Problem Of Failure To Thrive Health And Social Care Essay

Although the term failure to boom ( FTT ) has been in usage in the medical idiom for rather some clip now, its precise definition has remained debatable1. accordingly, other footings such as â€Å" undernutrition † 1 and â€Å" growing lack † 2 have been proposed as preferred. FTT is a descriptive term applied to immature kids physical growing is less than that of his or her peers.3 The growing failure may get down either in the neonatal period or after a period of normal physical development.4 The term FTT is non, in itself, a disease but a symptom or mark common to a broad assortment of upsets which may hold small in common except for their negative consequence on growth.5 In this respect, a cause must ever be sought. Frequently, the rating of kids who fail to boom present a hard diagnostic job. Some of the troubles result from the legion differential diagnosings, the definition used or misdirected inclination to seek sharply for underlying organic diseases while pretermiting aetiologies based on environmental deprivation.6 In add-on, early accusals and disaffection of the kid ‘s parents by the health-care supplier will do the rating and direction of the kid who has failed to boom more difficult.7 In general, factors that influence a kid ‘s growing include: ( I ) A kid ‘s nutritionary position ; ( two ) A kid ‘s wellness ; ( three ) Family issues ; and ( four ) The parent-child interactions.3,8,9 All these factors must be considered in rating and direction of kid who has failed to boom. This paper presents a simplified but elaborate attack to the rating and direction of the kid with FTT.DefinitionThe best definition for FTT is the 1 that refers to it as unequal physical growing diagnosed by observation of growing over clip utilizing a standard growing chart, such as the National Center for Health Statistics ( NCHS ) growing chart.10 All governments agree that merely by comparing tallness and weight on a growing chart over clip can FTT be assessed accurately.11 So far, no consensus has been reached refering the specific anthropometric standards to specify FTT.11 Consequently, where consecutive anthropometric records is non available, FTT has been diversely def ined statistically. For case, some writers defined FTT as weight below the 3rd percentile for age on the growing chart or more than two standard divergences below the mean for kids of the same age and sex1-3 or a weight-for-age ( weight-for-hieght ) Z-score less than subtractions two.1 Others cite a downward alteration in growing that has crossed two major growing percentiles in a short time.3 Still others, for diagnostic intents, defined FTT as a disproportional failure to derive weight in comparing to height without an evident aetiology.6 Brayden et al.,2 suggested that FTT should be considered if a kid less than 6 months old has non grown for two back-to-back months or a kid older than 6 months has non grown for three back-to-back months. Recent research has validated that the weight-for-age attack is the simplest and most sensible marker of FTT.12Pitfalls of these definitions:One restriction of utilizing the 3rd percentile for specifying FTT is that some kids whose weight autumn below this arbitrary statistical criterion of normal are non neglecting to boom but stand for the three per centum of normal population whose weight is less than the 3rd percentile.5,6 In the first 2 old ages of life, the kid ‘s weight alterations to follow the familial sensitivity of the parent ‘s tallness and weight.13,14 During this clip of passage, kids with familial short stature may traverse percentiles downward and still be considered normal.14 Most kids in this class happen their true curve by the age of 3 years.6,14 When the percentile bead is great, it is helpful to compare the kid ‘s weight percentile to tallness and caput perimeter percentiles. These should be consistent with the place of tallness and caput perimeter percentiles of the patient.5 Another restriction of the 3rd percentile as a standard to specify FTT is that babies can be neglecting to boom with pronounced slowing of weight addition, but they remain undiagnosed and hence, untreated until they have fallen below the arbitrary 3rd percentile.6 These normal little kids do non show the disproportional failure to derive weight that kids with FTT do.6 This attack attempts non merely to forestall normal little kids from being falsely labeled as neglecting to boom, but besides excludes kids with diseased proportionate short stature.14 Having excluded these easy distinguishable upsets from the differential diagnosing of FTT, simplifies the attack to rating of the kid who has failed to thrive.6 A more across-the-board definition of FTT includes any kid whose weight has fallen more than two standard divergences from a old growing curve.3,15,16 Normal displacements in growing curves in the first 2 old ages of life will ensue in less terrible diminution ( i.e, less than 2 SD ) .13 Some writers have even limited the definition of FTT to merely kids less than 3 old ages old17,18 A precise age restriction is arbitrary. However, most kids with FTT are under 3 old ages of age.6,8EpidemiologyIn immature kids, FTT which does non make the terrible classical syndrome of marasmus is common in all societies.19 However, the true incidence of FTT is non known as many babies with FTT are non identified, even in developed countries.20-22 It is estimated to impact 5 – 10 % of immature kids and about 3 – 5 % of kids admitted into learning hospitals.3,5,23 Mitchell et al,24 utilizing multiple standards found that about 10 % of under-fives go toing primary wellness attention Centre in the United States showed FTT. About 5 % of pediatric admittances in United Kingdom are for FTT.4 The prevalence is even higher in developing states with wide-spread poorness and high rates of malnutrition and/or HIV infections.3,19 Children Born to individual teenage female parents an d working female parents who work for long hours are at increased risk.22 The same is true of kids in establishments such as orphanhood places and places for the mentally retarded5,22 with an estimated incidence of 15 % as a group.5 Under-feeding is the individual commonest cause of FTT and consequences from parental poorness and/or ignorance.19,22,24 Ninety five per centum of instances of FTT are due to non plenty nutrient being offered or taken.25 The peak incidence of FTT occurs in kids between the age of 9 – 24 months with no important sex difference.22 Majority of kids who fail to boom are less than 18 months old.3 The syndrome of FTT is uncommon after the age of 5 years.3,22EtiologyTraditionally, causes of FTT have been classified as non-organic and organic. However, some writers have stated that this nomenclature is misleading.27 They based their sentiment on the fact that all instances of FTT are produced by unequal nutrient or undernutrition and in that context, is o rganically determined. In add-on, the differentiation based on organic and non-organic causes is no longer favoured because many instances of FTT are of assorted aetiologies.3 Based on pathophysiology ( the preferred categorization ) , FTT may be classified into those due to: ( I ) Inadequate thermal consumption ; ( two ) Inadequate soaking up ; ( three ) Increased thermal demand ; and ( four ) Defective use of Calories. This categorization leads to a logical organisation of the many conditions that cause or contribute to FTT.10Non – organic ( psychosocial ) failure to boomIn non-organic failure to boom ( NFTT ) , there is no known medical status doing the hapless growing. It is due to poverty, psychosocial jobs in the household, maternal want, deficiency of cognition and accomplishment in infant nutrition among the care-givers5,11. Other hazard factors include substance maltreatment by parents, individual parentage, general immatureness of one or both parents, economic emphasis and strain, impermanent emphasiss such as household calamities ( accidents, unwellnesss, deceases ) and matrimonial disharmony.6,8,22 Weston et al,28 reported that 66 % of f emale parents whose babies failed to boom has a positive history of holding been abused as kids themselves, compared to 26 % of controls from similar socioeconomic background. NFTT histories for over 70 % of instances of FTT.6 Of this figure, about one-third is due to care-giver ‘s ignorance such as wrong eating technique, improper readying of expression or misconception of the baby ‘s nutritionary needs,29 all of which are easy corrected. A close expression at these hazard factors for NFTT suggest that babies with growing failure may stand for a flag for serious societal and psychological jobs in the household. For illustration, a down female parent may non feed her baby adequately. The baby may, in bend, go withdrawn in response to female parent ‘s depression and provender less well.10 Extreme parental attending, either disregard or hypervigilance, can take to FTT.10Organic failure to boomIt occurs when there is a known implicit in medical cause. Organic upsets d oing FTT are most commonly infections ( e.g HIV infection, TB, enteric parasitosis ) , GI ( e.g. , chronic diarrhea, gastroesophageal reflux, pyloric stricture ) or neurologic ( e.g. , intellectual paralysis, mental deceleration ) disorders.6,19,22 Others include GU upsets ( e.g. , posterior urethral valve, nephritic cannular acidosis, chronic nephritic failure, UTI ) , inborn bosom disease, and chromosomal anomalies.6,7 Together neurologic and GI upsets account for 60 – 80 % of all organic causes of under nutrition in developed countries.30 An of import medical hazard factor for under nutrition in childhood is premature birth.1 Among preterm babies, those who are little for gestational age are peculiarly vulnerable since antenatal factors have already exerted hurtful consequence on bodily growth.1 In societies where lead toxic condition is common, it is a recognized hazard factor for hapless growth.5,31 Organic FTT virtually ne'er presents with stray growing failure, other m arks and symptoms are by and large apparent with a elaborate history and physical examination.32 Organic upsets histories for less than 20 % of instances of FTT.6Assorted failure to boomIn assorted FTT, organic and non organic causes coexist. Those with organic upsets may besides endure from environmental want. Likewise, those with terrible undernutrition from non-organic FTT can develop organic medical jobs.FTT with no specific aetiologyReappraisal of the literature on FTT indicate that in 12 – 32 % of instances of kids who have failed to boom, no specific aetiology could be established.23,33-34Causes of failure to boomA. Prenatal instances: ( I ) Prematureness with its complication ( two ) Toxic exposure in utero such as intoxicant, smoke, medicines, infections ( eg German measles, CMV ) ( three ) Intrauterine growing limitation from any cause ( four ) Chromosomal abnormalcies ( eg Down syndrome, Turner syndrome ) ( V ) Dysmorphogenic syndromes.B. Postnatal causes based on pathophysiology:A. Inadequate thermal consumption which may ensue from:I. Under feeding Incorrect readying of expression ( e.g. excessively dilute, excessively concentrated ) . Behaviour jobs impacting eating ( e.g. , kid ‘s disposition ) . Unsuitable feeding wonts ( e.g. , uncooperative kid ) Poverty taking to nutrient deficits. Child maltreatment and disregard. Mechanical eating troubles e.g. , inborn anomalousnesss ( dissected lip/palate ) , oromotor disfunction. Prolonged dyspnea of any causeB. Inadequate soaking up which may be associated with:Malabsorption syndromes e.g. Celiac disease, cystic fibrosis, cow ‘s milk protein allergic reaction, giardiasis, nutrient sensitivity/intolerance Vitamins and mineral lacks e.g. , Zn, vitamins A and C lacks. Hepatobiliary diseases e.g. , bilious atresia. Necrotizing enterocolitis Short intestine syndrome.C. Increased Caloric demand due toHyperthyroidism Chronic/recurrent infections