websites/blogs (Apple.com, PGs Vocalpoint). Content Communities are sites that allow users to post and share content. Such communities exist around anything from videos and photos to stories and links. Some of these sites include voting functions that allow the community to determine the relevance of content. Sites like YouTube, Flicker, Vimeo and Jamendo.com greatly simplify the process of sharing and commenting on Photos, Videos and Music. Other examples are content sharing combined with assistance Piczo.com and general intellectual property sharing sites Creative Commons. Forums are areas in which multiple users can create topics and then comment on these topics. They are commonly used as resources for those interested in particular topic. It is a place for online discussion, often around specific topics and interests. Forums came about before term social media and are a powerful element of online communities. It is also known as chat rooms and message boards, with the main feature being that anyone can start a discussion thread. Wikis are community -generated documents and databases. These websites allow people to add content to or edit the information on them, acting as a communal document or database. The best -known wiki is Wikipedia, the online encyclopaedia which has over 2 million English languages articles. Virtual Worlds represent one of the most novel areas on the web, in which users can engage in immersive worlds. Some of these spaces closely mirror real-world notions such as community and economics. Second Life is an example of virtual worlds. Micro blogging are social networking combined with bite-sized blogging, where small amounts of content updates are distributed online and through the mobile phone network. Twitter is well known form of micro blogging. Social Bookmarking sites like digg, del.icio.us, Newsvine, Mixxit, Reddit allows users to recommend online news stories, music, videos and content to others and vote on what is interesting. Many other forms of social media exist are news aggregators, podcasts (Apple iTunes), mash-ups, company sponsored cause/help sites (Doves Campaign for Real Beauty, click2quit.com), invitation only social networks (ASmallWorld.net), commerce communities (eBay, Amazon.com, Craigs List, IStockphoto, Threadless.com), news delivery sites (current TV), educational materials sharing (MIT OpenCoourseWare, MERLOT), open source software communities (Mozillas spreadfirefox.com, Linux.org) , windows Live, Google community and Yahoo. The Use of Social Media in Marketing Communication: Communication has become more challenging due to rapid changes in technologies, multiple communication channels and consumers constantly changing preferences and media use for obtaining information. Effectiveness of communication will largely depends on understanding of consumers buying behaviour, indentifying their information need and provides them with the right information, in right time at right place. It is enormously important to make sure the appropriate media is used (Ennew, 1993). Selection of a medium is relative with the customer preference with that particular medium. In an interview by www.marketingprof.com , a marketing guru, Philip Kotler says; .major challenge today is getting people attention. Consumers are pressed for times and many worked hard to avoid advertising messages. The main challenge is to find new way to capture attention and position a brand in consumers mind.. (Kotler, 2005 ¶17) Multiple communication channels pose a challenge to marketers to select a right medium to reach their target consumers. Traditional marketing communication media are loosing thier importance and are being challenged by new media. The internet has replaced traditional media such as radio, newspaper, magzine and the TV as the preferred medium for advertising (Selek, 2010). TV advertising is loosing its effectiveness because of growing advertising clutter, the increeasing number of channels and reduced watching of television by certain group of people (Kotler, 2005). Social Media presence in marketing communication is increasing rapidly. Social media is becoming a part of the marketing strategies of organisations irrespective of shape, size, volume and purposes. Marketers are trying to make it as a part of the Integrated Marketing Communications (IMC) and element of their marketing mix (Mangold Faulds, 2009; Li Bernoff, 2008). IMC is a guiding principles, marketers has been practising since its identification as a marketing tools to communicate with their target market. IMC is arguably the best tools, as of now, use to coordinate and control varying elements of the promotional mix- advertising, personal selling, public relations, publicity, direct marketing, and sales promotion to develop customer focused integrated message and to achieve different organisational goals (Boone Kurtz, 2007). Social media is changing the landscape of marketing communication. Growing use and popularity of social media tools like Facebook, LinkedIn, MySpace, Twitter, Flicker, Digg, Del.icio.us, Foursquare and others have compelled organisations use of social media as an integrated marketing communication tool. Consumers are making conversation on these platforms. Facebook alone has 500 million users worldwide, which accounts nearly 8% of world population and collectively, users spend more than 700 billion minutes a month in Facebook (Smith, 2010). The possibility of exposure to mass audience and high engagement are propelling organisations to use social media to communicate to their target consumers. Fortunes 500 