Research On Children With Speech Language Impairment

Jana Bangayan May 13, 2016 GIVE A TITLE FOR THE PAPER 1. Citation: Washburn, A. J., Myers, S. S. (2010). Advancing Research on Children With Speech-Language Impairment: An Introduction to the Early Childhood Longitudinal Study - Kindergarten Cohort. Language, Speech, And Hearing Services in Schools, 41, 61-69. Retrieved May 6, 2016. 2. Purpose Of The Article Study: There have been a rising proportion of single-parent families, an increasing number of working mothers, and an increasing number of children with special needs. Due to these occurring societal shifts in the United States, the Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K) was conducted to study children in the United States who began kindergarten in 1998. In order to identify the contributions of families, classrooms, and schools that effectively promote child development, the U.S. Department of Education and the National Center for Education Statistics have prompted the ECLS-K to understand the processes of children’s learning development. The purpose of this study was for ECLS-K to provide information for researchers explaining the factors such as cultural differences, family processes, learning styles, educational preferences, and educational resources provided to children during their elementary and middle school years. The study was to explain ho w factors have greatly contributed to each child’s socio-emotional and academic growth. In particular, the U.S. Department of Education Office ofShow MoreRelatedMethods Used in Collecting Data1608 Words   |  6 PagesCHAPTER THREE RESEARCH METHODOLOGY Introduction This chapter presents the methods used in collecting data, how the data was processed and analyzed. 3.1 Research design A case study approach was used and it was confined to Harare Southern District. The case study allowed the researcher to gain in-depth knowledge of the problem. The behavior of parents of children affected with speech and language impairment was analyzed using the case study. The case study was of importance as it gatheredRead MoreEffect Of Therapy On Mainstream Schools Children With Language Impairments961 Words   |  4 Pagestherapy on mainstream school children with pragmatic language impairment, often abbreviated PLI. Pragmatics is the social language skills used in daily communications with others which include; what is said, how it is said, and with body language. The study was done on six male children with a mean age 7; 12 years (range = 5; 11 to 9; 9). The study aimed to determine the effects of intervention through a set of tests, some standardized, on mainstream school children with PLI and see the effects.Read MoreTargeting Specific Skills1158 Words   |  5 Pagesin Preschool Children with SLI When selecting a treatment approach to use with a child in speech-language therapy, one should consider the principle of selecting an approach based on a specific skill or an underlying process which is related to that skill. The principle of treating a specific skill versus an underlying process that is a requisite for that skill should be considered when planning treatment to target emergent literacy skills in children with specific language impairment (SLI). As willRead MoreExplain Some Ways in Which Environment Can Be Structured to Facilitate Communication in Children/ Young People with Slcn1631 Words   |  7 Pagesways in which environment can be structured to facilitate communication in children/ young people with SLCN Introduction. Speech, language and communication play a vital role in our lives. Without being able to talk to, and understand other people we can’t do things alike: Almost everything we do involves speech, language and or communication Children develop communication skills from birth. They rely on speech, language and communication to be able to learn at school and play with their friendsRead MoreDysarthria - Speech Disorder1321 Words   |  6 Pagesto one another. We speak using our voices and interacting with other people, who for the most part, speak the same language. When two different languages are put into one conversation it may make communicating difficult but not impossible. There are things that make communicating much more difficult than just having a language barrier. There are many people who have an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbols systemsRead MoreChildhood Apraxia Of Speech : A Motor Speech Disorder1715 Words   |  7 PagesApraxia Of Speech (CAS) Childhood apraxia of speech is a motor speech disorder. In CAS a child might have problems performing the correct movements for speech due to signaling problems between the brain and the muscles used for speech production. This signaling problem causes the child to have difficulty learning accurate speech movements. Speech movements that a normal developing child learns with ease are difficult for a child with apraxia of speech. The cause of childhood apraxia of speech is unknownRead MoreThe Effects Of Traumatic Brain Injury ( Tbi )805 Words   |  4 Pagesoccurrences in children. These are bruises in the brain which occur when an impact to the head causes the brain to shake back and forth against the skull. Children, including preschoolers, toddlers, and even infants, often bruise or bump their heads from variety of methods, including motor vehicle or bicycle accidents, falls from heights (beds, stairs, etc.), and sport related impacts (Duhaime et al., 1992). Occasionally, these impacts can be hard enough and result in a TBI. Some children may also incurRead MoreLanguage Impairment Of Children With Autism1355 Words   |  6 Pagesâ€Å"Language Impairments in Children With Fetal Alcohol Spectrum Disorder† from the Journal of population therapeutics and clinical pharmacology The purpose of this study was to identify pronounced deficits in the language of children with FASD. There were fifty children in this study. 27 of the children (10 female) with FASD, and 23 typically developing control children (9 females), ages 5-13. The children with FASD had been diagnosed with an alcohol related disorder. This study analyzes language inRead MoreThe Autism Screening Instrument For Educational Planning1400 Words   |  6 PagesWhen diagnosing autism spectrum disorder, it is crucial for the professional evaluating the child to know about the disorder. This is why speech-language pathologists normally play a part in the diagnosis. Other members of the team may include occupational therapists, physical therapists, pediatricians, and neurologists. Since problems with communication and social skills are early symptoms of this disorder, SLPs play a main role in the diagnosis and should be consulted early in the evaluationRead MoreADHD936 Words   |  4 Pageshypoth esized that within inpatient settings disorganized speech and impoliteness does not impact on peer social engagement, but may do so in other environments. Aphasic clients tended to be more coherent when discussing positive emotions (Borod et al., 2000). Research found that individuals with ADHD appear to have impairment in coherence tasks. In a sample of 49 children with ADHD and a control group, the ADHD group had significantly more impairment in regards to creating a causal structure and goal

The Storm Free Essays

It was a normal mid August afternoon, and as I plodded along the ordinary, yet somewhat apprehensive North Close, I knew something was wrong. My insides started to become tight, and my stomach rolled around and around, as if it was doing somersaults. I cautiously turned around. We will write a custom essay sample on The Storm or any similar topic only for you Order Now Nothing. My insides were getting tighter, and a sharp pain, as if someone had thrusted a blunt dagger into my side, started. I fell to the floor, almost knocked unconscious by the ever increasing pain. Salty tears rolled down my face, as I struggled and fought my way to my feet. Suddenly, the sharp stabbing pains had vanished. Nothing. Again, I turned round, this time not knowing what, if anything, was behind me. Again, nothing. I stared at the August sky, and soon realised that something wasn’t right. Those clouds, those big black malicious looking clouds, growing larger and larger, spreading left and right, covering every millimetre of the cobalt blue sky. They were unlike normal clouds. They were a rich black colour, like the colour of soot, and seemed almost human-like. My stomach churned again, and the pain returned, this time, stronger and more painful than before. I staggered home, tears flowing down my cheeks, and splashing onto the hard, rocky pavement. I could see my ouse in the distance. Coloured hay yellow and on the corner of Colorado Close and Main Street, it was extremely distinctive, and couldn’t be mistaken, although one really annoying and bothersome drunk continuously argues that it is a pub. I stopped, just short of the pelican crossing, and listened. The noticeable rumble of thunder filled the sky, and a large crack of lightning blasted through the air. A long pause, so long in fact, that it felt like an eternity. Nothing, not even the minute sound of a travelling car, or the scurrying of a terrified cat, just an unearthly silence. I continued to teeter and totter home, the pain becoming How to cite The Storm, Papers

Heroes free essay sample

Basically, heroes have a vision for society and their principles function as a catalyst that motivates the society. In addition to having ideas, heroes are brave. Unlike other people they have tremendous energy and patience to struggle with the adversity. Most people settle for the status quo because in reality they dont want to put themselves in danger or risk themselves for others. Heroes are brave enough to take risk for people and society and they never try to escape from hardship. In an article Heroism Must Mean More Than Sympathy, Nicholas Thompson (2002) writes, Heroes could earn that title simply for incredible acts of ravery several steps above the call of duty. He states that heroes do more than there is their duty. Most people simply perform their duty and focus on themselves for their own betterment. Heroes are remarkably brave in comparison to people in general. They genuinely make effort to protect right of society and people. We will write a custom essay sample on Heroes or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page For example, Amar Singh Thapa, a General of army in Nepal during British colonization in India and many other countries of Asia proved his bravery. At the time of British colonization in Asia, British army attacked the territory of Nepalese land. General Amar Singh Thapa fought against powerful British troop. In spite of lack of food for few days he continued war. At last British Army could not fight in such a hardship and Amar Singh won war against British. General Thapa protected country from British colony and saved Nepalese sovereignty and land. All Nepalese are proud of his bravery and his bravery is an exemplary in Nepal. For his bravery Nepalese admire to call him national hero of bravery. In other words, heroes act bravely in order to protect society and people by taking undesirable risk in their life. Finally, heroes have special skill and talent. Their skill and talent is enables them change the society in forward direction. Their creation and innovation are noteworthy. A person becomes hero because of his or her potential skill and talent to work for society (Brown, 1990; Psychology Today, 1995). Heroes have extraordinary skill and talent, which attract society and helps the society a great deal. For an example, Bill Gate has special talent and skill in development of computer software. Before Bill Gate developed software, computers were barely in use in public. The application of his software in the operating system in computers brought a big change in todays world. People admire such a skilled and talented person who brought a total change in this world. His outstanding talent and skill in software is praiseworthy. Mostly people emulate other’s work and learn from others. Since heroes posses special skill and talent, they are naturally creative and innovative. New inventions and creative thinking always attract a community if it can help society to move in right direction efficiently. For such promising work, they deserve to be called a hero. Heroes always help society and individuals to change and are a role model in society. Over all heroes have some characteristics in common that influence society and individuals. They live in heart and mind of people because of their extraordinary principles, bravery, skill and talent. References Browne, R. (1990). Heroes and Heroines. Detroit: Gale Research Inc. How to be great? What it takes to be a hero? (1995, November-December). Psychology Today,28, 46. Thompson, N. (2002, January 15). Heroism must mean more than sympathy. The Oregonian. Tollefson, T. (1993, May-June). Is a hero really nothing but a sandwich? Utne Reader.