e.g. , UTI, respiratory tract infection, TB, HIV infection Chronic anemiaD. Defective Utilization of Kilogram caloriesCongenital mistakes of metamorphosis e.g. , galactosaemia, aminoacidopathies, organic acidurias and storage diseases. Diabetess inspidus/mellitus Nephritic cannular acidosis Chronic hypoxaemiaClinical manifestations of FTT3,22Normally the parents/care-givers may kick that the kid is â€Å" non turning good † or â€Å" losing weight † or â€Å" non feeding good † or â€Å" non making good † or â€Å" non like his other siblings/age couples † . Usually FTT is discovered and diagnosed by the baby ‘s physician utilizing the birthweight and wellness clinic anthropometric records of the kid. The infant looks little for age. The kid may exhibit loss of hypodermic fat, reduced musculus mass, thin appendages, a narrow face, outstanding ribs, and wasted natess, Evidence of ignored hygiene such as nappy roseola, common tegument, overgrown and soiled fingernails or common vesture. Other findings may include turning away of oculus contact, deficiency of facial look, absence of snuggling response, hypotonus and premise of childish position with clinched fists. There may be marked preoccupation with thumb suction.EvaluationA. Initial ratingIt has been proposed that merely three initial probes are required to develop an economical, treatment-centred attack to the kid who presents with FTT and this include:35 ( I ) A thorough history including an itemized psychosocial reappraisal ; ( two ) Careful physical scrutiny including finding of the auxological parametric quantities ; and ( three ) Direct observation of the kid ‘s behavior and of parent-child interactions. The Psychosocial Review: The psychosocial history should be as thorough and systematic as a authoritative physical scrutiny Goldbloom35 suggested that the interviewers should inquire themselves three inquiries about every household: ( I ) How do they look ; ( two ) What do they say ; and ( three ) What do they make? a. History ( 1 ) Nutritional history Nutritional history should include: Detailss of chest eating to acquire an thought of figure of provenders, clip for each eating, whether both chests are given or one chest, whether the eating is continued at dark or non and how is the kid ‘s behavior before, after and in between the provenders. It would give an thought of the adequateness or insufficiency of female parents milk. If the baby is on expression eating: Is the expression prepared right? Dilute milk provender will be hapless in Calorie with extra H2O. Too concentrated milk provender may be unpalatable taking to refusal to imbibe. It is besides indispensable to cognize the entire measure of the expression consumed. Is it given by bottle or cup and spoon? Besides assess the feeling of the female parent e.g. , inquire â€Å" how make you experience when the babe does non feed good? † Time of debut of complementary provenders and any trouble should be noted. Vitamin and mineral addendum ; when started, type, sum, continuance. Solid nutrient ; when started, types, how taken. Appetite ; whether the appetency is temporarily or persistently impaired ( if necessary calculate the thermal consumption ) . For older kids enquire about nutrient likes and disfavors, allergic reactions or idiosyncracies. Is the kid Federal forcibly? It is desirable to cognize the feeding modus operandi from the clip the kid wakes up in the forenoon boulder clay he sleeps at dark, so that one can acquire an thought of the entire thermal consumption and the Calories supplied from protein, fat and saccharide every bit good as adequateness of vitamins and minerals intake. ( 2 ) Past and current medical history The history of antenatal attention, maternal unwellness during gestation, identified foetal growing jobs, prematureness and birth weight. Indexs of medical diseases such as emesis, diarrhea, febrility, respiratory symptoms and weariness should be noted. Past hospitalization, hurts, accidents to measure for kid maltreatment and disregard. Stool form, frequence, consistence, presence of blood or mucous secretion to except malabsorption syndromes, infection and allergic reaction. ( 3 ) Family and societal history Family and societal history should include the figure, ages and sex of siblings. Ascertain age of parents ( Down syndrome and Klinerfelter syndrome in kids of aged female parents ) and the kid ‘s topographic point in the household ( pyloric stricture ) . Family history should include growing parametric quantities of siblings. Are at that place other siblings with FTT ( e.g. , familial causes of FTT ) , household members with short stature ( e.g. familial short stature ) . Social history should find business of parents, income of the household, place those caring for the kid. Child factors ( e.g. , disposition, development ) , parental factors ( e.g. , depression, domestic force, societal isolation, mental deceleration, substance maltreatment ) and environmental and social factors ( e.g. , poorness, unemployment, illiteracy ) all may lend to growing failure.5 Historical rating of the kid with FTT is summarized in Table 1. ( B ) PHYSICAL EXAMINATION The four chief ends of physical scrutiny include ( one ) designation of dysmorphic characteristics suggestive of a familial upset hindering growing ; ( two ) sensing of under lying disease that may impair growing ; ( three ) appraisal for marks of possible kid maltreatment ; and ( four ) appraisal of the badness and possible effects of malnutrition.36,37 The basic growing parametric quantities such as weight, height / length, caput perimeter and mid-upper-arm perimeter must be measured carefully. Accumbent length is measured in kids below 2 old ages of age because standing measurings can be every bit much as 2cm shorter.36,37 Other anthropometric informations such as upper-segment-to-lower-segment ratio, sitting tallness and arm span should besides be noted. The anthropometric index used for FTT should be weight-for-length or height. Mid-parental tallness ( MPH ) should be determined utilizing the formula.40 For male childs, the expression is: MPH = [ FH + ( MH – 13 ) ] 2 For misss, the expression is: MPH = [ ( FH – 13 ) + MH ] 2 In both equations, FH is father ‘s tallness in centimeters and MH is mother ‘s tallness in centimeters. The mark scope is calculated as the MPH A ± 8.5cm, stand foring the two standard divergence ( 2SD ) assurance limits.14Appraisal of grade FTTThe grade of FTT is normally measured by ciphering each growing parametric quantity ( weight, tallness and weight/height ratio ) as a per centum of the average value for age based on appropriate growing charts3 ( See Table 3 )Table 3: Appraisal of grade of failure to boom ( FTT )Growth parametric quantityDegree of Failure to BoomMild Moderate Severe Weight 75-90 % 60 -74 % & lt ; 60 % Height 90 -95 % 85 – 89 % & lt ; 85 % Weight/height ratio 81-90 % 70 -80 % & lt ; 70 % Adapted from Baucher H.3 It should be noted that appropriate growing charts are frequently non available for kids with specific medical jobs, hence consecutive measurings are particularly of import for these children.3 For premature babies, rectification must be made for the extent of prematureness. Corrected age, instead than chronologic age, should be used in computations of their growing percentiles until 1-2 old ages of corrected age.3Table 2: Physical scrutiny of babies and kids with growing failure.AbnormalityDiagnostic ConsiderationCritical marks Hypotension High blood pressure Tachypnoea/Tachycardia Adrenal or thyroid inadequacy Nephritic diseases Increased metabolic demand Skin Lividness Poor hygiene Ecchymosiss Candidiasis Eczema Erythema nodosum Anaema Disregard Maltreatment Immunodeficiency, HIV infection Allergic disease Ulcerative inflammatory bowel disease, vasculitis HEENT Hair loss Chronic otitis media Cataracts Aphthous stomatitis Thyroid expansion Stress Immunodeficiency, structural oro- facial defect Congenital German measles syndrome, galactosaemia Crohn ‘s disease Hypothyroidism Chest Wheezes Cystic fibrosis, asthma Cardiovascular Mutter Congenital bosom disease ( CHD ) Abdomens Distension overactive Bowel sound Hepatosplenomegaly Malabsorption Liver disease, animal starch storage disease Genitourinary Diaper roseolas Diarrhoea, disregard Rectum Empty ampulla Hirschsprung ‘s disease Extremities Oedema Loss of musculus mass Clubing Hypoalbuminaemia Chronic malnutrition Chronic lung disease, Cyanotic CHD Nervous system Abnormal deep sinew Reflexes Developmental hold Cranial nervus paralysis Cerebral paralysis Altered thermal consumption or demands Dysphagia Behaviour and disposition Uncooperative Difficult to feed. Adapted from Collins et al 41 Growth charts should be evaluated for form of FTT. If weight, tallness and caput perimeter are all less than what is expected for age, this may propose an abuse during intrauterine life or genetic/chromosomal factors.2 If weight and tallness are delayed with a normal caput perimeter, endocrinopathies or constitutional growing should be suspected.2 When merely weight addition is delayed, this normally reflects recent energy ( thermal ) deprivation.2 Physical scrutiny in babies and kids with FTT is summarized in Table 2.Failure to boom due to environmental wantChild with environmental want chiefly demonstrate marks of failure to derive weight: loss of fat, prominence of ribs and musculuss blowing, particularly in big musculus groups such as the gluteals.6Developmental appraisalIt is of import to find the kid ‘s developmental position at the clip of diagnosing because kids with FTT have a higher incidence of developmental holds than the general population.36 With environmental wan t, all mileposts are normally delayed once the baby reaches 4 months of age.42 Areas dependant on environmental interactions such as linguistic communication development and societal version are frequently disproportionately delayed. Specific behavioral ratings ( e.g. , entering responses to near and backdown ) , have been developed to assist distinguish implicit in environmental want from organic disease.43 Assess the baby ‘s developmental position with a full Denver Developmental Standardized test.44Parent-child interaction:Evaluate interaction of the parents and the kid during the scrutiny. In environmental want, the parent frequently readily walks off from the scrutiny tabular array, looking to easy abandon the kid to the nurse or physician.6 There is small oculus contact between kid and parent and the baby is held distantly with small modeling to the parent ‘s body.6 Often the baby will non make out for the parent and small fond touching is noted.6 There is small pa rental show of pleasance towards the infant.6 Observation of eating is an built-in portion of the scrutiny, but it is ideally done when the parents are least cognizant that they are being observed. Breast-fed babies should be weighed before and after several eatings over a 24-hour period since volume of milk consumed may change with each repast. In environmental want, the parents frequently miss the babies cues and may deflect him during eating ; the baby may besides turn away from nutrient and look distressed.6 Unnecessary force may be used during feeding. Developing a portrayal of the child-parent relationship is a cardinal to steering intervention.11LABORATORY EVALUATIONThe function of research lab surveies in the rating of FTT is to look into for possible organic diagnosings suggested by the history and physical examination.33,34 If an organic aetiology is suggested, appropriate surveies should be undertaken. If history and physical scrutiny do non propose an organic aetiology, extended research lab trial is non indicated.6 However, on admittance full blood count, ESR, uranalysis, urine civilization, urea and electrolyte ( including Ca and P ) degrees should be carried out. Screen for infections such as HIV infection, TB and enteric parasitosis. Skeletal study is indicated if physical maltreatment is strongly suspected. In add-on