The Design of Health and Safety Control Systems Assignment

The Design of Health and Safety Control Systems - Assignment Example â€Å"It is an employer's duty to protect the health, safety and welfare of their employees, and other people who might be affected by their business. Your employer must do whatever is reasonably practicable to achieve this† (â€Å"Your Employer’s Responsibilities, 2011, pgh. 2). This includes the fact that the gas emitted from the spray makes people drowsy. If that is the case, and people are going to have to go down in the tunnel, it should be a team of people who are working on this project. There should be support in terms of physical support, and the gentlemen working on the project should have walkie-talkies. Not only that, but they should make sure to wear all appropriate and proper protective gear for this project. This would include whatever kind of suit is needed to go down into the tunnel and spray this highly toxic (and potentially flammable) sealant. Since the subterranean chamber is located in the middle of a field, the area surrounding the work area shou ld be completely examined by the company that is going to be doing the work in order to ensure that there are no problems with the ground surrounding the area in which the work is to be completed. Additionally, the area should be assured that it is secure to work within before any work is ever started. â€Å"A check should also be carried out to ensure that there are no cellars, underground watercourses, ground conditions or made up or soft ground, etc., which could create hazards during the operation† (Construction Confederation, 2008, pp. 8F-3). This is to ensure that there will be no cave-ins during the project, which could herald an early death for the person going into the subterranean chamber. The person must definitely have radio contact of some sort with the outside world, and in addition to proper gear—obviously the ground around the work area must be checked for its stability. If the stability of the subterranean chamber or its immediate environs is in any wa y compromised, that chamber should be considered dangerous and unsuitable for being checked by humans. In that case, what might happen is that, if it is unsuitable for a person to complete, perhaps a machine might be able to be deployed in order to do the job. If the job is too difficult for a machine to do as well, what might be considered the best option is for the subterranean chamber to be sealed up with concrete due to the cracks being too severe to be fixed by human design. If that is the case, it is not worth putting human lives in danger in order to solve a problem that is that difficult. Not only this, but, perhaps—rather obviously—the farmer must give his permission for the work to be done since it is on his property (if there is work to be done), unless the tunnel is not part of what he owns and is part of the public domain. Either way, he will have to be notified that construction is going to have to take place outside of his property. Operation #2 Recommen dations (475 words) The employee who is made to tidy up the designated are near the junior school in the suburbs of a small town should first consult a landscape architect as to how the landscaping would be carried out. â€Å"All municipalities operating a form-based code must have professional design expertise on staff in the person of an urban designer, architect or landscape architect, or else a design consultant retained to work with elected

Frankenstein - 1931 and 1997 Essay Example for Free

Frankenstein 1931 and 1997 Essay Horror genre, sympathy for Frankensteins creation and suspense Mary Wollstonecraft Shelly wrote Frankenstein in 1818. She was only 19 at the time. She had a unique upbringing as her mother was a radical feminist and her father was a politician. She then went on to marry Percy Bysshe Shelly who was a poet and helped her to write some of her book. Shellys book was thought to be the first horror/science fiction novel. There have been a number of productions of Shellys novel on stage and in 1931 there was a black and white movie about it, directed by James Whale. Then in 1997, Kenneth Branagh did his own production of the well-known novel. Scenes showing typical horror genre, sympathy for Frankensteins creature and scenes that create suspense are commonly found in the two movies of Frankenstein. The directors have used different media techniques to portray the movie in the way they want it to be viewed and interpreted by their choice of music, camera angles, special effects, editing, costumes, make-up, location and settings. The use of mise-en-scene is also important because if the things in the background dont match whats being acted the movie becomes unbelievable. Allowances like sound, colour and a few other things have to be made for the older versions of Frankenstein because the technology in the days it was made were very limited. By studying the birth scenes in both versions, the techniques used to create horror, drama and suspense and sympathy for the creature can be analysed. There are some similarities in both movies and some differences. First of all Ill explain the similarities and then the differences. In the Whale and Branagh versions both use low-key lighting to create a dark and spooky feeling. This is typical of horror movies and it can also create suspense because the audience cant tell what is around the corners. This creates suspicion, worry and uncertainty. It is also used because it connects with peoples fear of the dark. It is common to find bad weather in horror movies and this is evident in both of the Frankenstein movies. It is used just before and at the same time of the births. Whale and Branagh have used this technique because it gives a cold feeling and it gives credibility to what is happening in the foreground because the lighting, electricity is needed to make Frankensteins monster come alive. The locations of the births are quite typical too. In the Whale version its in a castle on top of a hill. Like House on haunted hill and it looks creepy and somewhere you would want to be. In the Branagh version its more like hell with cauldrons, heat and sweat. It reminds me of a witch brewing an evil poison. Both places for the birth are effective in creating a horror atmosphere but the second choice is less obvious. Non-diegetic, parallel fast background music can be heard in the birth scene in Branaghs version and this creates suspense because it gets peoples adrenalin going. But it is typically found in horror movies for this reason in particular. In the Whale version there is no music but this could be because of how old the movie is and it was hard to sequence the music with the scenes. In the Branagh version of Frankenstein one of the best ways sympathy is created for the creature is by the way he is presented to the audience. He looks almost human but has scars all over his face and body. It looks like someone who has been hurt badly and we feel sorry for him. On the other hand in the Whale version though its harder to feel sorry for Frankensteins monster because he looks less human and its harder to connect to him emotionally. In the Whale version Frankenstein is wearing a lab coat and his hair is gelled back. He looks more professional and like a proper doctor. This makes us feel sorry for Frankensteins creation because it shows that Frankenstein just sees him as an experiment and not as a human being with feelings. Whereas in the Branagh version he looks more wild and rough looking. This gives us the feeling he does care about the outcome of the monster because he has been so busy trying to make the monster alive that he has forgotten about himself and when he thinks the monster is dead he goes No, No, No, implying that he is saddened that it didnt work. In Branaghs version of Frankenstein you feel sympathetic with the monster when he is born, as he is naked, clumsy, and unable to walk. Amniotic fluid is everywhere and we watch Frankensteins monster slide and slip about. He appears vulnerable, like a baby. He cant control what hes doing and Frankenstein has to help him. This makes us pity him. This contradicts with the Whale version as we dont get to see the monster moving about, trying to touch or walk in the birth scene so we dont feel for him as much as he is still covered up and still practically lifeless.