Vietnam Logistics Report Essay Example

Vietnam Logistics Report Essay US economic and military aid to South Viet Nam grew through the 1960s in an attempt to bolster the government, but US armed forces were withdrawn following a cease-fire agreement in 1973. Two years later, North Vietnamese forces overran the South reuniting the country under Communist rule. Despite the return of peace, for over a decade the country experienced little economic growth because of conservative leadership policies, the persecution and mass exodus of individuals many of them successful South Vietnamese merchants and growing international isolation. However, since the enactment of Viet Nams doi moi (renovation) policy in 1986, Vietnamese authorities have committed to increased economic liberalization and enacted structural reforms needed to modernize the economy and to produce more competitive, export-driven industries. The country continues to experience small-scale protests from various groups, the vast majority connected to land-use issues and the lack of equitable mechanisms for resolving disputes. Various ethnic minorities, such as the Montagnards of the Central Highlands and the Khmer Krom in the southern delta region, have also held protests. We will write a custom essay sample on Vietnam Logistics Report specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Vietnam Logistics Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Vietnam Logistics Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Economy Overview Viet Nam is a densely-populated developing country that in the last 30 years has had to recover from the ravages of war, the loss of financial support from the old Soviet Bloc, and the rigidities of a centrally-planned economy. Since 2001, Vietnamese authorities have reaffirmed their commitment to economic liberalization and international integration. They have moved to implement the structural reforms needed to modernize the economy and to produce more competitive export-driven industries. Viet Nams membership in the ASEAN Free Trade Area (AFTA) and entry into force of the US-Viet Nam Bilateral Trade Agreement in December 2001 have led to even more rapid changes in Viet Nams trade and economic regime. Viet Nams exports to the US increased 900% from 2001 to 2007. Viet Nam joined the WTO in January 2007 following over a decade long negotiation process. WTO membership has provided Viet Nam an anchor to the global market and reinforced the domestic economic reform process. Among other benefits, accession allows Viet Nam to take advantage of the phase-out of the Agreement on Textiles and Clothing, which eliminated quotas on textiles and clothing for WTO st partners on 1 January 2005. Agricultures share of economic output has continued to shrink from about 25% in 2000 to less than 20% in 2008. Deep poverty has declined significantly and is now smaller than that of China, India, and the Philippines. Viet Nam is working to create jobs to meet the challenge of a labor force that is growing by more than one-and-a-half million people every year. The global financial crisis, however, will constrain Viet Nams ability to create jobs and further reduce poverty. As global growth sharply drops in 2009, Viet Nams export-oriented economy exports were 68% of GDP in 2007 will suffer from lower exports, higher unemployment and corporate bankruptcies, and decreased foreign investment. 3/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 1. 1. 1. Basic Facts Basic Facts Capital Languages Ethnic Groups (1999 Census) Religions (1999 Census) Country Size (comparison) Population Density (map) Source: CIA – The World Fact Book 2009 Ha Noi (Ha Noi) Geographic Coordinates: N 21 ° 02’, E 105 ° 51 Vietnamese (official) English (increasingly favored as a second language) French Chinese Khmer Mon-Khmer and Malayo-Polynesian (Mountain area languages) 86. 2% Kinh (Viet) 1. 9% Tay 1. 7% Thai 1. 5% Muong 1. 4% Khome 1. 1% Hoa 1. 1% Nun 1. 0% Hmong 4. 1% Others 80. 8% None 9. 3% Buddhist 6. 7% Catholic 1. 5% Hoa Hao 1. 1% Cao Dai 0. 5% Protestant 0. 1% Muslim Country comparison: Between Germany and Norway (Ranking 65) Country comparison to the world: Between Mexico and Ethiopia (Ranking 13) Source Map: www. eliefweb. int Population Density within and outside a 10m Low Elevation Costal Zone: 4/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 Basic Facts Border Countries Source: CIA – The World Fact Book 2009 Total Borderline: 4,639 km Coastline: 3,444 km (excludes islands) Cambodia 1,228 km China 1,281 km Laos 2,130 km Territorial Sea: 1 2 nm Contiguous Zone: 24 nm Exclusive Economic Zone: 200 nm Continental shelf: 200 nm or to the edge of the continental margin Commodities: Crude Oil, Marine Products, Rice, Coffee, Rubber, Tea, Garments, Shoes Total Exports: $62. 9 billion (2008 est. ) Exports Partners: US 18. 9%, Japan 13. 6%, China 7. 2%, Australia 6. 7%, Singapore 4. 2% Country comparison to the world: 51 Commodities: Machinery Equipment, Petroleum Products, Fertilizer, Steel Products, Raw Cotton, Grain, Cement, Motorcycles Exports Imports Total Imports: $75. 47 billion (2008 est. ) Imports Partners: China 19. 4%, Singapore 11. 6%, South Korea 8. 8%, Thailand 6. 1% (2008) – Country comparison to the World: 43 Paddy rice, coffee, rubber, cotton, tea, pepper, soybeans, cashews, sugar cane, peanuts, bananas; poultry; fish, seafood Agricultural Products 1. 1. 2. Country in Figures General Information Country Size Population Population Growth Rate GDP per capita Population under poverty line (%) HIV Prevalence (%) Time Zone (GMT +/-) Climate Description Currency Telephone dialing code Driving Source: CIA – The World Fact Book 2009 Total surface: 331,210 sq km Land surface: 310,070 sq km Water surface: 21,140 sq km 86,967,524 (July 2009 est. ) 0. 98% (2009 est. ) Country comparison to the world: 128 US $2,800 (2008 est. ) Country comparison to the world: 168 14. 8% (2007 est. 0. 5% (2007 est. ) Country comparison to the world: 73 UTC+7 Tropical in the south; monsoonal in the north with a hot rainy season (May to September) and a warm dry season (October to March) Dong (VND) + 84 Right Requirement for Viet Nam visa is varied from embassy to embassy. Hereafter Viet Nam visa requirements if you using online visa services. 1. Send your visa request by applying online at www. visatoViet Nam. org then the servic es will arrange a pre-approved letter for the delivery of a Viet Nam visa on arrival at the airport. Within 12 business hours after receiving final confirmation on payment, services will send the pre-approved letter with code for Viet Nam visa. 2. Using the pre-approved letter with the code sent by the services and 2 photos size 2in x 2in or 5. 08cm x 5. 08cm for pick up visa stamped on the passport. 3. The passport validity must exceed 1 month based on the specific visa, for example, the passport must valid at least 2 months if the required visa is for 1 month, or the passport must be valid at least 4 5/70 Visa requirements and cost LCA – Viet Nam – Initial Assessment 2009 Version 1. 5 months if the required visa is for 3 month. 4. The service fee is US $ 20 and has to be paid for in advance, 5. The stamp fee will be paid at the airport or at check-in point or at embassy. Stamp fee tarif as following : Viet Nam stamp fee for single entry visa of 1, 3 or 6 months : US$25 Viet Nam stamp fee for multiple entries visa of 1, 3 or 6 months : US$50 Viet Nam stamp fee for 1 year multiple entries visa : US$100 Source: www. visatoViet Nam. org Money Parity and Inflation Year 2009 (Nov 2009) 2008 2007 2006 2005 2. 2. Source: CIA – The World Fact Book www. Viet Namtravel. org Exchange Rate: US$ = Dong (VND) Rate of Inflation 17,690 24. 4% 16,548 8. 3% 16,119 7. 5% 15,983 8. 3% 15,746 9. 5% Humanitarian Background 2. 2. 1. Disasters, Conflicts Migration History Sources: Viet Nam Country Risk Profile Report 2009 – World Bank UN Natural Disasters Emergencies Programme Coordination Group (PCG 10) Overview Because of its topography, Viet Nam is susceptible to typhoons, floods, droughts, sea water intrusion, landslides, forest fires and occasional earthquakes of which typhoons and floods are the most frequent and most devastating hazards. The storm season lasts from May to December with storms hitting the northern part of the country in May through June and moving gradually south from July to December. Given the massive concentration of its population along the coastline and in the low lying deltas, disasters cause a high loss of life and damaged livelihoods. The encroachment of economic activity and development into marginally suitable areas such as floodplains, costal swamps, drainage channels or other natural buffers only adds to the vulnerability of the population. Disasters, Conflicts Migration Natural Disasters Drought Yes Earthquake Yes Frequency Comments Medium Low/Medium According to the Ministry of Natural Resources and Environment Viet Nam has approximately 30 earthquakeprone areas Medium Outbreaks of known communicable diseases continue to occur regularly in Viet Nam and the region. Of particular concern is planning and preparedness for an influenza pandemic, a rare but recurrent event Low Cold spells affect Northern Viet Nam High -. More than one million people are affected by annual flooding in Viet Nam Epidemic Extreme Temperature Flood Yes Yes Yes 6/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 Insect Infestation Yes n/a Slides Volcano’s Wave/Surge Wild Fires Wind Storm / Typhoons Man Made Civil Strife International Conflict Displaced in Country Refugees in Country Yes No Yes Yes Yes High Landslides are a common type of disaster in Viet Nam, consisting of river bank erosion, coastline erosion, and landslides on mountain slopes, etc. n/a Low Though a tsunami has not yet happened in Viet Nam, many coastal areas of Viet Nam may be affected by a tsunami due to the earthquake potential that exists in some neighboring countries. Medium High The storm season lasts from May to December The frequency and intensity of tropical cyclones originating in the Pacific have increased over the last few decades and pose as one of the major disasters affecting Viet Nam No No No No Nearly a half million people had settled in the West before the 1987 Comprehensive Plan of Action ended in 1996. 110,000 Vietnamese who risked pirates and drowning on the high seas in an attempt to gain asylum in the West were rejected and sent home, some after languishing for years in refugee camps around the region. The majority have successfully reintegrated, allowing UNHCR in late 1998 to significantly reduce 25 years of activity in the Southeast Asian nation. Source: UNHCR Refugee Magazine 1999 In 2003, 166 casualties reported, down from 237 in 2001, however, estimates include 1,110 people killed and 1,882 injured every year on average Source: Handicap International Belgium 2003 Refugees from country Yes Landmines year Casualties / Yes *: www. em-dat. net/disasters/countryprofiles. php Centre for Research on Epidemiology of Disasters, Belgium /70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 2. 2. 2. Calamities and Seasonal Affects Seasonal Affects on Transport Transport Primary Road Transport Secondary Road Transport Rail Transport Air Transport Waterways Transport Comments Landslides, congestion Landslides, congestion Landslides, congestion From May to December May to December May to December Seasonal Affects on Storage and Handling Activity Storage Handling Other 2. 2. 3. Comments Shortage No affect From May to December May to December Capacities to Respond to Emergencies Government The Government of Viet Nam holds primary responsibility for providing humanitarian assistance to people in need. The United Nations Natural Disasters and Emergencies Program Coordination Group ( PCG 10) serves as a forum for UN agencies, including FAO, UNDP, UNICEF, UNFPA, UNIFEM, UN HABITAT, WHO, IOM and WB. The objective of this Preparedness Plan is to ensure coordination of UN assistance to the Government of Viet Nam (GoV) in respect to disaster risk reduction, disaster preparedness, mitigation, relief/ rescue, rehabilitation and reconstruction. The National Disaster Mitigation Partnership is the Government of Viet Nam’s counterpart to the PCG 10. The PCG 10 is expected to maintain close coordination with their Government counterparts, the National Cluster Leads. On the 5 ASEAN Regional Forum on Disaster Relief, (Dec 2005) the Vietnamese delegate stressed on the necessity inter-agency coordination, especially between the military and civilian agencies. Illustrating the government response measures and capacities in providing humanitarian assistance, the International Federation of the Red Cross and Red Crescent (IFRC) reports on the operations (IFRC DREF Final operations report, 8 July 2009) following the Typhoon Hagupit: â€Å"Following the weakening of Typhoon Hagupit from a full-fledged typhoon into a tropical depression, heavy rains caused flash floods and landslides in 11 northern provinces of Viet Nam on 26-28 September 2008. Of these, the provinces of Bac Giang, Lang Son, Quang Ninh and Son La suffered the worst results. Flooding was severe in many areas, particularly in the Bac Giang province where up to 62 communes and towns in three districts were submerged. In Quang Ninh province, as many as 70 communes in six districts were under deep water (†¦). Response from the central government in the wake of the disaster was mainly through the mobilization of army troops to evacuate affected people to safer and higher places such as cement buildings. After the immediate emergency, the government also worked through the health sector to provide Chloramine B to purify water, or support in cash of VND 2 million (USD 115) per family who lost family members in the disaster. Local governments in their respective provinces immediately reacted during the emergency by providing instant noodles and water to those affected. Later assistance was mainly from local donors such as entrepreneurs, religious groups or organizations in the form of cash, instant noodles, rice or cloth, but in limited quantities. † th 2. . 3. 1. 8/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 Ministry Address Ministry of Agriculture and Rural Development (MARD) 2 Ngoc Ha Street, Ba Dinh, Ha Noi , Viet Nam Disaster Management Center, 2 Ngoc Ha Street, Ha Noi, Viet Nam 2. 2. 3. 2. Name Address Contact Details Tel: +84 4 823 5804 Fax: +84 4 823 0381 ICARD: Tel: +84 4 733 2160 +84 4 823 5804 Fax: +84 4 823 0381 Web: www. agroviet. gov. vn Tel: +84 4 3733 5805 Email: [emailprotected] gov. vn [emailprotected] gov. vn Mr. Dang Quang Minh – Director Email: dqminh. [emailprotected] com Humanitarian Community Contact Details Tel: +84 4 3942 1495 Fax: +84 4 3942 2267 Contact Details Tel: Fax: Email: Tel: +84 4 3942 4208 Fax: +84 4 3942 3257 Web: www. fao. org. vn Tel: +84 4 826 3703 +84 4 942 8926 Fax: +84 4 942 4285 +84 4 826 3703 Web: www. redcross. org. vn Email: [emailprotected] org. vn Phone: +84 4 762 8422 Fax: +84 4 762 8423 Email: [emailprotected] org. vn Web: www. cecivietnam. org Tel: +84 4 3 573 5050 Ext 230 Fax: +84 4 3 573 6060 Web: www. savethechildren. net/vietnam Tel: +84 4 3945 4362 Ext 121 Mob: +84 913 520 770 Fax: +84 4 3945 4365 Tel: +84 4 942 5706 Fax: +84 4 942 5705 Email: Ha Noi. [emailprotected] org Web: www. unicef. org Tel: +84 4 6251 0448 Fax: +84 4 6251 0576 Email: [emailprotected] com Web: www. samaritanspurse. org Humanitarian Coordination Name Address Contact John Hendra – UNDP Resident Coordinator 25-29 Phan Boi Chau, Ha Noi, Viet Nam Coordination Mechanisms, Committees Groups Name Address Contact OCHA FAO 3 Nguyen Gia Thieu Street, P. O. Box 63, Ha Noi, Viet Nam VRC 82, Nguyen Du Street, Ha Noi, Viet Nam CESI Block P, La Thanh Hotel, 218 Doi Can Street P. O. Box 233, Ha Noi, Viet Nam Save the Children Building E3, Trung Tu Diplomatic Compound, 6 Dang Van Ngu Street, Ha Noi, Viet Nam Oxfam th 6 Floor, 22 Le Dai Hanh District Hai Ba Trung Ha Noi, Viet Nam UNICEF 81A Tran Quoc Toan, Hoan Kiem District Ha Noi , Viet Nam Samaritan’s Purse 24. T1 – Suite 2405 Hoang Dao Thuy St, Ha Noi, Viet Nam N/A Andrew Speedy FAO Representative andrew. [emailprotected] org Mr. Tran Ngoc Tang (Ph D) President Mr. Doan Van Thai (MA) V. President and Secretary Gen Arne Anderson Logistics Delegate, IFRC Phan Cong Tuan Country Representative Ngoc Anh Nguyen Ngoc Anh Admin Manager Email: [emailprotected] rg. v n Provash Mondal Humanitarian Programme Coordinator in Viet Nam Email: [emailprotected] org. uk Mr. Jesper Morch (Danish) UNICEF Representative Email: [emailprotected] org Mr. Jean Dupraz (French) Deputy Representative Email: [emailprotected] org Stephen G. Copple Country Director 9/70 LCA – Viet Nam – Initial Assessment 2009 Ver sion 1. 05 2. 3. National Regulatory Departments Ministry Name Address Ministry of Finance 28 Tr n Hung D o, Ha N i, Viet Nam Summary of Role and Services Contact Names Email Minister: Vu Van Ninh V. Minister: Nguyen Cong Nghiep Email: [emailprotected] ov. vn Contact Details Tel: +84 4 220 2828 Fax: +84 4 220 8091 Web: www. mof. gov. vn The Ministry of Finance is a Government agency which has the function of implementing the State management in finance (including: State budget, tax, fees and other revenues of the State budget, national reserve, State financial funds, financial investment, corporate finance and financial services); customs; accounting; independent auditing; insurance; prices; securities; conducting the ownership rights to the State’s investment capital in enterprises according to regulations of the Law. Pursuant to the Decree No 118/2008/ND-CP issued by the Government, the main tasks and duties of the Ministry of Finance are as follows: 1. Submit to the Government and Prime Minister for approval law and ordinance projects. Draft legal documents, strategy and development planning, long-term, five-year and annual plans on the fields within the Ministry’s authority. 2. Issue legal documents within the Ministry’s authority. 3. Instruct, guide, supervise and to be in charge of implementing the legal documents, strategy, planning, plan; to set up the propaganda, disseminate, educate legal documents on the fields within the Ministry’s authority. 4. Manage the State budget. 5. Manage the collection of tax, fees and other revenues under the State budget. 6. Manage the budget fund, the State reserve fund another State financial funds. 7. Manage the national reserves. 8. Manage the State assets. 9. Manage corporate finances and the State capital at the enterprises. 10. Manage the Government borrowings and debt servicing from domestic and abroad; and international grants. 11. Implement the State management in accounting and auditing. 12. Manage banks and non-banking financial institutions regarding issues; financial services. 13. Manage customs activities. 14. Implement the State management in prices. 15. Issue Govt bonds and participate in stock market management under the regulations of law. 16. Manage, supervise stock and stock market. 17. Organize and guide the implementation of statistics in the fields within the Ministry’s authority. 8. Undertake international cooperation and economic integration in the fields within the Ministry’s authority. 19. Organize and guide the implementation of scientific research, scientific and technology application in the field within the Ministry’s authority. 20. Decide specific orientations and measures and guide the operating mechanism of public services providing organizations in the field s within the Ministry’s authority in accordance with provisions of Laws; to manage and guide the implementation of activities of non-productive units within the Ministry’s authority. 1. Implement the State management to associations and non-Governmental organizations in the fields within the Ministry’s authority. 22. Inspect, control, settle complaints and denouncements, resist corruption, and be processed by authorized level or be submitted to the competent levels for settlement in accordance to the regulations of law applied for finance-budget management regime breaks and violations. 23. Conduct administrative reform under the Government program. 24. Manage organizational structure, permanent staff; guide the implementation of the provisions on salary, bonuses, disciplines for the State officers within the Ministry’s authority; train and retrain staff in the whole sector. 25. Manage the assigned capital and assets and the distributed budget plan under the provisions of the Law. 10/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 Ministry Name Address Viet Nam Customs: No 162 Nguyen Van Cu Street, Long Bien District, Ha Noi Capital, Viet Nam Summary of Role and Services 1. 2. 3. 4. 5. . 7. Contact Names Email Director General: Le Manh Hung Standing Deputy Director General: Nguyen Ngoc Tuc Email: [emailprotected] gov. vn Contact Details Tel: +84 4 872 7033 Fax: +84 4 872 5949 Web: www. customs. gov. vn Management over imports exports activities and international trade. Conditions to the trade and production development. Protection and contribution to the facilitation of development of national econ omy. Protection of revenues. Fighting against smuggling, combat commercial fraud, and protection of the interests of consumers. Contributing to the protection of economic sovereignty, national security and community security. Assisting in socio-economic management. NB: The website contains the rules and regulations applied to the customs for importers Ministry Name Address Viet Nam Food Administration 138A Gian Vo, Ha Noi, Viet Nam Summary of Role and Services The Viet Nam Food Administration is responsible for managing food hygiene, safety, and quality and has made significant progression since its establishment in 1999. Food safety remains a high priority in Viet Nam with growth of export markets and increasing food imports, there is a need to rapidly build the capacity of the food Administration to reduce the threats of food borne disease. The Food Administration has demonstrated commitment to the food safety challenges it faces, and has embarked on an innovative capacity building activity with technical assistance from the World Health Organization. Recently, the Food Administration signaled its ongoing commitment to food safety via the signing of a Technical assistance agreement with the Asian Development Bank to undertake a capacity building project titled Capacity Building for the Prevention of Food borne Disease. Under this agreement, the Food Administration is working with a World Health Organization team on a series of activities that will develop its food safety program, promote food safety, and reduce the incidence of food borne diseases. The agreement will also position the Food Administration as the national lead agency for food safety matters in Viet Nam. The Technical Assistance Agreement commenced in July 2001, and included the following specific components: 1. 2. 3. 4. Policy Review, Law Reform and Assistance for more Effective Law Enforcement Strengthening the National Food Safety Laboratory Network Implementation of Food borne Disease Surveillance System Establishment of a Centre for Information, Education, Communication and Training in Food Safety Contact Names Email Name: Title: Email: [emailprotected] ov. vn Contact Details Tel +84 4 2220 2222 Fax: +84 4 2220 2525 Web: www. moit. gov. vn Contact Names Email Director: Prof Dr Phan Thi Kim Email: [emailprotected] vnn. vn Contact Details Tel: +84 4 846 4489 Fax: +84 4 846 3739 Web: http://vfa. gov. vn Ministry Name Address Ministry of Industry and Trade 54 Hai Ba Trung, Hoan Kiem, Ha Noi, Viet Nam Summary of Role and Services 1. 2. 3. 4. 5. 6. 7. 8. Grant of license for electricity operation Procedures for handling anti-subsidy investigation Procedures for investigation and settlements of anti-dumping Procedures to request for exemption for Agreements in Restraint of Competition of and Economic Concentration Procedures for economic centralization announcement Procedures for complaint, investigation, handling of competition cases Grant of Certificate of eligibility for bottling liquefied petroleum gas Grant of trading and using industrial explosives license 11/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. Procedures for Digital signature authentication Procedures for grant of quotas for import (export) of production materials and industrial explosives Procedures for grant of permit for industrial explosives and Ammonium Nitrate import and export Procedures for granting certificate of declaration of dangerous chemicals Procedures for grant of permit for industrial explosives and Ammonium Nitrate import and export Procedures for safeguard measures application investigation Grant of certificate of liquefied petroleum gas trading eligibility Grant of certificate of petrol and oil trading eligibility Grant of license for Goods Exchange Establishment Procedures for grant of license for export and import of petrol and oil Procedures for assigning minimum quotas for import petrol and oil Grant of tobacco trading license Grant of alcoholic beverage trading license Grant of license for Goods Exchange Establishment Grant of certificate of petrol and oil trading eligibility Grant of certificate of liquefied petroleum gas trading eligibility Grant of permit for import of zone layer depleting substances Permit for sugar, salt, tobacco raw material and poultry egg import under quotas Grant of permit for sport gun and cartridge import Grant of certificate of eligibility for free duty goods trading Grant of automatic import permit Grant of export permit for fertilizer originating from imported sources Grant of Certificate of Origin Approval for Plans on import, temporary import for re-export of supply, machinery and equipment of construction foreign contractors in Viet Nam Permit for import of cigars and cigarettes for duty-free goods trading Grant of Permit for temporary import for re-export, border-gate transfer of goods in the list of goods banned from import and suspended import, banned from export and suspended from export Grant of license for temporary import for re-export of safrole Grant of Cambodia’s timber import permit Grant of tobacco production license Grant of Certificate of eligibility for tobacco raw material processing Procedures for grant of Liquor production License Approval of foreign – invested enterprise’s plan of finished product import for marketing Ministry Name Address Ministry of Transport of Viet Nam 80 Tran Hung Dao St, Hoan Kiem Dist, Ha Noi, Viet Nam Summary of Role and Services Contact Names Email Contact Details Tel: +84 4 3942 0863 Fax: +84 4 3942 0863 Web: www. mt. gov. vn To formulate and submit national master plan for transport development to the government. To give instructions to provinces, cities under the central management and specialized administrations to formulate local master plan for transport development in accordance with the national master plan to submit to the government for approval. To give instruction to specialized administrations to draft laws and by-laws (laws, ordinances), policies on transport management to submit to the government for approval or the Ministry of Transport will promulgate in accordance with its authorization. To issue national standards and classify categories of seaports, river ports, road network, railways, inland waterway, and maritime channels in accordance with the laws and regulations; and to give instructions to specialized administrations to implement the above-mentioned standards. To submit to the government for approval or to approve works, transport construction projects, technical designs, and implementation methods, check hand-over of transport construction projects in accordance with the laws and regulations on infrastructure construction management. To supervise the approval of projects of specialized administrations within authorization of the administrations. To manage the quality of transport infrastructure construction works in accordance with the national standards. 12/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 To give guideline and supervise the issuance, extension and withdrawal of certificates and licenses of construction, operation regarding traffic and protection of transport structures in accordance with the laws and regulations. To stipulate technical standards for imported or locally produced transport means, equipment and spare parts in accordance with technical specifications, economic condition and traffic safety of Viet Nam. To be responsible for supervision of the enforcement of laws, policies and the ministrys regulations on state management of road, railway, inland waterway and maritime transport nation-wide. Ministry Name Address Ministry of Science and Technology 39 Tran Hung Dao Street, Ha Noi, Viet Nam Summary of Role and Services: Contact Names Email Minister: Hoang Van Phong Deputy Minister: Le Dinh Tien Email: [emailprotected] gov. vn Contact Details Tel: +84 4 943 9731 Fax: +84 4 943 9733 Web: www. most. gov. vn The Ministry of Science and Technology is a governmental agency which performs the function of state management of science and technology, covering: †¢ Scientific and technological activities †¢ Development of scientific and technological potential †¢ Intellectual property; standardization, measurement and quality control †¢ Atomic energy, radiation and nuclear safety †¢ State management of public services in accordance with law. Back to Top of Chapter or back to Table of Contents 13/70 LCA – Viet Nam – Initial Assessment 2009 Version 1. 05 2. 4. Customs Information 2. 4. 1. Customs Clearance Customs Clearance Document Requirements Non Refundable AID Goods Un-refundable aid goods mean un-refundable amount under forms of money, assets from governments, non-governmental organizations (NGOs), foreign individuals and groups to Viet Nam in the support of developing Vietnamese society and economy or for humanitarian purposes that are implemented through political documents signed by two parties and approved by competent authority and under form of humanitarian aid, urgent relief in service of recovery of damages from wars or natural disasters 2. 4. 1. 1. †¢ Customs Procedures †¢ †¢ †¢ †¢ †¢ †¢ The approval of program or project or the permit of competent state body. Project or program documents, agreements, protocol, diplomatic notes or arrangements officially signed with foreign partners or aid announcement. Bill of Lading of goods imported Confirmation of un-refundable aid goods issued by External and Financial Department of Financial Ministry. Import contract or entrusted contract for importation of goods stating that goods have been imported through un-refundable ODA source. Based on customs dossier and actual goods, customs office that carries out customs procedures for importation shall issue decision on tax exemption for each case. References †¢ †¢ †¢ †¢ †¢ 2. 4. 1. 2. Decree No 54/CP dated August 28, 1993 of Government detailing the implementation of Law on export and import tax. Decree No 17/2001/ND-CP dated May 4, 2001 of Government promulgating regulations on managing and using official development assistance fund. D