to being unproductive, unsighted research lab fishing expeditions should be avoided for the undermentioned reason:5,6 ( I ) they are expensive ; ( two ) they impair the kid ‘s ability to derive weight in a new environment both by scaring him/her with venepuncture, Ba surveies and other nerve-racking processs and the no unwritten provenders associated with some probes prevent him/her from acquiring adequate Calories ; ( three ) they can be misdirecting since a figure of laboratory abnormalcies are associated with psychosocial want ( e.g. , increased serum aminotransferases, transeunt abnormalcies of glucose tolerance, decreased growing endocrine and Fe lack ) ; 21 and ( f our ) they divert attending and resources from the more productive hunt for grounds of psychosocial want. In one survey, a sum of 2,607 research lab surveies were performed, with an norm of 14 trials per patient. With all trials considered, merely 10 ( 0.4 % ) served to set up a diagnosing and an extra 1 % were able to back up a diagnosis.34Further Evaluation( 1 ) Hospitalization: Although some writers province that most kids with failure to boom can be treated as outpatients,4,5,11,45 I think it is best to hospitalise the baby with FTT for 10 – 14 yearss. Hospitalization has both diagnostic and curative benefits. Diagnostic benefits of admittance may include observation for eating, parental-child interaction, and audience of sub-specialists. Curative benefits include disposal of endovenous fluids for desiccation, systemic antibiotic for infection, blood transfusion for anemia and perchance, parenteral nutrition, all of which are frequently in-hospital processs. In add-on, if an organic aetiology is discovered for the FTT, specific therapy can be initiated during hospitalization. In psychosocial FTT, hospitalization provides chance to educate parents about appropriate nutrients and feeding manners for babies. Hospitalization is necessary when the safety of the kid is a concern. In most state of affairss in our set up, there is no feasible option to hospitalization. ( 2 ) Quantitative appraisal of consumption: A prospective 3-day diet record should be a standard portion of the rating. This is utile in measuring under nutrition even when organic disease is present. A 24-hour nutrient callback is besides desirable. Having parents compose down the types of nutrient and amounts a kid eats over a three-day is one manner of quantifying thermal consumption. In some cases, it can do parents aware of how much the kid is or is non eating.11Table 4: Summary of hazard factors for the development of failure to boomBaby featuresAny chronic medical status ensuing in: – Inadequate consumption ( e.g, get downing disfunction, cardinal nervous system depression, or any status ensuing in anorexia ) – Increased metabolic rate ( e.g, bronchopulmonary dysplasia, inborn bosom disease, febrilities ) – Maldigestion or malabsorption ( e.g, AIDS, cystic fibrosis, short intestine, inflammatory intestine disease, celiac disease ) . – Infections ( e.g. , HIV, TB, Giardiasis ) Premature birth ( particularly with intrauterine growing limitation ) Developmental hold Congenital anomalousnesss Intrauterine toxin exposure ( e.g. intoxicant ) Plumbism and/or anemiaFamily featuresPoverty Unusual wellness and nutrition beliefs Social isolation Disordered eating techniques Substance maltreatment or other abnormal psychology ( include Muschausen syndrome by placeholder ) Violence or maltreatment Adapted from Kleinman RE.1Table 1: Summary of historical rating of babies and kids with growing failurePrenatalGeneral obstetrical history Recurrent abortions Was the gestation planned? Use of medicines, drugs, or coffin nailsLabour, bringing, and neonatal eventsNeonatal asphyxia or Apgar tonss Prematureness Small for gestational age Birth weight and length Congenital deformities or infections Maternal bonding at birth Length of hospitalization Breastfeeding support Feeding troubles during neonatal periodMedical history of kidRegular doctor Immunizations Development Medical or surgical unwellnesss Frequent infectionsGrowth historyPlot old pointsNutrition historyFeeding behaviour and environment Perceived sensitivenesss or allergic reactions to nutrients Quantitative appraisal of consumption ( 3-day diet record, 24-hour nutrient callback )Social historyAge and business of parents Who feeds the kid? Life emphasiss ( loss of occupation, divorce, decease in household ) Handiness of societal and economic support ( Particular Supplemental Nutrition Program for Womans, Babies and Children ; Aid for Families with Dependent Children ) Percept of growing failure as a job History of force or maltreatment by or of care-giverReview of systems/clues to organic diseaseAnorexia Change in mental position Dysphagia Stooling form and consistence Vomiting or gastroesophageal reflux Recurrent febrilities Dysuria, urinary frequence Activity degree, ability to maintain up with equals Beginning: Duggan C.46DIFFERENTIAL DIAGNOSIS OF FAILURE TO THRIVE1. Familial short stature Although kids with familial short stature frequently are in the 3rd percentile on the growing chart, they have normal weight-to-height ratio and growing speed bone ages equal to their chronological ages and they look happy and healthy.47 Their growing curve runs parallel to and merely below the normal curves.48 2. Constitutional growing hold In constitutional growing hold, weight and height lessening near the terminal of babyhood, parallel the norm through in-between childhood and speed up toward the terminal of adolescence.48 Growth speed during childhood is normal, bone age is delayed, pubescence is delayed, wellness is otherwise normal and normally they have household history of delayed growing and puberty.47 3. Early oncoming growing hold Approximately 25 % of normal babies will switch to take down growing percentile in the first two old ages of life and so follow that percentile.11,49 This should non be diagnosed as failure to boom. Smith DW et al13 reported that 30 % of healthy, full-term, white babies cross one percentile line and 23 % cross two lines as they move from birth to age of 2 old ages. In both the history and physical scrutiny, there are no singular findings except that similar characteristics may be found in other siblings in the family.23 Although in some kids puberty may be delayed, normal pubertal growing jet occur subsequently in adolescence.23 The bone age corresponds to the tallness age.23 4. Specific infant populations Preterm babies and those who suffered intrauterine growing limitation may show growing failure in the immediate postpartum period50,51 but catch-up growing has been reported to happen during the first 2 to 3 old ages of life.52,53 As long as the kid ‘s growing follows a curve with a normal interval growing rate, FTT should non be diagnosed.54 Over diagnosing of growing failure can be avoided by utilizing modified growing charts developed for specific populations such as preterm infants,55,56 entirely breast fed infants,57,58 specific ethnicities ( e.g. , Asians ) 59,60 and babies with familial syndromes such as Down61 and Turner62,63 syndromes. The usage of these charts can assist reassure the doctor that these kids are turning suitably. In preterm babies, their chronological age should be corrected by gestational age until age of 24 months for weight measurings, 40 months for length, and 18 months for caput circumference.1 This is a petroleum method because it does non capture the variableness in growing speed that really low birthweight babies demonstrate.48 Entirely breast-fed babies tend to plot higher for weight in the first 6 months of life but comparatively lower in the 2nd half of the first year.48 5. Diencephalic Syndrome This syndrome must be differentiated from psychosocial FTT. The Diencephalic syndrome usually presents in the first twelvemonth of life with failure to boom, bonyness, increased appetite, euphoric affect and nystagmoid oculus movements.64,65 Clinically they differ from FTT because in contrast to their hapless physical status they are watchful, happy, active, associate easy and are non depressed.65 The Diencephalic syndrome consequences from neoplasms in the country of the hypothalamus and the 3rd ventricle.64 6. Psychosocial short stature ( Psychosocial nanism ) Psychosocial nanism is a syndrome of slowing of additive growing combined with characteristic behavior perturbations ( sleep upset and eccentric eating wonts ) , both of which are reversible by a alteration in the psychosocial environment.66 Normally the age at oncoming is between 18 and 24 months.66 Affected kids are frequently diffident and inactive and typically down and socially with drawn.5 The short stature may or may non be associated with accompaniment FTT.5MANAGEMENT OF A CHILD WITH FAILURE TO THRIVETreatment of FTT is both immediate and long-run and should be directed at both the baby and the mother/family. A good intervention program must turn to the followers: 1. The kid ‘s diet and eating form 2. The kid ‘s developmental stimulation 3. Improvement in care-giver accomplishments 4. Nursing considerations in the intervention of FTT 5. Presence of any implicit in disease 6. Regular and effectual follow up 7. Consultation and referral to specializers 1. The kid ‘s diet and eating form The pillar of direction of failure to boom, irrespective of aetiology, is nutritionary intercession and feeding behaviour alterations. For breast-fed babies, feeding interval should non be greater than four-hourly and the maximal clip allowed for suckling should be 20 proceedingss. Beyond this clip the baby would pall. Behavioural alteration should center on bettering feeding techniques, avoiding big sum of juices and extinguishing distractions such as telecasting during meal times. Fruit juice is an of import subscriber to hapless growing by supplying comparatively empty saccharide Calories and decreasing a kid ‘s appetency for alimentary repasts, taking to decreased thermal intake.67 Successful direction of FTT is followed by catch-up growth19 Catch-up growing refers to deriving weight at greater than 50th percentile for age.68 For catch-up growing, kids with FTT require 1.5 to 2 times the expected Calorie intake for their age.25Calculation of catch-up requirement30Kcal or gm protein for weight age ten ideal organic structure weight Actual weightAgeKcal/kggram protein/kg0 – 6 months 115 2.2 6 – 12 months 105 2.0 1 – 3 old ages 100 1.8 4 – 6 old ages 85 1.5 Beginning: Vinton NE et al30 Age Weight 3rd Catch-up growing fiftieth 97th Figure 1: Failure to boom and catch-up growing related to weight centile Beginning: Poskitt EME19 Some kids with FTT are anorectic and finical feeders. They may, hence, non be able to devour this sum of Calories in volume and therefore necessitate calorie-dense provenders. Toddlers can have more Calories by adding taste-pleasing fats such as cheese or butter ( where non executable palm oil ) to common yearling nutrients. In add-on, vitamin and mineral supplementation is required. Although some practicians add Zn to cut down the energy cost of weight addition during catch-up growing, the informations about its benefit are mixed.69,70 Meals should be pleasant, on a regular basis scheduled, and the kid should non be fed excessively quickly or excessively easy. Get downing with little sum of nutrient and offering more is preferred to get downing with big measures. Bites need to be timed in between repasts so that the kid ‘s appetency will non be spoiled. The type of thermal supplementation must be based on the badness of FTT and the implicit in medical status. For case, the sum of protein in the diet must be carefully monitored in kids with nephritic failure.3 Children with terrible malnutrition must be re-fed carefully to forestall re-feeding syndrome.3,67 For older babies and immature kids with psychosocial FTT, repast times should be about 30 proceedingss, solid nutrients should be offered before liquids, environmental distraction should