High Stakes Testing Essay -- Education School Standardized Tests Essay

High Stakes Testing Albert Einstein once stated, â€Å"not everything that counts can be counted and not everything that can be counted counts.† High-stakes testing attempts to determine the knowledge a person has obtained throughout grades K-12. These standardized tests are being used to judge a person’s ability to graduate from high school and also judge if a child has enough knowledge to proceed to the next grade level. Throughout this paper, I will be discussing how these tests do not accurately portray one’s intelligence, how they have increased drop out rates, and also show the damaging psychological affects they have had. High stakes testing does not accurately determine a student’s intelligence. In 1999, the National Academy of Sciences researched the appropriate and inappropriate uses of tests. They agreed that â€Å"no single test score can be considered a definitive measure of a student’s knowledge†(http://www.allianceforchildhood.net/news/histakes_test_position_statement.htm). To use these standardized tests to decide if a person has earned his/her diploma is unreasonable, and they have been proven ineffective. The Alliance for Childhood states that, â€Å"the use of standardized tests as the sole measure of whether students are promoted, are placed in low-track classes, or will graduate from high school is condemned as insupportable by every professional testing organization.†(alliance). In Arizona, the AIMS (Arizona’s Instrument to Measure Standards) test will soon be used in this way; high school seniors in the year 2008 must pass this test to graduate. A study prepared by the Arizona Standards organization states that, â€Å"the Arizona AIMS test, if implemented today, would fail between 50% and 75% of all high s... ... Standards (AIMS). Arizona Department of Education. Retrieved October 24, 2002 from the World Wide Web: http://www.ade.state.az.us/ standards/aims/PerformanceStandards/performancelevels.asp 2. Testing and Grade Retention. Retrieved October 24, 2002 from the World Wide Web: http://www.fairtest.org/arn/retenfct.htm 3. High Stakes Testing Position Statement. Alliance for Childhood. Retrieved October 24, 2002 from the World Wide Web: http://www.allianceforchildhood.net/news/histakes_test_position_statement.htm 4. Haney, Walt. The Myth of the Texas Miracle in Education. Retrieved October 24, 2002 from the World Wide Web: http://www.epaa.asu.edu/epaa/v8n41/ 5. What’s Wrong With High Stakes Testing in General and Aims in Particular? Retrieved October 24, 2002 from the World Wide Web: http://www.azstandards.org/protestmaterials.htm High Stakes Testing Essay -- Education School Standardized Tests Essay High Stakes Testing Albert Einstein once stated, â€Å"not everything that counts can be counted and not everything that can be counted counts.† High-stakes testing attempts to determine the knowledge a person has obtained throughout grades K-12. These standardized tests are being used to judge a person’s ability to graduate from high school and also judge if a child has enough knowledge to proceed to the next grade level. Throughout this paper, I will be discussing how these tests do not accurately portray one’s intelligence, how they have increased drop out rates, and also show the damaging psychological affects they have had. High stakes testing does not accurately determine a student’s intelligence. In 1999, the National Academy of Sciences researched the appropriate and inappropriate uses of tests. They agreed that â€Å"no single test score can be considered a definitive measure of a student’s knowledge†(http://www.allianceforchildhood.net/news/histakes_test_position_statement.htm). To use these standardized tests to decide if a person has earned his/her diploma is unreasonable, and they have been proven ineffective. The Alliance for Childhood states that, â€Å"the use of standardized tests as the sole measure of whether students are promoted, are placed in low-track classes, or will graduate from high school is condemned as insupportable by every professional testing organization.†(alliance). In Arizona, the AIMS (Arizona’s Instrument to Measure Standards) test will soon be used in this way; high school seniors in the year 2008 must pass this test to graduate. A study prepared by the Arizona Standards organization states that, â€Å"the Arizona AIMS test, if implemented today, would fail between 50% and 75% of all high s... ... Standards (AIMS). Arizona Department of Education. Retrieved October 24, 2002 from the World Wide Web: http://www.ade.state.az.us/ standards/aims/PerformanceStandards/performancelevels.asp 2. Testing and Grade Retention. Retrieved October 24, 2002 from the World Wide Web: http://www.fairtest.org/arn/retenfct.htm 3. High Stakes Testing Position Statement. Alliance for Childhood. Retrieved October 24, 2002 from the World Wide Web: http://www.allianceforchildhood.net/news/histakes_test_position_statement.htm 4. Haney, Walt. The Myth of the Texas Miracle in Education. Retrieved October 24, 2002 from the World Wide Web: http://www.epaa.asu.edu/epaa/v8n41/ 5. What’s Wrong With High Stakes Testing in General and Aims in Particular? Retrieved October 24, 2002 from the World Wide Web: http://www.azstandards.org/protestmaterials.htm

light pollution Essay -- essays research papers