5 Arabic Words in the News

5 Arabic Words in the News 5 Arabic Words in the News 5 Arabic Words in the News By Daniel Scocco An article in this morning’s newspaper contained the following Arabic words: bidoon djellabah Salafists Shiite Sunni â€Å"He was identified as a member of the country’s large stateless population known as bidoon.† 1. bidoon The word does not appear in either the OED or M-W. I found this definition in an article at PBS: Bidoon refers to a diverse group of people [in Kuwait] who at the time of independence were not given Kuwaiti nationality. The term comes from the Arabic phrase  bidoon jinsiya, â€Å"without nationality.† A Wikipedia article spells the word Bedoon and defines it as â€Å"an ethnic group in Gulf Arab states and Iraq.† â€Å"[He] was wearing jeans, a knee-length djellabah robe [sic] and a loose towel over his head† 2. djellabah I didn’t find this word in either the OED or M-W, but I did find it at Dictionary.com: djellabah: a loose hooded cloak, typically woolen, of a kind traditionally worn by men in North Africa. â€Å"French authorities say Salhi had links to radical Salafists- who preach an ultraconservative form of Islam† 3. Salafists A Salafist is an adherent of Salafism. I found this definition of Salafism in an article at PBS: Salafism  is an ideology that posits that Islam has strayed from its origins. The word salaf is Arabic for â€Å"ancient one† and refers to the companions of the Prophet Mohammed. Arguing that the faith has become decadent over the centuries, Salafists call for the restoration of authentic Islam as expressed by an adherence to its original teachings and texts. â€Å"The Sunni extremists of Islamic State consider Shiites to be heretics† 4. Sunni The OED defines Sunni this way: The orthodox Muslims who accept the Sunna as of equal authority with the Quran, considered collectively. Note: The OED defines Sunna as â€Å"the body of traditional sayings and customs attributed to Muhammad and supplementing the Quran.† â€Å"Authorities said he flew into Kuwait’s international airport at dawn on the day of the noontime attack at one of the emirate’s oldest Shiite mosques.† 5. Shiite In this sentence, Shiite is the adjective form of Shia, a Muslim sect whose name derives from Shiat Ali, â€Å"the party of Ali.† When Muhammad died in 632 CE without naming a political successor, some of his followers thought his son-in-law Ali should be their leader; others declared for his father-in-law, Abu Bakr. Abu Bakr served as the first caliph (632-634); Ali served as the fourth caliph (656- 661). Today, the majority of Muslims are Sunnis- somewhere between 85% and 90%. Shiites represent only about 10% of Muslims, but in Iran, Iraq, Bahrain, and Azerbaijan, they are in the majority.   Note: Caliph is from an Arabic word meaning successor. After the death of Muhammad, it became the title given in Muslim countries to the chief civil and religious ruler. The last caliph in Istanbul was killed by Mongol conquerors in 1258. The Ottoman caliphate was abolished by Kemal Ataturk in 1924. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:List of 50 Great Word Games for Kids and Adults50 Musical Terms Used in Nonmusical Senses

Censorship vs Freedom of Speech

Every form of expression should be allowed, even if it is freedom of speech, art, symbol, or any other form recognized by the first amendment. Freedom of speech is freedom given by the Constitutional Bill of Rights. Thanks to these rights, our country and government are as strong and resilient as today. Thanks to these rights, as our country we have been able to develop and expand our vision today. These rights are the foundation and foundation of our country and why our country is separated from all other countries in the world. Freedom of speech review: Children's Internet on the Internet is a very controversial communication device in today's society. If you want, you can find information on almost all the topics they choose. Censorship and freedom of expression are topics that are widely discussed when dealing with current Internet freedom, especially when dealing with young people. On the Internet, do I need to review illegal topics that children can post and view freely? Is the Internet free? Speaking of government, let's see how to freedom of speech. State censorship on the Internet is a common phenomenon that can not be imagined. According to Freedom House 2/3, the Internet users of the world live under government censorship regulation, suppression of speech and thought is increasing. Freelance publishers can only use 13% of the world's population. I will take it for a while. 13% More reports come from the social media platform, the Internet's living room, which is creating a phenomenon called silent spiral. Family, friends, colleagues, and the wider society are different. Atlantic articles reveal the prevalence of self-censorship Freedom of expression and freedom of censorship - What is the pros and cons of having to review the media and the public? What are the terms of the review discussion? Is the censorship system rational or can freely control the voice of the media and the freedom of speech? What is the priority of religious, business and governm ent censorship? Does someone benefit from reviewing information? Is it beneficial for society as a whole? The pros and cons of censorship is worth studying the role of deciphering freedom of speech in society and the role of different types of censorship.

Peace in World Politics Essay Example | Topics and Well Written Essays - 1500 words

Peace in World Politics - Essay Example This essay stresses that if all the states in the world were to be democratic and these values and principles shared across the board then instances of armed conflicts would never arise. The universality of such shared principles among nations therefore will prompt peaceful coexistence amongst nations. Theoretically, the plausibility of peaceful relations among countries observing liberal principles is obvious, but the reality on the ground confirms a very different scenario. States are complex and the internal dynamics of countries and their relations to other countries might negate advancement towards peaceful coexistence. In fact, realist point out that such propositions are merely idealistic thinking and that results from the ground paints a very different picture. Currently countries such as the United States, Germany and Brazil are embroiled in disputes over claims that the United States has spied on their highest offices. Since these nations are very democratic and liberal, in stances of armed conflicts can be a far-flung idea. Internationally, fear and distrust is not uncommon and this is the real picture, there is no even a single self-defining state that has the capability of exposing its states secrets to other nations, irrespective of the cordial relationship, which such States enjoy. This paper makes a conclusion that the legality given to liberalist’s view of democracy-by-democracy peace theory liberalism has developed to be a basis of violence and intimidation in the world stage.

