Choroidal Neovascular Membrane Associated with Sildenafil

Choroidal Neovascular Membrane Associated with Sildenafil CHOROIDAL NEOVASCULAR MEMBRANE ASSOCIATED WITH SILDENAFIL Â  Erectile dysfunction is an important problem among men aged 40 years and older. More than half of all men in this broad age group experience some degree of erectile dysfunction. Thus, the provision of an orally administrated efficacious treatment in the form of sildenafil represents a major therapeutic advantage.(1) Choroidal neovascular membrane (CNV) is ultimately the result of a break in a structural layer beneath the retina known as Bruch’s membrane, which separates the nourishing vascular layer called the choroid from the retina. A break in Bruch’s membrane may allow the ingrowth of vessels from the choroid to a position just beneath the retina.(2) Ocular side effects are not uncommon when sildenafil is used. Minor side effects include pupillary dilation, conjunctival injection (redness), sensitivity to light (photophobia), and dryness. Visual function studies in healthy subjects and in patients with eye disease suggest that sildenafil does not affect visual acuity, visual fields, and contrast sensitivity. Transient, mild impairment of color discrimination can occur around the time of peak plasma levels.(3-7) The purpose of the present case report is to describe a patient who developed CNV after ingestion of Sildenafil for erectile dysfunction. CASE REPORT The patient was a 53-year old male who presented with a blurred and loss of vision in the right eye. His physical examination did not reveal any significant signs. The patient was fit and healthy otherwise and had no history of glaucoma, diabetes, hypertension, or other systemic vascular disease. Visual acuity was 4/10 in the right eye and 10/10 in the left eye. Anterior segment examination was normal. Fundus examination of the right eye revealed that the macula upper temporal quadrant was characterized by hemorrhagia and an elevated area (Figure 1A), the left eye revealed an atrophic area outside the macula. The FA of the patient revealed an area of bright hyperfluorescence in the early phase and leaks in the late phase (Figure 1B). A diagnosis of CNV was made. Argon laser photocoagulation was applied on the right eye. The patient did not suffer until 6 months after the laser application and the visual acuity in the right eye had increased up to 9/10. However, 6 months after the las er application, the patient noted loss of vision in the right eye. Argon laser photocoagulation was applied again. The control FA of the patient did not reveal a leakage of the scar on the right eye (Figure 2). The visual acuity of the patient was 10/10 bilaterally and he didn’t reveal any complaints. After 3 years, the patient was referred to our clinic with blurred and loss of vision in the left eye and when the patient underwent rigorous historical questioning, he noted that all his complaints were revealed with the use of 50 mg sildenafil. He said that he had taken 50 mg sildenafil before his complaints were revealed. His visual acuity was 10/10 in the right eye and 4/10 in the left eye. The FA revealed CNV and photodynamic therapy and intravitreal anti-VEGF injection were applied to his left eye (Figure 3). DISCUSSION In this study we present a patient with CNV associated with sildenafil use. CNV is ultimately the result of a break in a structural layer beneath the retina known as Bruch’s membrane, which separates the nourishing vascular layer called the choroid from the retina. A break in Bruch’s membrane may allow the ingrowth of vessels from the choroid to a position just beneath the retina .2 These vessels may then leak fluid or blood, initially distorting or blurring vision, and may eventually lead to scarring in the macula and severe loss of central vision. CNV is associated with many diseases. The most common causes are age-related macular degeneration (AMD), presumed inflammatory and infectious conditions, myopic macular degeneration, trauma, angioid streaks and laser therapy, however many cases are idiopathic.