be minimized and kids should eat with other people and non be forced-fed.71 The primary doctor may see confer withing a pediatric dietitian to assist supply calorie-dense diet.Monitoring nutritionary therapyThe first precedence is to accomplish ideal weight-for-age. The 2nd end is to achieve catch-up in length to that expected for the age. Stairss in the intervention are directed towards both immediate and long-run normal growing of the child.72 Effectiveness of therapy is monitored by addition in weight. Weight addition is response to adequate thermal eatings normally establishes the diagnosing of psychosocial FTT.3,23 If FTT continues in infirmary despite equal dietetic input, supernatural organic disease is most likely and requires farther investigation.23 Adequacy of weight addition varies with age ( see Table 5 ) .Table 5: Acceptable weight addition for age per twenty-four hoursAge ( months )Weight addition ( gram/day )Birth to & lt ; 3 20 – 30 3 to & lt ; 6 15 – 22 6 to & lt ; 9 15 – 20 9 to & lt ; 12 6 – 11 12 to & lt ; 18 5 – 8 18 to 24 3 – 7 Beginning: Brayden et al 2 Calculation of day-to-day or monthly growing such as weight addition in gms per twenty-four hours ( see Table 5 ) allows more precise comparing of growing rate to the norm.48 Although length growing is harder to measure, it should be 0.2 to 0.4mm per twenty-four hours in most children.73 2. The kid ‘s developmental stimulation: Organized programme of intensive environmental stimulation and fondness during waking hours using parents, voluntaries and child-life ( societal ) workers is necessary.33 Temporary or lasting Foster place may be required to extinguish inauspicious psychosocial environment. Surveies have shown that appropriate psychosocial stimulation is of import for cognitive development, both early and later in the kid ‘s life.74,75 3. Improvement in care-giver accomplishment Parents should be counselled about household interactions that are damaging to the kid. Pay attending to the care-giver ability to acknowledge the kid ‘s cues, reactivity and parental heat and allow behavior towards the kid. Guaranting that the nutrient is suitably prepared and presented and doing allowances for any troubles that the kid has in masticating and get downing may all take to improvement.3 Introduction of solids in little frequent provenders is utile. Babies should be fed in semi-upright position.76 All members of staff must work constructively with the parents, progressively go throughing duty back to them. They should avoid judgmental vocalizations. Prosecuting the parents as co-investigator is indispensable. It helps further their self-esteem and avoids faulting those who may already experience defeated and quilty because of sensed inability to foster their kid. 4. Nursing considerations in the direction of FTT: A nursing-care program should include careful charting of consumption, weight, and observations of the female parent ‘s eating manner and interaction with the kid. The nursing staff should teach the female parent on how to better behaviours that may be deprivational, including instructions on how to keep the infant stopping point during eating. The female parent should be taught how to cook locally available nutrients. Feeds should be thickened to increase its thermal denseness and therefore consumption. Educate the parents about the kid ‘s nutritionary and psychological demands. The kid should be stimulated by maternal attention, fondness and societal interaction with playthings and equals. Home visits by a community wellness nurse to measure household kineticss and economic state of affairs is of import. Parental anxiousness about the kid ‘s FTT can be allayed by reassurance by the nurse. 5. Underliing organic disease: Treat smartly any identified implicit in organic disease. Often the implicit in cause of FTT syndrome remains ill-defined, and an empiric test of nutritionary therapy by a individual experienced in feeding babies along with careful observation and support of the household is necessary. Children with FTT must be evaluated treated quickly and adequately for infection. The interactive relationship between nutritionary position and infection are peculiarly evident during babyhood. 6. Regular follow up: Upon discharge, near follow up with place visits is indispensable to guarantee care of nutritionary position. In this respect, Wright CM et al77 have shown that place nursing visits is associated with better results. Follow up should guarantee that the kid is so now booming physically by detecting their growing parametric quantities, utilizing the appropriate growing charts. It besides ensures that the kid continues to have equal nutrition at place. Cognitive development should be monitored and, where necessary, extra stimulation provided at place or in a preschool installation. The period of recuperation which should embrace calorie-dense diet is indispensable for full recovery of kids with FTT. Regular effectual follow up is critical in that accomplishing nutritionary and growing recovery in infirmary is likely less hard than keeping equal long-run nutritionary consumption and developmental stimulation at home.37 Children with FTT should be followed up at least every 4 hebdomads un til catch-up is demonstrated and the positive tendency maintained. 7. Consultation and referral to specialist ( s ) : For kids who are non bettering because of undiagnosed medical status or a peculiarly ambitious societal state of affairs, a multidisciplinary attack may be required.10,78Algorithm of an attack to direction of the kid with FTTDetailed History ( including itemized psychosocial reappraisal )Child with FTTThorough Physical Examination ( including auxological parametric quantities )Admit to infirmary with primary caregiver/motherInitial probes include FBC, ESR, uranalysis, urine civilization, stool for egg cell, cyst of parasite. Screen for HIV infection, TerbiumTest of nutritionary therapy with calorie-dense dietFeeds goodFeeds illFeed goodPoor or no weight addition in 4-5 yearssReassess ( farther physical test and probe )Good weight addition infirmary in 4-5 yearssGood weight addition in infirmary in 4-5 yearss Poor or no weight addition in infirmary in 4-5 yearss inNo organic diseaseReassess ( farther physical test and probe )Organic diseasediagnosedNegativeconsequencesSee psychosocial job and interveneRegular followup with growing supervising e.g monthlyRegular followup with growing supervising e.g monthlyOrganic diseasediagnosedInvite appropriate specializer ( s ) for disease-specific interventionSee psychosocial job and interveneRegular followup with growing supervising e.g monthlyInvite appropriate specializer ( s ) for disease-specific interventionRegular followup with growing supervising e.g monthlyPrevention OF FAILURE TO THRIVEPromotion of sole chest eating for early babyhood followed by optimal complementary eating in the presence of good hygienic patterns diminishes the hazard of infections, promotes infant growing and prevents child undernutrition.79 Community attempt to educate and promote people to seek aid for their societal, emotional, economic and interpersonal jobs may assist cut down the incidence of psychosocial FTT. Promoting rearing instruction classs in secondary schools every bit good as educational community programmes may assist new parents enter parentage with an increased cognition of an baby ‘s nutritionary and other demands. Early sensing of FTT and intercession can cut down the badness of symptoms, heighten the procedure of normal growing and development and better the quality of life experience by babies and kids. Prevention of LBW ( a hazard factor for FTT ) through balanced energy-protein supplementation, micronutrient supplementation, intervention of infection/malaria, surcease of smoke and intoxicant consumption in gestation are major intercessions capable of forestalling LBW.80Complication1. Malnutrition-infection rhythm: Perennial infection exacerbate malnutrition, which in bend leads to greater susceptibleness to infection. Children with FTT must be evaluated and treated quickly for infection. 2. Re-feeding syndrome: Re-feeding syndrome is characterized by unstable keeping, hypophosphataemia, hypomagnesaemia and hypokalaemia.68 To avoid re-feeding syndrome, when nutritionary rehabilitation is initiated, Calories can safely be started at 20 % above the kid ‘s recent intake.68 If no estimation of thermal consumption is available, 50 to 75 % of the normal energy demand is safe.68 If tolerated, thermal consumption can be increased by 10 to 20 % per twenty-four hours with monitoring for electrolyte instabilities, hapless cardiac map, hydrops, or feeding intolerance.68 If any of these occurs, halt further thermal additions until the kid ‘s clinical position stabilizes. 3. Chronic, terrible undernutrition in babyhood may deject caput growing, an baleful forecaster of subsequently cognitive disability.3PrognosisThe timing of abuse, continuance and badness of the disease doing growing failure find the ultimate outcome.25,30 The extent to which full catch-up growing occurs is frequently debated. A short period of hapless growing is likely to decide wholly if sustained equal nutrition is supplied for accelerated growth.19 On the other manus, drawn-out period of hapless growing is likely to take to persistent little size, peculiarly if it occurs early in babyhood when it may be hard to do up the immense increases in size of the first 6 months of life.19 When growing wavering occurs during or merely prior to puberty, there is merely a limited period of clip during which catch-up growing can happen, finally taking to incomplete catch-up growth.19 Repeated episodes of growing wavering without catch-up growing will take to clinical marasmus if decease from overpowering infection does non intervene.19 There are a limited figure of outcome surveies on kids with FTT, each with different definitions and designs, so it is hard to notice with certainty on the long-run consequences of FTT.81 In a big case-control survey of kids aged 7 to 9 old ages from an industrial economic system who had FTT in babyhood, Drewett et al82 confirmed continued lower attainments in weight, tallness and caput perimeter but non important differences in intelligence quotient. Other systematic reappraisals concluded that the long-run result of FTT is a decrease in intelligence quotient ( I.Q. ) of approximately three points, which is non of clinical significance.83 Long-term effectsA on tallness and weight look more pronounced than on I.Q.84 Children with past history of non organic FTT have been found at the age of five twelvemonth to be shorter and lighter than their matched controls.85 Regardless of aetiology, FTT in the first twelvemonth of life is peculiarly baleful, because maximum postpartum encephalon growing occurs in the first 6 months of life.3 Approximately a 3rd of kids with psychosocial FTT are developmentally delayed and have societal and emotional problems.3 The forecast is mor e variable in organic FTT depending on the specific diagnosing and badness of FTT. Merely one tierce of kids with FTT are finally judged to be normal.86 A possible account is that making optimum potency may be hard given that the socioeconomic and cultural environment in which these kids live is non easy changed.DecisionAlthough definitions of FTT vary, most governments agree that merely by comparing tallness and weight on a growing chart over clip can FTT be assessed accurately. Laboratory rating should be guided by history and physical scrutiny findings merely. The direction of FTT should get down with a careful hunt for its aetiology. Nutritional intercession utilizing calorie-dense diet is the basis of intervention of FTT, irrespective of aetiology. Social issues of the household and associated medical jobs most be addressed. A careful and timely hunt for cause of FTT and aggressive caloric supplementation are of import in obtaining the best possible result in kids with FTT.