Light pollution happened slowly at first which was several decades ago it was a process that was hardly noticeable. A light here, a light there, burning way into the dark nighttime realm, helping us see in the darkness when people all their our beds fast asleep. The process still continues today, with little thought ever given to what we are stealing away. Our intentions are good but our methods need adjustment, and they needs to be done immediately. In fact, our methods should have been changed years ago, but nearly everyone has resisted, perhaps due to a profound lack of awareness. The use of too many lights at night can cause environmental pollution, known as light pollution. Light pollution can block our ability to see the original shining stars, which can affect people’s discoveries in astronomy. But since the lights are also very important for us at night when we are driving or walking alone on a street, I think there are certainly some solutions for protecting our natu ral environment while we can also use the lights at the same time. To admire the beautiful stars in the sky instead of looking at it in a picture, we can start to save energy resources by cutting off some unnecessary lights such as commercial building lights, outdoor residential lights, and by using shielded light to reduce the amount of light that we use in certain areas. Light pollution is when sky glow produced by the scattering of artificial light caused by the poor quality of outdoor lighting (Nakata) causing too much wasted light dispersed upwards. Therefore recent studies show that â€Å"Nationally, more than 30% of the electricity generated for outdoor illumination is simply squandered by being misdirected into the sky. That comes to 4.5 billion dollars annually† (Lipsitz) for the electricity generated to send light into the sky and across property lines where it serves no benefit. Wasted light sent to the sky needlessly and seriously affects scientific research today for professional and amateur astronomers along with some NASA research. Astronauts have complained about this problem for years. Astronomical observatories are closing down because they can no longer see enough celestial objects to justify continuing their funding or research. For example, the Hubble telescope’s research is interrupted by light pollution, it was affe cted so much that astronomers did not get to see certa... ... studded with tiny points of light coming from countless miles away will return again where they belong, where they have always been since the dawn of time itself, and where they should remain for countless generations to come† (Haas,). Starting from today, we can do a little to help protecting our homeland that everybody shares, and give the chances to see the real stars in the future. Work Cited Page Lipsitz, Joshua D. â€Å"Preliminary results of an Internet survey.† Light pollution (13 Feb. 2001): 26 Mullen, Rutledge M. and Swain S. Modeling the Process of Science: Investigating the effects of light pollution. Tennessee: Middle Tennessee State University, 1987. Nakata, Goshima K. â€Å"Despite light.† Journal of the Galaxy. 23.4 (1997): 897-907 â€Å"Shields to make light work of city pollution.† Nature 416: 6879 (28 Mar.2002): 358-364 Nadis, Steve. â€Å"Biologists join drive to turn down the lights.† Nature 419: 6910 (31Oct. 2002): 868 Rao, Joe. â€Å"A clean, well-lighted planet.† Natural History 106:7 (Sep. 97): 70 Wainwright, Martin. â€Å"Bright lights do not deter criminals.† The Guardian (21 Nov. 2003): 14 Haas, Cliff. â€Å"Where has the night sky gone, and why should we care?†(Apr. 2000): 282 light pollution Essay -- essays research papers Light pollution happened slowly at first which was several decades ago it was a process that was hardly noticeable. A light here, a light there, burning way into the dark nighttime realm, helping us see in the darkness when people all their our beds fast asleep. The process still continues today, with little thought ever given to what we are stealing away. Our intentions are good but our methods need adjustment, and they needs to be done immediately. In fact, our methods should have been changed years ago, but nearly everyone has resisted, perhaps due to a profound lack of awareness. The use of too many lights at night can cause environmental pollution, known as light pollution. Light pollution can block our ability to see the original shining stars, which can affect people’s discoveries in astronomy. But since the lights are also very important for us at night when we are driving or walking alone on a street, I think there are certainly some solutions for protecting our natu ral environment while we can also use the lights at the same time. To admire the beautiful stars in the sky instead of looking at it in a picture, we can start to save energy resources by cutting off some unnecessary lights such as commercial building lights, outdoor residential lights, and by using shielded light to reduce the amount of light that we use in certain areas. Light pollution is when sky glow produced by the scattering of artificial light caused by the poor quality of outdoor lighting (Nakata) causing too much wasted light dispersed upwards. Therefore recent studies show that â€Å"Nationally, more than 30% of the electricity generated for outdoor illumination is simply squandered by being misdirected into the sky. That comes to 4.5 billion dollars annually† (Lipsitz) for the electricity generated to send light into the sky and across property lines where it serves no benefit. Wasted light sent to the sky needlessly and seriously affects scientific research today for professional and amateur astronomers along with some NASA research. Astronauts have complained about this problem for years. Astronomical observatories are closing down because they can no longer see enough celestial objects to justify continuing their funding or research. For example, the Hubble telescope’s research is interrupted by light pollution, it was affe cted so much that astronomers did not get to see certa... ... studded with tiny points of light coming from countless miles away will return again where they belong, where they have always been since the dawn of time itself, and where they should remain for countless generations to come† (Haas,). Starting from today, we can do a little to help protecting our homeland that everybody shares, and give the chances to see the real stars in the future. Work Cited Page Lipsitz, Joshua D. â€Å"Preliminary results of an Internet survey.