(2) Sildenafil is a potent and selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5), an enzyme expressed throughout the smooth muscle of the vasculature.3 Through this mechanism, sildenafil potentiates the nitric oxide (NO)-cGMP pathway that mediates corpus cavernosum smooth muscle relaxation and thereby significantly improves penile blood flow. Basic science and clinical research have effectively documented the effects of sildenafil on the retinal and choroidal vasculature. Sildenafil also has a weaker inhibitory action on PDE6, located in the rod and cone photoreceptors. Modest, transient visual symptoms, typically blue tinge to vision, increased brightness of lights, and blurry vision, have been reported with sildenafil use and occur more frequently at higher doses. Visual function studies in healthy subjects and in patients with eye disease suggest that sildenafil does not affect visual acuity, visual fields, and contrast sensitivity.(5,6) Transient, mild impairment of color discrimination can occur around the time of peak plasma levels. However, we were not able to find any case of CNV associated with sildenafil use in the literature. Sildenafil induces angiogenic response in human coronary arteriolar endothelial growth factor (VEGF).(7) The same mechanism may be available on the retina and sildenafil may increase the levels of VEGF. This issue requires further studies and patients with CNV should be questioned about the use of sildenafil. Patients should consult with an ophthalmologist if there is any question about the health of their eyes prior to using sildenafil. REFERENCES Irwin Goldstei, Tom F. Lue, Harin Padma-Nathan et al. Oral sildenafil in the treatment of erectile dysfunction N Engl J Med 1998; 338:1397-1404 Bressler NM, Bressler SB, Fine SL. Age related macular degeneration. Surv Ophthalmol 1988;32:375-413. Michael F. Marmor, Robert Kesler. Sildenafil and Ophthalmology. Survey of Ophthalmology 1999;44:153-162. Alan M. Laties, Eberhart Zrenner. Viagra and Ophthalmology. Progress in Retinal and Eye Research. 2002;21:485-506 DÃ ¼ndar SO. Visual loss associated with erectile dysfunction drugs. Canadian Journal of Ophthalmology 2007;42(1):10-12 Zrenner E, Koppiker NP, Smith MD, Constable I, Littlewood R, Stuckey B. The effects of long-term sildenafil treatment on ocular safety in patients with erectile dysfunction. Invest Ophthalmol Vis Sci 2000;41:S592. Vidavalur R, Penumathsa SV, Zhal L. Sildenafil induces angiogenic response in human coronary arteriolar endothelial cells through the expression of thioredoxin, hemeoxygenase and vascular endothelial growth factor. Vascul Pharmacol. 2006;45:91-95. FIGURE FOR LEGENDS FIGURE 1A: Fundus examination of the right eye revealed that the macula upper temporal quadrant was characterized by hemorrhagia and an elevated area FIGURE 1B: The FA on the right eye of the patient revealed an area of bright hyperfluorescence in the early phase and leaks in the late phase FIGURE 2: The control FA of the patient did not reveal a leakage of the scar on the right eye after laser photocoagulation was applied. FIGURE 3: The FA on the left eye of the patient revealed an area of bright hyperfluorescence in the early phase and leaks in the late phase

