Development, Features and Treatment of Acne Vulgaris

Development, Features and Treatment of Acne Vulgaris Millions of people worldwide suffer from acne vulgaris. Acne vulgaris is classified as inflammation of the skin and the appearance of blemishes. With a large variety of acne treatments, it can be hard to know where to start. From home remedies to prescribed medications, it is common for individuals to have trouble with finding the right treatment. Acne vulgaris is treatable with a number of methods, but it is important to understand that the successful eradication of acne vulgaris is specific to the individuals skin. The development of acne is a disorder of the sebaceous glands. The development of acne begins at the cellar level where the hair follicle is blocked. The hair follicle is an opening in the skin which hair and sebum reach the skins surface. The hair follicle and the sebaceous gland is where acne begins to form. This process may go wrong for those who have acne and the dead skin cells and oil are not cleared out of the pore properly. (Mayo Clinic, 2015) The sebum and dead skin cells become trapped in the follicle. This debris that is trapped in the follicle blocks the pore opening. The blockage is a called a comedo, a clogged hair follicle in the skin. The blockage invites Propionibacterium acnes (P. acnes), a bacterium that causes the inflammation of acne breakouts. The comedo creates an environment that lacks oxygen in the follicle. This environment is favored by P. acnes that will thrive and grow out of control in the follicle. The follicle will continue to fill up with sebum, dead skin cells, and bacteria and it will start to swell up. White blood cells go to fight the bacteria in your pores. Redness, swelling, and pus is created forming a pimple. There are multiple things that cause acne. First, there are overactive sebaceous glands. The sebaceous glands are responsible for creating sebum and oil that are needed for the skins surface. People who are prone to acne have sebaceous glands that create more sebum than what is needed. The excess oil in the hair follicle will create a blockage in the pore and becomes a comedo. (Web MD, 2015) This is what creates the environment that invites Propionibacterium acnes to grow. Second cause of acne is the abnormal shedding of the skin cells. The epidermis, the top layer of your skin, is always shedding dead skin cells. This natural process of exfoliation is called desquamation. Skin cells travel through the epidermis until they reach the stratum corneum, the outermost layer of the epidermis, where they will fall out and become replaced by newer skin cells below. Desquamation goes wrong with those who have acne and cells are produced faster than normal and the skin cells wont shed and will get trapped in the follicle. The third cause is the proliferation of bacteria in your skin. The most common bacterium that is found in your skin is Propionibacterium. This bacterium grows out of control in those with acne. P. acnes thrives in your pores that are blocked because of the lack of oxygen. P. acnes digest the oil that is trapped in the pores of your skin and produces a fatty acid waste. The waste will irritate your skin that causes the redness and inflammation. P. acnes is antibiotic resistant and cannot be washed away. However, there are treatments available that can help you treat and get rid of the bacteria in your skin. There are other factors that cause acne outside of your body. For example, hormones enlarge the pores and increase the rate of sebum production that can cause clogging. There are many different kinds of acne that you can get. These include: whiteheads, blackheads, papules, pustules, nodules, and cysts. Whiteheads, in appearance, are exactly how they are sound. This type of acne has a white head on the surface of your skin. This is caused by sebum and dead skin cells that are blocking your hair follicles. Sebum production and dead skin cell exfoliation is natural for your skin and is needed to keep your skin healthy. However, if this process goes wrong, then that is when you risk getting clogged pores because excess oil and dead skin cells will get trapped and accumulate. Blackheads are relatively similar to whiteheads and also look exactly how they sound. Blackheads are also classified as comedones and look like black dots on the surface of your skin. (Acne, 2015) However, whiteheads are closed in the pores of your skin and blackheads are open. This gives the blackheads appearance. Blackheads are formed when the blockage that is trapped inside the p ore becomes oxidized. Papules are essentially a level higher than a whitehead that has been inflamed. A papule contains bacteria, sebum, and dead skin cells similar to the whitehead, but it does not contain pus. It is set apart from whiteheads by inflammation and redness. Pustules are similar to papules, but contain pus. Pustules are small round lesions appearing whitish on the center because of the pus. Nodes and cysts are similar to each other in terms of acne types. Nodules are severely inflamed and large lesions on the deep layers of the skin. Cysts are smaller and softer pus-filled lesions. These two types of acne can occur together, creating nodular cystic acne, or independently. These types of acne begin as papules and pustules and become nodes/cysts when they become irritated. This causes them to go deeper into the skin and produce pus. Many treatments and medications to treat acne vulgaris can be bought over the counter. Over-the-counter medications and treatments are also known as OTCs. These medications and treatments do not require a prescription issued by a doctor. Treatments that can be readily obtained are known to treat mild to moderate acne. Common over the counter treatments can take the form of lotions, gels, and washes.