† Light pollution (13 Feb. 2001): 26 Mullen, Rutledge M. and Swain S. Modeling the Process of Science: Investigating the effects of light pollution. Tennessee: Middle Tennessee State University, 1987. Nakata, Goshima K. â€Å"Despite light.† Journal of the Galaxy. 23.4 (1997): 897-907 â€Å"Shields to make light work of city pollution.† Nature 416: 6879 (28 Mar.2002): 358-364 Nadis, Steve. â€Å"Biologists join drive to turn down the lights.† Nature 419: 6910 (31Oct. 2002): 868 Rao, Joe. â€Å"A clean, well-lighted planet.† Natural History 106:7 (Sep. 97): 70 Wainwright, Martin. â€Å"Bright lights do not deter criminals.† The Guardian (21 Nov. 2003): 14 Haas, Cliff. â€Å"Where has the night sky gone, and why should we care?†(Apr. 2000): 282

Postmenopausal Hormone Replacement Therapy Health And Social Care Essay

In the United Kingdom, about one million post-menopausal adult females use oestrogen entirely or in combination with progestogen, as portion of endocrine replacing therapy ( HRT ) , to handle the symptoms of the climacteric ( WHC, 2010 ) . HRT first became available to adult females in the United Kingdom in 1965 ( Patient UK, 2010 ) , and was traditionally prescribed for its ability to cut down vasomotor symptoms, and its preventive effects against the development of postmenopausal osteoporosis and cardiovascular bosom disease ( WHC, 2010 ) . During 2002 and 2003, two of the biggest epidemiological surveies on HRT, Million Women Study ( an experimental questionnaire ) in the UK and Women ‘s Health Initiative survey ( a clinical randomised test ) in the USA were published. Their consequences presented concerns sing the safety of traditional HRT ; peculiarly in respects to its associated hazards to the cardiovascular system and chest malignant neoplastic disease as a consequence of drawn-out use ( WHI, 2002 ; MWS, 2003 ) . The complicated image presented of the hazards and benefits of HRT has received a considerable sum of scientific and public attending, fuelling wellness anxiousness amongst medical professionals and HRT users likewise. During the period of 2003 and 2007 the figure of adult females utilizing HRT fell by 66 % ( WHC, 2010 ) . This paper presents a reappraisal of scientific literature on the efficaciousness of HRT in the direction of menopausal symptoms and assesses the proficiency of its non-hormonal options.Why a Menopause?At birth, the human ovary contains 1 to 3 – 106 Graafian follicles, with no new gametes formed after this clip ( Kim et al, 1997 ) . This figure regresses to less than 1 – 104 at the clip of climacteric ( physiology text book ) . Menopause is described as a province of oestrogen lack that is brought approximately by the loss of aboriginal follicles in the ovaries doing a failure in oestrogenic end product ( Greendale and Sowers, 1997 ) . Throughout the generative lifetime, ovarian follicles become bit by bit desensitized to gonadtrophin exposure ( physiology text book ) . This leads to the loss of progestin production and a pronounced diminution in endogenous oestrogen degrees ( Greendale and Sowers, 1997 ) .EpidemiologyHarmonizing to the office of National Statistics 2009 figures, there are about 37.8 million adult females in the UK, of whom 13.6 million are aged 45 or over ( ONS, 2010a ) . Statistics indicates that 52 is the mean age of menopausal onset ( NHS Choices, 2010 ) , and so most of these adult females will be in or shortly come ining the post-menopausal province. The current life-expectancy for a new-born miss is 81.9 old ages ( ONS, 2010b ) . Womans can therefore anticipate to populate a 3rd of their lives in a possible oestrogen deficient province ( Howard et al, 1981 ) . Womans are considered to hold reached the climacteric, after a 12 month period of amenorrhoea ( Green dale and Sowers, 1997 ) . The concluding menstruations is so retrospectively designated as the clip of climacteric ; the clip predating this is post-maturity ( Greendale and Sowers, 1997 ) . The climacteric is associated with a assortment of physical and psychological symptoms ( Porter et al, 1996 ) , where vasomotor instability and urogenital wasting are the most normally documented short-run post-menopausal symptoms. Approximately, 75 % to 80 % of all adult females normally experience their first symptoms of the climacteric during the peri-menopausal period ( Bachmann, 1999 ) ; of whom 45 % of adult females will happen the symptoms straitening ( RCPE, 2003 ) .The climacteric in the long-run increases the hazard for the development of cardiovascular diseases and osteoporosis ( Iqbal and Zaidi ) ; this is due to the physiological effects caused by the worsening degrees of estrogens in the bosom, liver, encephalon and bone ( Katzenellenbogen, 1996 ) .Vasomotor SymptomsThe vasomotor s ymptoms of the climacteric, ( for illustration hot flowers, dark workout suits, insomnia and palpitations ) ( Howard et al, 1981 ) are the most common