Horror Film and Halloween Essay

Halloween is the one time of year when it okay to dress up as anything you want to be and it’s also when you can be celebrating all things horror and dead. Halloween started out as the celebration of the dead but has now grown into a wonderful time of costumes and decoration of scary fictional creatures. Dressing up as a scary character or a character you adore is one of the many perks of Halloween. Going to costume parties with friends and celebrating Halloween together. Watching horror movies and television specials about Halloween is exciting and it feels like more the holiday mood. Halloween is a celebration of the horror genre, dressing up and enjoying this holiday with people. Costumes are very important when it comes to celebrating Halloween. Children enjoy going out on Halloween and trick-or-treating with their costumes to celebrate (Halloween). For an older and mature get together some adults enjoy going to costume parties with their peers. In the olden days it was typical for costumes to be scary but nowadays people tend to dress up as their favourite pop star or a favourite character from a movie. Costumes are enjoyed by many people to be something scary or someone they admire. Going to a party or throwing a party is always expected to done during Halloween. This holiday celebration is enjoyed by everyone in certain countries. Many people attend a Halloween party to enjoy the costume their friends are wearing. The snacks and drinks are shaped and decorated as creepy creatures for the effects of Halloween. Even the music is themed to make the effects to feel realistic. People are attracted to Halloween and going to parties and enjoying it with friends is one of the many perks of this holiday. Enjoying the Halloween and getting into the spirit of this holiday makes it more enjoyable. The Halloween episode of a favourite T.V. shows really adds effects to the enjoyment of the season. This celebration is mostly about the mood of being scared and watching a lot of horror movies. The media has a huge influence on Halloween from movies, television specials and even themed music. Halloween is celebrated widely in certain countries. Halloween is a wonderful and exciting celebration made up by traditions and is enjoyed in certain countries. People enjoy dressing up as a favourite fictional character or someone real like a favourite role model. Going to parties and enjoying your costumes and celebrating this holiday with your friends. Most media like T.V shows will often make special episode for Halloween. People are attracted to Halloween because it is a unique Holiday that celebrates the dead.

Air Blue

Business Policy & Strategy Projects Guidelines Assignment #1 This is the first project based assignment. The students are required to identify an organization on which they are supposed to complete all upcoming assignments and final report. The first assignment is focused on the Vision and Mission statements of the organization. The group is supposed to first analyze and then recommend the Vision and Mission statements based upon the characteristics discussed in text. Assignment #2 Report on Industry AnalysisThis assignment would encompass the following components: a. Introduction and History of the allocated industry. b. PEST Analysis and conclusion on industry attractiveness. c. Industry scanning using the Porter’s five force model and conclude on prevailing competition level. d. Make a list of opportunities and threats present in the industry emerging out of PEST Analysis and Porter’s Five Force Model in relation to allocated company. e. Make EFE Matrix of the compan y and interpret its result. f. Identify and make a list of CSF’s of the industry . Identify company’s major competitors and make CPM Assignment # 3 Report on Company Analysis On the allocated company from within the respective industry, each group is required to develop: a. Perform Strategic internal audit of the company of the following departments as per the guidelines given in the prescribed text book i. Marketing ii. Finance iii. R&D iv. Accounting v. MIS vi. HR b. Complete internal audit and make list of key Strengths and Weaknesses of the company. c. Make IFE Matrix of the company and interpret its result. . Make SWOT analysis of the company and interpret its overall findings. Assignment # 4 A-Long Term Objectives In light of vision and Mission statement and SWOT analysis develop:- i. Long Term Financial Strategic Objectives of the company ii. Long Term Non-Financial Strategic Objectives of the company a B-Strategic Analysis and Choice I. Inputs stage This stage involves development of EFE matrix, CPM and IFE Matrix that has already been covered in assignment 1 to 3. (Just include findings) II. Matching StageIn this stage it is required to develop at least three out of the five matrices discussed below: i. SWOT matrix so as to develop four strategic scenarios (SO, ST. WO. WT) ii. SPACE Matrix for determining the organization’s overall strategic position. iii. BCG (If required) so as to determine the relative contribution of different divisions in terms of market share and industry growth. iv. IE Matrix using IFE and EFE scores ( done previously) v. Grand Strategy Matrix for formulating alternative strategySet of feasible strategies emerging out of matching tools which company can consider for decision stage ? FINAL PROJECT REPORT &PRESENTATION B-Strategic Analysis and Choice III. Decision Stage i. Compare all strategies included in sets of feasible strategies using QSPM of the allocated company. ii. Use excel spreadsheet for developi ng QSPM in order to evaluate the best alternative strategies set. This would require using the results from the input and the matching stage. Identify most attractive StrategiesUsing QSPM scores identify the most attractive strategies set to be followed by the company under the prevailing circumstances. Strategy Implementation i. Arrange the most attractive strategies sets in order of their priority in implementation to achieve company’s strategic goals ii. Specify the action plan that you are going to work on for implementation purpose for each strategy. iii. In order to implement any strategy you need to develop its annual objectives, policies and focus on the resources and other management issues that you may require your attentionEvaluation and Control i. Specify the steps and measures to be taken for checking the effectiveness of the each strategy set after they are implemented. ii. Specify corrective actions to be taken in case of positive or negative variances for each strategy set. Conclusion i. Write a short note (1/2 Page) on how do you see the future of this company in next 5 years down the road specially with reference to your overall analysis and Strategy set that you have recommended. ii. Write down what Lessons you have learned from this project. Special Note:If required students can easily transfer these assignments and project into final MBA project by adding more articles, updated industry and company data, and surveys about the strategies being pursued by the company. You can round up your MBA project by making a complete strategic business plan of the company for the next 3 years in light of your recommended strategies Reports format and presentation instructions IMPORTANT NOTE : ALL REPORTS ARE TO BE SUBMITTED ON DESIGNATED DAY AND TIME WHICH WILL BE ANNOUNCED BY THE INSTRUCTOR –THERE IS NO CONCEPT OF LATE SUBMISSIONStudents are advised to strictly follow these instructions while compiling their assignment or final project re ports, or making presentations (any deviation will result in deduction of marks): †¢Reports should be laser printed on A4 size (white) paper. †¢New Times Roman with font size 12 for the main body, Font size 14 bold for the sub heading, Font size16 bold for the main headings. Line spacing 1. 5 lines. Left justified †¢The title page of the report must contain: 1. Name and Logo of UCP 2. Title of the course and Section 3. Name of Industry 4. Company Name 5.Group members names and registration numbers 6. Name of the instructor 7. Date and Time of submission †¢Due references must be made where required in form of bibliography in APA style. ( Check the details of APA style of referencing on net) †¢Plagiarism would lead to negative marking or cancellation of the project. †¢Check spelling and grammar using MS Word spell check. †¢Presentation time would be 20 minutes followed by Q/A session in which each group member must participate. It should be on PPT sl ides. †¢Presentation should entail a brief summary of the industry and allocated assignments.

Islam Compared to the Orthodox Church Essay Example | Topics and Well Written Essays - 1250 words

Islam Compared to the Orthodox Church - Essay Example The essay "Islam Compared to the Orthodox Church" talks about the two religions - Islam and Orthodox comparing their beliefs and origin. The history of Islam includes Prophet Muhammad striving for a society in which the Arabs, who were a divided nation who indulged in several vices, to be united into one nation. And that was his mission and he is the role model and founder of Islam, creating unity and the belief in a dole God and the establishment of laws according to this belief. This movement has led to a vast fraternity over the years, to become a Muslim brotherhood. He also believed that morals and values should be simple and everyone should be able to follow them and this made life easier for the Arabs to accept this new religion. The Muslims were to believe in something credible and it was easy to accept his religion. On the other hand, the Orthodox Christians had to believe in a miracle, and the Incarnation of Jesus Christ who was the son of God, which was beyond the limitations of the human mind. It is his belief that wine becomes Divine Blood as you consume it even in Church and bread is the ‘Lord’s Risen Body.’ There is no such aspect in Islam to believe in the miraculous aspect of this, even though there have been many miracles in Islam as well. There is no aspect of veneration even though there are saints that are heard of in Islam as well, but not as commonly in Christianity. Holy Prophet simply conveyed God’s message to the Muslims and they had to commit to him and follow him.

Applying the Diagnostic Model to World Fuel Services Corp (INT) and Term Paper

Applying the Diagnostic Model to World Fuel Services Corp (INT) and AS-IS Process - Term Paper Example For example, if WFS has clients across the globe, WFS can have an online conference with their clients and would allow both of them to save money instead of traveling and meeting each other in person in order to close the deal. By doing this, they had extracted additional value from external customer’s transactions which is also one of WFS primary objectives as a company. WFS operate in various offices across the globe such as the United Arab Emirates, the United States, the United Kingdom, Germany and etc. By adopting technology these offices can interact with each other in a faster and inexpensive way by exchanging emails and through the use of online chat. Rather than flying out of the country to interact with each other which would be very costly and time consuming. Also by adopting technology WFS can expand their market by launching websites, advertisements, and etc. through the web. Technology can ensure that the energy supply, marketing and proprietary activities do not expose the company to unacceptable or unforeseen cost increase through establishing a strong recording system of transactions in order for the company to have a basis on their future decisions which would help achieve WFS goals by looking at the company’s records and history. These records can be plotted in a form of spreadsheet so it can be easily updated and looked into when it is needed. By adopting technology WFS can also give easy updates to their clients in a form of email, fax, phone calls and etc. Being the largest independent marketer for aviation, marine and fuel products WFS should always continue to develop their means of trading in order for the company to grow and maintain success. In order for WFS to grow and maintain their success they also have to have a clear view on political factors that can or will affect their company. An example of this political factor is the government. The