Belonging Related Texts Essay

What do you think the most powerful influences that impact on an individual’s sense of belonging? * Strictly Ballroom by Baz Lurhmann * The Red Tree by Shaun Tan * Who you are by Jessie J You will almost always find where you belong if you search for it. So ultimately a sense of belonging comes down to perception. This starts from places and/ or relationships, which potentially alter your understanding or you and the world around you, so you can accept the person you are and your individual identity by creating this sense of belonging. In strictly ballroom by Baz Lurhmann, The Red Tree by Shaun Tan and who you are by Jessie J the composers use a wide range of techniques to convey the ideas belonging through forcible authority, challenging authority and alienation. These are illustrated through the concept of belonging to a person or place. These three ideas demonstrate what the most powerful influences are that can cause someone to feel a part of something or not. Forcible authority is illustrated in the film ‘Strictly Ballroom’ by Baz Lurhmann. Forcible authority is when a person or group has the power to make you feel a certain way that you may not agree on and make you feel as though you do or don’t belong. This is conveyed in the film when Barry Fife the president of Australian Dance Federation (ADF) forces Scott Hastings to dance a particular way. The forcible authority is demonstrated in Strictly Ballroom with close ups and bright lighting on Barry’s face. This creates attention and power to the audience’s concept on Barry. Scott then feels isolated from the ADF as a result of Barry’s ideas for the ADF. Forcible Authority is also shown in ‘The Red Tree’ by Shaun Tan. This is conveyed through visual techniques of the little girl standing alone in many pages of the book. The concept of a powerful influence is a little red leaf with â€Å"without sense or reason† this demonstrates herself as a symbol of the ‘little red leaf’ with many factors contributing to that idea. E. g. ‘The little girl with the red hair’ The little girl becomes frustrated by society and not being able to find her place or where she feels she belongs without sense or reason. Here the most powerful influences that influence the little girl is her on mind set on other people and how she see’s everyone trying to conform and belong to a place she hasn’t been nor understands. Forcible authority is again conveyed in the song ‘who you are’ by Jessie J through the singers lyrics. Jessie illustrates a strong opinion on society’s sense of belonging when she states â€Å"forget how to fit the mold, yeah! † this informs the audience that society’s conception of belonging is based on a mould and she feels out casted because she doesn’t know how to find her place in society anymore. Jessie feels as though society has clung to a certain way of thinking and living, this is because of the forcible authority, which is the society as a powerful influence on Jessie’s sense of belonging. Challenging Authority is another idea shown in ‘strictly Ballroom’ this can be when you choose to do something about following other rules from a higher authority. This is illustrated when Scott is introduced to Fran’s grandmother Ya Ya. She explains that dancing comes from the heart. The close ups of Ya Ya’s hands beating the traditional rhythm of the Paso Doble on Scott’s chest gives both Scott and Fran the inspiration to dance their own moves which demonstrates to the Audience how they are challenging authority and now have somewhere to belong to. Challenging authority is illustrated in ‘The Red Tree’ when the little girl struggles to find herself in society; this becomes an issue throughout the whole book, always feeling as though she didn’t belong. The very last page is her standing in her room with a large Red Tree filled with lots of red leaves and you can see that she has accepted herself in the society. She has done this because she has a glowing smile on her face. Jessie demonstrates challenging authority in â€Å"Who you are† by giving advice to other people to be yourself instead of living a lie and following society’s rules. This is illustrated when Jessie sings â€Å"Don’t lose who you are in the blur of the stars! †Alienation is the estrangement of somebody who is forced or unforced to distance people from each other or of people from what is important or meaningful to them. Strictly Ballroom demonstrates many moments of alienation, one particularly is Scott feeling as though he doesn’t belong in the ADF because he doesn’t confine with the ballroom dancing rules. This is illustrated when himself and Fran dance their own steps and cause a stir in the ADF judging, this is a powerful impact on belonging because if you don’t follow the rules you are forced to feel neglected. Alienation is also illustrated in The Red Tree through pictures and descriptive language. The visual technique as quoted, â€Å"nobody understands†, It is raining and the brushstrokes are soft but distinctive nd the colours are dull and dark creating the audiences idea of how the girl is feeling. The girl is a seclusion to society showing her being an ‘outsider’, the visual techniques are a powerful influence to belonging and clearly demonstrate how the girl feels alienated by society. Jessie J also shows alienation in ‘Who you are’ b y the visual technique in the film clip, Jessie sings â€Å"Sometimes it’s hard to follow your heart. † In this particular part she is sitting in an empty bathroom with dim lighting, this demonstrates her feelings of loneliness and confusion. Jessie feels confused because she doesn’t know what the right thing to do is and this causes her alienation to the environment she is in, this particular songs provides proof with her excluding herself from society until she makes up her mind. Jessie being the most powerful influence as she is the only one making the decision to alienate herself. Strictly Ballroom by Baz Lurhmann , The Red Tree by Shaun Tan and Who you are by Jessie J all convey powerful influences such as authority to demonstrate people belonging and not belonging . This is conveyed through the techniques of forcible authority, challenging authority and alienation.

Impact of Sarbanes Oxley Act, 2002 on GlaxoSmithKline UK Essay

Impact of Sarbanes Oxley Act, 2002 on GlaxoSmithKline UK - Essay Example Globally, several legislative and administrative requirements in the form of new accounting standards, requirements as to detailed disclosures in financial statements and stricter enforcement of regulations on securities exchanges have been prescribed to ensure that governance of corporate entities is maintained at levels that are beneficial to themselves as well as to the people dealing with such bodies corporate. In the past, corporate governance had been used to protect the interests of company stockholders. However 'Corporate Governance' has assumed a new dimension in the post 'Enron' and 'Post Globalisation' scenario as almost every major developed and developing nation ensures some sort of promotion and protection of corporate governance principles. However there are certain basic views or models that describe the corporate governance practices universally. According to Tricker (1996) "Stewardship theory, stakeholder theory and agency theory are all essentially ethnocentric" Tricker (1996) observes although there is no change in the underlying ideologies there are conflicting theories of corporate governance established on the basis of the perceptions and expectations of the respective roles of individual, enterprise and the state. The basic principles of the different theories depend largely on the relationships that exist between these agencies. The conflicting views on the corporate governance are presented below: The Agency Model Hawley & William (1996) state the emphasis of corporate governance lies in constructing rules and incentives in the form of implicit or explicit contracts for the purpose of aligning the behaviour of managers being the agents with the expectations of the owners being the principals. Under the agency theory of corporate governance it is assumed that the ownership of the firms is dispersed as the American 'modern' corporation. The main consequence of such a form of dispersed ownership is that there exists a gap between the owners representing the 'principals' of the firm and those who are responsible for the running the day to day operations of the firm who are known as 'agents'. Thus as Shelifer and Vishny (1997) state, "agency theorists aim to understand how investors get the mangers to give them back their money and hence minimize agency costs." According to Jensen & Meckling (1976) since the relationship between the owners and managers of a corporation is that of a pure agency rela tionship, the issues associated with the 'separation of ownership and control' in the modern ownership corporation are also mostly agency based. The Stewardship Model In the stewardship model,

Bus 617-week 10 Essay Example | Topics and Well Written Essays - 750 words

Bus 617-week 10 - Essay Example Evaluation of the program’s effectiveness within my organization would be through ensuring it is not duplicative and regularly monitoring the shelf life of the courseware. This practice would support workplace happiness by bringing in a true worldwide buy in of training programs among the participants and significantly reducing the cost of training. The practice is also flexible. What is happening now in my organization is lack of excellent content that can be applied globally and it is affecting the entire learning industry. Going by the potential of this practice, the future looks great and promising. The reason as to why I am saying that the future looks great is because using the practice well together with the program would just have the best effect on any given organization apart from mine. This information I acquired through real-time research and everything taught can be built on oneself. Most of the information came from a pdf called best practices of high functioning learning organizations. The rest of the information came from comparing notes over the internet and library. As I complete this exercise, I feel comfortable with the information that I acquired because it is self-explanatory and I can easily feel it transforming my organization and the entire industry. I have five goals namely extending my organization by going global, creating satisfaction to my customers, getting better learning programs for my organization, reducing the cost of learning and engaging my customers in the best way possible. One year from now, I will have done a lot considering the use of global practice. The organization at this time looks great, as I have gone global. The priority is however going global and the starting point is using the global practice. The advantages are that it could place the organization better competitively and at the same time, the disadvantage being that it would take more time to fully be implemented

Shape Memory Alloy Essay Example | Topics and Well Written Essays - 500 words

Shape Memory Alloy - Essay Example This hypothesis shall be verified during research[1,2]. The research work will be referred from journals and academic libraries. The research and development by the scientists on this metallurgy shall be revealed and explored through journals and research papers. The references o experiments shall be provided; it is on record that several experiments have been conducted to verify that SMA materials reversible solid state transformation. The experiments shall be referred to verify the composition of the alloys in SMA, the transformation temperature of the material is controlled and determined by the composition, manufacturing process, and physical conditions [4]. The findings of the impact, hardness and non-destructive testing shall be captured in the paper; these materials have the property to sustain significant bending and torsion-al forces. It has observed that these material tend to seize when establishing contact with other materials; these materials therefore exhibit high co-efficient. However such characteristics are essential for security surveillance at airports to firmly confirm the type and nature of material being transported. These materials have good life, and are resistant against corrosion.