A multicultural counselor Essay

It is crucial that a multicultural counselor have ample strategies in order to be effective in multicultural counseling. This is because the counselor handles clients who have diverse cultures and, therefore, need to be adaptive to the various cultural values and beliefs of the client. In order, for a multicultural counselor to be effective, it is vital that the counselor should first understand his or her own culture. This understanding of own culture comprises being aware of one own life philosophies, being able to recognize the different structures involved in reasoning and also being aware of how the understanding effect ones communication and also the style one uses to assist the client. Lack of this understanding may make the counseling process ineffective. Self-awareness helps the counselor identify specific cultural values and the influence they may have in the counseling process. This helps the multicultural counselor be able to counter the effects that the values may pose to the counseling intervention. It is also necessary that multicultural counselor prevent adhering to a specific counseling theory during the counseling process. This is because many cultural groups do not share the type of values, which are implied by the counseling methods (Gielen, Draguns & Fish, 2008). The various values usually do not share the same expectations for the conduct or the outcome of the counseling session of the counselor. This calls for a need for the counselor carry out an investigation about their clients cultural background, be open and flexible to the definitions of the appropriate of the correct behaviors according to the cultural values of the client. It is also beneficial for the multicultural counselor to have an understanding of many languages. This is because language barriers act as a hindrance to effective multicultural counseling. As a result, of the language barrier, the client and the counselor may not understand each other well making the client unable to express the complexity in their thoughts and their feelings. This may also make the counselor feel frustrated due to lack of bilingual ability. Language barriers also lead the counselor to offer the wrong diagnosis (Association for Multicultural Counseling and Development, 2009). Multicultural counselor should acknowledge cultural diversity he or she should appreciate the value of different cultures and use it in assisting the client. The counselor should not have any cultural bias or carry cultural stereotypes into the counseling process. He or she is supposed to understand that all cultural values are the same, and they should be respected. Respect of cultural diversity plays a great part in enhancing the effectiveness of multicultural counseling. This also calls for the multicultural counselor to have humility and modesty. (Gielen, Draguns & Fish, 2008). It is also essential that a multicultural counselor should have social conflict resolution strategies in order to carry out an effective counseling. This helps the counselor to be able to help the client to solve the problems he or she may be experiencing within himself and the conflict that may be existing between him or her and the community. It is also important that multicultural counselor take a pluralistic view in the counseling process. This is where the counselor puts into consideration all aspects of the client’s personal history, social and cultural orientation. (Association for Multicultural Counseling and Development, 2009). Therefore, it is important that multicultural counselors avoid culture stereotypes and false expectation. This is done by understanding their clients’ background and finding the most appropriate strategies to employ in the counseling process. The strategies should suit the needs of the client. The counselor should be sensitive the cultural values of the client. Reference Association for Multicultural Counseling and Development (AMCD), (2009) Journal of Multicultural Counseling, Birmingham, England, retrieved www. multiculturalcenter. org/jmcd/ on 8 April 2010. Gielen, U. Draguns, J. & Fish, J. (2008) Principles of multicultural counseling and therapy, New York, Brunner-Routledge, retrieved from http://www. netLibrary. com/urlapi. asp? action=summary&v=1&bookid=233302 on 8 April 2010.

Microsoft Office Word, Excel, and Powerpoint in the Business Enviornment.

In most work environments, Microsoft Office Word, Excel, and PowerPoint are being used on a daily basis. From being a Loan officer to a front desk cashier these three apps are very helpful in our work place. Microsoft Word is good with writing business letters and business cards, Excel is good with making spreadsheets or charts for your business, and lastly, PowerPoint is good with making presentation audio and visually. In the following paragraphs below I will explain why these three are most helpful and useful in the work place. For one, Microsoft Office Word is mostly used to writing business letters to their clients. From one paragraph or 4 pages it’s where they will have their letter written up and printed. There are also different tools like spell check and grammar, formatting tab, paragraph selection and etc. that also become useful. Business cards can also be used on Microsoft Word and then printed out which also is being used in the work place environment. (office Microsoft) Secondly, Microsoft Excel is mostly used because of its layout and widespread availability, it is often used as a tool to create and maintain a list. More users use it to store database records, create charts or graphs. A lot of organization uses excel to manage their budgets, business planning, customers records, business intelligence, analysis of sales data, customer data, performance dashboard, etc. (advanced excel) Lastly, Microsoft PowerPoint presentations utilize both audio and visual techniques, making for easier understanding. Normal teaching and training is interactive and more effective by using PowerPoint presentations instead of simple lectures. Many executives and managers use PowerPoint for this reason. Executives use this as a strategy to increase sales. Using PowerPoint in front of a potential client shows that you are up with the time. Plus, projecting charts that all can see also makes the presentation more interactive for the client. (powerpoints and apps) So all in all I hope you find Microsoft Word, Excel, and PowerPoint useful in the work place. Not only will it help you and your business be successful but also have that professionalism. ? Reference Microsoft office np November 1, 2011< http://www. baycongroup. com/powerpoint> Baptiste, Jason np November 1, 2011 < http://jasonlbaptiste. com/startups/microsoft-excel>