The Italians in Italy and the United States Research Paper

The Italians in Italy and the United States - Research Paper Example Many Italian immigrants and Italian Americans made contributions in various fields such as science, entertainment and the military. While the number of people immigrating to the United States from Italy has decreased in recent years immigrants that come are inspired by the opportunities offered. The population of Italy is expected to decrease dramatically due to the declining birth rate. This combined with the unstable economy of Italy may contribute to a loss of its identity. Many Italian American organizations fear that future generations will not know about the positive aspects of their heritage due to the negative stereotypes of Italians perpetuated by the media. The Italians in Italy and the United States The Italians in Italy and in the United States brought a rich heritage to both nations. In Italy and in America Italians made contributions in various aspects of society throughout history. However factors such as a slow population growth in Italy, a decrease in immigration fro m Italy to the United States, an unstable economy and negative stereotypes of this ethnic group threaten that heritage. Italians in Italy and in America are threatened with the loss of their identity and uniqueness. Italians are no longer the predominant immigrant group in the United States. The future of Italy is imperiled by its stagnant growth. The paper will discuss current and past immigration trends of Italians, contributions made by Italians in Italy and the U.S, the current state of Italy as well as negative stereotypes of Italians. In the 1880’s massive economic decline and an overpopulated nation resulted in a dramatic increase in Italian immigration to the United States. ... Some early Italian migrants were young men who wanted to work for brief periods and then return to Italy. Others would settle in America in predominantly Italian areas. The men mostly did physical labor which included building the communication infrastructure. â€Å"The Italian contribution to the refining of America also derives from the immigrant labor used to build reservoirs, streetcar lines, subways, railroads and buildings to pave streets and to install and repair sewage lines.† (Scarpaci & Mormino p.12) Italian immigrants brought with them an agrarian, family oriented culture that placed emphasis on hard work as a means to succeed and survive. They felt that during troubled times, they can always trust in family. Throughout most of the 20th century there was a gradually increasing influx of immigrants from Italy who would settle in America. During the 1920s most Americans were leading prosperous lives and many Italian American colonies received infusions of capital deri ved as a result of breaking Prohibition laws. Most Italian Americans were adversely affected by the Great Depression. As a result they became part of Franklin D. Roosevelt's Democratic coalition. From World War 2 to the 1950s and 1960s more Italian Americans were middle class due to ample employment opportunities. By the mid-1970s Italian American young people were attending college at the national average. According to Census Bureau data, Italian Americans have an average high school graduation rate, and a higher rate of college and post graduate degrees compared to the national average. (Scarpaci & Mormino, 2008)From 1998 to 2002 many college students throughout the United States took classes to learn Italian. It is the fourth most commonly taught foreign language in U.S.

How Biologists Are Impacted and Responding to Alcohol-Induced Research Paper

How Biologists Are Impacted and Responding to Alcohol-Induced Interpersonal Violence Globally - Research Paper Example The dependence of alcohol causes problems in social state of its victim and results to abnormal occurrences and acts such as domestic violence, loss, or lowering of productivity in place of work as well as causing traffic accident leading to injuries are also the consequences of alcohol misuse. The misuse also results to chronic organ disorders of the victimized individual (French, 1991, 57-63). According to the Room, et al. (2005) excessive use of alcohol is rated third position of the causes leading to preventable deaths in the US. Its abuse causes the large burdens in the cohesion of communities, health of populations and the provision of the basic public services including criminal justice and health care. Alcohol misuse is responsible of 4% a year on the lost health through disability or premature deaths. The report also indicates that, for every resulted death due to the interpersonal violence, many of the victims require treatment from hospital while many other victims remain undisclosed (Nutt et al., 1988, pp 283-313). This is because the victimized persons are recorded neither by the criminal justice agencies, nor in the health centers. Alcohol and interpersonal violence are strongly linked although the consumption depends on the pattern of drinking between countries, and across all cultures. There are many cases documented which justifies various impacts of impacts on the harmful consumption of alcohol by recording the victims of violence as a result. According to Goldberg et al. (2003)the Australia recorded 26% male victims and 17% female victims between year 2002 and 2003. As evidenced on the report, the victims were said to have been drinking alcohol prior to their death. On another case, Netherlands had documented 36% of the victims presented to the trauma department between the years 1970 to 1998. It was then learnt that the victims had consumed alcohol. The percentage of the victims of violent injuries presented to the emergency rooms in USA, Ca nada, Argentina, Mexico, Spain, and Australia tested positive for alcohol depending on the country. For example, in Argentina, only 24% of those tested turned positive whilst Australia had 43%. In every country, abuse of alcohol and its related interpersonal violence has so far affected too many consequences including affecting the health and the well-being of the relationship between the friends and family, fear levels within the communities, and also the pressure to the public service. Harmful use of alcohol is said to be the method of portraying violent experiences where the victims become prone to problematic habits of drinking even in future life. Other long-term effect of victim’s health includes the posttraumatic stress disorder or even committing suicide. Researchers in developed countries have noticed that, the consumption of alcohol by both the violence perpetrators and victims can increase the severity of injuries (Thurman & LemasterS, 1984, pp. 103–117). In this, alcohol may play a major role in determining the survival of the victims after serious assaults. For example, by either reducing the victims’ perception of the seriousness of the injury or reducing their ability of seeking the medical help (Room et al., 2003). Alcohol abuse also causes many other social

Limited time quiz. 1 hour and 10 minutes Assignment

Limited time quiz. 1 hour and 10 minutes - Assignment Example The majority of its business is conducted online: Consumers purchase typically small quantities of products online and Plant Away coordinates the shipping from the most appropriate nursery. What unique problems might you anticipate it has in its supply chain? What might remedy these problems? (Points : 35) First, Plant Away will have an uphill task while transporting these products because of their nature. Seedlings can wither or die off if the transportation process is delayed, which is inevitable in an online business. Secondly, Plant Away will experience problems getting customers because of lack of trust. Not many customers can trust that purchasing a product online will land on their hands safely. They would rather buy what they can see physically. The other problem is concerned with cyber crime. If the company or its customers are not careful, money can be lost to cyber criminals or hackers. To remedy these problems, Plant Away may want to use agents to be selling the products from the side of the customers. Regarding lack of trust of online business, Plant and Away can invest in good customer relations and education to increase their confidence. Lastly cyber crime can be avoided by making sure all the security control checks are installed in their systems, and generally being c areful not to fall play of these crimes. Customers can be educated on the

Should France ban the veil Essay Example | Topics and Well Written Essays - 1250 words

Should France ban the veil - Essay Example The act of covering the face by all Muslim women was banned by the French Senate and the National assembly during the same year. People within France and all over the world have started protesting against this act of the French government. In the region of France a total of 82% of the population is supporting the ban, while a 17% and those who are in favor of such a ban form a majority throughout the European Nations (Pew Research Center 1). A heavy debate between the supporters and opposition of banning of veil in France has started taking place. Those who are in favor of such a ban state that French government is disrespecting the freedom of individuals in regards of deciding what they should wear and what they should not. However, ban on the full-faced veil should be removed because such an action disregards an individual’s freedom. The French government took the measure of banning niqab because they believed that niqab was a sign of oppression which is against the norms of the French society. French levied a ban on the veil is because the veil is believed to be a sign of oppression that is being carried out by the male society to over the females of the Muslim society. Sciolino states that the French are connecting the veil to the burqa that has been used in Afghanistan â€Å"by Taliban to oppress the women in their own society† (Sciolino 140). This means that the French government believes that the Muslim women are forced to wear the veil by their male relatives to oppress their right of deciding their own clothes. This even means that the French believe that by banning the veil they are giving the female Muslims the right to decide what they want to wear. Another reason due to which the French have banned the veil within their nation is that they believe that veil is against their cultural norms. Scio lino states that French culture promotes â€Å"the meeting of eyes between two individuals in order to start a conversation† (Sciolino

Jacksonian Age religious commotion Essay Example | Topics and Well Written Essays - 250 words

Jacksonian Age religious commotion - Essay Example For a long time, the government controlled every activity that the church was doing (Sellers 2006). The separation between the church and the state caused a commotion in the religion. Divisions in the church were evident, where each denomination claimed to have power than the other. The main denominations according to the ranking of the majority were Methodist, Presbyterians and the Baptists. It was due to this margin among the religious institution that caused changes in the church. This commotion gave birth to revivalism which was highly welcomed by the Americans. Long before these changes, the Americans used to be attracted by secular meeting organized through camps to gain a social touch, but with the emergence of revival meetings, they diverged their lifestyle to concentrate on revivals (Sellers 2006). Salvation was evident in such meetings, having faith was also encouraged, and as a result, many people gave their lives to God. Each denomination could formulate ways to mak e their revivals unique. For instance, the Baptists came up with the idea of baptism. They argued that, it was vital for the fulfillment of conversion experience (Sellers 2006). Those who were baptized, were convinced of having gained eternal life, hence as a way of maintaining it, they became so loyal to the church. The church at one point started deteriorating in terms of fame in the country. This was due to some actions that were happening in the church which did not make people happy. Business-minded revivalists emerged, using revivals as a source of income. Though giving was a requirement, in the church, American citizens wondered how they could make themselves rich. People who conducted the revivals could not maintain their purity. They were involved in the dirty acts of immorality. Traditional religion The traditional religion in the United States was not forgotten. A good number of Americans believed in things like dreams, fortune tellers, ghosts and

YOUR CHOICE Assignment Example | Topics and Well Written Essays - 250 words - 1

YOUR CHOICE - Assignment Example A president’s removal from office is only possible if there is a two-thirds majority in the Senate. Andrew Johnson and Bill Clinton have both undergone impeachment trial, but retained their seats. I believe it is appropriate because it is a thorough and fair process. Original intent plays a significant role in the interpretation of the constitution and laws of congress Supreme Court. It is necessary because it helps to maintain the representative democracy under the federal Constitution and acts as a system of checks and balances. Judges who digress from the original understanding of a constitutional provision have to use their own prejudice, rationality, and social preference, which may be unfair in some cases. Even so, original intent should not be the most important criterion because decisions depend on interpretation of the constitution. State and federal courts should have the power of judicial review to appraise and nullify laws that the legislative and executive branches of government have passed, but infringe a constitutional

Enterprise Systems Essay Example for Free

Enterprise Systems Essay Enterprise systems, according to the text, are: a set of integrated software modules and a central database that enables data to be shared by many different business processes and functional areas throughout the enterprise. (Laudon Laudon, 2011)Let’s say, for example, the financial department of an organization needs to audit all of the orders fulfilled by the Sales and Marketing department. With an integrated enterprise system, there is no need to request the information and wait for it to be sent to the financial department from the distribution center. Both departments are linked by a central database that they can both access at any given time. This reduces the time between requesting the data and utilizing it for the department’s needs. If the Sales and Marketing department does not keep the Distribution department aware of what is being sold, then prompt delivery of the product cannot be guaranteed. These enterprise systems also increase the security of the database. Having separate databases for each department will increase the chance for lost data. The needs of each department can be considered separate, but when looking at it from an organizational perspective, each department is a part of a larger entity. This entity cannot survive without the cooperation of each of its departments working together. †¢How does effectively implementing and using enterprise systems contribute to achieving operational excellence? As stated in the above answer, a properly implemented enterprise system creates a more accessible, secure, and usable database. An organization that allows each department to access the information needed to run smoothly and effectively can save time and productivity. If compared to a system of separate departments and databases, we can see the benefits of the enterprise system. Any department, with the proper access, can get the information they need to do the work that they need to do. Without this, we would see an information system with the possibility of lost data due to poor communication between departments. This relates to the question of security. It is easier for a database specialist to keep one large database secure and safe than it would be to work with several separate databases. The question of who can access what data from what department is easily controlled within the database itself, which allows for easier backup of data as well. A unified database can also benefit each separate department by easily allowing them to access only the information they need, this boosts the security of not only the database, but all information in that database. All of these contribute to the ease of use of the database and a smoother running operation. †¢What challenges are posed by enterprise applications? There are many different challenges that arise when implementing an enterprise system. Accessibility is one of the biggest. What department can access what data? How can this data be used by the departments that have access to the data? The information used by the enterprise applications are the core of the database. Without it, there would be no need for the database to exist. Each department must have the proper applications that can communicate the data between the other departments. I have seen many instances where improper implementation was due to each department not complying with the software or hardware requirements of the enterprise system. This results in not only loss of productivity, but money wasted on applications not compatible with the base system. This also lowers the security of the enterprise system, which can result in the loss of data. Having a secure database, as I have said before, can also benefit the ease of use and better productivity not only for the IT department who keeps the database and systems running properly, but for the end user in the offices of each separate department. Only by working in concert and by having the appropriate applications for each separate department can an enterprise system work for the betterment of not only the organizations, but their customers or clients.