Critique of a research article (See below for article )) Essay

Critique of a research article (See below for article )) - Essay Example rect relation to the research gap outline in the above introductory paragraph, Sawyer and Penman (2007) address the impact of computer use on nursing practitioners. More specifically, they address the physical consequences of usage and whether or not nurses receive the required ergonomics training and implement it in their practice. This study will critique offer a comprehensive critique of Sawey and Penman’s (2007) article. The critique will commence with an overview of Sawyer and Penman’s (2007) article. Within the context of this overview, the rationale for the article will be explicated, a brief review of its selected methodology presented and, importantly, the importance of the article and its relevance to contemporary nursing practices will be fully articulated. Computers are becoming increasingly prevalent in the healthcare setting, and their potential applications and value are extensive. Computers store and process information that can be interconnected to various sources to transfer information from one source to another within the hospital and outside to the world at large. Within the field of nursing, computers can be used by nurses for the purposes of education and seeking information, facilitating communication, and patient documentation. While much of the literature focuses on factors contributing to computer utilization, few studies describe the actual computer utilization by nurses. The available literature identifies uses and benefits of computer access that are often anecdotal and assumptive. Computer technology is rapidly evolving, and research is not keeping up with examining and documenting its impact on the profession of nursing. In a profession focused on providing evidence based practice, current and relevant evidence is needed regarding, not just the actual application of computers by nurses, but the health-related impact of usage on nurses. The implication here is that the rationale for this article stems from the role which

Identity Theft Research Paper Example | Topics and Well Written Essays - 1750 words

Identity Theft - Research Paper Example As it is, people whose identity are compromised and have been assumed by another can suffer tremendous loses. Once the important information of a certain person is exposed to unscrupulous persons, such information can be used against that person. If the financial information of a certain person is compromised and the identity theft gain access to the person’s bank accounts, credit cards and others, the theft may be able to easily steal the money of that person (Abagnale, 2007). Aside from taking money from their victims, some identity thieves may use the signature or the accounts of their victim to commit crimes either online or offline (Cullen, 2007). A good example of this is when an identity theft uses the signature of another person to perpetuate fraudulent transactions either online or offline. By use the identity of the victim, the identity thief may be able to get away with the crime and his or her victim gets into trouble with the authorities. II. How Identity Theft Ca n be Committed Over the years, techno savvy thieves have developed a number of ways to steal important information by breaking into the information security system of companies and individuals. ... tity thief’s operation depends on the kind of strategies and mechanisms that he or she employs to get the necessary information to usurp the identity of another. In recent years, social engineering have become one of the most potent tools used by identity thieves to gain access to buildings, databases and computer systems across the country (Hadnagy, 2010). In this era of social networking when millions of people meet online to make friends or transact business, social engineering becomes one of the easiest methods of defrauding unsuspecting internet users. How does an identity theft make use of social networks to defraud his or her victims? Social engineering employs human psychology so instead of using software and programs to attack the database or the security system of a certain company or individual, the identity theft target the people who have access to the database or the security system (Hadnagy, 2010). The common strategy here is to study the work patterns of the ta rget individual or group of individuals and find strategies to trick these people into divulging passwords and access codes to their system. Social networking sites are often used by these people to befriend their targets and learn whatever they can from these people through trickery and guile. In a sense, social engineering is like stalking a prey and punching when the prey is at its most vulnerable moment. As it is, this method of retrieving information from human sources is a long process so it may take days, weeks or even months before the identity thief actually gets the information that he or she needs. Given this situation most of those people who employ this strategy to gain access to database may need to invest a lot of time on their targets (Hadnagy, 2010; Wilhelm, 2010). Note that

Re-assesment work Essay Example | Topics and Well Written Essays - 2000 words

Re-assesment work - Essay Example Table of Contents Table of Contents 3 1. Reflection on the feedback 4 2. Identification of service package of The Edge 4 3. Service Blueprint for The Edge 4 3.1 Actions of the customer 4 3.2 Onstage employee actions 5 3.3 Backstage employee actions 5 3.4 Supporting processes 6 3.5 Physical evidences 6 4. Walk Through Audit (WTA) of The Edge 7 5. Discussion of GAP analysis and its application to The Edge 10 6. Five dimensions of quality 12 7. Use of technology at The Edge to improve customer service 13 8. Creation of new service blue print for The Edge 14 Conclusion 15 Reference list 16 1. Reflection on the feedback The feedback delivered clearly mentioned that the Harvard referencing needs to be followed exactly as required. Other than that the skills audit module is also reassessed to incorporate the changes and the points that was not there in the 1st submission. On an overall basis the whole assignment is reassessed entirely in order to cover all the points that were not mentioned in the first submission of the assignment. 2. Identification of service package of The Edge The Edge caters to a wide range of customers. The service package of The Edge is as varied as its customer base. It offers three specific types of services. One is the normal food service, the second one is catering or serving in special events and apart from that it also holds private bookings (Benner and Sandstrom, 2012). The service packages are food and drinks, and holding special events. 3. Service Blueprint for The Edge The failure of The Edge is described across 5 important areas of service blue print 3.1 Actions of the customer The customer actions can be described in two different ways. One is active and the other one is passive. In active action, the customer and the canteen staff work together for creation of the service. In this case the canteen staff did not provide customers with suggestion of what they would like to have as improvements over the current food and meal menu (Chi efele, 2012). Since the canteen did not use the customer feedbacks as potential source of improvements so this led to further deterioration of services. The second type of action is passive action. Here the customer and the canteen staff do not have significant chances of interection (Garrick, 2011). The Edge actually gave more importance to this type of action from the customers. The customers were not provided with any kind of complaint form or customer feedback form. Thus the customers were offered services that lacked variety and innovation. Canteen customers usually look out for two different things when they visit canteens, one is affordability and other one is variety. The prices charged are affordable but lack of variety became one of the prime reasons for dissatisfaction. 3.2 Onstage employee actions The onstage employee actions denote the actions that are performed in the view of the customer. The canteen staff lacked simple courtesy of greeting the customers and seeing to it that the customers are attended as quickly as possible. Thus after entering the canteen the customers had to in fact find themselves a table on their own (Gulbrandsen and Smeby, 2008). This does not go well with all types of customers. Since The Edge is a well-known canteens in University of East London, this kind of service created dissatisfaction among the loyal

Sharia Law and International Commercial Arbitration and Enforcing Dissertation - 1

Sharia Law and International Commercial Arbitration and Enforcing Foreign Judgments - Dissertation Example The purpose of the study was to explore the possibility of a conceptual harmonisation of conventional and Islamic arbitration between parties in different countries. The dissertation commences with a review of the historical development of arbitration in Islamic countries under Sharia law, in order to gain an understanding of the manner by which aspects of arbitration are perceived by the Muslim faithful. The discussion proceeds along this line to the philosophy behind salient concepts in the Islamic faith, particularly those elements that are seen to be of greatest disparity with conventional concepts. After examining these differences specifically as they pertain to Saudi Arabian law, the accession of the Kingdom to the various international conventions governing arbitral judgments and awards, their recognition and enforcement, as discussed. From this vantage point, the likelihood of integration of international legal development and legal development under Sharia law is assessed. The paper concludes that conceptual and philosophical consistencies exist between both systems that could viably form the basis for a harmonised law – an international arbitration law embodying provisions that blend with Sharia principles, and the evolution of Sharia law to be consistent with international law. Acknowledgements Table of Contents Abstract 1 Table of Contents 4 7 Chapter 1: Introduction and Research Question 8 1.1Chapter Overview 8 1.2Background to the study 9 1.3Alternative dispute resolution systems 10 1.4Background of international commercial arbitration and award enforcement 11 1.5 Research objective and research question 14 1.6 Research methodology 14 1.7 Scope and Limitations 15 15 16 CHAPTER 2 16 Chapter 2: Development of Arbitration Law in the Islamic countries( Middle East) 16 2.1 Chapter Overview 16 2.2 History and Development in Middle East regional arbitration law 17 2.3 Conflicts between International Commercial Arbitration and Sharia law 22 2.4 Re conciliation of ICA with Sharia principles 32 2.5 On the possibility of harmonising Sharia principles with international arbitration law 34 2.6 Chapter Summary 36 37 CHAPTER 3 37 Chapter 3: Islamic Principles In Commercial Law and Arbitration 38 3.1 Chapter Overview 38 3.2 Islamic teachings related to business and commerce 38 3.3 The practice of Sulh 40 3.4 The Islamic principle of Ijtihad 41 3.5 The teachings of Islam with regard to arbitration 43 3.6 Arbitration in terms of the perspective of Sharia Law 46 3.6.1 Legality of Arbitration from the Quran 46 3.6.2 Legality of Arbitration from the Sunnah 48 3.6.3 Legality of Arbitration from the Secondary Sharia Sources 49 3.7 Enforcing foreign judgments and awards 50 3.8 Chapter Summary 52 54 CHAPTER 4 54 55 Chapter 4: Implementation of International Commercial Arbitration in Saudi Arabia 55 4.1 Chapter Overview 55 4.2 The acceptance by Islamic countries of the global system of arbitration 55 4.3 Arbitration in terms of the perspective of Saudi Law 57 4.3.1 The concept of Arbitration in Saudi Law and its Characteristics 57 4.3.2 International Commercial Arbitration in Saudi Arabia 57 4.4 Chapter Summary 59 Chapter 5: Synthesis of Saudi Arbitration Law and International Commercial Arbitration 61 5.1 Chapter Overview

Behavioural-Based Safety in the Construction Companies Essay

Behavioural-Based Safety in the Construction Companies - Essay Example While there are many other explanations, the research paper will seek to determine the explanations that are applicable to the current case study, which is employee perception of BBS at the workplace, BBS training, safety awareness, safety participation, and group safety culture. A quantitative method study will be used for this research study with a survey-based research design. The research study will utilize probability sampling, which will seek to get at least fifteen labor workers at Tarmac Zawawi LLC. It is expected that high scores in BBS training, perception, awareness, participation, and group safety culture will result in high levels of safety and, therefore, fewer incidents and accidents. Because of the equipment, machinery, working height, and external activities involved in the construction sector, it is one of the most dangerous occupations in the industry. There are a number of factors, which lead to accidents in this setting. One of them is unsafe conditions and behavior, in which the individual’s behavior accounts for approximately 75% of all events (Roughton & Mercurio, 2012: p82). In addition, most studies suggest that unsafe behavior among workers is more to blame than the safety of conditions in the occurrence of accidents. If unsafe conditions do exist and individuals accept the risk associated with the construction and continue normally with their activities, accidents cannot be blamed on the conditions alone. Therefore, failure to identify conditions that are unsafe prior to and during construction, to continue with construction even after the unsafe conditions are identified, and unsafe performance without regard to the conditions at the site are three major reasons for construction site accidents (Roughton & Mercurio, 2012: p86). In  addition, unsafe conditions are brought about by unsafe actions from individual workers and their colleagues, management practices, and inhuman events.  