ground why menopausal adult females seek medical aid ( Howard et al, 1981 ) . Three quarters of peri-menopausal adult females will see hot flowers ( Howard et al, 1981 ) , where symptoms are normally observed within the first twelvemonth after the concluding menstruations ( Rees and Purdie, 2006 ) . Hot flushes characteristically last between 0.5 and 5.0 old ages after natural climacteric ( Bachmann, 1999 ) , but in 25 % to 50 % of instances can last longer than 5 old ages ( Howard et al, 1981 ) . The frequence of hot flash happenings and its continuance can change from less than daily to several per hr with continuances between a few seconds to 10 proceedingss long ; nevertheless on mean hot flower episodes lasts for around four proceedingss ( Patient UK, 2010 ) . The etiology behind vasomotor symptoms is ill-defined, but it is thoug ht to be due to a combination of hormonal, metabolic, and psychogenetic factors which occur as a consequence of oestrogen backdown ( Bachmann, 1999 ) . In 1986, Sliva et al conducted a survey on rats and established the action of oestrogen in the preoptic country of the hypothalamus, here it was found to modulate the firing rate of thermosensitive nerve cells in response to stimulation. Surveies have shown that oestrogen appears to heighten ?2-adrenergic inhibitory activity ( Bachmann, 1999 ) .Women with hot flowers have higher arteriole sensitiveness to catecholamines ( Bachmann, 1999 ) .The decrease in ?2-adrenergic receptor activity leads to sudden, transient and fickle peripheral vasodilatation in the tegument blood vass, which produces the hot flower ( Bachmann, 1999 ) . Night workout suits ( sleep hyperidrosis ) , is a common job accompaniment with day-time hot flowers ( Porter et al, 1996 ) . Hot flowers and sleep hyperhidrosus can hold a Domino consequence on a patient ‘s overall quality of life ( Bachmann, 1999 ) , as a consequence of weariness, crossness, hapless concentration, and impaired memory ( Porter et al, 1996 ) .Vasomotor TherapyNumerous surveies have documented the effectivity of short-run oestrogen therapy in handling the frequence and badness of hot flowers and dark workout suits caused by climacteric. For illustration, Haas et Al ‘s 2003 double-blinded, randomized, placebo-controlled survey on 18 menopausal adult females reported that there was no immediate decrease in vasomotor symptoms after induction of oestrogen therapy ( Figure 2 ) . At first both placebo and oestradiol reduced the figure of hot flowers by 27 % and 35 % , severally. The initial placebo consequence, nevertheless, was non sustained throughout the surv ey. In contrast, those patients treated with oestradiol continued to detect a lessening in the figure of hot flowers per hebdomad, until a 74 % maximum decrease was reached after 4 hebdomads of therapy. The frequence of hot flowers fluctuated somewhat at that degree until the terminal 2 hebdomads when the placebo-only period was initiated ( see figure 2 ) . These findings were reiterated in MacLennan at Al ‘s 2004 scientific reappraisal of 24 double-blinded, randomized, placebo-controlled tests, which assessed unwritten HRT therapy. Consequences demonstrated in nine RCTs, showed a average per centum decrease of about 75 % comparative to placebo in hebdomadal hot flower frequence ( p & A ; lt ; 0.0001 ) correlating to Hass at al earlier 74 % decrease for hebdomadal hot flower episodes for HRT. In adult females randomised to have placebo intervention, a 57.7 % decrease in hot flush frequence was observed by the terminal of the survey. Eight RCTs, found that symptom badness of th ose treated with HRT was besides significantly reduced compared to placebo ( P & A ; lt ; 0.0001 ) . A direct comparing of the effectivity of combined HRT versus oestrogen merely HRT was attempted but did non make statistical significance ( p value = 0.085 ) . There is a little sum of dependable grounds available to rede the continuance of usage for the intervention of vasomotor symptoms. Clinical Knowledge Summaries ( 2010 ) recommend the prescription of uninterrupted combined unwritten or transdermic HRT, for the direction of hot flowers. Treatment for vasomotor symptoms should be continued for at least one twelvemonth ; otherwise, symptoms may repeat ( Rees and Purdie, 2006 ) . This was observed in Haas et Al survey where, during the 2 hebdomad placebo merely period ; the frequence of hot flowers began to return to baseline degrees in the group having oestradiol ( see figure 1 ) . A progressive backdown from intervention therefore is advisable. This is achieved by bit by bit cut downing uninterrupted combined HRT dosage to the lowest strength of tablets or spots, whereby half a tablet day-to-day or half a spot should be used for a farther 1-2 months ( Rees and Purdie, 2006 ) . Menopausal symptoms normally decide within 2-5 old ages ( RC PE, 2003 ) ; the consequence of uninterrupted combined HRT can be sustained for up to three old ages during disposal where, apart from shed blooding, side-effects are non normally reported ( Maclennan et al, 2004 ; Henriksson et Al, 1996 ) . Current research has confirmed the efficaciousness of oestrogen, combined or entirely, in bettering hot flowers and dark workout suits, as its effects are strong. However, farther research is required to distinguish whether combinations of low dose oestrogen and progestin may accomplish the tantamount consequence of a higher dosage of oestrogen when used entirely.Figure 1: Summarises the entire figure of Hot flowers recorded by patients on transdermic estradiol ( N = 10 ) and placebo ( N = 8, foremost