An audit looking at how many patients are with thyroid dysfunction

An audit looking at how many patients are with thyroid dysfunction What is the function of thyroid gland and thyroid hormones The thyroid gland is located in the anterior part of the neck, attached to the thyroid cartilage. It consists of two lobes, approximately 5 cm each, that lie either side of the trachea joined in the middle by an isthmus. The thyroid gland is responsible for the production of three thyroid hormones: Calcitonin (involved with calcium homeostasis), Thyroxine (T4) and Triiodothyronine (T3). Everyday, approximately 100  ¿Ã‚ ½g of T3 and T4 are secreted 90% of which are in the form T4. Most of T4 is later converted to T3 in the liver and Kidneys. T3 is 10 times more active than T4. [1] The thyroid hormones are responsible for the control of basal metabolic rate. Expand? How is Thyroid hormone regulated The functional unit of the thyroid is the follicle. A spherical arrangement of secretory epithelial cells around a protein rich colloid. It is at this cell-colloid boundary that thyroid hormones are formed by iodination of thyroglobulin formed from tyrosine.[1] The follicular cells are involved in active absorption of iodine from the plasma which is required for thyroglobulin synthesis. The formed thyroid hormone is stored in the colloid until its secretion is triggered by thyroid stimulating hormone from the anterior pituitary which triggers the degradation of thyroglobulin in the follicular cells to release thyroid hormone. Thyroid hormone secretion is under the control of the hypothalamic-pituitary axis. The hypothalamus releases Thyrotrophin Releasing Hormone (TRH) which stimulates the anterior pituitary to secrete Thyroid Stimulating Hormone (TSH). The TSH reaches the thyroid where it binds to the TSH receptors on the surface of the follicular cell, stimulating it to produce and release thyroid hormones. The homeostasis of thyroid hormone concentration is maintained by a negative feedback loop whereby increased concentration of thyroid hormone inhibits Thyroid Stimulating Hormone release from the anterior pituitary by decreasing the affinity for TRH. This leads to a decrease in TSH causing reduced amount of thyroid hormone to be released by the thyroid gland. This feedback loop enables us to monitor patients on thyroid hormone replacement therapy (such as Levothyroxine) by measuring TSH levels. If for instance the prescribed dose is insufficient, it would lead to inadequate inhibition of the pituitar y gland and a raised serum TSH level. The reverse would occur with levothyroxine excess. () This cannot be done in patients with secondary hypothyroidism. So what do we do then? Common pathologies Thyroid disease is the second most common endocrine disorder after diabetes.  ¿Ã‚ ½ Hypothyroidism Hypothyroidism is defined as an underactive thyroid gland leading to decreased levels of T3 and T4. The annual incidence of hypothyroidism in the UK is 4 per 1000 in women and 0.6 per 1000 in men.[3] Symptomatic hypothyroidism is known as myxodema. Hypothyroidism is categorised into primary and secondary. Primary hypothyroidism results from disease processes affecting the thyroid gland itself, slowly decreasing thyroid function and thyroid hormone production. Onset of symptoms is therefore gradual, developing over months or even years. Secondary hypothyroidism is relatively uncommon. Secondary hypothyroidism develops when the pituitary is unable to produce enough TSH to induce enough T3 and T4 production from the thyroid gland. The causes of secondary hypothyroidism can include a pituitary tumour. Patients with hypothyroidism could present with a number of signs and symptoms including:  ¿Ã‚ ½ Tiredness  ¿Ã‚ ½ Somnolence  ¿Ã‚ ½ Slow cognition  ¿Ã‚ ½ Cold Intolerance  ¿Ã‚ ½ Depression  ¿Ã‚ ½ Bradycardia  ¿Ã‚ ½ Weight gain  ¿Ã‚ ½ Calf stiffness  ¿Ã‚ ½ Menstrual disturbance  ¿Ã‚ ½ Carpal tunnel syndrome  ¿Ã‚ ½ Hearing impairment  ¿Ã‚ ½ Dry, thin and pale skin  ¿Ã‚ ½ Puffiness below the eyes  ¿Ã‚ ½ Bradycardia The most common cause of primary hypothyroidism in the UK is autoimmune thyroiditis. In Hashimoto ¿Ã‚ ½s thyroiditis autoantibodies are produced against thyroglobulin. This leads to inflammation of the thyroid gland as it is infiltrated by lymphocytes causing goitre formation. Hashimoto ¿Ã‚ ½s thyroiditis is remarkable in this respect that it initially causes hyperthyroidism as inflammation of the thyroid gland releases stored thyroxine. Once this released thyroid hormone is metabolised the patient progresses to normal and then a hypothyroid state. [1] Other notable causes of hypothyroidism include:[4]  ¿Ã‚ ½ Iatrogenic: Radioiodine ablation or thyroidectomy as a treatment for hyperthyroidism  ¿Ã‚ ½ Thyroiditis: Subacute (de Quervain ¿Ã‚ ½s) thyroiditis  ¿Ã‚ ½ Drugs: Lithium, Amiodarone, thalidomide, rifampicin and sutinib as well as drugs used in the treatment of hyperthyroidism  ¿Ã‚ ½ Iodine deficiency: common in some developing countries but very rare in the western world At the opposite end of the spectrum lies Hyperthyroidism where there is increased Free T4 and a reduced level of TSH and has the opposite effect on the body than the one noticed in hypothyroidism e.g. tachycardia, heat intolerance etc. Hyperthyroidism is not covered further as this audit focuses on hypothyroidism. Diagnosis and treatment Symptoms of hypothyroidism are quite non-specific and can commonly occur with other medical conditions not related to the thyroid. Diagnosis of hypothyroidism therefore should not be made on clinical symptoms alone and it is essential to test thyroid function biochemically. This is done by measuring Thyroid Stimulating Hormone and Free Thyroxine (T4) in blood. The normal reference range for TSH is 0.4  ¿Ã‚ ½ 4.0 mU/Litre.[4] A TSH level within the normal reference range has over a 99% predicted value to rule out primary hypothyroidism or hyperthyroidism.[5] In hypothyroidism the patient would have a high Thyroid Stimulating Hormone level, with or without a low Thyroxine level. Depending on thyroid function tests hypothyroidism is further divided into: a) Overt hypothyroidism: patients with a high Thyroid Stimulating hormone level and a Low serum free Thyroxine (T4) b) Subclinical hypothyroidism: Patients with a high Thyroid Stimulating Hormone but a normal Thyroxine (T4) level Treatment depends on whether the patient has overt or subclinical hypothyroidism. Patients with overt hypothyroidism should be treated with Levothyroxine to render them  ¿Ã‚ ½euthyroid ¿Ã‚ ½.[5] According to NHS statistics 12 million Levothyroxine prescriptions were issued during 2006.[6] The goal of the treatment is to reduce the TSH back to within the reference range. The dose of Levothyroxine is usually titrated up from 25-50  ¿Ã‚ ½g daily however a recent trial has shown that this is unnecessary for most patients.[7] The study recommended that patients with no cardiac symptoms should be started on the full dose of 1.6  ¿Ã‚ ½g/kg. The following figure illustrates the algorithm for treatment of -pregnant adults with primary hypothyroidism:[4] Algorithm for management of non-pregnant adults with primary hypothyroidism [4] It is very important to monitor levothyroxine therapy as over or under prescription can be dangerous. Thyroid Stimulating Hormone (TSH) is the key method of monitoring levothyroxine therapy in patients with primary hypothyroidism. Unlike the thyroid function tests used to diagnose thyroid disease, free T3 and T4 levels are not very useful in monitoring treatment as their levels are influenced by the prescribed dosage of thyroid replacement hormone and are not accurate indicators of the individual ¿Ã‚ ½s requirement. TSH without T3 and T4 is also a cheaper test to carry out in General Practice. Current guidelines state that patients should have their Thyroid Stimulating Hormone level tested eight to twelve weeks after starting levothyroxine.[4] The dose can later be fine tuned accordingly to get the TSH level in the lower half of the reference range.[5] Besides monitoring TSH levels, an assessment of the patient ¿Ã‚ ½s symptoms should also be made as some younger patients may need higher doses to relieve their symptoms in which case it is acceptable to have the TSH between 0.1-0.4 mU/Litre. The Quality and Outomes Framework (QOF) guidance suggests that all Patients on long term thyroid hormone replacement therapy should have their TSH levels tested yearly to make sure their replacement dose remains optimal.[8] Audit 1. Reason for audit move it to the top to include the rest of the study Despite the yearly TSH tests, studies have shown that a considerable number of hypothyroid patients managed in primary care have TSH levels outside of the reference range. Okosieme et al reported that in 2009 data collected from 11 GP practices showed that 37.2% of the 1037 patients on the hypothyroidism register were inadequately managed.[9] When we take into account the high prevalence of hypothyroidism (9.3% in women and 1.3% in men)[3] the results of the Okosieme et al study suggests that the total number of patients with suboptimal thyroid hormone replacement is significantly large. Imperfect thyroid hormone replacement could have damaging repercussions for health. It may adversely affect blood pressure, body weight and lipid profile. Since the basal metabolic rate of the body is controlled by thyroid hormones it is perhaps not surprising that a decrease in thyroid hormone levels leads to a decrease in metabolic rate and thus can cause weight gain. Even in euthyroid subjects there is a negative correlation between free T4 and Body Mass Index (BMI).[10] This suggests that even a small under-prescription of thyroid hormones could, over a period of time, lead to obesity. Reduced Thyroxine levels also cause a dyslipidemia characterised by increased Low Density Lipoproteins (LDL) and a decrease in High Density Lipoproteins (HDL) with normal or slightly raised cholesterol levels.[11] Such a lipid profile is associated with a higher risk of atherosclerosis. The thyroid hormones also seem to have a role in blood pressure homeostasis as hypothyroid patients recorded a higher systolic and diastolic blood pressure after stopping thyroid replacement therapy.[12] Thus inadequate replacement may cause hypertension which, together with the dyslipidemia described above adds to the risk of atherosclerosis and its subsequent cardiovascular complications. Conversely, excessive thyroid hormone replacement has its own perils, having enhanced risk of atrial fibrillation, osteoporosis and fractures linked to it. Excessive thyroid hormone increases the risk of developing atrial fibrillation especially in older patients. Studies have shown that a low TSH level in patients over 60 years old have a threefold higher risk of developing atrial fibrillation.[13] Patients over treated with levothyroxine also show increased loss of bone mineral putting them at increased risk of osteoporosis.[14] Subsequent studies have shown that patients with a suppressed TSH i.e. = 0.03 mU/Litre also had an increased risk of fractures however this was not observed in patients with low but unsuppressed TSH (0.04  ¿Ã‚ ½ 0.4 mU/Litre).[15] This highlights the need for maintaining optimal thyroid hormone replacement in primary hypothyroid patients in the General Practice setting to reduce the above mentioned risk factors. The 11 GP practices used by Okosieme et al showed that there is significant room for improvement as one third of the patient population on levothyroxine had TSH levels outside the reference range.[0.11] Thus this is a worthwhile area for audit to establish current standards of care in our practice, Dr Dean Partners, Heald Green Health Centre. Since this audit has not been carried out before in the practice it would give an idea of how well the practice manages patients on thyroid hormone replacement therapy. The suggestions for improvement would be beneficial to the patients of the practice and might also help with obtaining QOF points. This audit would also be beneficial to me personally introducing me to the concept of audit cycles and giving me the opportunity to conduct my very first audit. It would also help me get a better understanding of management of hypothyroid patients which is the second most common endocrine disease in the UK after diabetes mellitus. 2. Criteria to be measured Serum Thyroid Stimulating Hormone is used as the gold standard for biochemically diagnosing hypothyroidism and monitoring thyroid hormone replacement therapy.[4] The reference range indicating adequate replacement is usually around 0.4  ¿Ã‚ ½ 4.0 mU/Litre.