companies have been using social media as one of the most important tool in their marketing strategy (Barnes Mattson, 2008). Increase in advertising spending on social media shows preference of marketers in social media against traditional media as a marketing communication tool.The growing popularity of internet business such as google and social networking sites (SNS) like Facebook have increased the use of social media in advertising. Advertising spending in the social networking area is estimated to be $865 million, with a projected value of $2 billion by 2011, or almost 8.5% of total online spending (eMarketer, 2006 cited in Gangadharbatla, 2008). Facebooks  £525 million revenue from advertising in 2009 (Smith, 2010) shows the magnitude of growing popularity of scoial media as a marketing communication tool. Marketers are shifting their marketing spending from traditional means of communication to digital ones, focusing on search, dispaly ads and social networking. Marketers who believe that most important way to improve communication effectiveness is to shift investment from traditional channels to digital channels are increasing. Another noticable changes is to shift advertising spending from awerness and brand building to promotional marketing (Ramsey Douglas, 2010). According to a 2009 survey, conducted by the Association of National Advertisers (ANA) and Marketing Management Analytics (MMA), most marketers say that they plan to increase their budgets for interactive marketing by pulling funds out of traditional media. Survey shows that U.S. companies moved total of $60 billion from traditional media into online marketing in 2009 itself, which represents a major shift from traditional marketing to digital marketing in an effort to increase marketing effectiveness. Research shows that after the corporate website, the most effective way to communicate with prospects is through social media. As many as 80% of U.S. companies are using social media in their marketing efforts, either placing ads on sites, monitoring sites for chatter about their brands, or engaging directly through sites like Facebook. For most marketers two prime objectives for usiing social media are enhancing brand awareness and deepening realationships with consumers. Many others use social media to expand to new audiences and acquire new customers (StrongMail, 2009). Social Media enables customer to talk to one another, which is an extention of traditional word-of-mouth communication (Mangold Faulds, 2009). The role of social media giving customer to communicate to one another is unique from traditional marketing communication. In his book The New Influencers, Gillin (2007) says that Conventional marketing wisdoms has long held that a dissatisfied customer tells ten people. But that is out of date. In the new age of social media he or she has the tools to tell [billions] consumers in few hours. The Internet has become a mass media vehicle for consumer-sponsored communications. It now represents the number one source of media for consumers at work and the number two source of media at home (Rashtchy, Kessler, Bieber, Shindler, Tzeng, 2007). Consumers are turning away from the traditional sources of advertising: radio, television, magazines, and newspapers. Consumers also consistently demand more control over their media consumption. They require on-demand and immediate access to information at their own convenience (Rashtchy et al., 2007; Vollmer Precourt, 2008). Social media is perceived by consumers as a more trustworthy source of information regarding products and services than corporate-sponsored communications transmitted via the traditional elements of the promotion mix (Foux, 2006). There are varying levels of trust and credibility among marketing channels: pretty low for ads, more so for traditional media and even lower for brand websites. Social media leverage the trust that users have with one another. This is well proven fact in marketing that most effective influencers in buying decisions are friends and family. Social media has been providing consumer different platforms to communicate easily with friends and family quickly and effectively. Recommendations from friends and acquaintances, particularly those people we think are most like ourselves, garner the highest trust. Almost three-fourths of customers consult product reviews before making a purchase, and more than half have made a purchase based on consumer reviews. They create transparency and establish trust to prospects (Ramsey Douglas, 2010). Marketers use several methods to improve consumer retention. Social media is becoming an important part of consumer retention and is giving companies new ways to tap into consumer mindset. A survey conducted by King Fish Media (2009) shows that 72% of US marketing managers, who participated in the survey, believes that social media is the most effective way to communicate with current consumers. Social media leave behind the old model of one- to- one communication and enable communication from one to many or many- to- many. Social media such as blogs, tweets, wikis, and social networks are all about speeding up and enriching communication. Social media tools bring the advantages of flatter, more democratic and presumably more effective communication networks (Hawn, 2009). The advent of social media challenge traditional type of intrusive and one way communication. Social media offer multi -dimensional communication among marketers to consumers, consumers to consumers and consumers to marketers. Social media is a great tool for listening