Health Program For Latina Immigrant Essay Example | Topics and Well Written Essays - 750 words

Health Program For Latina Immigrant - Essay Example The other most important thing that I should be aware is the mode of greeting in which most of the Latin people are welcoming and mostly use hugs and cheek kisses as a mode of greeting. Knowing this will ensure I behave according to in order to show my gratitude. Politeness is also a key value and thus noting that interrupting someone shows disrespect. I will huddle this during the program period. Religion and family are highly valued and thus being conversant with the Roman Catholic Church doctrines will make it easier not to respect them in my teachings. Most of the Latin Immigrants are not well educated thus using a program in Spanish to suit them, this is better than translating a program made in English. The props used should be also in Spanish and as an educator; I would involve Spanish entertainment and their cultural foods to win their hearts. Since most of them are not well educated, it is wise to ESL approach, which will captivate more interest with all the people that want to learn English. Lastly, I would participate fully with the church thus create an admirable image thus; people would be welcoming and willing to listen to me.Would your program be for the person, extended family, or neighborhood?My program will be for the extended family since the Latin culture values it most. This will make my bonding experience easier since most of the immigrants have no documents and are afraid of being deported. These immigrants will secure to have classes in their homes.

The ultimate guide to a woman’s heart Essay Example for Free

The ultimate guide to a woman’s heart Essay Dear Dr. Cortez: I had read your book, The Ultimate Guide to a Woman’s Heart and have found it to be quite helpful. As an example of the â€Å"typical male† mentioned in your book, I had been insensitive to the feelings of the women who I have had relationships with and I now realize the error of my ways. I applaud you gratefully for the tremendous insights that your book has shared with me and with all your male readers who are clueless about how to treat women properly. I currently am happily in a relationship with a woman that I can aptly refer to as â€Å"the one† described in your book. I am very concerned about this current relationship and I would like to ask you some questions in reference to your book in order to help me secure a lasting bond with my Maria: 1.)  Ã‚  Ã‚   When you mentioned â€Å"patience† on page 54, did you mean the â€Å"just† kind or the â€Å"unconditional†? 2.)  Ã‚  Ã‚   As pertains to your guidelines on page 28, did you mean to say that flowers and chocolates were both necessary, or would just one or the other do? 3.)  Ã‚  Ã‚   May I have a better idea of what you meant by â€Å"frequent† on page 59? Would thrice a week do? 4.)  Ã‚  Ã‚   I am usually quite busy because of work, would you suggest that I use strategy 3 or 5 on chapter 3? 5.)  Ã‚  Ã‚   Just in case a â€Å"fatal disaster† like the one described in chapter 6 page 89 occurs, is there really no chance to overcome it? I truly hope that you could help me with these questions. You have made an avid reader in me and I will watch out eagerly for your succeeding works. I have included a self-addressed stamped envelope for you to return the answers to me.   If you prefer, you can fax me at 304-411-0807; e-mail me at [emailprotected]; or call me at 304-411-0809. Your answers will be of tremendous help in keeping the woman of my dreams happy. Sincerely,Joshua Gardens.

The Ransom of Red Chief Essay example -- Literary Analysis, O. Henry

The life of O. Henry ties in very closely with the narrative The Ransom of Red Chief. Life had been well until O. Henry had been accused of the embezzlement of bank funds. O Henry denied the indictment but was still put in jail. In prison, he wrote and published hundreds of short stories in order to support his daughter. O. Henry was once asked why he wrote; he replied that every story conveys something about being a person. Having been wrongly accused may have led O. Henry to communicate his belief that criminals receive what they deserve in The Ransom of Red Chief. O. Henry utilizes a first person point of view in his writing to emphasize the significance of a single character. The center of attention is mainly focused on Sam, the narrator (337). The first person point of view is the most limited for the perspective is only from one individual. However, this is useful when the author wants to focus the thoughts and actions of only one character. The first person point of view is recognized by the words â€Å"I† or â€Å"we†, as seen on page 337. O Henry’s conflict plays an important element in the narrative. In The Ransom of Red Chief, two conflicts are established, man vs. man and man vs. man. This is most common with the protagonist versus the antagonist or a good versus evil narrative. The most easily recognized is the primary conflict, where Bill and Sam kidnap Johnny and are desperate for money from Ebenezer (337). The secondary conflict occurs when Bill and Sam have difficulty managing Johnny (339). Interestingly, Johnny enjoys being kidnapped and relates it to a game of Indians and war (340). This creates an unexpected and twisting plot throughout the story. The two conflicts... ...e denouement. Bill swears that he will cross the Central, Southern, and Middle Western States, and be tripping for the Canadian border (347). As good a runner as Sam was, Bill was a good mile and half out ahead of him (347). This narrative best shows O. Henry’s opinion that criminals receive what they deserve. O. Henry integrates his own personal beliefs into the narrative The Ransom of Red Chief. O. Henry communicates a lesson to the reader that actions have their consequences. Likewise, in reality, criminals will not be tolerated and receive the deserved punishment. On the other side, people who commit good deeds will receive a long lasting reward. O. Henry communicates to the reader that evil deeds will lead to unforgiving penalties. But like the criminals people are given a second chance to run away and start a new life through Christ.

Caribbean Poetry

Caribbean Voices : Living a Double life / Dual Identities. Caribbean Poetry is the expression of the constant dualistic nature of the Caribbean identity. Caribbean Poetry exemplifies a unique hybrid made from the voice of the Caribbean experience and its postcolonial English heritage but this creates an inner crisis. The inner crisis of two conflicting cultures that create further conflicting ideas of home and belonging on one hand and growth and fulfilment on the other. But it is also about the resolving of these inner issues. A life in limbo. Searching for identity in Limbo.The Carribean Voice is spoken through the Poetry of the Caribbean islands. The answer to the identity crisis can be found amongst the poetry. It’s hybridity, uniqueness and resilience are all characteristics of the poetry and therefore the poet. What does the poetry reveal about the problems of post colonial identity, including the relationships between personal identity and cultural identity and such iss ues as double consciousness and hybridity. Looking at the difficulties inherent in the postcolonial subject's attempt to formulate a new personal and national identity.Social and cultural oppression are the effects of colonialism. The aftermath, language and culture. Hybridization and double consciousness are the effects of colonization. Homelessness and exile. Living in a state of limbo. Caught between two cultures. Introduction: Living in Limbo The poetry not only addresses the issues of the Caribbean people but over time has developed into something much more. It has become philosophical and wise and this is down to its cultural experiences. The Caribbean offers us literature about the process of growth through, or in spite of, a history of exploitation and prejudice, about the turning of negatives into positives.. ’ (Burnett, 1986, Pg23) Chapter one: Home, Hybridity and Diasporic Existence – look at what the poetry tells us about the writers sense of home, national identity, cultural identity. The social and cultural oppression they faced. Chapter two: The power of Language – what does the language in the poem tell us about the identity of the poet, liberating or oppressive, close reading of the poetry.Chapter three: The future of the post colonial subject/ the aftermath of colonialism – is the identity of postcolonial subject destined to be uncertain, identity being cultural or personal? Double consciousness exile and homelessness . Taking of different cultural influences and making them whole. Poetry is a way of breaking through/ deconstructing the colonization and forming new senses of identity that is a combination of all the cultures. Taking the bits you prefer or the best bits and forming something much better out of it. Way to combat is to embrace the differences and create new forms of identity.Introduction Poetry from the Caribbean Islands has evolved remarkably. It has now developed an identity of its own despite emerg ing through the forced combining of different cultures. This new identity is belonging to the poets of the islands and this identity is resilient and clearly uniquely Caribbean. Through colonial education writers were able to take the Great Tradition of European poets and give them a new identity by changing the subject matter of the poems and experimenting with rhythms and poetic languages stemmed from the African heritage these writers uniquely possess.It becomes a magical combination of poetic prose and oral tradition that the writers use to share with the reader the experiences and realities of the Caribbean existence. What results is poetry that is able to communicate to masses of people, from different cultures, in a form so well placed that it becomes both simple and profound. The poetry not only addresses the issues of the Caribbean people but over time has developed into something much more. It has become philosophical and wise and this is down to its cultural experiences. The Caribbean offers us literature about the process of growth through, or in spite of, a history of exploitation and prejudice, about the turning of negatives into positives.. ’ (Burnett, 1986, Pg23) The poetry of these writers has a way of shedding the old skin of western thinking and emerging with a new self awareness, that comes with a new form of self expression. Carribbean poets portray via their poetry, the personal struggles they experience, of yearning to be home whilst fearing rejection and seeking their own national and cultural identity through their own displacement.Chapter Two: Language and Technique within Caribbean Poety: ‘Not Just a Pretty Verse’ Walcott’s poetry is of a high literary quality, is the success of his poetry not an example of the oppressor still containing the power of approval. Walcott represents the colonial subject adopting the style of the colonizer and his remarkable talent becomes impossible to ignore. Brathwaiteâ€℠¢s poetry rebels against Standard English and literary traditions and draws from his African heritage to express himself in a unique form, so that it cannot be compared or approved of by English traditions.Where Walcott adopts and accepts the example set by the European colonizers, Brathwaite is determined to set a new example. There is evidence of a dual identity within Caribbean poetry and it is this dual identity that supplies the poetry its richness and depth that make it uniquely Caribbean thus making it successful in terms of literary value and technique in its own right. This is evidently apparent in the works of Derek Walcott and Edward Brathwaite. Both poets utilise their colonial heritage in different ways.Walcott embraces the duality with some apprehension, but always remains graceful and loyal to his art form's indignity, he writes with dignity and recognition. Brathwaite however is the more accessible poet of the two in terms of his focus in all things historical and so cial. Brathwaite is concerned with the dilemmas of the Caribbean experience. However in spite of their differences, when viewed complimentary to each other, as opposed to compared and critiqued on their differences alone, the works of these two poets amalgamate and create a unique Caribbean voice.A voice that expresses the beauty in this new art form, a new mode of poetic expression and poetic language whilst dealing with the problems of a dual identity. The advantage of the colonial subject’s cultural hybridity would arguably be the development of language. A Caribbean writer is not only able to use Standard English to express his art but can as easily slip into the local vernacular of his native home. This invaluable skill of a multiple form of expression creates a very distinctive style and a unique elegance to the poetry.The Caribbean writer inherits the English language, which itself is a hybrid, not forgetting the Spanish or the French-based ‘patois’, and t ogether these European languages are combined and rewritten by the Caribbean poets. This gives the writers of the Caribbean a chance to develop and adapt language even further and create a new form and create a brand new poetic language which results in a unique richness that can only come from the Caribbean. Caribbean poetry can often be categorised and placed into neat sections.By sectioning off the poems in terms of their style is to ignore the importance of the embracing of their hybridity. To fully appreciate the work of the poets is to ignore the neat piles they have been placed into and listen to the voice of the poet, on an individual poem basis. To discuss the language within Caribbean poetry and the expression of Caribbean poetry it is impossible to ignore the term ‘oral tradition’. The use of this term, or more particularly the debates surrounding its literary value, is a frequently discussed topic in the study of Caribbean poetry. It is only since the 1970s that the term ‘oral tradition’ began to be consistently used in connection with the certain developments in West Indian poetry. ’ (Brown, Morris, Rohlehr, 1989, Pg1) There has always been an issue of the viability of this poetry and this leads to debates with regards to class and power. Societies have not always relied on the written to preserve their history and therefore the importance of oral tradition is crucial when trying to grasp any kind of understanding of the culture and heritage of the Caribbean.For the purpose of this essay the term ‘oral tradition’ will be used in conjunction with the words vernacular and dialect, to describe the native dialect of the poets, as and when they choose to use these forms of expression. It is the hybridity of these forms combined with the literary traditions that they are so often compared to, that will be the focus of this essay, and the benefit of its hybrid nature, not the political factors that are involv ed in its validity as an expression of poetry. Focussing on the hybridity of poetic form for now, the poet that excels in this manner is Claude Mckay.McKay’s poem’s formal style shows a clear influence of the traditional English verse, the style of the sonnet. McKay’s appreciation of literary quality is obvious. The rewriting of the sonnet to express the heartbreak of prejudice is arresting and completely enraptures its audience, ‘McKay pours old wine – brilliantly – into new bottles. ’ (Denize, Newlin, 2009, Pg100) What is remarkable about McKay is how he uses the famous verse established by his oppressors to express and communicate the sorrow of prejudice.McKay appreciates the art of poetry in a traditional literary sense yet he uses it to express the realities and emotions of subjects that are personal to him, issues of race and oppression. What is also unique about McKays sonnets is that anger and frustration runs through the poems , parallel with dignity and bravery. This combination of emotions is powerful and inspiring. The combination is achieved through a mixture of technique and chosen language.In ‘The White House’ the first two lines use the cacophonic sounds of the consonants ‘t’ and ‘s’ to portray a frustration and annoyance with the situation. ‘Your door is shut against my tightened face, And I am sharp as steel discontent;’ The cacophony effect replicates a tut sound. The next two lines however are less aggressive in tone as McKay describes his dignity despite his frustration, ‘But I possess the courage and the grace To bear my anger, proudly and unbent. ’ Traditional and vernacular style of Louise Bennett. Her authentic Carribean voice, storyteller.Humour and satire within the poetry of Louise Bennett. Brathwaite revolutionary style, experimented with rhyming patterns and shapes. It appears incomplete and as though the form has not be en established, but the poetry possesses an authority that demands the attention of the reader. Caribbean poerty written in the English language should ponly serve to strengthen a sense of identity by proving that Caribbean ideas can survive translation. There is an undeniable strength and tenacity evident in Caribbean poetry. Chapter Three : What the future holds†¦ the aftermathLinton Kwesi Johnson, younger in Jamaican heritage, Johnson would become more accessible to the Black British youth. Use of music to express his poetry. Evolved from Brathwaite’s rthymitic style. ‘to think of the world you might inherit, less in terms of the size of the estate than in the level of pollution that hangs over it’ (Markham, 1989, Pg19) A formally colonized nation can use language as an aid to progression on the path to reclaiming and recreating its own identity. Poetry is a means of negioting the conflicting cultures to achieve a positive sense of identity.Colonial educa tion should be used as a means by which to strengthen not demean your cultural heritage; a means to forge a new identity of your own. The Sonnet Tradition and Claude McKay Donna E. M. Denize and Louisa Newlin The English Journal  , Vol. 99, No. 1 (Sep. , 2009), pp. 99-105 Published by:  National Council of Teachers of English Article Stable URL: http://www. jstor. org/stable/40503338 Morris, Mervyn, Disappointed Guests: Essays by African, Asian and west Indian Students, ed H. Tajfel and J. L. Dawson, Oxford Uni. Press, 1965, Pg5-26.