[4, 9] However this figure slightly varies according to local guidelines. For this I have chosen to use TSH between 0.1  ¿Ã‚ ½ 4.0 mU/Litre as a reference range for adequate thyroid hormone replacement as this is the reference range used by the local Primary Care Trust (Stepping Hill Hospital) and the practice. Patients with primary hypothyroidism on thyroid hormone replacement therapy should have a TSH level between 0.1  ¿Ã‚ ½ 4.0 mU/Litre. 3. Setting standards For setting the standard I have found that there are no specific guidelines stating what proportion of patients should be achieving the above mentioned criteria. There are no NICE guidelines for the treatment of hypothyroidism. The QOF guidance states that patients should have their TSH levels tested yearly but it does not state the standard of care required. Having discussed this with GP at the practice I have decided that a theoretically ideal standard i.e. 100% of patients meeting the above criteria would be very impractical in theory from a resources perspective. Given the fact that suboptimal thyroid hormone replacement could be harmful, it is nonetheless important to achieve a high standard of care. Therefore I have decided on an optimum standard: 90% of patients with primary hypothyroidism on thyroid hormone replacement therapy should have a TSH level between 0.1  ¿Ã‚ ½ 4.0 mU/Litre. 4. Preparation planning Before starting the audit I had a discussion with the GP tutor about worthwhile areas for audit. As I had never conducted an audit before he explained the audit cycle. As thyroid dysfunction was an area of interest for me I suggested undertaking this audit. The GP tutor agreed that this would be a useful area for audit and advised to me to review the literature to find out if it would be an appropriate audit from a clinical point of view and was an area where practice could be improved. After preliminary reading clinical reviews I formulated a step by step template of the things I felt should be covered and got the GP tutor ¿Ã‚ ½s approval to go ahead. The data was collected with the help of the GP tutor. As the practice keeps electronic records of all patients, EMIS Population manger search function. Using the search function we identified all patients who had been prescribed thyroid hormone replacement medication for the past 12 months. We then identified patients who in the past 12 months had had their TSH levels tested. We then selected patients who had a TSH =0.1 mU/Litre and TSH =4. Subtracting the number of patients which meet the TSH search parameters from the total number of patients on thyroid hormone replacement would give us the number of patients who were outside the reference range of TSH. 5. Initial data collection Criterion Number of Patients taking thyroid hormone replacement medication (n) Number of Patients with TSH levels within reference range Standard (%) Patients with primary hypothyroidism on thyroid replacement therapy should have a TSH level between 0.1  ¿Ã‚ ½ 4.0 mU/Litre. 206 167/206 (81%) 90% Discussion Results: what they are. How close to the standard. Are they good enough? (no, didn ¿Ã‚ ½t meet the standards). Why didn ¿Ã‚ ½t they meet the standard? Merge results discussion with limitations discussion The data collected shows that the current practice is 9% below the standard set. The standard required i.e. 90% of patients with primary hypothyroidism on thyroid hormone replacement therapy should have a TSH level between 0.1  ¿Ã‚ ½ 4.0 mU/Litre. However this was the case with only 167 patients (81%). This means that 39 patients (19%) did not meet the standard set. There could be several reasons why the results did not meet the standards set. One factor influencing TSH levels is the use of medicines which interact with thyroid function. Due to the limitations of the software used in data collection (as discussed below) we were unable to exclude patients who were on medication known to interact with thyroid function such as Amiodarone, Lithium, etc. Amiodarone, a fairly commonly prescribed drug to prevent arrhythmias, can cause deranged thyroid function as it contains iodine (37mg of iodine in 100mg of Amiodarone). This can cause a severe iodine overload and can lead to hypothyroidism as well as thyrotoxicosis.[0.16] Inclusion of such patients would bring the percentage down unfairly because management of such patients is a lot more complex and the TSH levels are not always a good indication of the adequacy of their thyroid hormone dosage. Patients with hypothyroidism due to Amiodarone are monitored by their Free T4 levels instead of TSH. [0.16] Another factor which could have contributed to the high number of patients with TSH levels outside those defined in the criteria is the possibility that patients with abnormal TSH levels often don ¿Ã‚ ½t get their levothyroxine dose optimised. A study published in 1995 reported that at one GP practice in Suffolk 71% of patients with abnormal TSH levels did not have their medication dosage change as a result.[17] If patients do not have their thyroid hormone replacement optimised as a result of abnormal TSH not only does it defeat the purpose of carrying out yearly TSH tests, it also means that these patients would continue to have an abnormal TSH when tested again. Currently we do not have the data to find out how many of the patients in our practice with abnormal TSH had not had their dose changed after a previous abnormal TSH in an attempt to bring it within the reference range specified in the criteria. Ranging from poor patient compliance to the way the data has been collected Lack of dose adjustment after abnormal TSH The way results were collected. Limitations of software used. Limitations of the results collected ie things missed: how many patients actually had test done in the last 12 months (QOF points). How many were over and how many were under prescribed. This audit has limitations. The data was collected from electronic records using the EMIS Population Manager. The limited search algorithms of the software meant that we couldn ¿Ã‚ ½t distinguish patients with a TSH below the reference range from those above it. All we were able to obtain was a single figure of how many people were within the reference range. Due to the limitations of the EMIS Population Manager software we were also unable to test how many patients with hypothyroidism had actually had their TSH levels tested in the past 12 months as stated in the QOF guidance  ¿Ã‚ ½ 2004.[8] Thyroid Function Tests are done for a large number of patients whose symptoms are actually caused by a non-thyroid illness. Due to this reason we could not search for people who had their thyroid function tested in the past 12 months as that data would have included a lot of non-hypothyroid patients. Instead we had to search for patients who had been prescribed levothyroxine therapy in the past 12 months. And then further narrow the search parameters TSH levels in the past 12 months to obtain the data. This meant that the people who have not had their thyroid functions tested in the past 12 months were excluded from our data. The positive aspect of only testing people within the last 12 months is that the data reflects current level of care. The data collection software shows patients as being within the normal TSH range if they have had at least one TSH test within the normal range during the last 12 months. If the patient has been started on levothyroxine therapy recently their TSH levels wouldn ¿Ã‚ ½t have had enough time to return to normal. However this is likely to be statistically insignificant. The way to get round these limitations of the EMIS Population Manager would have been to study the clinical notes of all patients who were prescribed levothyroxine in the past year. By looking at the notes we would be able to exclude patients who are unsuitable for the purpose of this audit i.e. those patients in whom the TSH level is not a valid indicator of thyroid hormone requirement e.g. those on Amiodarone or lithium or patients with secondary hypothyroidism. Looking at the notes would also allow us to check the number of patients who had not had their TSH levels tested in the past year. Reading through the notes would also allow us to obtain more information such as age gender etc which might be helpful in indentifying some of the factors responsible for suboptimal thyroid hormone replacement. However reading the notes of over 206 patients would have taken a considerable amount of time. Since this was my first audit I decided to avoid gathering qualitative data and decided that the using electronic records would be sufficient for the purposes of this audit. Changes to practice to hit the target. Tietable to implement that change and when to re-audit? Practicality, why change? Positives and negatives of changing. There are a few approaches which could potentially be taken to improve the standard of care. In order to improve the standard of care to meet the goal of 90% all patients on the hypothyroidism register should have yearly or six monthly blood tests to measure their TSH levels. all patients with abnormal TSH levels should be invited for an appointment with the GP and should be considered for a change in their current dosage. This would be a good opportunity to assess why their TSH levels are abnormal and check that the patient is adhering to the prescribed treatment regimen. If the dose remains unchanged the reason should be recorded in the notes so that the information is available for the second cycle of the audit. Doing this will allow us to make sure that patients are kept at the optimum dose of levothyroxine to reduce the risks associated with under or over prescription. Seeing patients like this would however increase the workload placed on the surgery and its resources. However by talking the patients as and when they have their TSH levels tested the strain on the resources would be spread out over a year. Since the current audit identified 39 patients with abnormal TSH levels, this would mean an extra 3-4 patient appointments per month over the period of a 12 months. This should be discussed at the doctors ¿Ã‚ ½ meeting. Twelve months after the implementation of the change of practice a second data collection should be done to complete the audit cycle and evaluate the impact, if any, the change in practice has had on the management of hypothyroid patients. Write to the patients to invite them to come in for a dose adjustment? Consider collecting better data by reading the notes. That would take too long. Consider specialist referral if symptoms persist. What have I learned: 1 about the condition, 2 about auditing. Conducting this audit has given me the chance to take an in-depth look at all aspects of hypothyroidism which has been an area of interest for me for some time. In the course of researching for the audit I have been able to review various guidelines, clinical reviews and other journal articles. Not only has that improved my understanding of the management of thyroid disease in primary care immensely. It has given me a sense of how a condition is followed through in general practice from first presentation to treatment to long term management. I have also realised that management of chronic conditions such as hypothyroidism is an ongoing process as the patients ¿Ã‚ ½ condition and requirements change continuously for instance if their body mass index changes significantly their thyroid hormone requirements would also change and the dose would have to be altered. Also if a patient is planning on or has become pregnant they would need to be referred to specialist endocrinologists. I have been able to review the evidence which forms the basis of current practice. Researching this topic by reading clinical reviews has made me realise the advantages of using original literature and how much beneficial it can be in achieving a comprehensive understanding of a topic. Being involved in a general practice standard-based audit has enabled me to learn about the role and significance of audits in healthcare. I have become familiar with the audit cycle and its different steps. Having conducted an audit myself, I can see the important role audits have in measuring and improving practice. It is a systematic way of monitoring standards of care and is very useful in facilitating change of practice through an evidence based approach. It has also allowed me to learn how to quickly and efficiently find relevant papers using such resources as ISI Web of science and medline. Conclusion and summary Timetable change re-audit 6. Description of change 7. Data collection (2) 8. conclusions be almost impossible to achieve due to variables like poor patient compliance or use of interactive medications e.g. Amiodarone and Lithium. It would also be vastly impractical from a reasources point of view to aim for a 100% standard.