seven hebdomad ; N=7, last five hebdomads ) each hebdomad ( adapted from Haas et Al, 1988 ; Bachmann, 1999 )Pre-treatment stage: A 4-week pre-treatment period during which capable eligibility of menopausal position was confirmed. Treatment stage: An active 6 hebdomad survey stage, during which the happenings of Hot flowers between 0.05 mg/ dm3 transdermic estradiol was compared against placebo. Estradiol showed to be well more effectual than placebo in cut downing vasomotor flowers during hebdomads 6 to 10. Placebo stage: Two hebdomad period where patients continued to supervise symptoms while single-blindedly utilizing a placebo spot. An addition in vasomotor flushing towards baseline was observed in estradiol-treated patients.Urogenital AtrophyThe surcease of the catamenial rhythm, consequences non merely in the conventional hot flowers observed in diagnostic menopausal adult females but besides causes alterations to the functional capacity of the urogenital piece of land ( Samsioe, 1995 ) . Urinary incontinency, recurrent lower piece of land infections, vaginal uncomfortableness, dyspareunia, and shed blooding are all symptoms of atrophic vaginitis ( Howard et al, 1981 ; Bachmann and Nevadunsky, 2000 ) . These symptoms occur as a consequence of atrophic alterations caused as a effect of a gradual diminution in go arounding estrogens ( See figure 3a ) . Once degrees fall below the threshold where endometrial proliferation is possible, the vaginal canal begins shortening and there is a loss of rugae in the vaginal wall ( DeMasters J, 2000 ) . The urinary piece of land symptoms observed is a consequence of the urethra and vagina sharing the same embryologic beginning ( Howard et al, 1981 ) . Vaginal symptoms, unlike hot flowers often persist and can worsen with age ( Grady, 2006 ) . In a 2006 survey of the Management of menopausal symptoms, Grady reported up to 30 % prevalence of atrophic vaginitis symptoms amongst adult females during the early postmenopausal period with an in addition to 47 % prevalence during the ulterior postmenopausal period ( Grady, 2006 ) . During the climacteric, the vaginal wall musculuss deteriorate to bring forth a thin, unsmooth, inflamed mucous membrane susceptible both to bacterial infections and petechial hemorrhage caused by mechanical emphasis ( Samsioe, 1995 ) . The destructive effects caused by the diminution in oestrogen degrees are most outstanding in the fundal part of the vagina ( Samsioe, 1995 ) . Hormonal alterations induced by the climacteric, actuate metabolism in the bacterial vegetation and pH of the vagina ( Samsioe, 1995 ) . Before the climacteric the vagina is colonized by lactobacilli which maintain a low vaginal pH, by and large 4.5 or less ( Brizzolara et al, 1999 ) , bring forthing a protective environment aga inst the colonisation of the vagina and urethral tissue by Gram-negative bacteriums ( Samsioe, 1995 ) . After the climacteric lactobilli becomes replaced by faecal-type vegetations which cause postmenopausal adult females to go prone to urinary piece of land infection ( see figure 3b ) . The symptoms of urogenital degeneracy can be categorised into two groups: 1 ) Lower urinary piece of land – for symptoms affecting the urethra and bladder 2 ) Vaginal – for those confined to the vagina and the vulva such as vaginal waterlessness, combustion and itchiness ( Samsioe, 1995 ) . The prevalence of urologic symptoms ‘ ( including urgency, frequence, dysuria, and incontinency ) is a job which increases in badness with age ( Grady, 2006 ) ; this nevertheless can be farther insinuated by the wasting of the urethral mucous membrane caused during the menopausal passage ( Molander, 1990 ) . In postmenopausal adult females, the control of urination becomes progressively reliant on the support of the urogential musculuss to urethrovesical junction, due to widening of the urethra ( Samsioe, 1995 ) . The decrease in oestrogen degrees consequences in the deficient blood supply to the urogenital tissues and hence impedes full muscular functionality ( Molander, 1990 ) . Poor anatomical support to the urethra consequences in the uneffective control of urination ; which consequences in pelvic laxness and emphasis incontinency ( Samsioe, 1995 ) . The diminution in go arounding blood in urogential tissues means there will besides be an damage in the immune system antibod y response to foreign organic structures ( Molander, 1990 ) ; this in add-on to the broadening of the urethra, facilitates the migration of bacteriums into the lower urinary piece of land ( Samsioe, 1995 ) .Pre-menopauseFigure 3a and 3b: Summaries the alterations in the vaginal and urethra observed as the influence of oestrogen lessenings ( adapted from Samsioe, 2005 ; Brizzolara et Al, 1999 )Figure 3a: The diminution in serum oestrogen degree causes a lessening in vaginal blood flow and secernments. As a consequence, lactic acid degrees and animal starch content of the vaginal wall decreases, this causes the hyalinisation of collagen and the impairment of elastic tissue. Atrophy of the vaginal tissues nevertheless, does non get down until endogenously produced estrogens have fallen below the threshold required for endometrial proliferative activity. Therefore the clip period between the start of climacteric and the start of wasting opens a curative window. This has allowed the poss ibility for drugs to be able to aim urogenital wasting without put on the lining endometrial proliferation which can ensue in malignant neoplastic disease, extinguishing the demand for progestin co-medicationFigure 3b: The conventional