Grapes of Wrath the Theme of Decay in Chapter 25 - 864 Words

One of the most pervasive themes in this passage is that of a spreading decay that is taking over the society. This is first expressed in quite a literal sense, as an actual decay of fruit and produce, which spreads like a virus across the American countryside and farming lands. Due to the economic mismanagement of the farming industry, fruit and other produce are left to rot and decay on the trees because they are not picked by the farmers. The text gives many examples of different fruits being left to decay on the farms. We see, for example, the cherries, that are described at first as â€Å"full and sweet†, being left to turn into seeds which â€Å"drop and dry with black shreds hanging from them†. The purple prunes, which now â€Å"carpet the†¦show more content†¦Secondly, the repetition depicts figuratively the accumulation and spreading of the problem. It is not a problem that is isolated to one kind of fruit, or one particular farming community, but a p roblem that is rapidly becoming widespread. The image of â€Å"the smell of rot filling the country† also reinforces this idea of an unstoppable spread of decay, infiltrating the whole country bit by bit. This spreading decay is not only literal in the text, but it also symbolizes the proliferation of social injustice and inequality that is infecting the country. Interestingly, the text uses the spreading decay of the fruit as a cause, a symptom and a symbol of the spreading social inequality and discontent. The decaying fruit is a cause of the social discontent, as the rotting fruit is an affront to those who cannot afford to buy enough food for themselves and their families. As the text says: â€Å"a million people hungry, needing the fruit – and kerosene sprayed over the golden mountains†. People are literally forced to watch â€Å"potatoes float by†, â€Å"screaming pigs being killed in a ditch and covered with quicklime†, and â€Å"mountains of oranges slop down to a putrefying ooze†. The waste of good food is thus a cause of separation between producers and consumers, as the potential consumers of produce cannot understand the willful destruction of fruit and food that could have been such a benefit to them. We see in the text a very vivid depiction of this causal relationship: â€Å"childrenShow MoreRelatedGrapes of Wrath - Chapter 25 Analysis1462 Words   |  6 PagesAP Language, Per. 5 12 January 2013 Grapes of Wrath Analysis The cold, soaked earth, which was a source of life not too long ago, abducts a young child while the mother can only watch hopelessly as the husband shovels mounds of dirt. This event is not too different than most that citizens living during the Dust Bowl had to deal with. The self-destructive nature caused the American people to keep expanding and shaping the land as they saw fit. Because of this they overworked the land which, combinedRead More Chapter 25 of The Grapes of Wrath by John Steinbeck Essay examples2622 Words   |  11 PagesChapter 25 of The Grapes of Wrath by John Steinbeck In the twenty-fifth chapter of his novel The Grapes of Wrath, John Steinbeck presents the reader with a series of vivid images, accompanied by a series of powerful indictments. Steinbeck effectively uses both the potent imagery and clear statements of what he perceives as fact to convey his message. This short chapter offers a succinct portrayal of one of the major themes of the larger work. Namely, the potential bounty of nature corruptedRead MoreRastafarian79520 Words   |  319 Pagespolicy statements, pamphlets, and organization manuals have also provided useful information. Chapter 1 reviews and reï ¬ nes Webers theory of charisma and routinization, using insights from a number of social movement scholars. Though this book focuses on routinization, it is necessary to locate routinization and its twin concept, charisma, in the wider context of Webers view of social change.11 In chapter 2, I identify the economic, political, and cultural deprivation of the poor in Jamaica as the