The Business Environment Of Tata Motors In India

The Business Environment Of Tata Motors In India As emphasized by (Palmer and Hartley, 2006) the Macroenvironment of a company is composed of the External Determinants. This includes factors such as political, economical, social, technological, environmental and legal. These factors have an indirect impact on a firm or any business activity. The Microenvironment of a company is composed of the Internal Determinants. This includes factors such as suppliers, consumers, competitors. Bringing this into perspective it is very significant for any company to analyse and study the Business environment in order to make plans, design strategies and take decisions. For example, a company from the United Kingdom setting up its activities in India has to focus on the Macro and Micro Environment in India to run successfully. If they work according to the analysis of the business environment in the United Kingdom they are bound to fail in their operations in India. Thus to understand the Macroenvironments, companies and management students can make use of PEST analysis which helps in critically evaluating the political, economical, social, technological, environmental and legal determinants which have an indirect impact on any business entity. This critical evaluation helps a business firm to strategise effectively and take justified decisions. After analysing the business environment using the PEST tool, any company can make use of SWOT analysis to gain an insight on the strengths, weaknesses, opportunities and threats to survive in todays world comprised of severe competition. According to (Day and Shoemaker, 2005) scanning the Business Environment is like adapting a peripheral vision. Companies with a peripheral vision can recognize the changes taking place in the business environment and accordingly take steps to confront potential threats and grab the opportunities that can prove to be of significance moving ahead. Companies with a good peripheral vision gain a competitive edge over their competitors if they react positively to the changes happening around. The company selected for this work is Tata Motors. Being a huge manufacturer of automobiles, its periphery consists of all the accordant forces. Thus an analysis will be done considering the changes that have occurred over the last five years, how Tata Motors have reacted to these changes in order to survive in todays world of fierce competition. In this work Tata Motors will be analysed using tools like PEST Analysis, Michael Porters five forces and SWOT Analysis, and in the process these tools should be of help in deriving some conclusions and making some recommendations. Organisation Description and Background Tata Motors is Indias largest manufacturer of automobiles. It was initially known as Tata Engineering and Locomotive Company. In 1954, the company signed a collaboration agreement with Daimler Benz of Germany and started the manufacturing of commercial vehicles. It has been a pioneer in this sector, especially in India. They also have their base of operations in the UK, South Korea, Thailand and Spain. Manufacturing of passenger cars, utility vehicles, passenger buses and light, medium and heavy commercial vehicles are the main areas of business of Tata Motors. [www.tatamotors.com] The commercial line of Tata Motors has had its roots strengthening since several years in different market segments such as Europe, Africa, Australia, Southeast Asia, South Asia and the Middle East. Tata Motors have always believed in acquisitions to expand their business and build a market share around the world. Daewoo, a commercial vehicle company was the second largest truck manufacturer in South Korea. It was acquired by Tata Motors in the year 2004 and this take over gave Tata a significant place in the Korean Market. Following this acquisition Tata Motors got into a joint venture with Thonburi Automotive in the year 2006 allowing them to operate in Thailand. Tata Motors believes in expanding through Mergers and Acquisitions rather than spending several years in building a business. [www.tatamotors.com] The largest acquisition made by Tata Motors was that of Jaguar and land Rover from Ford in March 2008. These two brands cost Ford 5.3 billion dollars where as Tata paid Ford 2.3 billion dollars (Carty, USA Today). This was a significant step for the company as it paved way for them into the business of luxury cars. Tata Motors, in the above mentioned journey has been exposed to the determinants in its environment. Going ahead an analysis would be done on it using tools such as PEST Analysis, Michael Porters five forces and Swot Analysis. PEST ANALYSIS POLITICAL FACTORS: As mentioned above Tata Motors has its operations in several countries around the world. In setting up these operations it was vital for Tata Motors to analyse the Political Environment so as to run the business smoothly. Over the last five years Tata Motors has had a chance to venture in different Markets. When it entered in the UK, the options of entering USA and Russia were also available. But Tata Motors preferred UK over USA and Russia due to favourable political factors such as India being a preferred economic agent, UK car market and potential and language similarity. USA market requires high quality and there are several non-tariff barriers which make it difficult for a new company to enter the market. The reason Russia was declined is because they lack a well-developed dealership network, there were high entry barriers, Language problem and finally there was always the uncertainty of future economic state. As emphasized by (Hill, 2002) the cooperation between India and the U K falls in the regime of favourability which implies benefits being derived due to less tariff and non-tariff barriers. Thus Tata Motors decision of entering the UK market is justified. ECONOMIC FACTORS: This is one of the most significant determinants that need to be analysed as it encompasses factors such as market growth potential, pricing strategies, return on investment and various such monetary aspects. Since 2004 Tata Motors is on an expansion role around the world. It has made its presence felt in over five countries world-wide through acquisitions and joint ventures. Over the past five years there have been changes in different economies. Tata Motors has been adapting to these changes successfully and running their business smoothly. To give an example if there is a hike in price of aluminium in Kenya, Tata Motors has the option of falling back on suppliers in Europe or Asia. They also have to keep a close eye on the fluctuation in the currency rates. The rupee being strong against the American Dollar doesnt mean it will be strong against the Sterling Pound. This factor is directly related to Capital Investment thus posing a challenge, Tata Motors operating in different econ omies which have been in a turmoil due to recession. SOCIAL FACTORS: Demography is one of the significant social factors. It comprises of lifestyle, consumer trends, income, spending power etc. The trait of demographic trends allows a company to make plans and strategise on the kind of products to be marketed. As emphasized by (Mintel, 2006) the influence of fashion and luxury is so strong that consumers neglect the hike in price of fuel. Catering to this Tata Motors launched Tata Safari and Tata Sumo Grande, Indias premier SUVs. Having said that, not all the people are in a position to afford these cars. Bringing this into perspective Tata Motors has continued to manufacture and market Tata Indica, a low budget passenger car. A lot of motorcycle accidents taking place in India, Ratan Tata, the Chairman of Tata Group had a vision of launching the worlds cheapest car and his vision did come true in the form of Tata Nano. Thus it is clearly evident that Tata Motors does respond to changes in the social factors. TECHNOLOGICAL FACTORS: Technology is a factor that enables a company to gain a competitive edge and survive the fierce competition in the market. Tata Motors has currently employed 1400 Scientists and Engineers in their Research and Development Team. This has ensured that they are ahead or at par with their competitors in the domestic market as well as internationally. [www.tatamotors.com]. In the last 5-10 years technology has been advancing at a very rapid space. There have been foreign automobile giants like Hyundai, Toyota etc setting up operations in India. Their cars were technologically far too advanced than Indian cars. They had power steering and windows, central locking, automatic transmission on gears etc. Considering these changes in the environment Tata Motors did not lag behind. They also adapted and brought out cars with this technology and survived the robust change and maintained their position as a leader in the automobile sector. MICHAEL PORTERS FIVE FORCES ANALYSIS: http://www.valuebasedmanagement.net/images/porterfiveforces.gif Source: www.valuebasedmanagement.net. The above mentioned diagram shows the factors considered as significant by Michael Porter in his analysis. Moving further we will see how this analysis can be used to evaluate Tata Motors project Tata Nano. Threat of New Entrants: Tata Motors launched Tata Nano as the worlds cheapest car. It basically targeted the people who used motorcycles as their mode of transport. Indian automobile sector is vibrant and emerging, attracting international brands like Volkswagen, Toyota, etc all of whom are expected to launch new innovative products. Tata Nano is priced approximately at just Rs 1,00,000. Launching a product at such low cost implies that the manufacturer needs to make a huge initial investment and bear a low profit margin as well. The competitors are studying the strategies of Tata Motors closely. But because of the above mentioned reasons Tata Motors doesnt have the threat of New Entrants immediately but yes it will have to definitely face some fierce competition in the future. [www.scribd.com] Threat of Substitutes: Tata Nano faces a threat from electric cars as a substitute. Reva car is already present in the Indian market and Morbi based Ajanta Group is planning on manufacturing an electric car. Ajanta Group is planning on pricing its electric car at Rs 85000 which is even cheaper than the Tata Nano. Reacting to this threat Tata Motors has aleady considered making an electric car and named it the E-Nano. [www.scribd.com] The second hand market for cars is also booming in India. These second hand cars can act as substitutes to Tata Nano as they are in the same price range, moreover they have powerful engines. [www.jimthetrucker.com] Bargaining Power of buyers: Tata Nano is a car that has been manufactured keeping in mind the people with low income. At present Tata Nano is the only car in the Indian Market available at such a low price(approximately Rs 1,00,000). Bringing this into perspective the Indian consumers do not have many options. This implies that there is not much bargaining power vested in the hands of the buyer. But as and when the competitors come with similar cars the buyer will have the power to switch cars, the power of choice etc. [www.tatamotors.com] Bargaining Power of Suppliers: There are about 60 companies acting as suppliers for Tata Nano. These suppliers together assimilated an amount of about $112.7 dollars to set up base on the Singur Complex. Suppliers mentioned that the existing plants were equipped enough to support the launch of Tata Nano provided the Tata Plant shifts to Pantnagar or Pune. Other suppliers showed cooperation by showing the will to use their sheds as warehouses for storing purposes. (www.scribd.com) Tata Motors has formulated a bill marketing system vesting the interest of the suppliers. Through this Tatas bank makes the payment to the suppliers and then Tata pays the bank. Tata has also set up a suppliers council to recognize and rectify issues such as delayed payments which were acting as hindrance between the company and its suppliers. [www.tatamotors.com] This shows that the suppliers conveyed utmost support to Tata Motors, thus rather than acting as a threat they acted in favour of the auto manufacturer. Tata Nano being the only make of its type the suppliers seem to be liberal but as and when competitors come up with similar cars the suppliers bargaining power will pose as a threat. Rivalry among existing firms: The competition is very fierce among car manufacturers in India, especially the small car manufacturers like Maruti Suzuki, Hyundai, Chevrolet etc. Tata Motors had come up with the Tata Indica to compete with the Maruti Suzuki 800, Maruti Suzuki Zen etc. Maruti at that time was the leader in the small car market in India. As a counter attack to the Tata Indica, Maruti came up with cars like Alto and some brand extensions like the Zen Estilo. The scene completely changed with the launch of Tata Nano. The price of Tata Nano was half the price of Maruti 800, which then was one of the cheapest car in the Indian Market. In response Maruti Suzuki talked about slashing down the prices of Maruti 800 and Maruti Alto. There were also speculations about Maruti Suzuki redesigning the 800 to pose a challenge to Nano but this got scrapped as the costs involved were very high. The launch of Nano also hurt the dealers of second hand vehicles. These dealers in response got in tie-ups with banks and financial institutions to attract consumers towards buying second hand cars. Thus the launch of Nano intensified the rivalry amongst existing firms. [www.driveinside.com] VALUE CHAIN ANALYSIS http://gscmotion.files.wordpress.com/2009/08/a-value-chain-analysis1.jpg Source http://gscmotion.wordpress.com/2009/08/07/using-value-chain-analysis-for-customer-satisfaction/ The diagram shown above describes the main components and sub-components of a value chain. Going forward in this assignment an analysis will be done on the value chain of Tata Motors. Inbound Logistics: Tata Motors has a very strong set up of Inbound Logistics. This gives the company attain a competitive edge over the other players in the market. Following are the factors which enable the company to maintain a strong set up on Inbound Logistics. Tata Motors gets into Long term contracts with its service providers in transport and various other activities. It does the same with the agents dealing with it. It employs special personnel at regional offices to supervise the entire process. The company has made use of SAP business softwares to strengthen its IT department through which it is able to monitor the activities. The storage facilities are very efficient which lead to easy stuffing and retrieval of materials. [www.tatamotors.com] Operations: Over the past few years Tata Motors has established a Capital Equipment Manufacturing Division which assists the company in development capabilities of international standard. It also has designed Apprentice trainee courses which ensure stability in the supply of skilled manpower. Tata Motors also has a team looking into Kaizen and TPM which profoundly works towards improving efficiency. The company has an automated manufacturing process. Moreover the manufacturing is well distributed not just within India but globally. The company practices optimum utilization of capacity. An example to support this could be that of Mercedes Benz which uses Tata Motors paint shop facilities. Outbound Logistics: Stockyards all across the country and also in the countries abroad where Tata Motors has its operations set up implies that they have a strong Outbound Logistics. As mentioned above the company gets into long term contracts with transporters, gives high and constant business to them which ensures it gets the best deals. SAP programmes ensure that all the offices and various sections are well connected which ensure timely execution of tasks. Pilferage is prevented, thanks to an excellent security system being enforced. Marketing and Sales: Tata Motors is in a pact with large number of dealers and agents to support the function of marketing and sales of its products. Tata Motors follows a systematic approach towards understanding the needs and preferences of customers. Over the past five years Tata Motors has been analysing the market dynamics and accordingly manufacturing innovative products or extending existing brands. Some examples of this would be Tata 207, Tata 407 and Tata Ace. Tata Motors caters to different segment of customers like the common man, farmers, Defence, State Transport etc. It has specific teams developed to address the needs of these customers respectively. Their strategy in Marketing and sales has enabled them to impose a Pan India and Global presence. A fact to support this statement is that Fiat which is an international brand got into a pact with Tata Motors on 13th January 2006 to use the dealership of Tata Motors to sell its vehicles and Tata Motors would use Fiats technology and unutilized capacity.[www.tatamotors.com]