to consumers and improving products and services using feedback and suggestion from consumers. Understanding the speed and breadth of response to a consumer issue is crucial in social media (Econsultancy, 2009). Mangold Faulds (2009) argue that social media is a hybrid element of the promotion mix because it combines characteristics of traditional IMC tools (companies talking to consumers) with a highly magnified form of word-of-mouth (customers talking to one another) wherby marketing managers cannot control the content and frequency of such information. Consumers ability to communicate with one another limits the amount of control companies have over the content and dissemination of information. In the era of social media, consumers have greater access to information and great command over media consumption than ever before (Vollmer Precourt, 2008). In the era of social media, marketing managers control over the content, timing, and frequency of information is being severely eroded. In the new communication paradigm, information about products and services also originates in the marketplace. This information is based on the experiences of individual consumers and is channelled through the traditional promotion mix. The traditional communication paradigm, which relied on the classic promotional mix to craft IMC strategies, must give way to a new paradigm that includes all forms of social media as potential tools in designing and implementing IMC strategies. Contemporary marketers cannot ignore the phenomenon of social media because it has rapidly become the de facto modus operandi for consumers who are disseminating information on products and services (Mangold Faulds, 2009). In this section researcher tried to gain insights about social media from available literatures and its uses in marketing communication. In following section researcher reviews of existing literature on social networking site Facebook and its uses by students, motives of use and use of Facebook in selection of universities, which is the main purpose of this study. The Facebook: Facebook is very popular social networking sites, which gives user an opportunity to create personal profile (include general information like education background, work background, and favourite interest), build a friend networks who have Facebook account, upload and share photos, put comment, show liking or agreeableness on any subjects, issues, comments, products and brands through like button, write notes and create news and many more. Facebook members can also join virtual groups based on common interests, see what classes they have in common, and learn about others hobbies, interests, tastes, and romantic relationship statuses through the profiles (Ellision, Steinfield, Lampe, 2007). It also has an option to add specific applications to further personalise ones profile (Rosmarin, 2007). People mostly use it to make friends, networking with friends, share links and videos, and learn more about the people they meet (Reuben, 2008). A Harvard undergraduate student and a programmer Mr. Mark Zuckerberg along with his friend Eduardo was set up Facebook.com in February 2004 at Harvard University dorm as an online student directory for only Harvard students (Cassidy, 2006; Mayer Puller, 2007; Boyd Ellison, 2007). To join a user had to have a Harvard.edu email address. Facebook extended beyond Harvard to other Ivy League school in spring 2004. In fall 2004 Facebook.com had added websites to several hundred of colleges and university, then later expanded to any university students having an university e-mail and now anyone over age 13 with an valid e-mail account can join Facebook (Reuben, 2008). Mr. Zuckerberg, who set up Facebook at his early 20 (now 26), has grown it into a business worth an estimated  £15 billion (Smith, 2010). Facebook has now become habitual and a part of everyday life for 500 million users worldwide. Facebook has reached almost eight percent of world population with meteoric rise of its users from 150 millions in January 2009 to 500 million in 2010 (Smith, 2010). Today, Facebook is the number one social networking site beating MySpace, LinkedIn, Foursquare etc. Facebook is third popular online brand after Google and MSN respectively. According to Nielsen survey (April, 2010) 54% worlds internet population visiting Facebook and spends 6 hours per person every month. On average user create 90 pieces of content every month, 30 billion pieces of content (web links, news, blogs etc) are shared each month, more than 3 billion pictures are uploaded every month, there are more than 60 million status updates a day and have an average of 130 friends (Smith, 2010). Collectively, users spend more than 700 billion minutes a month on Facebook. Alex Burmaster, of research agency Nielsen Online said: Facebook has become a phenomenon of our time, its become almost like a mobile phone, [and] people cant imagine their lives without it. Popularity of Facebook among Colleges and Universities Students: Origin of Facebook is directly associated with university students. Facebook was set up by a university student as an online student directory. Initially, it was restricted to users with a harvard.edu email address and was confined to colleges and universities students and staffs. It was officially open to non-academic and non-US based users in September 2006 (Joinson, 2008; Reuben, 2008). Facebook has become a number one choice among universities students. According to Pew Research Centers survey nearly three quarters (73 percent) of online teens and an equal number (72 