Academic Argumentative Essay Topics Reviews & Guide

Academic Argumentative Essay Topics Reviews & Guide A History of Academic Argumentative Essay Topics Refuted To help students just like you find debatable topics, we've gathered a wide selection of ideas on distinct subjects and academic levels. Teenagers shouldn't be permitted to drive till they are 18. Using Academic Argumentative Essay Topics To assist you craft an intriguing essay, here are a few excellent persuasive topics for you to pick from. Popular themes for academic papers can be located on our site too. You may pick topics from assorted lists of ready themes. Argumentative essay topics are so important since they are debatableand it's vital to at all times be critically contemplating the world around us. Deciding on your topic isn't that easy. Choosing topics is a distinct skill which you should learn and practice at school, so quit procrastinating and stick to the simple tips below as a way to develop fresh ideas and make a great topic to work on. Deciding on an emotional topic is also a superb idea. You don't need to acquire super technical with legal argumentative essays, but make sure to do your homework on what the recent laws about your preferred topic actually say. In choosing your topic, it's frequently a good notion to start with a subject which you already have some familiarity with. Quite frequently, the very best topic is one which you truly care about, but you also will need to get ready to research it. Otherwise, you've got to consider about choosing another topic. Finding Academic Argumentative Essay Topics Your academic essay should evoke an emotion that is needed to spark different ideas, opinions and other sorts of responses. The last aim of the paper is to create an educated stance. Also, do not forget that you'll have to deliver some factual evidence for your opinion (after all, any academic paper needs to be supported by academically recognized sources), thus do not go for subjects which are purely opinionated and don't have any possibility of justificat ion. Top Academic Argumentative Essay Topics Choices MLA would be the simplest style to get started with, and it's best for each of the ideas listed above. Before you commence writing your essay, you should study the sources pertinent to the prospective subject, and make certain you have enough evidence to hold up your thesis statement. Just based on how best to compose an argumentative essay can be determined by emotion. Argumentative writings is a particular sort of a paper. A persuasive essay ought to be thoroughly based on cold-hearted arguments, even though it might attract emotions too. An argumentative essay is a certain kind of academic writing. The Number One Question You Must Ask for Academic Argumentative Essay Topics You are able to also restate the ideas you have discussed in the body paragraphs in order to make your point valid. In high school, you're supposed to decide on the type of topic you'll be in a position to dig into that is, you must make sure to can come across enough info on the topic. When you're picking your topic, bear in mind that it's much simpler to write about something which you currently have interest ineven in case you don't know a good deal about it. It's important to select debatable argumentative essay topics as you need opposing points which you can counter to your own points. How to Get Started with Academic Argumentative Essay Topics? The course materials which you require to speak about within an academic essay can reflect your degree of understanding about the discipline. To compose a strong argumentative essay, students should start by familiarizing themselves with a number of the common, and frequently conflicting, positions on the research topic so they can write an educated paper. Since academic essays are popular in the subject of education and research, you should be certain your writing is both logical, interesting and informative. In other words, an academic essay may be an evidence of the depth of your research procedures and the rest of the activities which you have executed so you can support the content of your written output. The above-mentioned topic selection may give you a crystal clear comprehension of what things to write about. You may continue to keep your argumentative essays for your upcoming job portfolio in case they're highly graded. No matter the quantity or kind of research involved, argumentative essays must set a very clear thesis and follow sound reasoning.