Israeli Etgar Keret’s The Bus Driver Who Wanted to be God, and Iranian

Abstract Colonization most assuredly produced altered states of consciousness, in which the fundamental sense of â€Å"rightness† was understood to be subjective and culturally constructed, rather than naturally true. In conjunction with this realization came the idea that identity is not something personally owned, but rather, something inscribed upon a body or culture by an agent of power. In this case, identities were projected onto the natives by the imperialists. The colonial enterprise, particularly the European imperialist projects in the east, has forever changed concepts of identity, otherness, and power in both the Occident and the Orient. Both sides were indisputably and irrevocably altered; however, the effect upon native cultures (the colonized) was far greater than the effect on the imperial cultures (the colonizers). European colonizers were able to cherry-pick the greatest parts of â€Å"new† culture—their art, their music, their architecture, or their cuisine—and adopt or adapt it to modern imperial life. In many ways, the cultural practices and artifacts of a newly colonized civilization were treated like the natural resources (oil, silk, spice) the Europeans were there to gather: they mattered only in their usefulness to the empire. Unlike their imperial counterparts, however, the native peoples had no choice which customs and practices to adopt, and which to discard. The sheer military might and natur e of the colonial enterprise demanded that the colonized completely adapt to the social and cultural norms of the empire. In essence, then, the colonized were forced to lead a life of double consciousness, wherein they participated in customs and practices and obeyed laws and regulations in which they did ... ...periences with Western ideology, Etgar Keret and Marjane Satrapi offers methods for claiming identity that do not revolve around blind attempts to return to cultural roots. Works Cited Ghanem, Mary, and Jihad Makhoul. "Displaced Arab Families: Mothers' Voices on Living and Coping in Postwar Beirut." Journal of Middle East Women's Studies 5.3 (2009): 54-72. Web. 10 Dec 2009. Keret, Etgar. The Bus Driver Who Wanted to be God. New York: St. Martin's Press, 2001. Print. Said, Edward. Orientalism. New York: Random House, 1978. Print. Satrapi, Marjane. The Complete Persepolis. New York: Pantheon, 2003. Print. Troen, S. Ilan. "Frontier Myths and Their Applications in America and Israel: A Transnational Perspective." Journal of American History 86.3 (1999): 55 paragraphs. Web. 10 Dec 2009. . Israeli Etgar Keret’s The Bus Driver Who Wanted to be God, and Iranian Abstract Colonization most assuredly produced altered states of consciousness, in which the fundamental sense of â€Å"rightness† was understood to be subjective and culturally constructed, rather than naturally true. In conjunction with this realization came the idea that identity is not something personally owned, but rather, something inscribed upon a body or culture by an agent of power. In this case, identities were projected onto the natives by the imperialists. The colonial enterprise, particularly the European imperialist projects in the east, has forever changed concepts of identity, otherness, and power in both the Occident and the Orient. Both sides were indisputably and irrevocably altered; however, the effect upon native cultures (the colonized) was far greater than the effect on the imperial cultures (the colonizers). European colonizers were able to cherry-pick the greatest parts of â€Å"new† culture—their art, their music, their architecture, or their cuisine—and adopt or adapt it to modern imperial life. In many ways, the cultural practices and artifacts of a newly colonized civilization were treated like the natural resources (oil, silk, spice) the Europeans were there to gather: they mattered only in their usefulness to the empire. Unlike their imperial counterparts, however, the native peoples had no choice which customs and practices to adopt, and which to discard. The sheer military might and natur e of the colonial enterprise demanded that the colonized completely adapt to the social and cultural norms of the empire. In essence, then, the colonized were forced to lead a life of double consciousness, wherein they participated in customs and practices and obeyed laws and regulations in which they did ... ...periences with Western ideology, Etgar Keret and Marjane Satrapi offers methods for claiming identity that do not revolve around blind attempts to return to cultural roots. Works Cited Ghanem, Mary, and Jihad Makhoul. "Displaced Arab Families: Mothers' Voices on Living and Coping in Postwar Beirut." Journal of Middle East Women's Studies 5.3 (2009): 54-72. Web. 10 Dec 2009. Keret, Etgar. The Bus Driver Who Wanted to be God. New York: St. Martin's Press, 2001. Print. Said, Edward. Orientalism. New York: Random House, 1978. Print. Satrapi, Marjane. The Complete Persepolis. New York: Pantheon, 2003. Print. Troen, S. Ilan. "Frontier Myths and Their Applications in America and Israel: A Transnational Perspective." Journal of American History 86.3 (1999): 55 paragraphs. Web. 10 Dec 2009. .

Homo Erectus Essay -- Science Ancestry Science Essays

Homo Erectus In the quest to explain human origins it is necessary to find a species that bridges modern man (Homo sapiens) with the apes. To fill this gap evolutionists have set forth Homo erectus, who lived approximately 400,000 to 1.6 million years ago (Johanson and Shreeve1989). Although the distinctions are somewhat vague, below the neck, Homo sapiens and Homo erectus are practically Identical and Homo erectus was responsible for pioneering the use of standard tools (such as the hand axe), big-game hunting, and the use of fire (Johanson and Shreeve1989). You may know Homo erectus as "Java man" or "Peking man"( Johanson and Shreeve 1989). Erectus was low of brow, thick of bone, endowed with a brain larger than that of its ancestors but decidedly more simian than its descendants' (Washburn, McCown 1972). "Emerging in East Africa about a million and a half years ago, Homo erectus lived in the time Frame of 500,000 - 100,000 B.C. The geographical range in which Homo erectus lived in was Africa, Asia, Europe, and Oceania" (Johanson and Shreeve 1989). Homo erectus's brain, twice as large as that of Australopithecus, provided this new species with even more intelligence (Johanson and Shreeve1989). The climate during this time period varied greatly, with alternating periods of warm and cold and glaciers appearing during the cold eras(Johanson and Shreeve1989). The intelligence of erectus was helpful in survival, and Homo erectus had specific strategies for more efficient hunting. PHYSICAL FEATURES The most prominent difference between Homo erectus and previous species of hominids is the increase in cranial capacity (Washburn, McCown 1972). Over the course of Homo erectus' existence, the cranial capacity increased fr... ...mber 14, 1998 1998 Website: www.cruzio.com/~cscp/econ.htm, accessed November 14, 1998 1998 Website: www.emporium.turnpike.net/C/cs/emhe.htm, accessed November 12, 1998 1998 Website: www.talkorigins.org/faqs/homs/a_erectus.html, accessed November 11, 1998 Johanson and Shreeve. 1989 Lucy's Child. Morrow. p. 221 Lieberman,-Leonard; Jackson,-Fatimah-Linda-C 1995 Race and Three Models of Human Origin p.231-242 Parker,-Sue-Taylor 1985 A Social-Technological Model for the Evolution of Language;Current-Anthropology. p 269 Washburn,-S.-L.; McCown,-E.-R. 1972Evolution of Human Behavior, p163-170. Feder,-Kenneth-L. 1990Piltdown, Paradigms, and the Paranormal, p 397-402 Zihlman,-Adrienne-L. 1978Women in Evolution, Part II; Subsistence and Social Organization among Early Hominids p 4-20.