Lyndon Johnson’s War Book Review

Book Review Lyndon Johnsons War Review The Vietnam War involved many decisions and outcomes, many of which have latter been reviewed with more uncertainty then confidence. With this Michael Hunt, the author uses both American and Vietnamese resources, some which before the book were never heard from. He uses these sources to try to explain how the United States of America was sucked into involvement with Southeast Asia.The overall conclusion of the book does not bring to many new views on why the United States involved itself with the issues of Vietnam but more confirms already believed views that they began in the conflict with comprehension of Vietnam’s problem other than the issue of the cold war. The preface, Hunt expresses how his early beliefs on Vietnam were molded by books he had read including Lederer and Burdick's The Ugly American, Fall's Street without Joy, and Greene's The Quiet American.He talks of living with his family in Saigon for the summer in the 1960s. His father worked with the U. S. military mission, to revamp the simple idea of Americans as â€Å"innocent moral crusaders†) in which was done outside of and in blindness to the actual Vietnamese history and culture. Hunt begins with an extensive look at the America’s view and movement on to the Cold War. In Chapter One, â€Å"The Cold War World of The Ugly American,† he reviews the United States' indifference to the problems Vietnam while centering on a more international inference.That makes Ho Chi Minh with the seem to be more a communist instead of a patriot and which in turn led initially to help the French colonialism in the area, then to the support of anticommunist leaders, an move that attracted the United States to the issue. Hunt then blames Eisenhower administration's views, which gave a † †¦ simple picture of Asians as either easily educable friends or implacable communist foes† (p. 17). The second Chapter, the author looks at Ho Chi Minh and why he was so well liked among the Vietnamese.Though not forgetting his communist background, Hunt makes the argument that Ho was more of a practical person who would, to better the Vietnamese, use any way possible. Eisenhower’s administration refused to accept this kind of sweeping nationalism which â€Å"†¦ left nationalism starkly at odds with communism and could make no sense of politically engaged intellectuals as ready to rally against American as they had against French domination† (p. 41).Hunt hold back some of his not so found thoughts for the Kennedy administration who aided making Vietnam as a not declared war while the United States started to be more involved in the 1960s. In the chapter â€Å"Learned Academics on the Potomac† he examines people such as Robert McNamara, Dean Rusk, McGeorge Bundy, and John F. Kennedy himself in light of their ongoing outlook and the issues of Southeast Asia coming from the administration beforehand.Hunt s’ main reasoning for the sole responsibility of United States militarily involvement in Vietnam is in the title itself. In the chapter â€Å"That bitch of a war† near the end of in the book, which is quoting Lyndon Johnson, the author blames the true reason for the war to be Johnson’s fault. Though what we learned previously throughout the book helped set the spark of the war, Johnson overlooked many chances to extinguish the problems.Hunt states that Johnson â€Å"imagined a moral landscape† in Vietnam while using drawing from unrelated experiences from his time spent in Congress and the Texas Hill Country create plan of stability in Saigon. An example from the chapter â€Å"How distant Johnson's Vietnam was from the real thing and how close to his own American experience is evident in his constant injunction to his Vietnamese allies to act like proper leaders–by which he meant helping constituents, showering benefits on them, and getting out fo r some serious handshaking† (p. 7). The ending chapter, â€Å"How Heavy the Reckoning,† Hunt looks at the United States' departure from the war and the outcomes of that conflict on the American mind. Hunt takes the U. S. relationship with Vietnam all the way into the early 1990s, when a relationship was planned don being rebuilt by President Clinton. With the American involvement still happening, He uses an analogy by referring to American involvement as â€Å"only a flesh wound† (p. 125).

Communication and motivational skills Essays

Communication and motivational skills Essays Communication and motivational skills Paper Communication and motivational skills Paper Motivation is big factor fair all levels and ages for example a child could have a completely different motivation from an adult. A big part of what motivates children is fairness in what they are doing Barnes, P (2002) where as an adult competitor might have a different motivation as winning the league or getting a bonus in there pay for playing well. But if you are able to find the different aspects that will motivate your group of individuals the best. To be effective at you role as a leader or coach you have to look at your team and decide which method of motivation to use. Barrett, J (1998) suggests that you have to either use the carrot or the stick. The carrot being giving your team praise and stick being shouting at them and making sure the person or team knows what they did wrong. And this is where you see good coaches excel, as they are able to separate when and at what time to use these two different types of motivation. When you look at what stops a person from being a successful leader there is many obstacles that a leader has to over come, such as Insincerity, favoritism, lack of Motivation, lack of recognition, poor response, or no response, lack of time Carling, W (1995) we see there that motivation or a lack of it is a reason that a leader will not be successful or even at least meet there potential. So to have the ability to motivate a team is vital without this attribute you will never be able lead a team to any effectiveness at all. Without this attribute the members of your team will be unable to reach there full potential without the proper motivation. Players respond differently when motivated without it they will look flat and work to the lowest of there capabilities. Without the motivation of your players you will never be an effective leader the people around you will just not reach there potential. When looking for the different contributes of a good leader it will always come back to motivation and communication of the leader. Throughout this essay we have seen the difference that having good communication can have on a leader. You see this in all the top leaders day in day out. We see could leaders in football such as the managers who are continually in communication with here players getting there views across and making sure that they are performing the tactics that they have set. Where as if you look at less successful managers such as Sunday league football you would see team coaches who are not communicated with the other players which is so important for success. Without this important communication it is almost certain that there will be no motivational qualities in the coach. We see the importance of a leader to be able to motivate his group so that they meet their targets. We see this in coaches he when there team maybe be down at half time he is able to take them to changing rooms and motivate his players into putting in better performances. This is a sign of an effective coach or leader. With a coach or leader who communicates will with the group of people you are able to see the confidence that a leader has from his group they will no that he is a could leader or coach and so will work at there best for him. We see these effective coaches or leaders everywhere you look when at school your teacher at school was a leader, your local coach can be an effective leader he my not look as good as those in the premiership but they can be just as effective as them with there team. So in looking at all of the effective leaders that there is in the world it is vital for them to have an appropriate level of communication and motivational skills.

Management skills and entrepreneurship Assignment

Management skills and entrepreneurship - Assignment Example Accordingly, exploration of hindrances in growth opportunities became a critical subject for most entrepreneurial researches (Shane and Venkataraman, 2000). In this context Shelton (2005) has proposed the concept of scale barriers to shed some light on the issues related to growth of new venture. Primarily, there are three kinds of resources that are necessary for growth of a firm, namely, financial resources, competitive position and management and organisational capability. Start-up firms are generally small in size and practically inexperienced in an industry. Consequently, they experience resource deficiencies in various functional areas due to small size and lack of sufficient knowledge of the industry. Shelton (2005) defined all these deficiencies as scale barriers which have significant negative impact on growth of new firms. Therefore, growth in new ventures can be illustrated as a process of conquering various scale barriers that develop as a result of liabilities such as newness and smallness. Inexperienced position and small size of start-up firms can be related to resource deficiencies, whose dimensions are not only limited to ignorance but also include lack of key strategic and organisational resources (Shepherd, Douglas and Shanley, 2000). The authors proposed a model where they suggested that an entrepreneur generally influences growth of a new venture on the basis of limited yet critical resources while the unavailable resources are listed as additional scale barriers. The entrepreneur needs to overcome these barriers to establish a mature and successful organisation (Shepherd, Douglas and Shanley, 2000). Author such as Singer (1995) presented a triad of causal constructs of success and failure of a new venture in this regard. However, it was gathered that most scholars primarily focused on managerial and environmental aspects of the triad and ignored the structural

The Chrysanthemums and A Jury of Her Peers Essay

The Chrysanthemums and A Jury of Her Peers - Essay Example This research will begin with the statement that in the world of literature, every author begins the creative process differently. Some start by creating a desired perception in their work by using unique and captivating settings to capture the attention of the audience. Through this choice of style, they can explore and show their audience the world in which they are going to place their characters. All of these approaches to writing are correct and accepted in writing, however; there are issues that must be observed to make any piece of literature to be considered a masterpiece in the field of writing. The setting of a story conveys characters and themes in a novel differently depending on the nature and type of the setting. These can be illustrated using these two novels chrysanthemums and A Jury of Her Peers. Close analysis of the chrysanthemums reveals that the story takes place in the Salinas Valley during the month of December at Henry Allen’s property located on the fo othill. Immediately we meet characters who depict a rural setting just in the preliminaries of the novel. The women are isolated in their own world and the men portray strength and are manlier than ordinary men are. Elisa’s husband rides on a range while Elisa herself is confined to her house and only works in her flower garden. The setting of the novel conditions her character and makes her behave rural like. Looking at the themes the rural setting of the story brings out the issue of oppression of women and freedom.

Thousand miles away essay on memorable place Example | Topics and Well Written Essays - 250 words

Thousand miles away on memorable place - Essay Example Baku Azerbaijan, sometimes spelled as Baki, is translated from the native language of Azeri. Baku is the capital of Azerbaijan and the the largest city port of the Caucasus region. Located on the Southern shore of the Abseron Peninsula overlooking the Caspian Sea, this city has been host to voyagers from around the world who left their mark on its life and culture. A Herring Gull that flies over this city will see it as a green crescent facing the blue oceanic infinity. During World War II Baku was the main city that Adolph Hitler wanted to target since Baku was the main oil supplier for all of the Soviet army, home to some of the oldest oil fields in the world. The oil-smelling mountain winds would remind this fact to every history-loving new visitor to Baku. This has been the richest city of former Soviet Union, with its vast expanses of oil and gas fields, and the suburbs showcasing white oceans of cotton and large groups of grazing cattle. The famous sturgeon fish that supplies t he whole world with black caviar is another asset of this sea port. The current population of Baku is slightly more than three million and about nine million for the whole country of Azerbaijan (US Department of State). Azerbaijan is a former country of the Soviet Union and got its own independence back in 1989. Baku is very special for me since I spent my first 16 years of life there. With that, it brings lots of good memories of childhood and the beginning by early transition into adulthood. I’ve gained numerous life lessons there but the most important that I’ve gained is to always have a dream, a goal, and not to give up and make things happen instead of letting them go, and to always finish what I’ve started no matter if it’s a short term achievement or a long term accomplishment that striking for. Baku brings me good memories from my childhood, memories of my early school age and my

Research Paper Essay Example | Topics and Well Written Essays - 250 words - 1

Research Paper - Essay Example To be specific, choosing an apt thesis for my research work was the most important problem. I need to prove myself that I am able to point out my own opinion on the topic selected for the research work. One can see that thesis is to be considered as the core element of a research work which influences the work as a whole. I was totally confused because I was permitted to choose the topic by my own. So, I decided to go through books. This initiative helped me to have through knowledge in the topic selected for the research work. I came to realize that no one can plan a research work without having thorough knowledge in the topic. I decided to make use of the books, journal articles and other sources and began to take notes. Then, I chose an apt thesis for my research work, went through other research works, and created an outline for my work. Next, I went through the notes and chose the most important points and quotations related to the topic. This was an easy task for me because the knowledge gathered from books, online journal articles, and other sources helped me to create an apt bibliography. Then, I began to write my first draft, including all the points to be included in the research work. After completing my task, I came to know that one of my peers is facing difficulty with the task of finding relevant sources for the research work. To be specific, this problem cannot be dealt with ease. My friend/peer must show utmost care and attention in finding relevant sources. For instance, my friend can go through the available books, journals and other sources in the library. After completing this task, my friend can make use of ‘Google Books’ to search books. Besides, my friend can make use of online magazines, online journal databases, online editions of newspapers and online libraries. I hope all these steps can help my friend/peer to complete