Essay on The war against terrorism - 976 Words

Is war the right way? Why do people resort to such violent acts as bombing, assassinations, and hi-jacking? How do individuals and organizations justify these acts of terror? These acts can be described as terrorist actions. Terrorism is a growing international problem. During the last twenty years, new terrorist groups have sprung up all over the world. Governments have had little success in their attempts to resolve issues in which terrorism is used. A major problem in discussing terrorism is establishing a generally accepted definition. Terrorism can be described as the unlawful use of fear or force to achieve certain political, economical, or social aims. Because it is so hard to define, organizations like the United Nations have had†¦show more content†¦In some cases it may be right but to fight terrorists with war is the wrong way. It is only showing that our country is worse than they are. By committing war we are only embracing the thought that fighting and killing is the only way to go. This war that we are creating against these people and their actions is not justified in any manner. We are only creating more of a war in our own country than we are in the country of the one we are trying to fight. We have created such a war that people can even go places they normally go without being check by an officer or being suspected by someone that u are a terrorist. As we further bomb and shoot at these terrorists we the y will further come back as if they have lost nothing. We see these terrorists in the news every day and we see that they are not even moved by the actions we are doing to them. They just brush it off as if it where nothing and had nothing to lose. In this case they don’t lose anything but there husbands or wives or maybe their children, they can’t lose a home because most of them don’t have homes and if they do they are very dirty and small. One’s gut reaction to any kind of attack is to get revenge, but much like a tango, it takes two to wage war. And frankly, we Americans should stand our ground! Show everyone that terrorism will not be tolerated! †¦ and show it peacefully. Once someone drops a nuclear bomb in this day and age, the world, as we know it, will come to anShow MoreRelatedThe War Against Terrorism Essay781 Words   |  4 PagesThe War Against Terrorism On August 2nd 1990, Iraq invaded the small oil rich country of Kuwait on its southeastern border. Iraq claimed that Kuwait was a long time province from the 1800’s and early 1900s’, whose lands belonged under control of Iraq, a so-called province. Saddam Hussein also argued that Kuwait was pumping oil from an oil field that was on the border of the two countries and belonged to Iraq. Upon gaining control of Kuwait, Hussein was able to eliminate his previous debtRead MoreThe Threat Of The War Against Terrorism1002 Words   |  5 Pagesworld evolves new threats appear and some stand by what they believe in. These beliefs cause harm to other people. An example this would be, big military forces trying to prove a point by killing innocent civilian lives. This is where the Counter Terrorism forces comes into play. Such as the United States Seal team six, United kingdom S.A.S and Kopassus - Gultor 81. They seek out those who do wrong and bring them to justice. The only pr oblem is that they need to have a stronger force to be able toRead MoreThe Battle Against The War On Terrorism1753 Words   |  8 PagesWhat Now? An analysis of the responses to the Senate Report on CIA Interrogation The fight against the â€Å"war on terrorism† has initiated a debate in the United States over the use of torture and advanced interrogation techniques to extract information needed to protect the safety of its citizens. In lieu of the Sept. 11, 2001 attacks, government officials believed that using extensive force against suspected is justified, especially if such force results in the prevention of future planned attacksRead MoreUs War Against Terrorism Essay724 Words   |  3 Pagesconsistent in its process of combating against terrorism and other ills in the region with other regional organizations as he says â€Å"U.S. policy in Central Asia is embattled and under siege. Moscow and Beijing, as well as to a lesser degree Tehran, view America’s political and strategic presence in Central Asia with unfeigned alarm. Indeed, Russia and China suspect America’s desire for bases there. Despite Russo-Chinese protestations of support for the U.S. war on terrorism, in fact they wish to exclude AmericaRead MoreGeorge Bush and His War Against Terrorism Essay928 Words   |  4 PagesGeorge Bush and His War Against Terrorism When George W Bush came to the presidential office of America at the beginning of the year 2000, there was already a lot of controversy that surrounded him. He was appointed Governor of Texas in 1995 and as of 7:30pm, December 7, 2000, 152 people have been executed during Bushs office as governor. This makes Texas Governor George W Bush the most-killing Governor, in the history of the United States of America. This list canRead MoreThe Consequences of Terrorism Essay1580 Words   |  7 Pages Day in and day out facing the music of the war against terrorism, the term, again, imposed on the people of Pakistan who live the term as their reality, disinterested in the background an origin of the term. The western contrived term was first used by used by the American President, George W. Bush, during tenure trigger of the war against terrorism happened. At Camp David George W. Bush in his speech said This crusade – this war on terrorism – is going to take a while, ... and that wasRead MoreAnalysis Of George Orwell s Nineteen Eighty Four Essay1739 Words   |  7 Pagesthis, the theme of terrorism and war is questioned by Lee Rogers in this report â€Å"The U.S. Government is Preparing for War Against the American People† where he states that the government of the U.S. is planning on going against its own citizens and their choices. All three of these dystopias, state an example of complete government control and terrorism. Terrorism is used to deceive citizens of these societies and strengthen government control over society. The concept of terrorism is used to not considerRead MoreEssay on Human Rights, War and Terrorism1226 Words   |  5 PagesHuman Rights, War and Terrorism After every war come the peace talks; after millions of people had been killed. After the terrorist attacks comes the investigation, reason, or counter-terrorism; after lives had been wasted. There is time for the nations of the world to come together to understand one another in order to avoid war and terrorism and that time is now. War is as old as man. It is a reign of terror when people are always on the run, always hungry, alwaysRead MoreInternational Terrorism - the Worlds Greatest Challenge Today?680 Words   |  3 PagesInternational Terrorism – The World’s Greatest Challenge Today Today the threat of terrorism is becoming more and more serious. Terrorism is considered the greatest threat against the safety of the world, and especially the USA, today. The extent of the terrorism has increased significantly over the last couple of years, since the terrorist attacks against the US on the 11th of September 2001. After these attacks former president of the US, George Bush declared a war against terrorism. There areRead More Why Terrorism Should Be a Global Concern Essay1380 Words   |  6 PagesThe war on terror is at the peak and there are vivid indications that every stone will be turned to halt it. A central assumption is that terrorism is a religious war, apparently between Christians and the Muslims. This is just a moral claim that terrorists are using to attract more people over to their side, as well as create solidarity among the Muslims. As a result, the imagery and the reality of terrorism differ overwhelmingly. There are various terror occurrences around the globe that are similar