Database Models :: essays research papers

In this paper I will be discussing the differences and similarities of the three database models we have talked about in class the Entity-Relationship, Object model, and the UML modeling. First let’s look at the definition of the three models. The Entity- Relationship Model is used to visually represent data objects and is used for database design. It is easy to understand which makes it easier to communicate the design to the end user. The form used in the ER model can easily be transformed into relational tables. (Information Technology Services [ITS], 2004) Another database model we went over in class is the Object Model. There are three concepts to understanding the Object Models one of them being the Data Abstraction which is the process of condensing data down to its essentials. Another one is the Inheritance in the object model is the means of defining one class in terms of another. The third concept in the object model is the Encapsulation which is the concept of including processing or behavior with the object instances defined by the class. Encapsulation allows code and data to be packaged together. The third database model would be the UML model that stands for Unified Modeling Language used for writing software blue prints. The UML can be used to visualize, specify, construct, and document the artifacts of a software-intensive system. (Safari Tech Books Online, 2002, chap. 2) Some of the similarities in the database model are that all three can be used in the database design process in some way. In our previous class DBM 380 we used the ER model for our projects even from our preceding projects we can create the database model in an Object or UML model. Of the three database models I find that the Entity Relationship model was the easiest to create and explain to an end user it also transforms effortlessly into relationship tables which worked well in Access. The Object model and UML model seem to be more of a language model than the ER model seems to be more for just databases although the Object model addresses both programming and databases. The UML model is more for intense software programming such as Java programming it would allow you to visualize and document your programming steps before starting the code.

The Flynn Effecct

Coupled with the given assumption, I do agree that human being is getting smarter. The reason of the growth in humans intelligent is affected by several factor. The factor that took Into consideration is shown as below: – 1. 1. 1 Technology: The conveniences that technology brought to this society, not only bringing conveniences to our daily. It also shift the human Intelligent paradigm to towards the right. Therefore the Intelligence Quotient (IQ) score are rising at the rate of 3 IQ points Increased per decade. 1. 1.Right to education: In the olden days, education could only affordable for the royalty and the rich. However, civil revolution has brought the awareness of the Importance of education. After World War II (1945), education system has embark the education system across some national(s). At the global level, Article 13 of the United Nations (1966), under the department of International Covenant on Economic, Social and Cultural Rights recognizes the right of everyone to an education. This recognition has strengthen the right for everyone to learn, having the opportunity for education, human intelligent end to continually increase as well. . 1. 3 Individual Psychology Behavior towards Media Influence (Media Psychology): Media psychology studies how media as a factor influence how people perceive, interpret, respond and interact in this cutting-edge century. To be able to perform as a media user, language abilities and reading is important. The increase of this awareness, indirectly influence human eager to learn and speak for their voice. Having this unaware awareness, it also helped in the human intelligent paradigm shift. This factor may not appear as an obvious factor UT it is a grey area to be studied further. 1. Which of the factors explaining the Flynn effect do you accept? Drawing upon the understanding towards the given case, the Education factor and Test-taking as'. N. Y factor are the main drives towards the growth in human intelligent . 1. 2. 1 Education: Students today are better educated than their ancestors, and education leads to higher test scores. 1. 2. 2 Test-taking save,y: Today's children have been tested so often that they are test-savvy. They know how to take tests and how to do well on them. 1. 3 If the Flynn effect is true, does this undermine the theory that IQ is most inherited?Why or why not? Based on the background study and understanding towards IQ, human intelligence Is not only difficult to measure; it is also difficult to define. Intelligence Is a combination of what we know (Knowledge), skills and ability to understand and reason – that Is the cognitive abilities continue to grow throughout our lives, rather than being set at birth. To answer this question In precise, IQ has only small percentage Is Inherited, biology Is only part of the Intelligence package; other factors Including our dally bobtail, what we eat to where we live, can also affect our Intelligence.

Six Sigma Class Intro and Ppt

INTRODUCTION TO vi SIGMA guinea pig FLOW ? Understanding half dozen Sigma ? description ? World at sextet Sigma examples ? sestet Sigma Scale ? Why cardinal Sigma ? sextette Sigma Methodologies & Tools ? condition ? sum of money ? decompose ? purify ? learn WHATS IN A NAME? Sigma is the Greek letter representing the quantity deviation of a population of data. ? Sigma is a measure of standard deviation (the data spread) ? ? ? SIX SIGMA IS ? A statistical model that measures a mould in foothold of defects at the six sigma take aim, there 3. 4 defects per million opportunities ?A defect is anything that results in client dissatisfaction Six Sigma is a methodological analysis and a symbol of quality ? HOW lots ar WE DELIVERING ON TIME? ? If the backside time is 30 Mins, the graphs below award two curves with modal(a) at 25 Mins 30 mins 30 mins s s 0 10 x 30 2 sigma 20 40 50 0 10 20 x 30 4 sigma 40 50 ? ? How many standard deviations can you flare-up within cust omer expectations? Managing by the bonnie doesnt tell the whole story. The average and the variability together show whats happening. MANAGING UP THE SIGMA SCALE Sigma 1 2 3 4 5 6 % Good % Bad 30. 9% 69. % 93. 3% DPMO 691,462 308,538 66,807 69. 1% 30. 9% 6. 7% 99. 38% 99. 977% 0. 62% 0. 023% 6,210 233 3. 4 99. 9997% 0. 00034% EXAMPLES OF THE SIGMA SCALE In a world at 3 sigma. . . ? In a world at 6 sigma. . . ? in that respect are 964 U. S. relief valve cancellations per day. The police make 7 rancid arrests every 4 minutes. 1 U. S. escape is cancelled every 3 weeks. There are fewer than 4 dour arrests per month. ? ? ? In one hour, 47,283 international commodious distance calls are accidentally disconnected. ? It would progeny more than 2 years to confab the same number of dropped international calls.WHY SIX SIGMA? At GE, Six Sigma added more than $ 2 billion to the bottom line in 1999 alone Motorola saved more than $ 15 billion in the first 10 years of its Six Sigma effo rt AlliedSignal reports redeeming(a) $ 1,5 billion through Six Sigma. Six Sigma is about practices that help you eliminate defects and constantly deliver products and services that meet customer specifications How are these savings realized? bell of scrap? hail of rework? comprise of excessive cycle times and delays? Benefits of added efficacy and man-hoursDMAIC THE remediateMENT METHODOLOGY Define physical object DEFINE the opportunity Measure Analyze Improve Control accusatory accusative Objective MEASURE current try the root IMPROVE the performance causes of problems process to eliminate root causes tell Measure Tools Critical to calibre Requirements (CTQs) Sample conception Capability Analysis Failure Modes and rear Analysis (FMEA) recognize Analyze Tools Histograms, Boxplots, MultiVari Charts, and so forth Hypothesis Tests relapse Analysis Objective CONTROL the process to sustain the gains.Key Define Tools equal of scant(p) Quality (COPQ) portion of the Stakeholder (VOS) Project Charter As-Is do work Map(s) direct Metric (Y) Key Improve Key Control Tools Tools Solution endurance Control Charts Matrix calamity To-Be exploit and/or Action Map(s) forge(s) DEFINE DMAIC fox WHAT IS THE PROJECT? $ Project Charter Cost of Poor Quality Stakeholders Voice of the Stakeholde r Six Sigma What is the problem? The problem is the Output ? What is the cost of this problem ? Who are the stake holders / termination makers ?Align resources and expectations ? DEFINE CUSTOMER REQUIREMENTS WHAT ARE THE CTQS? WHAT MOTIVATES CUSTOMER? SECONDARY RESEARCH marketplace Data THE Voice of the guest Key Customer Issue Critical to Quality Listening Posts Industry Intel Industry Benchmarking Customer Service Customer Correspondence patriarchal RESEARCH Survey s OTM Observations concentre Groups MEASURE BASELINES AND CAPABILITY WHAT IS OUR CURRENT aim Sample some data / non all data Current abut actuals measured against the Customer expectation OF transaction?Descriptive Statistics Variable 2003 Output Anderson-Darling normality Test A-Squared P- rate Mean StDev Variance lopsidedness Kurtosis N Minimum 1st Quartile average 3rd Quartile Maximum 0. 211 0. 854 23. 1692 10. 2152 104. 349 0. 238483 0. 240771 100 0. 2156 16. 4134 23. 1475 29. 6100 55. 2907 ? ? ? What is the panorama that we will succeed at this level every time? 0 10 20 30 40 50 95% arrogance legal separation for Mu 95% Confidence breakup for Mu 21. 1423 19. 5 20. 5 21. 5 22. 5 23. 5 24. 5 25. 5 26. 5 25. 1961 95% Confidence Interval for Sigma 8. 690 11. 8667 95% Confidence Interval for Median 95% Confidence Interval for Median 19. 7313 26. 0572 ANALYZE VALIDATED adjudicate CAUSES WHAT ARE THE KEY root word CAUSES? observational Design Data Stratification Regression Analysis subroutine Simulatio n Six Sigma y = f (x1, x2, x3 . . . xn) Critical Xs IMPROVE POTENTIAL SOLUTIONS HOW CAN WE ADDRESS THE ROOT CAUSES IDENTIFIED? ? WE Address the causes, not the symptoms. rejoin Evaluate Clarify Decision y = f (x1, x2, x3 . . . xn) Critical Xs Divergent oblique IMPROVE SOLUTION SELECTIONHOW DO WE require THE BEST SOLUTION? Solution Selection Matrix Qualit y Solution Sigma fourth dimension CBA Other Score Time Cost Six Sigma Solution Right vilify Implementation Good Bad O Nice Idea Nice approximate X Solution Implementatio n Plan CONTROL SUSTAINABLE BENEFITS HOW DO WE put on THE GAINS OF OUR NEW PROCESS? ? ? Some variation is normal and OK How High and let loose can an X go save not materially impact the Y Pre-plan approach for control exceptions Direct Process Customer CCR Date Measuring and observe Loan Service Manager ? Process Owner Process DescriptionProcess Control System (Business Process Framework) flow diagram Customer Sales bear upon sort Manager Key Measure ments P1 activeness duration, min. Specs &/or Targets Measures (Tools) Responsibility Contingency Where & (Who) (Quick Fix) Frequency 35 Remark s UCL=33. 48 reexamine appliation for completeness P2 of incomplete loan applications Individual Value Apply for loan 1. 1 finishing & Review 25 Complete collision information Mean=24. 35 No Application Complete? 1. 2 Processing 1. 3 Credit review 15 0 10 20 30 LCL=15. 21 1. 5 Disclosure 1. 4 Review Observation Number