Safe Travel Essay Example for Free

Safe Travel Essay These days, we Geeks don’t travel anywhere without our laptops. It’s a given that we need to have them on us! How would we survive?! Thankfully, Seth sent in the following tips to help us keep them safe while we are on the road. Pad The Laptop: Make sure the laptop bag or carrying case you transport your laptop in provides adequate padding. As you move about the airport or shove the laptop under the seat in front of you or into the overhead storage compartment, the laptop can be jarred and jostled quite a bit. Keep It On You: It is not uncommon for someone to set their luggage down while standing in line for a muffin, or to sit down while waiting for a flight. With all luggage, it is important to keep an eye on it and ensure nobody tampers with it or steals it. Because of their size and value though, laptops make prime targets and a thief can snatch the laptop bag and keep walking while you are unaware with your back turned. You should keep the laptop bag on your shoulder or keep it in sight at all times. Back Up Data: Perform a backup of all critical or sensitive data before departing. Just in case your laptop does become damaged or lost, you don’t want to also lose your important files and information. You can buy a new laptop, but it is much harder to replace lost data. Encrypt Your Data: Just in case your laptop should fall into unauthorized hands, you should make sure your hard drive is encrypted. Laptops with Windows Vista Enterprise or Ultimate come equipped with BitLocker drive encryption. If you aren’t using one of these versions of Windows Vista, and your company has not implemented any other sort of enterprise-wide encryption solution, you can use an open source solution such as TrueCrypt to protect your data. Document Identifying Information: In case your laptop does end up lost or stolen, you should be able to provide detailed information about the make, model, serial number and any other identifying information. You may need the information to file a claim with the airline or your insurance company, or to provide law enforcement. Use Strong Passwords: Follow the advice in Passwords and How to Make Them to make sure that your passwords can not be easily guessed or cracked if your laptop falls into the wrong hands. An excellent program for helping to secure and manage your passwords is Password Vault, which works for both Windows and Mac OS X. Use a BIOS Password: Protecting your laptop with an operating system login and password is a good idea, but there are ways to circumvent that protection and gain access to the data still. For better protection, you should enable password protection at the BIOS level so that the laptop can not even be turned on without the correct password. Implement Remote Data Protection: Another step you can take to make sure your data does not fall into the wrong hands is to look into products that will allow you to remotely destroy or erase the data on your laptop if it is lost or stolen. These products generally require that the unauthorized user connect to the Internet first in order for them to do their work though, so they are not a guarantee. Use Portable Storage: To make sure you have the business critical PowerPoint presentation or Excel spreadsheet that you need to show your business partners in order to seal the multi-million dollar deal (or whatever other important files and documents might be on your laptp) you should carry a copy on a USB thumb drive or some other type of portable storage that you can carry separate from the laptop in case it becomes lost or stolen. Just Leave The Laptop At Home: When it comes to all of the hassles and all of the issues that can arise from traveling with your laptop, you should also consider whether you really need to take it. You can carry your data or files on portable storage such as a CD, DVD or USB drive, or you can just email or FTP the data ahead of you. Then, you can borrow a desktop or laptop system once you are safely on the ground and at the office site you are visiting.

Criminal Justice Essay Example for Free

Criminal Justice Essay Dear Sir: As far as I know, the Abstract (also this emails attachment), is written as the final section of the Paper, after everything is said and done. Because you are the one doing the methods, the analyses, the results, and the discussion, I leave it up to you to key in the two or three remaining sentences for the final Abstract. Hence, the initial Abstract: In an attempt to initiate a reliable measure of the levels of perceptions of Criminal Justice Major Undergraduate College Students, this study possibly sharpens the definition of predictive behavior of the students who as respondents were surveyed by use of carefully formulated questionnaires to determine their general perceptions of the U. S. Criminal Justice System, their general perceptions on immigration law, immigration reform, and immigration control, as well as the students’ specific perceptions on the U. S. ’s ongoing Mexican immigration control. To perform comparison, the perception scores were statistically analyzed carrying out correlation test, t-test, and regression analyses tests between the general perception scores versus the specific perception scores. The results showed that   † Thank you very much. Very truly yours, Writer of32344972 Urgent revision xxx Urgent revision on your A STUDY OF UNDERGRADUATE COLLEGE CRIMINAL JUSTICE MAJOR STUDENTS PERCEPTIONS OF THE CRIMINAL JUSTICE SYSTEM. Date Revision Deadline Instructions March 19 8:16 March 20 8:16 I am still waiting for the Abstract to be downloaded in a Word document to complete my order. Once again, this was one of the three items I requested in my order. xxx

Cinema Is A Development Through Many Ages English Language Essay

Cinema Is A Development Through Many Ages English Language Essay Movie also is a great entertainment for peoples. Nowadays, many people love movies and going to the cinema for movie, especially the youngest generation. Cinema are attracted to people and they will be going to the cinema watching movie every week or twice a week for relaxing after day of work or study and this already become as a trend. Cinema is a nice place for entertainment, relax, enjoyable and fun for teenagers, forms a part of our leisure time because of today life has grown complex, full of worries and anxieties. Some of their life cannot without movie. Movie will teaching a lot for us that about life in the world. We are not only can learn and make our lives better and also learn reality in life from the movies. Movies also keep updated us and know the new information, famous and popular things, place or people around the world. A research shows (Levy, n.d) the vast majority (79 perecnt) of those questioned said, Going to the movies is a good escape from everyday life. A fil m can change people life become better or worse. There have 9 types of movies are shown in cinema such as horror movies, romantic movies, drama movies, suspense movies, action movies, violence movies, comedy movies and documentary movies. Despite the fact that, watching a movie not only can affects on moral values and cultures on people who are college students, scholar and childrens and also individual behavior. It can be influence in a numerous ways. The effects of movies are various, including weighing on elements of sex and race. Some of the peoples will influence their thinking, action and attitudes changes on some level by movies but movie has good influence for youth also. In fact, movie has beneficial and harmful effect of media on youth. According to appendix A, the questionnaire and survey shows 21 out of 30 are said that teenagers like to go cinema, others are neutral and disagree. In the other hand, 13 out of 30 are said that movie will influence the behavior and attitude of teenagers in general. Many of parents will control their children going to the cinema for movie or watching film in the house. The reasons of their parents control them because they worry their child influence bad attitude and moral influence from movie like smoking and fashionable such as hairstyle and wearing. Cinema would be easily influence teenagers attitude and thinking, they will change their mind. They would change their habits and try to imitate their favorite stars hairstyle, wearing and attitude. For example, some of the children they would learn smoking from the movie. Violence movie will influence teenagers whose mine are childish. They will try to imitate like ga ngster and doing bad things. Example damage people house and cars fight with others people, bullying and vandalism. Romantic movies also will affect youth thinking and behavior. After youth watch a romantic movie, the percentage of early married will increase because the end of the movie is the best. Many people agree watching movie on weekends but teenagers, scholar, student and college student who spend too much on watching movie will be addicted and tend have sedentary lifestyle. They will not only influence their cultural, lifestyle and homework and also physical influence. Physical influence means influence their health. They always stay at cinema or home watch movie and lack of doing exercise at outside to absorb a fresh air so that they will get fat and illness. Besides that, from the survey are said that 14 out of 30 said that the movie tickets are very expensive. It would be increase the expense of the parent. The survey are said that 16 out of 30 said that are disagree movies that are played more than 1 hour are wasting time. I am agreeing also because sometimes watching movie is not wasting time. That is giving us relax after working or study. Watching movie will keep updating us with the world what had happening and trend around the world. The questionnaire shows that movie will not affect relationship like family relationship, friends and couple relationship. I am agreeing movie is a best way to improve relationship when they are sitting together watch a film because they can share and communicate about their feeling, opinion or thinking from the movie, especially family relationship. Parents should spend one or two hours for movie to accompany their children. From that, parents can know well what their children thinking and doing. Furthermore, the questionnaire survey shows that 10 out of 30 are agree movies will help us to be more creative. 12 out of 30 are disagreeing with the movies help us to be more creative and 8 out of 30 are neutral. Movie is a mind-killer. It dulls you. In my opinion, watching movie will disturb youth mind while there are doing homework or finding a creative inspiration because most of the youth, even though is adult, they also will concentrate on movie more than their tasks. The survey of questionnaire shows that 13 out of 30 are agreeing movies will affect performance in education. Parents must be full of supervision because movies will affect youth examination result, affecting college students, scholar and children reading habit. However, movies can be a powerful teacher. Sometimes youth will learn harmony, cooperation, kindness though the movie. A recent article (Anon., 2003) states that high school programming promoting media have been shown too beneficial, they give students mo re understanding when learning. And also movies will help youth to improve their language. Conclusion and Recommendation: In the conclusion, my opinion, movie is harmful more than beneficial for youth. Movie has big power to affect youth thinking, attitude, behavior, habits, lifestyle, cultural and hobby, even though is an adult. In the cinema, violence movies shouldnt band but less than 18 years old should prohibition watching violence movie in cinema so that can reduce youth imitate to be a gangster, doing a vandalism and the world may be reduce scum because under 18 years old their mind are still young, they cant analysis what are right and wrong. For me, I am not agreeing every weekend going for movie that is not necessarily because tickets of the movies are expensive. It will increase parents burden. Sometimes parents should spend some times to accompany their children watching movie and control them do not spend too much time for movie although they are Study College or University because movie will influence their examination result. Watching movie is a great ways to improve relationship with fam ily and friends, not only couple. It can know well each others for the movie. However, movies will giving us relax and entertainment after working or study. In addition, movie will improve youth language and communicating skill with others. Question 2 Cheong Kar Mun 25, Persiaran Wira Jaya Timur 27, Taman Gunung View, 31350 Ipoh, Perak. Prime Ministry, Local Education Authority, 62, Jalan Damai, Off Jalan Ampang 55000 Kuala Lumpur, Perak Darul Ridzuan. 4th October 2012 Dear Sir/ Madam, Education Ministry to Support Teaching of Science and Mathematics in English My name is Cheong Kar Mun, study Diploma in Business Management at Olympia College Ipoh. I am support teaching of Science and Mathematics in English. Early learning science and mathematics in English for children are extremely important. 2. Nowadays, English used widely and can be founded in everywhere. English are considering as the most important language of the world. Teachers teaching Mathematics and Science in English since student are young age, it will continue accessing knowledge even they after graduate their high school, especially in sector of science. Learning mathematics in English since their young age will give students ability to learn advances subjects like physics and chemistry. Knowing English can helpful for scholars can communicate ideas and research finding peers in their field. That is a lot of information are available in English from library or internet. Scholar interested in doing research at an academic level on new scientific developments so that the prime minister should consider the Science and Mathematics teaching in English. They can search their scientific knowledge to foreign people through internet. Students will find a lot of the latest science information. Furthermore, if students do not understand the teacher explanation and they faces the difficult question on their lesson, revision or project works so that students can search more information of science through network. Many of network those are about scientific information will use and explanation in English. I am support using English to teaching Science and Mathematics because student can more understand and solve their problem and research easily when they search information through network. Education in English since they are young age is easily for them continue their higher studies because many of universities are using English in teaching include local university and some of parents send their child to overseas like United Kingdom, United State and Australia so that they can easily get their teacher explanation and teaching. They would no problem if they are taken in subject in engineering, medical, IT and accountancy fields. 3. The Star (2008) states that Science and Mathematics in English can help increase proficiency. Ministry of Education supposed to teaching Science and Mathematics in English when student Standard One. The aims of teaching Science and Mathematics in English can motivate students to learn English language efficiently and students will be used to English while communicate with other people and can speak fluent in English. Malaysia can improve their English level. The Star (2007) states that more of the people will speak in English than any other language, is the native language of more than 350 million people. Using English in education not only can motivate student speak English they still can learn more English words and proper grammar, new words and also focus on the scientific vocabulary. Students will improve their pronunciation. Some of the family they are using their mother tongue to communicate, if the school still using other language like Malay or Chinese to teach science and mathematics that would not be only cannot improve the standard of English and motivate them to learn English language, scientific vocabulary and also cannot speak fluent in English. If teaching in Malay language, student only can speak fluent in Malay and used to communicate with people in Malay, this should not be improving the ability of students to communicate in English. Lim Kit Siang (n.d) informed that the study found that fewer than 15 percent of teachers were fluent in English, and that most teach using a combination of both languages. Government should first train the teachers who are lack in English language only can improve the young generation English. 4. Teaching English and Mathematics in English not only pave the way for the youngest generation for student also very useful in their future, especially in science development. English language will help us and give us have confidence after graduate and it will bring for youngest generation a lot of challenges. Learning English language also is the key to our success. If we do it well in Mathematics and Science foundation in English language will have a lot of chances in job market are related Science and Mathematics because English is international language. Who are interested in accountant and having math foundation and higher math in English is useful of seeking accountancy job. In a business view, a international companies or corporation company will first consider and hire a employees are best, can speak well and write well in English and also dual language because they will easily communicate and doing a report with their clients those are in other foreign countries which they are do not know speaking in Malay or Chinese. However how excellent in the result is, if do not know and speak in English, that will always miss the job opportunities. Many of documents, report, projects, contracts, memo and emails are written in English, peoples are known in English it will easy to handle and understand the project or the job. The language of English has become internationally across the world especially daily communicating, business, science, technology, banking, medicine, computing, tourism and engineering. Speak well in English language in addition to native language can be beneficial if people are seeking job with international companies. They would not be communicating problem in workplace when they working. English language has become a basic requirement for students and job seekers will increasingly in globalised world. If can speak fluent in English will get the great job easy. 5. In addition, speak well in English like can much closer and more connected with the world. If when we going for travel at foreign country like United States, United Kingdom, Canada and Australia and so on so that we can get the travel become easier communicate with local people that may not speak any other language and it will be more enjoyable. Most of the banks, airports, and restaurant and hotel employees will communicate in English with customers and using English sign to guide you, especially 5 stars and above or high class restaurant. And the signboard of foreign country will write in English. Nowadays, not only in foreign country, it also in local country will communicate in English language in particular places like banks, high class restaurants and hotel. 6. In conclusion, my opinion teaching of Science and Mathematics in English must be continued for the betterment of future graduates and will practicing students English skills. Students will communicate in Malay, Mandarin and Cantonese language with their friends in the campus but they less using English to communicate so that I support using English to teaching Science and Mathematics because it will very helpful to train students used to using and learn English in the science and mathematics subjects. English language is the internationally language and would easy to search information of sector in science and mathematics. This is also a best way and the easy way to sew up the gap between the foreigners with us, especially science and mathematics development. In Malaysia, Malay language is the language to unite us while English language is important for us to stay relevant, intelligent, wise, positive, survive and successfully. Thank You. Your faithfully, - (CHEONG KAR MUN) Anon. (2003). Impact of media use on children and youth. Paediatrics Child Health. 8 (5), p301-306. Seucan, M. (2012). Cinema Influences Young Peoples View of the World. Available: http://ezinearticles.com/?Cinema-Influences-Young-Peoples-View-of-the-Worldid=7035864. Last accessed 6th Nov 2012.