percent) of young adults use social networking sites. The survey also reveals that among adults 18 and older Facebook is most preferred choice; 73% have profile on Facebook, 48% own profile on MySpace and 14% use LinkedIn (Lenhart, Purcell, Smith, Zickuhr, 2010). According to previous survey by Pew Center 50% of young adult social network users had profile in MySpace, 22% had profile on Facebook and only 6% had a profile on LinkedIn (Lenhart, A., 2009). The recent survey also shows that among adult profile owners with high school degree or less, 64% have a profile on MySpace, 63% have profile on Facebook and just 3% have LinkedIn profile. Adults with at least some college experience, 78% have profile on Facebook, where 41% have a profile on my space and 19% have a LinkedIn profile (Lenhart, et. al, 2010). It shows the greater presence and growing popularity of Facebook among colleges and universities students. There is growing concern about universities students excessive use of Facebook. Sheldon (2008) states that 93% student had a Facebook account, on average they spent 47 minutes a day on Facebook and in overall 81% student logged into Facebook on a daily basis. Social networking sites are widely thought to have changed students communication pattern because many college/university students lives have an online component (Zywica Danowski, 2008). There is hard debate going on about the risk of students being addicted to, and spending too much time on Facebook. Those who argue about negative impact and against on students excessive use of Facebook are demanding control on students from using Facebook. Facebook has been met with criticism by educators, with suggestions that students spend too much time on Facebook and find it addictive (Bugeja, 2006). Others, who believe control is not the right options, are suggesting attract and encourage students for its academic and positive use. Some studies have shown advantages of Facebook use for undergraduate students to assist and adjust to university life, especially those experiencing low self-esteem (Ellision, et al., 2007). Lloyd, Dean, and Cooper, (2007) concluded that students can benefit and suffer from using technology [Facebook]. Positive effects of technology [Facebook] are knowledge acquisition, socialisation and entertainment. However, negative effects include that students tend to be less healthy and passive in off-line activities when their sole purpose is for entertainment, which has a direct effect on their academic success, personal relationships, and wellness. Students Motives for Facebook Use: People use media to gratify their various communication needs and wants. Uses and gratification is viewed as a psychological communication perspective which focuses on how individual use mass media and other forms of communication to fulfil their needs and wants (Sheldon, 2008; Rubin, 2002). According to the uses and gratification perspective, media use is determined by a group of key elements including peoples needs and motives to communicate, the psychological and social environment, the mass media, functional alternative to media use, communication behaviour, and the consequences of such behaviour (Rubin, 1994). McQuail, Blumler and Brown (1972) classified mostly found needs and gratifications in four categories; diversion (escape from problems, emotional release), personal relationship (social utility of information in conversation, substitute of the media for companionship), personal Identity (value reinforcement, self understanding), and information (as cited in Sheldon, 2008). These classifications were, basically, developed for audiovisual media use and researchers extendend it for internet use and developed different motivational scales for internet use over time. According to Morris, and Ogan (1996) internet fulfills interpersonal and mediated needs. Needs traditionally fulfilled by media are social interaction, time pass, habit, information and entertainment (Flaherty, Pearce, Rubin, 1998). Media fulfilled interpersonal needs such as companionship, maintenance of relationship, problem-solving and persuation (Flanagin Metzger, 2001). LaRose, Mastro, and Eastin (2001) found that the expectation of finding enjoyable activities online predicted the amount of online media consumption. Song, LaRose, Eastin, and Lin (2004) identified virtual community as a new gratification that strengthen comunication with people met on internet. This definition contrast with relationship maintenance focused to maintain relationship with existing acquaintances (Song et al., 2004). Uses and gratification research has usually focused on how media are used to satisfy cognitive and affective needs relating personal needs and entertainment needs (Rubin, 2002), which includes need for personal identity, escapism, and self presentation. Researchers found various gratifications of internet and SNS uses such as acquisition of information, ability to engage in interpersonal communication and socialisation (Stafford Gonier, 2004); interpersonal utility functions such as relationship building, scoial maintenance and social recognition (Leung, 2007); interpersonal relations, information, and entertainment (Ho Cho, 2006); infromation, interpersonal communication, and entertainment (Matsuba, 2006). There has lot of research done about students motives in using Facebook. Majority of the previous research found friending, time pass, flirt and find new friends are the students prime motives to use Facebook. According to Coley (2006) most students use Facebook for fun to organise parties, and to