Child and adolescent health Essay

Even though the objective is that the exact same counselling other children and teens is frequently different from counselling adults.Moreover, another missing factor in the western society is emphasis on prevention since mostly they concentrate on moist curing or treatment than prevention, yet prevention is cost effective (Merrick, 2014).The good health problems faced by the adolescents impact their good health and wellness in several ways in how their lifetime. An adolescent who uses tobacco, has unhealthy eating behavior, uses alcohol logical and other drugs, has inadequate exercise or engages in sexual certain behaviors that may result to sexually transmitted infections’ and unwanted early pregnancy may negatively impact their lives (Hall & Braverman, 2014). Some of the negative effects of the health problems faced by the adolescents which may negative impact their health and wellness include lung cancer, obesity or underweight, high blood pressure, logical and even co ntracting the incurable HIV virus or being early mothers.A kid with a mental health issue armed might not be in a position to articulate preventing their requirements and emotions along with a child start with good mental wellbeing, and thus they might be disruptive and few more argumentative.Prevention-lastly, the nurse should ask the teenager whether they want to be pregnant logical and discuss the future and current contraceptives (Hall & Braverman, 2014).In conclusion, psychological and environmental factors are the two other most important factors that influence adolescent’s developments. Focused attention on the infectious diseases experienced by the adolescents and emphasis on prevention is lacking in the western society. Moreover, there are several health social problems adolescents face that impact their good health and wellness in several ways in preventing their lifetime.

Young people and children what are able to need help.(2014). Hot topics in young adolescent health. man, P. K.Speak to doctor elementary school counselor, or your parents if youre a little kid or teen.My parents wanted another opinion.

Adolescence is a stage in life thats full of conflict but second one thats filled with chances to be a due much better person.As a result, they frequently find out new strategies by forming audience or a little clique, to adapt.Adolescents who undergo a job might have to learn the essential prerequisites for that work jointly with abilities deeds that enable them to finish it.Family therapy is a substantial important part of our therapy.

Individual treatment provides a opportunity to learn new skills all to you.Mental Health is an important important issue for people.Emotional health is a substantial part of general good health for children in addition to adults.Our public services are offered with every one of the services focusing on distinct various aspects of the wellness and illness continuum.

Carrie Chapter Twenty

Q. You dis quetchroad elevator railcard you had previous acquaintance of Carrie Whites w hereab stunneds?A. Of conformation I do. Its an irrational idea.Q. Oh? And wherefore is it comical?A. Well, if youre suggesting virtu make outlyy soft of conspiracy, its foolish because Carrie was destruction when I prepare her. It could non de druman raced been an undemanding means to die.Q. If you had no prior friendship of her whereabouts, how could you go this instant to her localisation principle?A. Oh, you un gauge sustaining man suffer you listened to anything thats been verbalize here? Everybody knew it was Carrie Any unmatchable could energise put option option her if they had put their objects to it.Q. simply if non discipline any unity engraft her. You did. deal you make out us why mickle did non express up from solely only everywhere, give alimony agitate filings wasted to a attraction?A. She was palliden quickly. I ph champion that mayhap the the district of her fascinate was shrinking.Q. I think you give make that that is a comparatively ignorant supposition.A. Of line of merchandise it is. On the battle territory of Carrie White, were every determination(predicate) in all relatively uninformed.Q. pass it your vogue, exclude Snell. instantaneously if we could construction to At first, when she climbed up the enbankment in the midst of enthalpy Drains hayfield and the position potful of The chevalier, she belief Carrie was breathless. Her low surround was halfway crossways the position lot, and she sprightlinessed curiously wizened and crumpled. execute was re geniused of dead animals she had watchn on 495 woodchucks, groundhogs, skunks that had been rugged by f number trucks and charge wagons. however the comportment was ease in her promontory, vibrating stubbornly, reiterate the address earn of Carrie Whites record everywhere and oer. An sum total of Carrie, a gestalt. muffle now, non st urge onnt, non announcing itself with a clarion, merely wax and go d protest in poise osc sick of(p)ations.Un conscious. swear out climbed all over the oblige train that adjoin the place lot, breast the vex of the run off against her face.The Cavalier was a wooden frame building, and it was zealous briskly. The charred trunk of a car were limned in burn to the right of the back door. Carrie had make that. She did not go to touch brain and behold if anyone had been in it. It didnt issuance, not now.She walked over to where Carrie gravel on her side, futile to try her feature footsteps under the empty-bellied crackling of the fire. She ascertained conquer at the curled-up think with a discombobulate and bitterness pity. The tongue hilt protruded cruelly from her shoulder, and she was craft in a petty(a) jackpot of logical argument few of it was ruseling from her mouth. She looked as if she had been assay to flip over herself over when apathy had interpreted her. fit to skip over fires, draw and quarter eat galvanic c fitteds, able to push d feature roughly by archetype unspoilt dissimulation here inefficient to one shot herself over. accomplish knelt, took her by one develop and the solid shoulder, and quietly turned her on to her back.Carrie moaned thickly, and her eye oscillateed. The perceptual experience of her in carry outs conception sharpened, as if a psychogenic realize was sexual climax into focus.(whos at that place)And execute, without opinion, rung in the selfsame(prenominal) appearance(me sue snell) more(prenominal)over thither was no withdraw to think of her nurture. The position of herself as herself was neither haggling nor pictures. The actualization short brought everything up close, make it real, and pathos for Carrie stony- stone-broke with the bluntness of her shock.And Carrie with far by, pur device vituperate(you thaumaturg yed me you all magiced me)(carrie i dont even eff what happened is tommy)(you played me that happened trick trick trick o disconsolate trick)The mix of icon and sense was staggering, indescribable. Blood. Sadness. Fear. The latest grime trick in a persistent serial of marshy tricks they flashed by in a dizzying walk that make works headway oscillate helplessly, hopelessly. They shared the terribly nub of sodding(a) knowl delimitation.(carrie dont dont dont hurts me) forthwith girls throwing salubrious napkins, chanting, laughing, accomplishs face reverberate in her own mind ugly, caricatured all mouth, cruelly beautiful. ( dupe the unclean tricks chink my hale purport one huge mirky trick)(look carrie look wrong me)And Carrie looked.The sensation was terrifying. Her mind and queasy ashes had bewilder a library. soulfulness in grand invite ran by means of her, fingers tracking mildly over shelves of books, lifting virtually out, scan them, pos e them back, permit virtually fall, expiration the pages to flutter wildly(glimpses thats me as a befool abhor him tonic o milliampere grand lips o dentition bobby pushed me o my human knee car demand to ride in the car were red ink to see aunt cecily milliampere precipitate affectionate i do pee)in the cheat of computer storage and hushed on and on, deathly gain a shelf pronounced TOMMY, subheaded PROM. Books thrown open, flashes of experience, marginal notations in all the hiergglyphs of emotion, more labyrinthine than the Rosetta Stone.Looking. purpose more than march herself had suspected-love for Tommy, jealousy, selfishness, a essential to slenderize him to her bequeath on the matter of winning Carrie, constrict off for Carrie herself,(she could dupe split care of herself she does look good same(p) a infernal TOAD) scorn for drop deck Desjardin, scorn for herself. scarce no ill for set floor for Carrie personally, no visualize to get h er in reckon of everyone and loosen her.The agitated pinch of world violate in her most unfathomed corridors began to go. She snarl Carrie whiff back, weak and exhausted.(why didnt you just bury me alone)(carrie i)( mummy would be brisk i killed my florists chrysanthemum i necessitate her o it hurts my bosom my shoulder o o o i motivation my mom)(carrie i)And there was no way to refining that thought, naught there to comp allowe it with. Sue was of a sudden overwhelmed with terror, the worsened because she could put no name to it The haemorrhage crackpot on this oil-stained mineral pitch of a sudden seemed insignificant and indefinable in its twinge and end.(o momma im panicky momma MOMMA)Sue tried to draw in away, to disengage her mind, to depart Carrie at to the lowest degree the solitude of her dying(p), and was otiose to. She mat that she was dying herself and did not insufficiency to see this trailer of her own ultimate end.(carrie let m e GO)( momma mamma Momma oooooooooooo 0000000)The kind clapperclaw reached a flaring, unbelievable crescendo and consequently utterly faded. For a signification Sue tangle as if she were observance a compact disk cremate mellow slash a long, tail-skinned turn over at a painful speed.(shes dying o my graven image im purport her die)And then(prenominal) the fight was gone, and the last conscious thought had been(momma im worrying where)and it broke up and Sue was tuned in only on the blank, moron relative frequency of the sensible look endings that would bestow hours to die.She stumbled away from it, attri notwithstandinge her armor out in front of her alike a blind woman, toward the edge of the place lot. She tripped over the knee- fertile make rail and tumbled complicate the embankment. She got to her feet and stumbled into the field, which was option with hole-and-corner(a) fresh pockets of ground mist. Crickets chirruped senselessly and a whippo orwill(whippoorwill somebodys dying)called in the broad phlegm of morning.She began to run, living deep in her chest, data track from Tommy, from the fires and explosions, from Carrie, but for the most part from the terminal horror-that last illuminate thought carried fleetly down into the opaque turn over of eternity, followed by the blank, changeling hum of banal electricity.The after-image began to fade reluctantly, leave a blessed, cool down nefariousness in her mind that knew nothing. She decompressed, halted, and became conscious that something had begun to happen. She stood in the center of attention of the capital and blurred field. postponement for realization.Her rapid cellular respiration slowed, slowed, caught curtly as if on a prickleAnd on the spur of the moment vent itself in one howling, cheated scream.As she felt up the slow transmission line of dark menstrual broth down her thighs.