Affirmative Action :: essays research papers

Affirmative Action   Ã‚  Ã‚  Ã‚  Ã‚  In the Human Rights Act, Chapter 214 of the revised statutes, 1989, it states that â€Å"in recognition that human rights must be protected by the rule of law, this Legislature affirms the principal that every person is free and equal in dignity and rights without regard to race, religion, religious creed, colour, sex, physical or mental disability or ethnic or national origin.† Unfortunately though, sometimes this law is not always abided by. Women, aboriginal people who are physically or mentally challenged, and visible minorities have often been denied employment equity, or equal employment opportunities due to discriminatory practices. These groups should enjoy equal representative share of employment opportunities in all occupations and at all levels.   Ã‚  Ã‚  Ã‚  Ã‚  An example of discrimination that denies equal opportunity is the practice of allowing members of these four groups to advance within a company only to a certain level. The company may appear to be equitable by including members of these groups in management positions. However, the top executive positions are still out of reach for members of these groups not because these people are not qualified for the jobs, but because they are discriminated against. Legislation, including the federal Employment Equity Act, exists to ensure employment equity. Such legislation requires employers to report what proportion of their employees belong to these four groups. Employers must then prove that all groups are equally represented at all levels within their organizations.   Ã‚  Ã‚  Ã‚  Ã‚  Affirmative action promotes equality in the workplace in such areas as hiring, training-apprenticeships, promotion, compensation, transfer, layoff, termination and goals. It also promotes equal employment opportunities for those groups or individuals who are disadvantaged due to race, religion, creed, colour, disability, national or ethnic origin, sex, age or marital status. Affirmative action programs are designed to improve the lot of people who have suffered as a result of past discrimination.   Ã‚  Ã‚  Ã‚  Ã‚  By the year 2000, white males will likely account for only 15% of new workers - 85% of new workers will consist of women, aboriginal people, physically or mentally challenged people, and members of visible minorities. The number of women and minorities has increased in many occupations because of affirmative action programs. Some companies actually make a point of advertising that they are Equal Opportunity Employers.   Ã‚  Ã‚  Ã‚  Ã‚  Application forms and advertisements for employment should not make any inquiry that directly or indirectly expresses or invites any limitation, specification, preference or information as to age, race, colour, religion, creed, sex, sexual orientation, physical or mental disability, ethnic, national

Shakespeares Hamlet - Gertrude Essay -- GCSE English Literature Cours

Regarding Hamlet’s Gertrude  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚        Ã‚  Ã‚  Ã‚   Angela Pitt in â€Å"Women in Shakespeare’s Tragedies† comments that Shakespeare’s Gertrude in Hamlet is, first and foremost, a mother:    Gertrude evinces no such need to justify her actions and thereby does not betray any sense of guilt. She is concerned with her present good fortune, and neither lingers over the death of her first husband nor analyses her motives in taking another. . . .She seems a kindly, slow-witted, rather self-indulgent woman, in no way the emotional or intellectual equal of her son. . . . Certainly she is fond of Hamlet. Not only is she prepared to listen to him when he storms at her, proof that he is sufficiently close to her to have a right to make comments on   her personal life, but she is unfailingly concerned about him. . . .When she has drunk from the poisoned cup, almost her last words are: ‘O my dear Hamlet!’ The simple endearment is very poignant, reminding us that the bond between mother and son, and Hamlet’s desperate jealousy of Claudius, account for as much of the tragic progress of the play as the need to avenge old Hamlet’s death (46-47).    Is Gertrude a mother first, and queen second? This essay hopes to resolve seeming contradictions in the character of Queen Gertrude, as well as dealing with other aspects of her multi-faceted character.    At the outset of the tragedy Hamlet appears dressed in solemn black. His mother, Gertrude, is apparently disturbed by this and requests of him:      Ã‚  Ã‚  Ã‚   Good Hamlet, cast thy nighted colour off,   Ã‚  Ã‚  Ã‚   And let thine eye look like a friend on Denmark.   Ã‚  Ã‚  Ã‚   Do not for ever with thy vailed lids   Ã‚  Ã‚  Ã‚   Seek for thy noble father in the dust:   Ã‚  Ã‚  Ã‚   Thou know'st 'tis common; ... ...'s Hamlet." Early Modern Literary Studies 6.1 (May, 2000): 2.1-24 <URL: http://purl.oclc.org/emls/06-1/lehmhaml.htm>.    Pitt, Angela. â€Å"Women in Shakespeare’s Tragedies.† Readings on The Tragedies. Ed. Clarice Swisher. San Diego: Greenhaven Press, 1996. Reprint of Shakespeare’s Women. N.p.: n.p., 1981.    Shakespeare, William. The Tragedy of Hamlet, Prince of Denmark. Massachusetts Institute of Technology. 1995. http://www.chemicool.com/Shakespeare/hamlet/full.html    Smith, Rebecca. â€Å"Gertrude: Scheming Adulteress or Loving Mother?† Readings on Hamlet. Ed. Don Nardo. San Diego: Greenhaven Press, 1999. Rpt. of â€Å"Hamlet†: A User’s Guide. New York: Limelight Editions, 1996.    Wilkie, Brian and James Hurt. â€Å"Shakespeare.† Literature of the Western World. Ed. Brian Wilkie and James Hurt. New York: Macmillan Publishing Co., 1992.