ÂÂ   Common bases of over the counter acne vulgaris treatments include benzoyl peroxide, salicylic acid, and alpha hydroxy acids. Alpha hydroxy acids include glycolic acid and lactic acid. Benzoyl peroxide is the most common over the counter acne medication. (Mayo Clinic Staff, 2015)ÂÂ   Benzoyl peroxide is found in a variety of gels, lotions, and soaps. Benzoyl peroxide has drying qualities, which removes excess oil and dirt. Benzoyl peroxide also is effective at eradicating bacteria, which often lead to the formation of acne vulgaris. Due to its drying and cleansing properties, benzoyl peroxide also unclogs pores. Side effects of benzoyl peroxide may include rare allergic reactions, redness, dryness, and scaling of the skin. Salicylic acid is another over the counter acne medication that is used often. Salicylic acid is only available in concentrations of 0.5 to 5 percent. Salicylic acid is used primarily as a topical gel or cream that is applied to effected areas several times a day. Salicylic acid works by preventing the clogging of pores. Side effects that may occur with the use of salicylic acid include redness, dryness, and irritation. The most popular alpha hydroxy acids include glycolic acid and lactic acid. Although there are other hydroxyl acids, those acids havent proven to be as effective. Alpha hydroxy acids are synthetic acids that would normally be derived from milk and fruit sugars. Hydroxy acids work by removing the dead layer of skin cells on the top of the epidermis. Hydroxy acids do not remove the epidermis, but they do remove the first layer. Hydroxy acids also stimulate the production of new skin, which then leads to smoother, calmer acne. The two side effects of hydroxyl acids are s un sensitivity and irritation. Sulfur, another base of over the counter treatments, is especially effective at eradicating P. acnes bacterium. The P. acnes bacterium is known to have started developing antibacterial resistance. Sulfur is often combined with other acne-eradicating ingredients. Sulfur is known to dry the skin and cause it to peel off; this is helpful in terms of removing excess odor and preventing the clogging of pores. When over the counter methods of treatment do not work well, it is recommended to then visit a dermatologist. Dermatologists will properly access acne and prescribe a treatment. The three main fields of prescription treatments include topical methods, oral methods, and treatment-based methods. There is a very large variety of prescription treatments available. Although these treatments cannot be readily obtained, they are proven to be more potent and concentrated than over the counter methods. The most common topical treatments for prescription medications are retinoids, antibiotics, and dapzone. Retinoids come in the form of creams and gels. Retinoids work by preventing the plugging of hair follicles. Retinoids are derived from vitamin A and they come in many different types. Although they all serve the same purpose, retinoids include tazarotene, adapalene, and tretinoin. Antibiotics are used as topical ointments and creams to kill the bacteria inside of acne. Dapsone is also an effective topical treatment because in addition to an antibiotic, dapsone effectively works to kill bacteria and reduce inflammation. Other prescribed treatment methods are oral drugs. Oral drugs include oral antibiotics, oral contraceptives, anti-androgen agents, and isotretinoin. Oral antibiotics have a direct effect on acne by reducing inflammation and killing bacteria on the skins surface. (Mayo Clinic, 2015) Some individuals cannot be treated with antibiotics because they may have built up a tolerance to antibiotics. Doctors may also be concerned with prescribing antibiotics to treat acne because the antibiotics may be used for months, or even years. The usage of antibiotics for a prolonged period of time is likely to develop antibiotic resistance in that individual. Common antibiotics prescribed for acne include doxycycline, limecycline, minocycline, erythromycin, trimethroprim, and cortimoxazalone. Oral contraceptives are also used in women to help reduce acne. Oral contraceptives include hormones, such as estrogen and progesterone, which balances out the amount of androgen produced in the body. Anti-androge n oral pills may also be prescribed to limit the amount of androgen produced in the body. Isotretinoin is often the last resort for acne treatments because it is a pill that may cause major side effects. Although isotretinoin is very effective, it does require close monitoring by the doctor. Isotretinoin is only prescribed when all other treatment methods have failed. Women that are prescribed this treatment are required to first take part in a Food and Drug Administration monitoring program. Many other treatments prescribed by the doctor are therapies. Therapies include light therapy, which targets bacteria in the skin that cause inflammation. Chemical peels may also be conducted in a doctors office. Chemical peels are acids applied to the skin that help with the eradication of bacteria on skin.