drawings represent the pre and post-menopausal urethral opening and vaginal wall. The pH of vaginal fluid in postmenopausal adult females elevates to between 6 and 7 ; this facilitates the replacing of lactobacillae with gram negative source vegetations associated with urinary piece of land infection. In healthy vaginal epithelial tissue, parabasal cells are rare and normally represent less than 5 % of the epithelial cell population, this per centum increases to around 20 % after the climacteric.Post-maturityUrogential TreatmentSurveies have shown that estrogens, administered as systemic ( unwritten or transdermic ) or intravaginal estrogens, are extremely effectual at handling vaginal wasting. It is recommended that estrogens, when prescribed with th e purpose of pull offing urogenital symptoms, are given as low-dose readyings to assist understate systemic soaking up ( Grady, 2006 ) : this prevents the additions in oestrogen endogenous degrees that could potentially do estrogenic side effects. When HRT is used at the recommended low-dose and frequence, the add-on of a progestogen for endometrial protection is non necessary ( Figure 3a ) . The physiological alterations that consequences in the decrease of urogenital symptoms observed in oestrogen therapy, suggest that oestrogen lack may lend to this pathogenesis ( Samsioe, 1995 ) . The clinical efficaciousness of low-dose HRT readyings have been demonstrated in a figure of clinical tests. Barnabei et Al followed the menopausal symptoms and the effects of oestrogen and progestogen in the postmenopausal adult females, involved in the Women ‘s Health Initiative for a mean of 5.6 old ages. The consequences from the survey showed a 74 % decrease in vaginal wasting in adult femal es who had received oestrogen plus progestin and 55 % in those who had received placebo entirely. Intravaginal estrogens are besides extremely effectual at handling vaginal wasting ; Suckling et al Cochrane reappraisal found that all intravaginal readyings ( that were administered as picks, diaphragms, intravaginal tablets or the estradiol-releasing vaginal ring ) were every bit effectual and significantly reduced the symptoms of vaginal wasting. It is for this ground and that they by and large have small consequence on the serum oestrogen degrees that intravaginal oestrogens readyings are preferred to systemic oestrogen ( Suckling et al, 2006 ) . Surveies have besides shown that HRT is effectual in forestalling urinary piece of land infections. Cardozo et Al ‘s 1998 survey found that there was a important decrease in the incidences of urinary piece of land infection in adult females who had been treated with systemic oestrogen than those given placebo. Although several positi ons have compared many of the interventions for vaginal wasting, the long-run effects of intervention have non yet been expeditiously examined. Recommendations by regulative governments will hence be more accurate if intervention was assessed over a drawn-out period, such as one to five old ages, so that the unwanted responses to intervention can be farther examined.Menopause induced OsteoporosisOsteoporosis, the most damaging side-effect to wellness associated with the climacteric ( Samsioe, 1995 ) , is a skeletal disease characterised by a lessening in bone denseness and mass ( Howard et al, 1981 ) . The skeleton comprises compact and trabeculate bone ( Kanis, 1996 ) . In the healthy grownup, bone mass is comparatively changeless, this is despite there being considerable bone turnover, of which about 95 % of this is accounted for by the remodelling of bone ( Kanis, 1996 ) . This procedure is altered after the climacteric, where there is a period of rapid bone loss that lasts betwe en 5 to 10 old ages ( Kanis, 1996 ) . This consequences in a negative remodelling instability ( Kanis, 1996 ) . Bone mass reaches its extremum between the ages 30 and 35, after this extremum, bone mass declines at a rate of 1 % per twelvemonth ( Samsioe, 1995 ) . The rate of diminution can lift up to 6 % at the climacteric and history for a loss of a 3rd of bone mass ( Samsioe, 1995 ) , after the perimenopausal period the one-year rate of bone loss returns to the 1 % ( Samsioe, 1995 ) . There is besides grounds that there is an addition in osteoclastic activity ( Kanis, 1996 ) , where high circulating FSH induces increases osteoclast-mediated bone reabsorption which exceeds the formation of new bone ( Samsioe, 1995 ) . Both of these factors in concurrence consequences in the addition bone turnover and porousness that causes the loss of the trabeculate bone model and the cutting of the cerebral mantles ( Kanis, 1996 ; Samsioe, 1995 ) . This pathological procedure finally concludes wi th the break in the bone micro-architecture, which leads to the brickle castanetss that are more susceptible to break ( Kanis, 1996 ) . Womans have a higher cumulative life-time hazard for enduring from osteoporotic breaks about three times greater than in work forces ( Kanis, 1996 ) ; with 50 % of adult females and 20 % of work forces, over the age of 50, enduring from a break. The three most common sites of osteoporotic breaks are the distal radius, the vertebral organic structure and the upper thighbone ( Howard et al, 1981 ; Samsioe, 1995 ) . Hip break is a important cause of mortality and morbidity, where one in four adult females will non last the first twelvemonth following this break ( Samsioe, 1995 ) . Several surveies indicate that early oestrogen therapy intercession can detain or forestall bone loss at the climacteric, nevertheless, grounds back uping the