find dates. They use it to find people with similar interest, peer who are in same class, and with whom they feel a sense of community and connectedness and its become habit to those who are already in online. Urista, Dong, and Day, (2009) in their study what motivates young adults to use SNS (MySpace and Facebook) found that individual use SNS to fulfill their needs and wants, which includes efficient communication, convenient communication, curosity about others, popularity and relationship formation and reinforcement. Ellision, et al. (2007) suggest that Facebook is mostly used to maintain or reinforce existing offline relationships, as opposed to establishing new ones online. There is usually some common offline activity among individuals with friends one another, such as a shared class or extra curricular acitivity. Lampe, Ellison, and Steinfield (2006) found that Facebook users engage in searching for people with whom they have an offline connection more than they browse for new people to meet. Sheldon (2008) conducted a survey of 172 students and found that large porportion of students use Facebook to maintain relationship with people they already know, majority of students also visit Facebook for time pass like when feel bored or get wall post update notification, significant porportion of students use Facebook for entertainment purposes and a small porportion use Facebook to develop new relationship. According to Pew Internet American Life Project survey (2009) teens and adults use Facebook to stay in touch with friends (97 percent), make plans with friends (62 percent), make new friends (52 percent), organize with others for an event, issue or cause (56 percent), and flirt (22 percent) (Lenhart, 2009). 2,251 subjects were participated in the survey. Research on Facebook is starting to emerge along with its popularity. The applications and utilities of Facebook is also constantly being developed. Most of the previous studies about motives to use Facebook was done before 2008, when Facebook was just started to emerge and not much popular as now and not much applications as now. The researcher found limited limited predictors have been used to study students motive for Facebook use. In this paper the researcher try to find out university students motives of using Facebook using new predictors. The first research question of the study is; RQ1: What are the motives of university students for Facebook use? Students Use of Facebook in Selection of Universities and Colleges: Oklahoma State Universitys study highlights a typical lifestyle of a todays student. On average each day students sleep for 7 hours, spend 1.5 hours watching TV, spend 3.5 hours online, listen to music for 2.5 hours, talk on a cell phone for 2 hours, spend 3 hours in class, spend 2 hours eating, go to work for 2 hours and study for 3 hours. This totals 26.5 hours a day, nearly half of that involve technology. Students read 8 books a year, surf t

Canto 8 of Dante’s Inferno Essay -- Dantes Inferno Essays

In recent discussions of Canto 8 of Dante’s Inferno, many scholars have argued about Dante the pilgrim’s controversial abuse of one of the wrathful sinners of the fifth circle, Filippo Argenti. The altercation between the two is viewed in numerous lights. From one perspective it is seen as unjustified (ira mala) because Dante is seen as guilty of the sin being punished for in this circle, but also because his response was wrongly motivated. Others state that Dante’s anger was righteous (ira bona) because there was proper reasoning behind it. Kleinhenz, one particular scholar, argues that Dante’s outburst at Filippo Argenti is a result of the praise Dante received after initially criticizing the sinner. In his book, Inferno 8: The Passage Across the Styx, he maintains that Virgil’s praise â€Å"is perhaps wrongly motivated and consequently, that Dante’s reaction to Fillipo Argenti in this canto is equally erroneous†. Kleinhenz allude s to this point in his interpretation of Luke 11:27, where a woman who is praising Jesus is correct in her exaltation of the Mother and Son, but her praise is inappropriate to the situation. By analyzing the parallels between Virgil’s praise and the biblical verse, Kleinhenz argues that both Virgil and Dante’s actions are inappropriate and therefore ira mala. John A. Scott, however, views Dante’s outburst as being justified. In his book,Understanding Dante, Scott argues that Florence was very much a part of Dante’s life and that Filippo Argenti was an ostentatious man whose â€Å"arrogance and insolent display of wealth† as well as â€Å"corrupt nature† is viewed synonymously with Florence’s decline. Therefore Scott argues that Dante’s rage was appropriate because it was inspired by the new decadence of Fl... ...is anger can be viewed as ira bona and ira mala simultaneously. Wishing further pain upon Argenti in order to receive further praise from his mentor is an unreasonable excuse, but trying to become a better pupil and person by doing as his mentor says is reasonable. Becoming furious as a human instinct is rational, whereas doling out punishments while you are only a human is not. Dante did not react to the sinner in the way that he did for only one reason, instead he had many reasons to respond as he did. Works Cited Alghieri, Dante. Inferno. New York: Oxford UP, 1996. Print. John A. Scott’s Understanding Dante, Univ. of Notre Dame Press, Notre Dame, Indiana, 2004 (210-11) Kleinhenz, Christopher. â€Å"Inferno 8: The Passage Across the Styx.† Lectura Dantis. Brown University. No. 3 Fall 1988 21 pars: 21 Sept. 2009 .