ÂÂ   Steroids can also be injected in to nodular and cystic acne to improve appearance. With the injection of steroids, extraction of the cysts and nodules is not necessary. While treating acne, an emerging problem is antibiotic resistance in acnes. The Propoinibacterium found in P. acnes, is a slow growing, thick-walled bacteria that exhibits antibiotic resistance. To treat these types of acnes, doctors must turn to other methods of treatment besides antibiotics. Antibiotic resistance in P. acnes raises concern because it is quite possible that other bacterium may begin to show similar properties. P. Acnes bacterial resistance is common in people treated with antibiotics for acne, and the resistance can spread to their family members and neighbors. (Ngan, 2014) As described above, many methods for acne suppression are available. Although many methods are available, it is important to note that not all treatments are equal in terms of effectiveness and that treatment is individualistic. When choosing an acne treatment method, it is important to know which kind of acne needs to be treated, and how severe it is. Mild to moderate cases of acne vulgaris are commonly successfully treated with over the counter treatments, and severe acne vulgaris is often treated with the help of a medical professional. According to dermatologists, all acne vulgaris is believed to be treatable after proper assessment and examination of the affected individual. Bibliography M. (2015, January 20). Acne Causes. Retrieved January 19, 2017, from http://www.mayoclinic.org/diseases-conditions/acne/basics/causes/con-20020580 M. (2015, January 20). Acne Treatments and drugs. Retrieved January 19, 2017, from http://www.mayoclinic.org/diseases-conditions/acne/basics/treatment/con-20020580 M. (2015, July 09). Over-the-counter acne products: What works and why. Retrieved January 18, 2017, from http://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-products/art-20045814 Which birth control pills can help reduce acne? (2013, January 30). Retrieved January 19, 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072393/ Writer, S. (2017, January 11). Different Types of Acne | Learn What Acne Type you Have. Retrieved January 19, 2017, from http://www.acne.com/types-of-acne/acne-signs/

Environmental Crisis Exposed in The World Is Too Much With Us and Gods

Environmental Crisis Exposed in The World Is Too Much With Us and God's Grandeur   In his poem, "The World Is Too Much With Us," William Wordsworth blames modern man of being too self-indulgent.   Likewise, Gerard Manley Hopkins shows how the way we treat nature shows our loss of spirituality in his poem, "God's Grandeur."   We are ruthless by lacking proper appreciation for, being separated from, and abusing nature.    Man lacks proper gratitude for nature.   People often are blind to nature's great beauty.   "It moves us not," says Wordsworth.   Many people never see a sunrise or a sunset because we are too concerned with the hustle and bustle of our tiny worlds to appreciate the opulence around us.   We don't recognize the creation that God has bestowed upon us.   In his poem, Hopkins shows how the Earth is God's creation:   "The world is charged with the grandeur of God." He asserts that God's work is still to be seen in nature.   We don't always realize that we get all of our wealth from nature.   We often forget that "little we see in nature is ours."   Even our bodies are part of nature.  Ã‚  Ã‚   In the Bible, it says that we were created from the dust of the Earth.   Full appreciation is not always shown for the Earth, making us cruel to nature.  Ã‚  Ã‚        Ã‚  Ã‚  Ã‚  Ã‚   Many individuals are alienated from nature.   They are separated from nature because of the deep transformation of the landscape.   There are few natural things left in landscape.   "The soil is bare now, nor can foot feel being shod."   Hopkins uses this line to explain how out of touch man is with nature.   We cannot even feel the ground under our feet because of the shoes we wear.   Mankind also fears nature.   We are afraid of   "The winds that will... ...   We are separated from nature, we fear nature, and we mistreat animals.   Man also abuses nature.   We use nature to make money, we overuse nature, and we pollute nature.   Mankind is tremendously callous to the environment.   We must be sensitive to nature or the Earth will become like the world in H.G. Wells' novel, The Time Machine.   It will be filled with frail Eloi.   Underground there will be white, ape-like Morlocks.   Giant crabs will roam beaches, and the only remnant of the world today will be artifacts kept in a Museum of Green Porcelain.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚      All should read Hopkins's poem, "God's Grandeur," and Wordworth's poem, The World Is Too Much With Us so everyone will realize the man's responsibility to nature.   If we want our children and grandchildren to enjoy the quality of life we have today, environmental problems must be corrected now.   