E-tailoring Online: Customer Views and Impacts on Services

E-tailoring Online: Customer Views and Impacts on Services Abstract An increasing number of customers are turning to the Internet to make their purchases, as a vast array of goods and services are now only a mouse click away. E-tailing clothes is even more challenging, with new e-tailers hoping to attract and retain satisfied online customers, are constantly creating new opportunities for them, and in order to do that they need to know what evaluative criteria customers use when selecting an e-tailer as well as what they will purchase online. Past research has provided some insight into what characteristics customers assess whilst making this choice. This report has not been without its limitations. Consequently, the present study utilizes a literature review, qualitative and quantitative research to identify the core customer behavior towards this channel, In addition, results of the analysis show that the type of product on offer and the web attributes (determinants) are predictors of customers attitude toward online shopping for clothing and their perception hence, providing an understanding of how they are responding to the new online buying opportunities. 1. Introduction This research report is divided into 5 Chapters. Chapter 1 is meant to introduce the background of the research area with aims and objectives and focus of the study providing guidelines into subsequent chapters. This then will be followed with Chapter 2 having literature review of the matter giving an insight of the research area that will be referred, compared with the data collection and analysis will be made in Chapter 4. However, Chapter 3 will be discussed prior to the actual data collection as it is necessary to identify Research Methodology to be used for the research. Finally, Chapter 5 will have conclusions and recommendations with any limitations faced and with the mention of area for further research if any. The expansion in electronic commerce (E-commerce) has been phenomenal, with most of todays business transactions being conducted through the Internet. The emergence of this electronic retail (E-tail) market has been extraordinary. E-tailing is also a gaining popularity and changing the retail landscape, it is pervasive in what we thought of it six months ago is probably different to what we think of it today and also what we will think of it in six months time. Customers decision making process has also altered greatly with the introduction of this medium and more so as an alternative channel for shopping. Online shopping concept has already caused a stir in the retail industry in the UK, as more people are opting to buy online due to various reasons, a vast array of goods and services are increasingly being made available now through a click of the mouse, creating a new experience and culture. Many retailers are already delivering high value, personalised products and services at a fraction of the cost thereby making it more low cost and also appealing to the consumers (Birch et al, 2000). The number of consumers shopping online has increased markedly, according to Jardine (1999) people have increasingly become price sensitive and often compare prices of goods both online and offline before making the final purchase, in turn increasing competition amongst the retailers. This is the general overview of the e-tailing concept, as understood b y most of us. However, the purpose of this study is to concentrate on the online clothing market in the UK specifically London, in order to determine predictors of customers purchase intentions for clothing products via this channel. E-tailing of clothing items online has always been debatable, especially since clothing are â€Å"feel-and-touch† products, and cannot be bought without engaging this sensory aspect, unlike other cognitive products like books, computer software, dvds and music which do not really require this. Nevertheless, customers tend to buy more clothing products when they perceive the features of the online store, such as a convenience and secure system of ordering and payment, returns policy, the focus on product display, and the offering of products that have a range of acceptable fits as opposed to a precise fit and most of all choice this are some of the most general attributes a customer considers whilst shopping online for clothes. The attributes that enhance the online experience can be particularly influential for products such as clothing, which generally require physical interaction and evaluation prior to purchase. Web experience attributes can affect early decision making stages (search and pre-purchase evaluation) and influence purchase intent of the customer. With the current fragmented nature of the subject area and to keep up with the rapidly developing technology as well the customer attitudes, the author aims to build on the current body of knowledge, investigating and drawing together the key aspects which influence online shopping for clothes, so as to understand how the customers are responding to the new buying opportunities presented to them by the e-tailers in UK then concentrating on London where the survey was conducted by collecting data from a sample of participants, which aided in exploring the capabilities and further to determine consumer behaviour and customer relationship management p atterns in relation to E-tailing, thus the research objectives being set as: 1. To explore the impact of e-tailing in London. 2. To determine customers attitude towards shopping online. 3. To investigate customers perception of shopping online for clothing in London. In order to achieve the results of the set objectives, the author has explored the determinants the customers consider most important when making a purchase online and to what extent they create an impact on their perceptions. The first hand elements collated from the survey has helped to gain rich insights into customers behaviour and attitudes towards this channel. The secondary data which is covered in the second chapter under the literature review the author here has studied and explained the general E-tailing concept and picked relevant data to help understand the subject matter and provide a better insight into the field of e-commerce, covering a wider area (UK), then narrowing it down to specific location (London) which in turn has helped to achieve the set objectives and later also support the resultant findings in terms of the primary data collected via the survey by the author. 2. Literature Review Xing (2001) stresses that â€Å"The emergence and explosive growth of e-commerce through online trading have ushered in a new era of retail business†. 2.1 The Commercialisation of the Internet The Internet, once a tax-sustained and a government-regulated endeavour, is no longer restricted to non-commercial traffic. The early commercialisation of the Internet, in the mid 1990s gave rise to the e-commerce phenomenon. The Internet population has since grown tremendously, as a result of its opening to the commercial traffic in 1991. Its utilisation has since become remarkably more wide and varied in businesses; the application of internet has grown rapidly over the last several years, due to its contribution of the ever evolving new information technology and its positive gains to the business organisations. Its use apart from being internal its also employed externally and its used more commonly referred to as E-business (electronic business) derived from such terms as e-mail and e-commerce, which is the conduct of business on the Internet, not only buying and selling but also servicing customers and collaborating with business partners. IBM was one of the first organisations to use the term E-business (electronic business) when, in October 1997, it launched a thematic campaign built around the term. Today, major corporations have reconsidered their businesses in terms of the Internet and its new culture and capabilities. Companies are utilising the Web to buy parts and supplies from other companies, to collaborate on sales promotions, and to do joint research, exploiting the convenience, availability, and world-wide reach of the Internet, using it successfully. 2.2 The E-tailing Concept â€Å"The emergence and explosive growth of e-commerce through online trading have ushered in a new era of retail business† says Xing (2001). It was seen as a new channel for sale of products and services along with the traditional channels as well as a market penetration strategy for others. E-tail or E-retail the term, came into discussions or rather its origins as early as 1995, its an addition in the computing subject such as, e-mail, e-business and e-commerce. The business of e-retail has been defined as the sale of goods and services via internet or other electronic channels, for personal or household use by consumers (Harris and Dennis, 2002). Its more efficiently used as a marketing tool, which is integrated into traditional business strategies, and also being viewed as a new marketplace by existing businesses as well as new business ventures as the market place becomes more competitive and unpredictable, due to this, the growth of the electronic retail market has been rapid, significantly expanding reach in terms of people, location and range being variety of information, the World Wide Web has created benefits for both the marketers as well the consumers. For consumers, the Web can provide access to a wide range of products and services with low cost (Bakos, 1997), extensive and tailored information, at home convenience for product comparisons, enhanced interactivity (Cross and Smith, 1995), hence facilitating the formation of virtual communities for users with common interests. E-tailing and E-trading operates in all four of the major market segments; business to business, business to consumer, consumer to consumer and consumer to business. Initially, much direct selling (or e-tailing) was taking place on the internet of computer-related equipment and software, one of the first to report successful sales in the millions of dollars directly from the Web was Dell Computer, there after other businesses started employing the concept in various fields from; Travel bookings, Holidays, Books, Clothing and other accessories, this has particularly grown in the Business to Consumer market segment directly or indirectly as a result of the wide usage of the internet. The Internets greatest commercial advantage is said to be the reduction in transaction cost that directly lowers the prices for consumer (Pavitt, 1997), and therefore E-tailing is said to be a low-cost, efficient way to display merchandise, attract customers, and handle purchase orders (Bellman, 2001). 2.3 Online shopping in the UK Home shopping in various forms has been available to the consumer market for more than 100 years in the UK, paper catalogue being the first and the oldest form illustrated with Victorian ladies and do-it-yourself house kits a lot has changed since, in terms of improvements and choice, then came the emergence of home shopping television, however none has had the influence or the expected impact of shopping, as much as the World Wide Web. E-commerce has grown steadily in the UK since the early 1990s. According to Exley (2006, cited in Haymarket, 2006) consumers have become comfortable shopping on the internet and e-tailing is clearly a part of retails future. He adds that e-tail does not have to replace traditional bricks and mortar stores, â€Å"all retailers need to do is to provide a good in-store experience† (Exley, 2006, cited in Haymarket, 2006). â€Å"Since 2000, Internet shopping has soared by over 5,000% with UK consumers spending an astounding  £200 billion during this period. Internet shopping is clearly the bright spot in the UK retail sector, but this industry is still young and has potential for further growth.† (Tina Spooner, director of information, Interactive Media in Retail Group (IMRG), cited in press release, May 2009). No doubt, online shopping is rising steadily in the UK (from a consumers perspective) as internet access has become cheaper, high street cyber cafà ©s are increasing and Internet service providers (ISPs) have already eliminated subscription fees (Daniel, 2000). Furthermore as technology is set to get even more advanced, hand-held devices have become internet-enabled and nowadays most mobile phones connect to the web (Daniel, 2000). With all the above possible ways of shopping more customers are getting accustomed to the online shopping experience and utilising the new channel. This exc eptional growth of Internet shopping is also driven by greater emphasis on customers efficient use of time, as well as the ever increasing number of computer trained customers, hence giving it a positive outlook and a further opportunity for growth to the existing and perspective e-tailers. A wide range of products and services are available for the customers in the UK to buy online from a variety of retailers, which also gives them a better choice, so why would they go buy anywhere else? Although one reason may be convenience, sadly another is fraud; fraud poses the biggest threat to online shopping (Economist, 2004) but according to Pavitt (1997) consumers fear of shopping online is already resolved by the use of encryption technology. Moreover, the security systems are rapidly improving by the day, further dispelling the notion which is perceived by a majority of people worldwide that online shopping is a risky business. For example, secure digital systems such as encryption tools, digital signatures and the guarantee about security or privacy concern provided by the e-tailers have reduced security inhibitors and thus have increased consumers willingness to visit or purchase from sites (Ah-Wong et al., 2001; Han and Maclaurin, 2002). UK is the second largest e-taling market in Europe like Germany, it combines a large consumer market with internet penetration above the European average (Datamonitor, 2002). There are six leading online shopping companies that dominate the UK e-tailing market. These are; streetsonline.co.uk, Jungle.com, Amazon.com, Lastminute.com, Thomascook.com and Egg.com, all these providing a variety of products and services. What is the future of high street stores when most analysts agree that in five years time, online shopping could be worth  £200billion? This does represent some form of concern to high street stores in the UK as a percentage or it could be of the sales they lose. Nevertheless according to Brewer (2006); cited in Haymarket (2007) the future is brightest for those high street stores that could adopt a multi-channel strategy. However, Murphy (2006); cited in Haymarket (2007) says that â€Å"we have the most vibrant, competitive high street in the world and high street shopping is one of our biggest leisure pursuits. Can high street shopping be our biggest leisure pursuits since they boast to sell a variety of diverse products in-store? It is the refore inconceivable that the future of retail would be solely online†, although the number of customers making purchases online is also on the rise in the UK as mentioned earlier in this report. 2.4 The extent to which e-tailing builds relationships The impact of e-tailing will be felt differently and at different times by various retailers. In the context of buyer behaviour preferences (Daniel, 2000) says that e-tail is a transactional-sales medium rather than a relationship-building medium which means that e-tail cannot substitute personal contact such as customer service advisors, that makes it the most critical differentiation aspect to high street stores today. This emphasises the need further research on the customers perception of e-tail, i.e. to what extent does e-tailing build relationships? If empirical research suggests that e-tailing is a transactional sales medium then ultimately there may be an opportunity for e-tail to focus building relationships with customers that will create the need for further research on how e-tail may be able to become a relationship-building medium. Personal contact with highly trained and motivated salespeople, the service factor is still the critical differentiator for such businesses, and on-line experiences have yet to match that or offer a suitable counter value (Quelch, 1999 cited in Maruca, 1999). As Pavitt (1997) states that the impact of e-tail on high street stores may result in changes on three key fronts; â€Å"change in the nature of product offerings, customer buying patterns and its place in the value chain†. The changes in product offering may alter as a result of advances in digital technology. For example media products delivered via the internet or newspapers being published electronically, that would be a direct impact on high street stores (Pavitt, 1997). There is lack of empirical evidence to show what customers perceive of digital medium against physical goods, as an simple example, would customers prefer buying a DVD from a high street store, so as to get a feel of the physical aspect of this product as well as more information from the back cover of the DVD case, or from the Internet where information on the product is limited in two dimensional form. â€Å"There will be a great deal of change in the value chain as well due to shrinkage in distribution channels†, (Bellman, 2001). E-tailing eliminates traditional chain of wholesalers, agents, and other intermediaries thus creating a new distribution model focusing on manufacturer to consumer direct that implies a great potential for savings (Bellman, 2001). Today, majority of the manufacturers do not want to take the responsibility of dealing with single customer queries, which is one reason why they sell their products through intermediaries even on the Internet. With lack of evidence it still remains to be investigated as to what extent is the internet an intermediary? Another common question which arises in this case is; do e-businesses have any storage for products they advertise or do they order them directly from the manufactures or other traders as required? However, this can also be different in the case of businesses which use internet as a secondary channel for sell or distribution of their products, which they also sell in their physical store. Another issue that arises is to investigate potential shoppers perception in relation to price. Smith et als (1999); cited in Lii and Lee (2005) indicated that online shoppers believe that online stores enjoy a cost advantage over traditional channels in terms of administrative cost, overheads and transaction cost. These features of the online retail channel add to the perception of online shoppers that prices generally tend to be much lower online than that of the high street stores. Considering this then, do customers shop online because they perceive it to be cheaper? If so then how and in what w ays is online shopping cheaper compared to the high street stores where lots of products are reduced at competitive prices even at times with offers such as buy one get on free or a second product at half price, are always there. Is price an issue of concern or is it about building relationships? Would customers be willing to pay that extra price in exchange for good service, remains to be investigated? Good service may be classed by online shoppers such as providing a tracking system for their ordered goods, free return policy and delivery of the goods or a full money back guarantee on items that customers return which is in place with most e-businesses today. With regards to customers online shopping behaviour, Brown (2000) states that a survey by BT found out that consumers choose well-known brands when shopping online and those consumers want to be served immediately, be remembered and treated as individuals. Therefore, in what ways can e-businesses build relationships? According to Kalyanarm and Winer, (1995); Chandrashekaran, (2001); cited in Lii and Lee (2005) prior studies have revealed that in the off line retail channels, customers may use the advertised original price as a frame for reference to assess the accompanying sale price. The resulting price comparison between the original price and the sale price makes the price promotion more appealing (Biswas and Blair, 1991; Grewal et al, 1996; cited in Lii and Lee, 2005). On the other hand on line retailing enables potential customers to have quick and easy access to price and other product attributes and information necessary for price evaluations. An example is amazon.co.uk websit e. The Internet has empowered on line shoppers to better detect price discrepancies and bargains (Balasubramanian, 1997; Bakos, 1997; Hoffman and Novak, 1997; cited in Lii and Lee, 2005). Today Majority of e-tailers attract customers through promotion codes normally available through advertisement and marketing media from which customers, can usually claim some money off or some percentage of discount on their online shopping. What remains to be assessed is whether the promotional codes attract new customers and also retain existing customers to shop online? If e-tailers start providing regular promotion codes to new customers as well as regular customers with this, then will it add up to building a relationship? 