Acute Hepatitis B

Acute Hepatitis B GNUR543 St. John Fisher College Mr. Wilson is a 47 year old man being evaluated for complaints of fatigue, anorexia and abdominal distention. On examination, it is noted that the skin is jaundiced and the liver enlarged. D. W. denies significant alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is taking no medication. Laboratory tests reveal the following and a diagnosis of acute hepatitis B is made: 1. Review and analyze the laboratory data. What diagnosis is supported by these values? Give your rationale. Mr.Wilson’s lab work is reviewed below: * AST142 IU/L * AST (Aspartate aminotransferase) is an enzyme and blood sample results can detect if there is liver damage. AST is found in the heart and liver with much lower levels in muscles and kidneys. In a healthy person the AST is between 10-40 IU/L. If the liver is damaged, AST is released into the blood stream (Hepatitis B, 2011). * ALT120 IU/L * ALT (Alanine aminotransferase), if elevated can also be an indication of liver damage. ALT is an enzyme that is normally in the liver and kidneys. If the individual is healthy, the ALT is low, between 7-56 IU/L.Elevated ALT is an early indicator of liver damage usually elevating prior to a patient becoming jaundice (Hepatitis B, 2011). * GGT 42 IU/L * GGT (Gamma-glutamyl transferase) is an enzyme that is found in the liver but may also be in the spleen, kidneys and pancreas. As with AST/ALT, GGT is elevated when there is liver damage. The normal test range is 0 – 51 IU/L. GGT will be elevated when there is acute damage to the liver (or bile ducts) (Hepatitis B, 2011). * Alk Phos 84 IU/L * Alk Phos (Alkaline Phosphatase or ALP) is an enzyme found in the liver, bone, kidney and GI tract. Normal range for this blood test is 44 – 147 IU/L.Alk Phos, if elevated generally indicates that there is a blockage in the bile ducts. Also, if it is found to be high this means the pat ient can either have kidney disease or bone disease. To differentiate, a GGT test is also taken. If that result is high as well, a liver disease is present; if the GGT is within normal limits then the patient has bone disease (Hepatitis B, 2011). * Total Bilirubin1. 0 mg/dl * Total bilirubin is the product of damaged or broken down red blood cells in the body. The bilirubin is processed through the liver and the normal levels in the body are; 0. 3 – 1. 9 mg/dL.If this level is increased, it means that the liver is not processing the bilirubin due to liver disease (Hepatitis, 2011). * Albumin4. 3 g/dl * Albumin (ALB) measures the level of albumin in the patient’s plasma. Albumin is a protein that is made in the liver and is sensitive to any changes in liver function. Albumin mainly ensures that the cells in the body don’t leak, keep the tissues nourished and transports vitamins, calcium, hormones through the body. The normal range for Albumin is 3. 4 – 5. 4 g/dL. Albumin will be lower than normal in the case of malnutrition or liver disease (Hepatitis, 2011). HBsAgpositive * Anti-HBSnegative * Anti-HCVnegative * HIVnegative Test Name| Mr. Wilson’s Result| Normal Ranges| | AST| 142 IU/L| 10-40 IU/L| Elevated| ALT| 120 IU/L| 7-56 IU/L| Elevated| GGT | 42 IU/L| 0 – 51 IU/L| Normal| Alk Phos | 84 IU/L| 44 – 147 IU/L| Normal| Total Bilirubin| 1. 0 mg/dl| 0. 3 – 1. 9 mg/dL| Normal| Albumin| 4. 3 g/dl| 3. 4 – 5. 4 g/dL| Normal| Mr. Wilson’s labs indicate that he has chronic Hepatitis B. This is chronic because the indicators for acute liver damage are within normal limits. For example, if the patient were having an acute onset of Hepatitis B his Albumin would be low.Albumin is made in the liver and is very sensitive to any changes in the liver. If there was acute damage to the liver the Albumin value would not be in normal range. Also, Mr. Wilson’s bilirubin would be higher if he was having a cute hepatitis B. For the skin to be noticeably jaundiced the bilirubin level would usually be >2. 0 mg/dL (Hepatitis, 2011). The patients GGT would be elevated also if he was experiencing an acute episode of hepatitis B. Additional tests that might be helpful to making an accurate diagnosis would be; IgG-anti-HBc and IgM-anti-HBc.These tests show if the hepatitis is acute or chronic. The IgG-anti-HBc is positive if the patient is chronically infected. The IgM-anti-HBc would show positive if the patient is acutely infected with hepatitis B. The HBs-Ag will be positive in both acute and chronic cases. See the table below for an overview of the assessment and tests that are generally given when a new Hepatitis B diagnosis is reached. (Lok A. S. , 2011) 2. Explain the hepatocellular changes that occur with the above diagnosis. The liver has many roles in the body that associate it