Aprasia

l Burns: Understanding Nursing Research, 5th Edition Appraisal Exercises Critical Appraisal Guidelines for Qualitative Studies Research Article: Stress and nursing care needs of women with breast cancer during primary treatment: A qualitative study QUALITATIVE CRITICAL APPRAISAL GUIDELINES|KEY CONCEPTS INAPPRAISAL| Problem Statement1. Identify the clinical problem and research problem that led to the study. 2. How did the author establish the significance of the study? In other words, why should the reader care about this study? || Purpose and Research Questions1. Identify the purpose of the study. . List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. 3. Were the purpose and research questions related to the problem? 4. Were qualitative methods appropriate to answer the research questions? || Literature Review1. Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? 2. Are the references current? 3. Identify the disciplines of the authors of studies cited in this paper.Does it appear that the author searched databases outside of CINAHL for relevant studies? 4. Did the author evaluate or indicate the weaknesses of the available studies? 5. Did the literature review include adequate information to build a logical argument? Another way to ask the question: Did the author provide enough evidence to support the verdict that the study was needed? | 4. The author mentioned limitations of the study by a bias. Some women who were mentally unstable, or if the nurses felt as if they would be over whelmed with the interview were excluded. 5.The author did go into detail about the many things that are need for a patient with breast cancer. | Frame of Reference 1. Did the author identify a specific perspective from which the study was developed? If so, what was it? 2. When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? |1. The author did not mention a specific form which the study was developed. In my opinion it was developed to help with the coping of breast cancer in women. 2.The framework was to include the specific strain influencing the women affected during the time, the needs and expectations they had of the nurses. | Research Tradition1. Identify the stated or implied research tradition upon which the study was based. 2. Were the methods used in the study consistent with the research tradition? |1. There was not a stated research tradition stated but the implied one was phenomological research because it was based on real life situations. 2. The method used was consistent with the research tradition. The participants were interviewed and allowed to answer questions.They touched on many aspects of the strains when dealing with breast cancer. | Sampling and Sample1. Identify how subjects were selected. 2. At what sites were subjects recruited for the study? Did the sites for recruitment fit the sampling needs of the study? 3. What were the inclusion and exclusion criteria for the sample? 4. Were the selected subjects able to provide data relevant to the study purpose and research questions? 5. How many people participated in the study? Did any potential subjects refuse to participate? Did any of the participants start but not finish the study? |1.The 42 women were chosen by the nurses ate the hospital. They had to meet the following criteria early tumors, no further metastases elsewhere, no malignant pre-existing disease or neoadjuvant therapy, and the ability to understand the German language. Pg. 122. The patients were recruited while impatient in the hospital. That was a proper site for recruitment for this study because they were determining the stress and nursing care. 3. The inclusion was aimed at women with breast cancer in the stage of surgical procedures as primary therapy. The average ages of the women were 55 and the youngest person was 33 and the oldest was 79. g12 | Data Collection1. How were data collected in this study? 2. What rationale did the author provide for using this data collection method? 3. Identify the time period for data collection of the study. 4. Describe the sequence of data collection events for a participant. || Protection of Human Participants1. Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? 2. How were recruitment and consent techniques adjusted to accommodate the sensitivity of the subject matter and possible vulnerability of participants? . How were data collection and management techniques adapted in acknowledgment of participant sensitivity and vulnerability? || Data Management and Analysis1. Describe the data man agement and analysis methods used in the study. 2. Did the author discuss how the rigor of the process was assured? 3. What measures were used to minimize the effects of researcher bias? 4. Did the data management and analysis methods fit the research purposes and data? || Findings1. Did the findings address the purpose of the study? 2. Were the data sufficiently analyzed? 3.Were the interpretations of data congruent with data collected? 4. Did the researcher address variations in the findings by relevant sample characteristics? || Discussion1. Did the results offer new information about the target phenomenon? 2. Were the findings linked to findings in other studies or other relevant literatures? 