Macroeconomics of Brexit Motivated Reasoning

Question: Discuss about the Macroeconomics of Brexit for Motivated Reasoning. Answer: Introduction: For some time now, economists have been arguing about the potential effects of Brexit. While some strongly believe that it will adversely affect the economy of UK in the long run, others propose that the move may be beneficial for the economy over time. According to the article The Macroeconomics of Brexit: Motivated Reasoning? the claims presented by a majority of economists do not follow a clear way from economic standards and theories. In this view, the class material on Economics for Today by Layton, Robinson, and Tucker (2016) provides a useful tool for understanding the probable implications of the Brexit. From the point of view of a majority of economists, the Brexit would result in a reduction in the trade activities between the UK and the rest of the world. Consequently, this will make the British economy less productive and poorer than it would otherwise have been if it had remained in the EU (Buiter et al., 2016). In the same view, Layton et al. (2016) explain that the prevailing economic conditions in the international market affect the demand for a nations exports while the domestic conditions affect the demand for imports. Thus, the class text helps one to understand that the Brexit will significantly reduce the volume of trade between the UK and the rest of the world. It is imperative to note that the articles author is opposed to the view that the Brexit may trigger a recession period in the UK. Instead, the author believes that the exit may bring about significant uncertainties in the economy, thereby act as a deterrent to investment in the country. In agreement, the text by Layton et al. (2016) helps one further understand this concept. More specifically, they explain that investment demand is a volatile component because it is future oriented and risky. Typically, it depends on the expectations that investors have of future key influences (Watt, 2016). In addition, it is based upon the firms confidence about the profitability of the venture and future conditions of the country. Thus, the uncertainty arising from Brexit is bound to affect investment demand in Britain negatively. Even so, the adversity associated with the exit of Britain from the EU is somewhat exaggerated. It is worth pointing out the fact that the information provided in the article may be useful for ones future career and other economic applications. As a whole, the article is informative on the various implications of policy change. Thus, an economic student may apply the knowledge obtained from this piece to the workplace in the future. For instance, the concept of the effects of uncertainty on investment demand may be used when making investment decisions in the firm setting. Likewise, the concepts highlighted on the effects of policy change on demand may help one in mitigating the adverse effects of policy change on international and domestic trade. Thus, overall, the author of the article was successful in relaying useful information about the implications of Brexit and policy change as a whole. References Buiter, W, Rahbari, E, Schulz, C. (2016). The implications of Brexit for the rest of the EU. [Online] Vox. Available at: https://voxeu.org/article/implications-brexit-rest-eu [Accessed 14 Mar. 2017]. Layton, A, Robinson, T Tucker, I. (2016). Economics for Today. (5th Ed.) South Melbourne, Victoria. The Macroeconomics of Brexit: Motivated Reasoning?. (2016). [Online] The New York Times. Available at: https://krugman.blogs.nytimes.com/2016/06/30/themacroeconomicsofbrexitmotivatedreasoning/?_r=0 [Accessed 14 Mar. 2017]. Watt, W. (2015). The implications of a Brexit. [Online] Black Rock. Available at: https://www.blackrockblog.com/2016/03/11/implications-brexit/ [Accessed 14 Mar. 2017].