2.5 Customers general online shopping preferences in the UK On the basis of the objectives of this research, its crucial to investigate customers e-tail shopping preferences in the UK in general first, since ultimately perception leads to action. â€Å"When consumers are confronted by new forms of retail channels such as on line shopping, they may decide whether the difference between the on line shopping and off line shopping is significant to them. If the difference is perceived to be insignificant, customers may classify the two retail channels as the same. On the other hand, if the differences are perceived as significant, customers may classify the two shopping channels as different and make their purchase decision differently† (Lii and Lee, 2005). â€Å"Perception involves the process of categorization, and people tend to place new experiences into existing classifications of familiar experiences† (Monroe, 1990; cited in Lii and Lee, 2005). Late night shopping in the UK is fast becoming a way of life and a new culture, since for many people 24-hour high street shopping is invaluable as it allows them to fit it around their lifestyles, this is very common in the larger cities like London where this sort of service fits in well with the metropolitan lifestyle whereby time is crucial, however having said that, its also being almost equally favoured by people living in smaller towns or suburbs. The changes occurring in buyer behaviour patterns are alarming to high street retail stores as more and more people are beginning to work partly or wholly from home and they may prefer their goods bought online to be delivered at home, this is also rapidly picking up for supermarkets where the consumers prefer their grocery as well as other items shopped on line to be delivered at their doorstep (Haymarket, 2006). Whatever may be the case, Cottam (2006, cited in Haymarket, 2006) says that high street retailing is facing stiff competition with on line ‘anytime culture, meaning that customers are shopping 24/7 and therefore even high streets supermarkets such as Asda and Tesco have also launched 24-hour stores. Customers perceptions about 24/7 shopping remain to be investigated, since some high street supermarkets that tend to provide 24/7 services are closed on Sunday afternoons due to Sunday trading laws, but this has also changed in recent years. Once more it raises the question, what are customers perception of 24/7 culture in relation to the internet and high street stores, a fair example to portray, the 24/7 concept proved to be costly, in comparison to profitability against cost, for a superstore like Sainsburys as Sainsbury failed in its attempt, even though it believed it had the winning formula (Haymarket, 2006). The reason behind the failure was that Sainsburys could not attract enough customers as there is no guarantee that a fair percentage of existing or new customers will change their habits to take advantage of 24-hour shopping (Haymarket, 2006). Indeed this is a lesson for others (organisational learning) and thus most retailers are being cautious in their approach to 24/7 services. Bearing this in mind customers are constantly taking advantage of such facility and are trying or even getting used to shopping around the clock says Gladding (2006, cited in Haymarket, 2006). Analysts argue that 24-hour retailing is less likely to grow beyond its current levels as retailers have raised little awareness of the fact, hence stores such as Asda and IKEA are being cautious about this approach by advertising their long opening hours in the form of outside signage and flyers (Haymarket, 2006). The key question that arises from this scenario is the customers perception of the availability of 24/7 online shopping versus the high street 24/7 timings. Do customers really want go to shopping at high street stores and supermarkets at night (freely) compared to doing online shopping at night? Security is another issue that could be a vital sign of failure for high street stores or supermarkets to remain open 24/7 and be able to achieve their budget. Depending on the type of product, Andrew and Currim,(2004) have highlighted some key characteristics of customers shopping on line, despite the additional aspects. They say that consumers shopping online for products such as groceries differ from those who shop in high street stores claiming that on line grocery shoppers tend to be more frequent, heavy shoppers, less price sensitive, prefer larger sizes and do more screening on the basis of brand names. Alternatively, Morganosky and Cude ,(2000) suggest that convenience is the main motivation for on line shoppers, and according to Keh and Shieh,(2001) on line shopping is ideal for time-starved customers such as couples with two careers, children, and above-average income who want to spend time with their families instead. These suggestions are valid and can be applied to the reasons for consumers behaviour towards shopping online, however it also differs to the type of market and the products on offer. Hence, for those people, conven ience is more of a priority than price stresses, Keh and Shieh, (2001). Also Professionals, working women and single independent hard working individuals are just some of the people who do not have time on their hands and their perceptions of online shopping especially for items such as grocery remains to be determined. Keh Shieh, (2001) simply claim, with being deficient in practical evidence, that such customers dislike grocery shopping and only those with busy schedules will consider on line purchasing as a viable option. Online shopping may save time and money as the frustration of dealing with children at a store or supermarket that involves pushing carts up and down the aisles, waiting in long lines at checkout counters, and finding parking spaces, could be eliminated, Keh Shieh,(2001).Whilst on the other hand, as more people today having the opportunity to â€Å"surf† from their offices, they are more likely to shop during office hours and thus may prefer to collect their online shopping at ‘convenient stores on their way back home (Pavitt, 1997). Vaughan (1999); cited in Jardine (1999) head of consulting at Retail Intelligence says that â€Å"consumers might do their main shopping on the internet once a week but will still need to stock up on fresh foods locally† and this is the alternative method that supermarkets have taken by opening ‘convenience stores such as Tesco Express, Sainsburys Local, and MS Simply Food, (Jardine, 1999). According to Lii and Lee (2005), their study on examining customers perception of shopping on line suggests competitive pricing being the main reason. It allows them to compare prices of products more quickly and easily than when shopping in stores. (Korgaonkar and Wolin, 1999; Ernst Young, 2001; cited in Lii and Lee, 2005). According to the author, Mysupermarket.co.uk is a classic example; The website allows registered shoppers to compare their online shopping from high street supermarkets in the UK which are Tesco, Asda, Sainsbury and Ocado which is fully online based. Furthermore it allows users to switch at a click if they decide to change their preference to the cheapest supermarket. The problem associated with this is that it may be time consuming going through the tedious process of comparison because consumers may dislike switching from their preferred supermarket. In the authors view high street supermarkets also offer this service. A good example is that of Sainsburys supe rmarket where there is often a price comparison sheet placed next to their own shelf edge price tags showing their prices as compared to Tesco and Asda. If not then Sainsburys have opened small kiosks often located towards end of an isle where the customer advisor can compare their prices for customers with other competing supermarkets and if their prices are high then they do price match or sell the item even cheaper. This shows that the high street physical stores are also doing their best to match the benefits of on line shopping. Another factor that may drive away consumers from shopping on line is transportation cost. Bellman (2001), says that growing numbers of e-tailers are eliminating these costs as they find that customers often cancel orders after going through the entire ordering process and then considering the transportation cost being high, and this may be the key factor that drives potential customers away. The other fear of shopping online is privacy. Most web users refrain giving out their details, especially data in the form of credit card details as they fear exploitation of their privacy (Bellman, 2001). Insufficient product information on screen also contributes to decline of purchase. Apart from this, all secured websites do have a ‘time-out function where user sessions are based on time limits. If ‘time-out occurs, customers risk losing their entire shopping basket, which is quite frustrating from a customers point of view. These are some of the most common factors which may keep away customers from shopping online and reason their preference to shop in high street stores simply because they are well aware of the location, store layout, product selection and return policies as well as the stores reputation (Greenbury, 1999; cites in Maruca, 1999). Online e-tailing has a great and growing future, but the high street is still an important destination for customers. The limiting factor of e-businesses could be, a simple example, such as one cannot buy a piece of fruit via shopping online but can do so from a store. Furthermore, there is no empirical evidence to justify what drives customers to shop on line instead of high street stores, ultimately questioning what customers online shopping preferences are? 2.6 The E-tail clothing sector in UK Fashion is a sensitive and rapidly moving market which is growing at a faster pace in the UK, in comparison to its other European counter parts. Shopping on line for clothing products is also fast gaining popularity in the UK. Although buying over the Internet remains small in comparison with buying through the traditional channels, such as the brick-and-mortar physical stores, it is growing and clothing is a substantial portion of the e-tail sector in the UK. The online clothing sector caters for almost all segments of the UK market starting from the low cost value clothing to high end designer clothing including bespoke tailoring to couture clothing, the choice is unlimited and the options ever increasing. One can buy a single handkerchief to a full suit online, even clothing and accessories for all age ranges are available, whereby the customer can buy clothes for new born babies to clothes for senior citizens, therefore making this shopping Diabetes: Questions and Answers Diabetes: Questions and Answers DIABETES Diabetes Mellitus The medical name for diabetes mellitus comes from the Greek word that means to siphon and the Latin word that means sweet like honey. Diabetes mellitus is the name given to a group of conditions where there is too much glucose in the blood. It affects approximately 3% of the population. There are currently 1.4 million people with diabetes mellitus in the UK and it is expected that by 2010 that there will be a further 1 million. It costs the NHS 4.9 billion a year and affects a million people without them even knowing that they have it. (Devendra et al 2004) RELATED BIOLOGY Which organ is involved in the regulation of Blood Glucose Levels? The pancreas. Where is it located? Retroperitoneally, within the curve of the duodenum and with the tail extending to the posterior surface of the spleen. What type of tissue is it made up of? Primarily glandular tissue that has both endocrine (Insulin) and exocrine (Pancreatic digestive enzymes) functions. Which area of this organ is responsible for producing the hormones involved in the regulation of blood sugar levels? The Islets of Langerhans What are the main functions of insulin? To reduce the levels of blood sugar by facilitating the uptake of glucose from the bloodstream into the cells. It increases the rate of glycogen synthesis in the liver It promotes the synthesis of fatty acids in the liver It inhibits the breakdown of fatty acids in adipose tissue It stimulates the uptake of amino acids It increases cell permeability to potassium (after Wills C et al 2003), What type of substance is insulin made of? Circle the correct answer. Carbohydrate Protein Fats Name the calls that produce the hormone glucagon. Alpha cells What are the main functions of glucagon? An insulin antagonist, it raises blood glucose levels by increasing hepatic glycogen breakdown. It activates hepatic glyconeogenesis It enhances lipolysis of triglycerides One of these hormones has a Catabolic action and the other an Anabolic action. State what these terms mean and identify which hormone falls into which category. CATABOLIC Catabolism is the breakdown of complex biological molecules into smaller component ones Glucagon ANABOLIC Anabolism is the synthesis of complex biological molecules from simpler components. Insulin What are considered normal limits of blood sugar readings? Fasting blood sugar 3.0 to 6.1 mmol/l (Client note: this is variable I have quoted WHO figures – check what your tutor recommends and add it here!) Those with levels of 6.1 to 7.0 mmom/l are said to have impaired glucose tolerance (WHO 1985) CLASSIFICATION OF DIABETES MELLITUS State the 4 main categories. To the client: this is a loaded question. There are many different classification schemes. I quote the categories as defined in RECD 1997 Type 1 diabetes mellitus Type 2 diabetes mellitus Gestational diabetes mellitus Secondary diabetes mellitus – includes: Genetic defects of beta-cell function Genetic defects in insulin action Diseases of the exocrine pancreas Pancreatitis Trauma/pancreatectomy Neoplasia Cystic fibrosis Hemochromatosis Endocrinopathies Acromegaly Cushings syndrome Glucagonoma Pheochromocytoma Hyperthyroidism Somatostatinoma Aldosteronoma Drug- or chemical-induced Vacor†  Pentamidine Nicotinic acid Glucocorticoids Thyroid hormone Diazoxide Beta-adrenergic agonists Thiazides Phenytoin Alfa-interferon Infections Congenital rubella Cytomegalovirus Uncommon forms of immune- mediated diabetes Other genetic syndromes sometimes associated with diabetes Down syndrome Klinefelters syndrome Turners syndrome Wolfram syndrome Friedreichs ataxia Huntingtons chorea Lawrence-Moon Beidel syndrome Myotonic dystrophy Porphyria Prader-Willi syndrome (RECD 1997) Diabetes mellitus can be due to a deficiency in insulin synthesis, secretion and also in some cases resistance. It is also thought that some diabetics may have a combination of both. State 5 causes of Primary Diabetes Mellitus [aetiology]. Primary Diabetes Mellitus is subdivided into Type 1 and Type 2 varieties Aetiology of Type 1 is multifactorial. It is auto immune and trigger factors can be genetic or environmental Environmental causes include exposure to Coxsackie B virus, Rubella virus and Cytomegalovirus and exposure to cows milk. Aetiology of Type 2 is also multifactorial. It includes genetic factors and environmental factors including: western diet, lack of exercise, obesity and hypertension (Todd W et al 2000) NB Causes are still unknown, the above are thought to be trigger factors. State 4 causes of Secondary Diabetes Mellitus. Causes of secondary Diabetes Mellitus. There are several types of secondary Diabetes Mellitus including: gestational diabetes malnutrition-related diabetes pancreatic diseases causing diabetes endocrine diseases causing diabetes drugs and chemicals causing diabetes genetic conditions causing diabetes Causes depend on the variety but include pregnancy, pancreatitis and various drugs including: steroids thiazide diuretics phenytoin diazoxide streptozotocin Pancreatic diseases can cause Diabetes Mellitus including: acute and chronic pancreatitis pancreatic carcinoma cystic fibrosis haemochromatosis Disease processes can also cause secondary Diabetes Mellitus including: acromegaly Cushings syndrome glucagonoma phaeochromocytoma Complete the following chart by using the recommended textbooks to compare the two main types of Diabetes. TYPE 1 TYPE 2 Age at onset juvenile ( % of all cases about 10% about 90% Acute/insidious acute insidious Body build lean obese Genetic link high low Prone to ketoacidosis yes no Autoimmune Disease yes no Treatment insulin diet, oral hypog’s (Harris M 1995). What age group in the general population has the highest incidence of Type 2? Typically the 55-75 age range (Harris M 1995). Certain groups in the general population have an increased risk of developing Type 2 and currently Diabetes UK is promoting a campaign to identify those most at risk earlier, so that they do not develop the major complications associated with this chronic disease. This is called the Missing Million Campaign. Names these â€Å"At Risk† Groups 1. History of Heart Disease 2. History of Stroke 3. Obese (BMI>30) 4. Over 50s 5. Over 40s if from African