3. Describe the clinical, policy, theoretical, and other significance of the findings. Does the author explore these applications? || Logic and Form of Findings1. Were readers able to hear the voice of the participants and gain an understanding of the phenomenon studied? . Were elements of the research report easily found by readers? 3. Did the overall presentation of the study fit its purpose, method, and findings? 4. Was there a coherent logic to the presentation of findings? || Evaluation Summary1. Do the findings provide a credible reflection of reality? If so, how can the findings be used in nursing practice? 2. What do the findings add to the current body of knowledge? 3. State the conclusion of the critical appraisal of the study. || References cited in this appraisal that were not cited in the article:

The Withdrawal of Shareholders - Free Essay Example

Sample details Pages: 5 Words: 1478 Downloads: 10 Date added: 2017/06/26 Category Business Essay Type Analytical essay Did you like this example? Considering the many unfavorable results of company dissolution, it can be appointed in the articles of association that the withdrawal of shareholders should be the pre-procedure for dissolution of the company. Only when shareholders cannot agree upon their ways of withdrawal, the company takes the act of dissolution. Therefore, the author suggests that the company regulates in the articles of association that the withdrawal of shareholders should be a necessary procedure before the resolution of the company. But it should not force different parties of the shareholders to agree upon this resolution. Shareholders should be allowed to discuss on this matter, the best result is to form a resolution, but if a resolution cannot be made, the dissolution of the company is employed. Since dissolution of the company is the last measure for company to resolve corporate deadlock, it should be regulated in the articles of association, so that the company can enter into the dissolution process and thereby break the corporate deadlock. At the time of the establishment of a company, it allows shareholders to choose their ways of withdrawal according to their wishes and the actual situation of the company. It must be noted that the first approach is the best strategy. Not only does it allow the company to continue to exist, the procedure of it is simple. The second approach may well be a good way to resolve the corporate deadlock, especially for large-scale enterprises with good assets and good operating state. It is a move that can be boldly took on the condition that it does not damage the creditors’ interest. However, this approach involves reducing the company’s registered capital. Shareholders should form resolution on the reduction of capital (it is a difficult move in the case of the loss of mutual trust among shareholders). The company should notify known creditors and make newspaper announcements, but at the same time safeguard t he interests of creditors. It can be seen that the procedure of the second approach is more complicated than the first approach. And it also involves complex issues such as the protection of creditors and equity price. Therefore, for company with poor operating conditions, non-performing assets and debt, it should be cautious when adopting the second approach in case the withdrawal of one side of the shareholders may result in the situation where the company’s asset is insufficient to cover the debt, and therefore damages the creditors’ interest, especially when some shareholders attempt to withdraw their capital to circumvent their shareholder responsibilities. For these reasons, the author is inclined to the first approach. It has been mentioned that when taking the first approach, it is unfair to force one party to transfer their shares. The way of transfer should be allowed to be discussed. In order to determine the transfer and buyer of the shares, there is a à ¢â‚¬Å"bidding process† that can be referred to in the judicial practice. In the bidding process, the articles of association provide the bids. Within a prescribed period of bid, shareholders with the highest price become the buyer, while shareholders who do not participate in the bidding or offer a lower price have to transfer their shares. In such way, the company solves the transfer problem with a bid. The author believes that the transfer of shares is very complicated. There are plenty ways of transferring, for example, it can be transferred internally or externally. There are many shareholders in the internal transfer. To decide which shareholder to transfer to and the price of transfer can be a bother. It is difficult for the articles of association to cover all the situations. And often the more it regulates, the more possible vulnerabilities there are. Therefore, the author believes that the company does not need to have specific provisions on transfer in the articles o f association. It only needs to make sure that the transfer is a necessary pre-procedure. All sides can discuss upon this matter. And if a resolution cannot be formed, then the company dissolved. Therefore, the author suggests that the articles of association regulate the following: If the Board of