with many systems.For example, it acts as a digestive organ by secreting bile for the breakdown of fat (Co pstead, 2010). The liver also removes bilirubin from the blood, temporarily stores blood and synthesizes the blood clotting factors (Copstead, 2010). Other functions of the liver are; removing toxins from the blood, metabolizing both sex hormones and steroid hormones. Any damage to the liver can in turn disrupt any of these processes and functions that it performs. Some of the processes and functions can be changed in the following ways: * Liver inflammation: Inflammation in chronic hepatitis is associated with scarring.Severe inflammation can bridge together portal tracts within the liver, this is called â€Å"bridging necrosis† (Mani & Kleiner, 2009). It can also bridge to central veins, confluent necrosis (Mani & Kleiner, 2009). This leads to scarring, the creation of fibrous strands and in many cases will lead to fibrosis. Throughout the liver cells are becoming damaged therefore blocking and limiting the livers functionality. Hormone secretion, chemicals and toxins in th e blood, clotting factors and other defense fighting macrophages are interrupted (Copstead, 2010).Along with the inflammation, the patient will feel fatigued and will have a lowered immunity. * Ascites and peripheral edema: Abdominal distention, ascites, is a result of the damaged cells within the liver and more specifically the membrane of the cell has been damaged. There is an intra-abdominal buildup of sodium, water and protein. The cells in the liver are unable to maintain the appropriate osmotic gradient across the pleura (Copstead, 2010). This extra fluid is likely to accumulate in the dependant areas of a person’s body, such as ankles, legs, and arms (Kukka, 2010). Jaundice: Red blood cells have a short life span and as they die and/or are damaged the body will break them down and dispose of them. This is referred to as bilirubin metabolism and this happens in three phases; pre, intra and posthepatic. (Copstead, 2010). The red blood cells should be broken down, deliver ed to the liver and then transported through the biliary system and thus be wasted via the kidney’s or the colon. With damaged liver cells, the bilirubin is not excreted from the liver and there is a buildup of the conjugated bilirubin and the result is jaundice (Copstead, 2010).Other changes due to the liver damage are portal hypertension, gastric and esophageal varacies, vitamin mal-absorption, poor blood clotting and altered mental status (Copstead, 2010). The liver has such far reaching effect on so many organs and systems in the body that any damage to the liver will result in decreased functioning of other systems. Immediate tests to determine the cause and extend of the damage would be imperative to managing the disease going forward. 3. How should the disease be managed and monitored? Explain your rationale.If pharmacotherapeutics are used, explain your rationale and their mechanism of action. First steps would be to order additional labs including, IgM-anti-HBc, IgG- anti-HBc, HBeAg, HBV DNA, CBC with PT and electrolytes. In cases of acute hepatitis B, symptoms sometimes go unnoticed. The virus will normally go away on its own and if treatment is given, it is for the symptoms and most adults recover fully (Hepatitis B, 2011). But in the case of chronic HBV, the patient will need to be monitored to see if the virus is replicating (Lok A. S. , 2011). In patients with chronic HBV, the treatment oals are to reduce the long term effects of liver damage, prevent the transmission of the virus to others and manage any complications along the way (Lok A. S. , 2011). A clear diagnosis of chronic hepatitis B is needed. Results of blood work will determine the course of treatment. In Mr. Wilson’s case, with only the first lab results, it appears that he is in the active chronic infection stage. At this point the liver damage is still minimal. Because there does not seem to be significant liver damage a liver biopsy would not be indicated at this poin t (Lok A. S. , 2011).As the practitioner, I would recommend more blood tests, as noted above, and ongoing monitoring of the virus every few months. This will help in determining the activity of the virus. The medications used to treat chronic hepatitis B tend to have serious side effects. The patient must be willing to make a commitment to continue the therapy and adhere to close monitoring during any drug treatments (Hepatitis B, 2011). Supportive medicines are important to assist in treating side effects of the virus. For example, diuretics are prescribed if edema is not resolving on its own.Vitamins and minerals are indicated if labs show deficiency due to decreased