Caribbean or Asian backgrounds PATHOPHYSIOLOGY / CLINICAL FEATURES DEFINITIONS Define the terms:– Gluconeogensis Biosynthesis of glucose from sources other than glycogen Glycogenolysis Oxidisation of hepatic glycogen into glucose Briefly describe how insulin deficiency / absence can cause the above processes to occur. Insulin deficiency and/or low glucose levels promote the secretion of glycogen Glucagon promotes the activation of the enzyme adenylate cyclase in the liver which triggers glycogenolysis. This is exactly the opposite process to gluconeogenesis and is mediated by a number of enzymes, the most significant being pyruvate kinease Clinical Presentation – Complete the following When blood glucose levels arise above a certain amount the renal threshold in the kidneys is exceeded and glucose spills over in to the urine. This is called glycosuria. This excess glucose sucks up the water so that it can flow from the body; this is called. Large amounts of urine are excreted. This is called polyuria. Excessive thirst is called polydipsia. Excessive urination can result in lowered blood pressure and shock. Blurred vision can be caused by fluctuations in the amount floaters and water in the lens of the eyes during periods of dehydration. This is called osmotic myopia of the lens. Cells are not able to access glucose so they do not receive any fuel and as a consequence cannot produce energy. This triggers the brain to send a message of hunger. This excessive hunger is called polyphagia. Lack of energy makes the individual feel tired and weak. Other sources of energy are sought. Fat stores are broken down to provide energy. This may result in ketosis. Breakdown of fats results in the production of ketone bodies which are excreted in the urine. These are acidic and alter the blood PH. There is a sweet smell of ketones on the breath. This is called ketotic respirations. Weight loss also results. Breakdown of protein stores results in muscle wastage. Skin infections are common e.g. Staph boils, erysipelas . Excess glucose suppresses the natural defence mechanisms and the action of the lymphocyte* cells. Electrolyte imbalances occur. The electrolyte potassium affects cardiac muscle causing arrythmias if deficient. Urea and electrolyte imbalances also result in the following symptoms 1. Dry mouth 2. Thirst 3. Muscle weakness 4. Lethargy 5. Cardiac arrythmias. Numbness and tingling in the feet and cramps may result from peripheral neuropathy. Client Note (*)– this is debatable – your tutor may have a specific answer in mid for this one The recommendations of the W.H.O â€Å"Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications† were formally adopted in the UK on the 1st June â€Å"2000. The key recommendation, with regard to diagnosis is that fasting plasma glucose should be lowered from 7.8mmol/L to 7mmol/L. What is an OGTT? The Oral Glucose Tolerance Test In the oral glucose tolerance test the patient, after fasting for 15 hours, drinks 75 g of glucose in 300 ml of water, over 5 minutes. Blood glucose is measured before the drink and after 30, 60, 90 and 120 minutes. Urine is collected before the drink, and after 60 and 120 minutes. Before the test, for a period of 6 hours, the patient should avoid smoking and drinking coffee. There is a normal glucose tolerance if the venous plasma value is less than 7 mmol/l after the 2 hour period, If after 2 hours after the glucose load the value is between 7 and 11 mmol/l, then there is impaired glucose tolerance. If glucose is greater than or equal to 11.1 mmol/l this is diagnostic of Diabetes Mellitus OTHER TESTS / SCREENING PROCEDURES What is an HbA1c Test and why is it carried out? This is a measure of glycosylated haemoglobin in the blood. It is a longer term measure of the degree of blood glucose control. (DCCRG 1993) NICE target is 6.5 7.5 HbA1c When would Urea and Electrolyte levels and Blood Gases be tested? Normally only if metabolic imbalance is suspected, dehydration, renal involvement or occasionally as a screen for end-organ pathology (kidneys). U’s + E’s may be requested as part of a monitoring procedure. Blood gases may be useful if severe ketoacidosis is present. When would a Full blood count, specimen check and chest X-rays be carried out? This is more likely to be done as a screening or monitoring procedure (FBC or Urinalysis) unless there was an obvious clinical reason for doing them such as suspected anaemia etc. A CXR would be less likely to be carried out unless pulmonary or cardiac pathology was suspected (Client: this is contentious – as different clinicians have different rationales for these investigations.) When would and ECG and Lipid levels be checked? ECGs are likely to be checked on diagnosis, as a monitoring procedure or if arrythmias have been detected. They may also be done as a baseline investigation, with hypertension or if cardiac involvement is suspected. Lipids are very likely to be abnormal in Diabetes Mellitus. They would be checked as a monitoring investigation at most visits. (DCCRG 1993) When would a neurological assessment and inspection of the lower limbs be carried out? Peripheral neuropathy and vascular impairment are common sequelae to Diabetes Mellitus and this would be actively considered and evaluated at each monitoring visit. Probably at least twice a year or more frequently if indicated. (DCCRG 1993) Why are protein levels checked? Proteinuria is a good indicator of diabetic nephropathy. Urine protein should be checked at every monitoring appointment. Serum proteins are less sensitive but if renal pathology is established then it may be a useful investigation. (DCCRG 1993) When is urine checked for ketones? In the presence of dehydration, clinical suspicion of ketonuria, pregnancy and as a monitoring procedure. (DCCRG 1993) When would an eye inspection / photography be carried out and why is this done? Retinopathy is a potent cause of visual impairment and commonly found in the diabetic state. It is commoner with poorly controlled Diabetes Mellitus and Type I diabetes mellitus. It is one of a number of ophthalmic complications seen with diabetes and should be actively screened for at every routine visit. (DCCRG 1993) Why would a diabetic require having their blood pressure regularly recorded and what value is recommended? Hypertension is a common cardiovascular complication of Diabetes Mellitus and is an independent risk factor in Type II diabetes mellitus. The presence of hypertension and Diabetes Mellitus coexisting in the same patient will increase the overall morbidity risk of both cardiovascular disease and cerebro-vascular accident. A blood pressure reading below 130/85 mmHg is an ideal goal for most people with diabetes who dont have kidney complications, but some authorities may recommend an even lower blood pressure goal (below 120/75 mmHg) for people with diabetes who have kidney complications. (DCCRG 1995) State the main complications Short-Term Hypoglycaemia, dizziness, lethargy, impaired conscious level – drowsiness. Hyperglycaemia, nausea, headache, malaise, ketosis. Coronary heart disease, Cardiovascular disease (macro- microvascular disease) Retinopathy which can lead to blindness Nephropathy, which can lead to kidney failure and the need for dialysis Neuropathy which can lead to, among other things, ulceration of the foot requiring amputation Microvascular Retinopathy, Nephropathy Neuropathy These are generally related to HbA1c levels with the highest incidence of complication occurring when HbA1c levels are above 12% Atherosclerosis Arteriosclerosis Both processes can lead to : heart disease stroke peripheral vascular disease (Stratton I et al 2000) What are the SIGN Guidelines and name those that relate to Diabetes. A set of guidelines originally drawn up by Scottish Intercollegiate Guidelines Network. They include: visual impairment (SIGN 4) pregnancy (SIGN 9) children and young people (SIGN 10) renal disease (SIGN 11) foot disease (SIGN 12) cardiovascular disease (SIGN 19). Treatment- Give Principles   Type 1 Always insulin dependent. Active treatment involves titrating insulin dose against glucose levels and then maintaining levels by manipulation of the insulin regime Constant monitoring by either patient or physician Constant vigilance for complications Type 2 Depends on cause, but in most cases treatment involves lifestyle modification, weight loss, dietary carbohydrate restriction. If not successful then progression to oral hypoglycaemics and occasionally to insulin. Constant monitoring for the presence of complications Reduction of secondary causes of complication i.e. cessation of smoking. INSULIN Insulin was identified as a substance that prevented diabetes in the early 1890’s. Banting and Best extracted insulin from the pancreas of a dog in 1921 and the first human received a crude extract of insulin from the pancreatic glands of cattle in 1922. Over the years there have been many advances in the synthesis of insulin. Insulin is a protein. Insulin injections are vital for people with Type 1 diabetes as they are unable to produce insulin them selves and also for many with Type 2 diabetes whose condition has progressed to a point where tablets and diet cannot control it adequately. The aim of this treatment is to ensure that blood glucose levels are maintained at less that 6.5 mmol/l. (Client: see previous comments) Name 4 factors which influence control 1. Weight 2. Severity of disease process 3. Diet 4. Level of exercise (Wing RR, et al 2001) There are a variety of insulins available on the market. The two main sources are animal and human. How is human insulin produced? By recombinant DNA technology inserting human genes into bacteria such as E.coli which then produces insulin in commercial quantities. The majority of diabetics are now on Human insulin but unfortunately some people are still required to take animal insulin. Many drug companies are wishing to phase out animal insulin and at present Diabetes UK is campaigning to maintain these. Why does insulin have to be given by injection? Being a protein it cannot be given by mouth as it would be denatured in the gastro-intestinal tract. What other route is being researched as an alternative? A great deal of research has been lavished on alternative modes of drug delivery. Transdermal routes do not give reproducible and consistent blood levels. Oral insulin has not been a possibility in the absence of a specific peptide carrier system that would work in the gut. Nasal administration has been tried, but there was low bioavailability and absorption enhancers were needed, in addition the clinical effect was only over a very short period. Pulmonary routes appear to be promising but we already know that the pulmonary route is comparatively inefficient and requires ten times the amount of insulin to achieve the same clinical effect. Initial clinical trials show no side effects and research is currently continuing. (Heinemann L 2001) SIDE EFFECTS Initially on the commencement of insulin people may experience sensitivity around the injection site. How would you recognise this? This is a form of allergy. It can be local, in which case the local skin becomes red and itchy at the injection site. It may (rarely) be systemic giving rise to a uticarial reaction, tachycardia and tachypnoea. Very rarely a patient may experience anaphylaxis. Symptoms of hypoglycaemia may occur if too much insulin is injected or if not enough carbohydrate is consumed or if there is increased exercise without taking extra food. Hard lumps under the skin may occur at injection sites if they are not rotated. What is the correct medical term for these? Lipodystrophy The number of units prescribed is calculated depending on time of day, age, weight and lifestyle. Typical dose is 0.7-1.0 units per Kg of body weight. WARNINGS Insulin should never be administered in cases of HYPO. The body may get used to low levels of blood glucose and therefore the warning signs for HYPOs are reduced. Individuals who have lost these may be advised to raise their blood glucose levels slightly for up to 3 months to resensitise themselves to symptoms. Some people have also found that they have lost some or all of their symptoms of HYPO when transferring from animal to human insulin. Insulin dosages may have to change if there is disease of the adrenal pituitary and thyroid glands and also in the presence of liver and kidney disease. Taking of steroids will increase the insulin requirement. During illness, puberty or emotional trauma glucose levels can become elevated and therefore insulin doses require to be adjusted and more regular blood sugar monitoring is essential. During pregnancy insulin requirements may decrease in the first trimester and increase in the second and third trimester. The following drugs may increase blood glucose levels and therefore lead to a need for more insulin – Steroids Contraceptives Asthma Inhalers Some drugs lower blood glucose levels and therefore result in a reduction in insulin. These are:- Aspirin Beta blockers Mono-amine oxidase inhibitors. There are four categories of insulin. Give an example of each. Very short acting [ANALOGUE] – e.g. Humalog. Short acting [SOLUBLE, NEUTRAL] – e.g. Actrapid, Human Velosulin. Medium and long acting [ISOHANE, PROTAMINE ZINC] e.g. Human Insulotard. Combination of short and medium acting [MIXED, BIPHASIC] e.g. Human Mixtard. Who would most likely be prescribed very short acting insulins? The very unstable or out of control diabetic. Children more likely than adults. How long before a meal does short acting insulin require to be injected? Depends on type. Sol. Insulin starts working within 30-60 mins and lasts about 6-8 hrs. Other types such as Insulin aspart and insulin lispro both start working within 15 minutes and last for up to five hours. The glucose rise after a meal typically begins within about 15 mins so the insulin should ideally be in the system to counteract it. How often daily would you require to take the following insulins:- Short acting – about 2-4 times a day( when stable) Medium acting – about twice a day Long acting – Once (or perhaps twice) a day These answers depend on the age and size of the patient, as well as the severity of the disease process. Why is short acting insulin sometimes given with medium acting insulin? To give a smoother blood glucose profile and also to â€Å"fill in the gap† before the medium acting insulin becomes biologically active. Where should insulin be stored? In the fridge, but not frozen. Briefly discuss the types of equipment that are used to administer insulin? Commonest is still the disposable insulin syringe. Syringe should always be calibrated to match the insulin type. Most are U-100 now. Other options include the pen devices (expensive but convenient and largely â€Å"fool proof†). Jet injectors are occasionally seen, but not very common. In hospital surroundings insulin pumps (drivers or infusers) can be used. Ambulatory subcutaneous pumps are increasingly used to deliver continuous infusion. Very expensive but arguably capable of producing the best control. (HSG 1997) What advice would you give to a diabetic who is planning to go abroad on holiday with regard to their insulin? Take plenty with you as your brand may not be available abroad. Make sure you can keep it refrigerated. Run your blood glucose levels slightly higher than you are used to a) because of probable increased exercise and b) to reduce the risk of Hypo whilst away from home. Be extra vigilant with the blood sugar monitoring. Strange diet may have unexpected consequences. ORAL HYPOGYCAEMICS Below are the main categories of drugs. Give an example of each, including daily dosage and side effects? Sulphonylureas Chlorpropamide 250 mg (100 mg in the elderly) This is a very long acting drug, usually taken once daily with breakfast. Alcohol may cause flushing to the face. Biguanides Metformin Start at 500 mg twice a day or 850 mg once daily. The maximum daily dose is 2550 mg given in three divided doses Gastrointestinal side effects are a common occurrence in people taking metformin. Problems often include bloating, flatulence, nausea, stomach cramps and diarrhoea Occasionally a metallic taste in the mouth. Rare complication lactic acidosis (Knowler WC et al 2002) Prandial glucose regulator Repaglinide 0.5 to 4 mg with each meal Occasional gastro intestinal side effects (Bokvist K et al 1999) Alpha glucosidase inhibitor Acarbose 50 mg then titrated against clinical effect. Flatulence soft stools or diarrhoea. Glitazones [new drug] Rosiglitazone 4mg as starting dose increasing to 8mg if required Possible toxic effects on the liver (theoretical rather than practical) (Park JY et al 2004) ACUTE COMPLICATIONS The most common is Hypoglycaemia. It results from an imbalance between glucose intake, endogenous glucose and glucose utilisation. A decrease in the blood glucose level normally leads to stimulation of catecholamine secretion. Identify 5 causes. Insufficient carbohydrate intake Excessive carbohydrate utilisation (exercise) Intercurrent acute illness Overdose of insulin Other illnesses (viz glycogen storage diseases) Alcohol Name 8 clinical features that the patient experiences. Pallor Shaking Perspiration Fatigue A feeling of weakness Rapid heartbeat (Tachycardia) Hunger Agitation Difficulty concentrating Irritability Blurred vision Temporary loss of consciousness Confusion Convulsions Coma. What would be given in order to treat it? Depending on severity. If minor, warm sweet (glucose containing) drinks If major, IM Glucagon. Monitoring essential until fully recovered. What is ketoacidosis? A clinical condition almost invariably associated with low insulin levels. As a result, the blood glucose levels rise and the intracellular glucose levels fall. This requires the metabolism at a cellular level to be fuelled with fat derivatives rather than carbohydrates and this produces acidic ketones. These ketones normally require the presence of insulin for their catabolism. In its absence, they build up causing a metabolic acidosis and spill over into the urine when the concentration is high enough. Identify 5 causes Fluctuations in insulin regime Intercurrent illness Trauma Reduction in carbohydrate intake Dehydration +- severe exercise State 10 clinical features of this clinical state High blood sugar levels Frequent urination (polyuria) and thirst Fatigue and lethargy Dry skin Facial flushing Nausea Vomiting Abdominal pain Fruity odour to breath Rapid, deep breathing (Air hunger) Muscle stiffness or aching Coma The principals of management are:- Prompt administration of insulin (usually on a sliding scale) to reduce the hyperglycaemia and ketonaemia Replacing fluid loss (from polyuria and vomiting) usually by intravenous fluids Restabilising electrolyte imbalances secondary to dehydration, metabolic acidosis and hypokalaemia. Treatment for any underlying cause such as infection. LONG TERM COMPLICATIONS There are 10 steps that the diabetic patient can take to reduce his chances of developing complications. Regular screening of BP and maintain at 140/80 or lower. Regular HbA1c testing. Maintain blood glucose levels between 4-7mmols/L before meals. A