Directors could not form effective resolutions on matters that need to be resolved, then the meeting should be postponed and reconvened twenty-four hours later. If the board reconvened is still unable to form any effective resolution, it should keep detailed records of relevant discussions and hand them over to shareholders or designated representatives for further discussion and resolution. Within forty-five days after the board meeting reconvened, if shareholders or designated representatives still could not form any effective resolution, shareholders should discuss on the purchase of equity by one side of the shareholders from the other side. If shareholders fail to reach an a greement on the sale of equity, either party may inform the other party by written notice to convene a board meeting to discuss the dissolution of the company. Shareholders should urge directors to attend the meeting and agree to sign the resolution on the dissolution and liquidation of the company. It should be noted that, Article 75 in â€Å"The Law of Corporations† provides the shareholders withdrawal system, but it does not specify whether the corporate deadlock conforms to its regulations. The Article 75 regulates: â€Å"Under the following circumstances, shareholders who vote against the resolution may request the company to purchase their shares at a reasonable price: 1. The company does not distribute profits to shareholders for five consecutive years, while the company is actually profitable during the five years, and it conforms to the profit distribution conditions regulated in this provision; 2. The company merges, divides or transfers its main property; 3. Du e to the expiration of the term of the operation of the company as regulated in the articles of association, or other reasons for the dissolution of the company, the shareholders’ meeting forms an resolution to revise the articles of association and continue the existence of the company. Within 60 days after the meeting form the resolution, if shareholders cannot come to a purchase agreement with the company, they can institute a proceeding against the company within 90 days after the meeting. The author believes that the withdrawal situation as provided in the provision contains three parts: the shareholders’ meeting has form a resolution, shareholders who withdraw vote against the resolution, and it is the company who buys back the shares rather than other shareholders. But in the case of corporate deadlock, it is impossible for shareholders to from any resolution. And for Sino-foreign joint ventures, the organizational structure of the company is the board of direct ors rather than the board of shareholders. Therefore, provisions of the Article 75 in â€Å"The Law of Corporations† do not apply to the corporate deadlock of joint ventures. Section II Solution during the Event Solution during the event means when conflict among shareholders and directors has already affected the company’s management and operations, the company solves the deadlock through mediation and arbitration. Of course, mediation and arbitration can be applied to any stage of corporate deadlock, that is before, during and after the event. Before the event, the company can regulates in the articles of association that mediation should be a necessary pre-procedure when breaking the corporate deadlock. It can appoint a third person as the mediator. Both sides should cooperate with the mediator. Or the company can regulate in the articles of association the arbitration clause or arbitration agreement before the proceeding, so that it can refer to the arbitrati on for the corporate deadlock. Shareholders and directors can also mediate during and after the event to solve the corporate deadlock through mediation and arbitration. Either party can ask a third person to mediate. In order not to be lengthy and at that same time highlight the key point, the author will discuss the measures of mediation and arbitration during the event in this section. But in fact, as mentioned before, mediation and arbitration can be applied to any stage of the corporate deadlock. Mediation as the Necessary Pre-Procedure for the Resolution of Corporate Deadlock It is when there is problem in the â€Å"collaboration† of the company, directors or shareholders begin to take opposite attitudes and act against each other. Mediation can help to ease the conflicts and reconcile shareholders and directors. Life tells us that many things are not irreconcilable. By mediation of a third party, conflicts can be resolved, and misunderstanding can be eliminated. E specially for dispute caused by poor communication or momentary impulse, mediation can help resolve contradictions. Mediation has a direct effect on the conflicts. It is easy to use. And it consumes little social resources. Therefore, when corporate deadlock occurs, medication should be the first measure to be taken. The author suggests that a company can regulate in the articles of association that mediation should be a necessary pre-procedure when solving the corporate deadlock, and it can appoint a third party as the mediator. Don’t waste time! Our writers will create an original "The Withdrawal of Shareholders" essay for you Create order