liver function. If it is determined that Mr. Wilson’s virus is active (meaning he is able to infect others) there are new drugs available to choose from. Antiviral treatments include (Hepatitis, 2011): 1. Entecavir – a. A pill taken once a day for up to a year b. Used when DNA viral cells are actively re plicating 2. Interferon Alpha c. Injection a few times per week for up to a year d. Used when patient has compensated liver disease 3. Pegylated Interferon e. Injection once per week for up to a year f.Used when patient had compensated liver disease and evidence of viral replication and liver inflammation 4. Lamivudine g. A pill taken once a day for a year or more h. Used when patient has active liver inflammation and active viral replicating 5. Adefovir Dipivoxil i. A pill taken once a day for a year or more j. Used in patients with chronic HBV 6. Telbivudine k. A pill taken once a day for a year or more l. Used in patients with active viral replication, persistent elevations in ALT or AST or histologically active disease 7. Tenofovir m. A pill taken once a day for a year or more n. Used in patients with chronic HBVThe medicines listed above are used alone or more likely in conjunction with others. These are currently the only hepatitis B drugs that are approved by the FDA (Lok & M cMahon, 2009). According to the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines, the ultimate goal of therapy is to suppress the replication of the virus and put the liver disease into remission (Lok & McMahon, 2009). This is monitored by watching the patients ALT, AST and other liver, viral and blood tests. The viral tests are imperative to determine the proper adjustments in medications.For example, interferon has been shown to reduce the viral replication and inducing liver disease remission (Lok & McMahon, 2009). Also, a newer drug, tenovir has shown significant promise in reducing viral levels in patients as compared to adefovir (Lok & McMahon, 2009). Practitioners need to watch for resistance as well when using the anti-viral drugs. As noted, the drugs are used in combination as well and these have shown to be more effective than when they are used alone. The effects of combined usage are better antiviral effects and delayed resistance (Lok & M cMahon, 2009).Mr. Wilson’s ALT, HBeAg lab values and his HBV DNA will be a main determinate to the type of therapy he will receive. A liver biopsy will be indicated later on if his  HBsAg is positive for more than six months, his serum HBV DNA is greater than >20,000 IU/mL and he has persistent or intermittent elevations in his ALT/AST levels (Kukka, 2010). Summary Hepatitis B can be chronic or acute. When a person has acute hepatitis B they generally don’t even notice and never need treatment. If treatment is needed it is supportive treatment for the symptoms of the acute virus infection.Chronic hepatitis B patients are at risk for cirrhosis and HCC (hepatic cellular carcinoma) (Kukka, 2010). Patients that have chronic HBV need to be educated on the risk of infecting others and will, in some cases, need to alter their lifestyle to protect others from getting the virus. Treatment is dependent on the blood work up that is obtained. It is very important that a patient that goes on antiviral treatment remain on it to reduce drug resistant strains. Also, patients must be evaluated and treated for the side effects of the anti-virals as well as the symptoms of other affected organs and systems in the body.References Copstead, L. -E. C. (2010). Pathophysiology. St. Louis: Saunders. Hepatitis. (2011, July 6). Retrieved March 26, 2012, from Lab Tests Online: http://labtestsonline. org Hepatitis B. (2011, July 6). Retrieved March 25, 2012, from Lab Tests Online: http://labtestsonline. org Hepatitis B. (2011, September 1). Retrieved March 24, 2012, from Mayo Clinic: http://www. mayoclinic. com/health Kukka, C. M. (2010). Hepatitis B Fact Sheet. HCSP Publications. Lexicomp. (2012). Retrieved February 5, 2012, from Lexicomp: https://online-lexi. com Liver Blood Tests. (2012, March 28).Retrieved March 30, 2012, from e Medicine Health: http://www. emedicinehealth. com/ Lok, A. S. (2011, February 16). Overview of the management of hepatitis B. Retrieved March 24, 2012, from UpToDate: http://www. uptodate. com Lok, A. S. , & McMahon, B. J. (2009). Chronic Hepatitis B: Update 2009. Alexandria: American Association for the Study of Liver Diseases. Mani, H. , & Kleiner, D. E. (2009, May 1). Liver Biopsy Findings in Chronic Hepatitis B. Retrieved April 1, 2012, from University of Pennsylvania, Department of Medicine: http://webdev. med. upenn. edu

Conflict Theory And Labeling Theory - 1480 Words

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