continuation of the good effects after discontinuance remain debatable. A reappraisal by Bagger et Al in 2004, found there was a 4-fold increased hazard of breaks in adult females having placebo than HRT. From this consequence it was concluded that short-run oestrogen replacing therapy initiated in the early postmenopausal phases, can accomplish durable benefits to the skeletal system, in footings of the saving of bone mass and important decreases in the hazard osteoporotic breaks. However another survey by Yates et Al, found grounds that postmenopausal adult females who have discontinued HRT within the past 5 old ages have a hazard for hip break that was similar to adult females who have ne'er used HRT. The latter survey nevertheless has restrictions and is hence non conclusive. Womans who responded to the study tended to be y ounger and better educated about the importance of good wellness than the non-responders ( WHC, 2010 ) . Furthermore, it must besides be taken into consideration that the hazard of osteoporosis additions with increasing age and weight. HRT as a consequence would hold a greater decrease potency in the incidences of hip break in older adult females than in younger adult females. Therefore future surveies will necessitate to be adjusted to take into history these act uponing factors.The findings from the WHI and MWSThe possible relationship between the loss of ovarian map and development of Cardiovascular Disease ( CVD ) has been substantiated by legion case-controlled and laboratory surveies carried out since the 1980s ( Iqbal and Zaidi 2009 ) . These surveies demonstrated the protective effects of estrogens on the cardiovascular system ( Mendelsohn and Karas, 2002 ) ; which encourage the production of lipid profiles that cause vascular distension, prevents coronary artery disease and augmentation of endothelial fix after harm ( Mendelsohn and Karas, 2002 ) . After the oncoming of climacteric, degrees of estrogens begin to equilibrate to that of age-matched work forces ( Iqbal and Zaidi 2009 ) . Up until 2002, HRT was established as the most effectual signifier of intervention when bettering menopausal symptoms. However this was challenged by the publication of the preliminary findings of the WHI and MWS survey, which found the benefits of HRT on CVD to no longer be important when the other possible wellness jeopardies were taken into consideration ( WHI, 2002 ; MWS, 2003 ) . For illustration that the usage of oestrogen, with or without Lipo-Lutin, was found to be associated with an increased hazard for the development of certain signifiers of malignant neoplastic disease ( such as chest, ovarian and uterine malignant neoplastic disease ) ; this hazard was substantiated farther by drawn-out use ( WHI, 2002 ; MWS, 2003 ) . Findingss from the WHI, oestrogen plus p rogestin, test besides indicated that HRT could increase the hazard of CVD, which can take to shots and venous thromboemoblism ( WHI, 2002 ) . The WHI, oestrogen plus progestin, test published in 2002 monitored and compared the HRT related consequence on CVD and other facets of adult females ‘s wellness to that of placebo, in 16, 608 adult females in the United States aged 50 to 79 from 1993 to 2002. Around 50 % of the take parting adult females were randomised to take combined oestrogen and 50 % to take a placebo. The survey ended three old ages premature after the antecedently specified bound for chest malignant neoplastic disease instances, set by the WHI Data and Safety Monitoring Board was exceeded and overall hazards were considered to outweigh benefits. The preliminary findings showed a decreased in the hazard of osteoporotic breaks and colorectal malignant neoplastic disease ( Nelson et al, 2002 ; WHI, 2002 ) , but besides found a little addition in the incidences of coronary events, shot, chest malignant neoplastic disease and venous thromboembolism ( Nelson et al, 2002 ; WHI, 2002 ) . A subsequent reappraisa l of the findings from the WHI Study in 2004, adjusted for other act uponing factors, found different consequences where the apparent higher hazard for chest malignant neoplastic disease appear to be caused by natural factors instead than to HRT ( WHC, 2010 ) . When age was taken into history analysis showed that younger adult females get downing HRT may really be protected in some wellness facets ( WHC, 2010 ) . However those get downing on HRT over 70 did non hold the same benefits and alternatively were vulnerable to certain wellness hazards, nevertheless, this may be due to the associated hazard factors increasing with age.The Million Women Study was conducted from 1996 to 2001, analysed the hazard of chest malignant neoplastic disease and other adult females wellness issues in one million adult females taking HRT in the UK, and compared findings with that received from a sum of 828,923 adult females who were non-users: All take parting adult females were over 50 old ages old. F indingss published in 2003 found a little addition in the hazard of chest, endometrial and ovarian malignant neoplastic disease when oestrogen-only HRT was used. Combined HRT was found to hold a greater addition in the hazard of chest malignant neoplastic disease but was able to cut down the hazard of endometrial malignant neoplastic disease, when compared with oestrogen-only HRT. It was besides established that the hazard of chest malignant neoplastic disease is increased the longer HRT is used ; where the extra hazard for chest malignant neoplastic disease declined to that of ne'er users when intervention ended.Restriction of the surveiesWomen ‘s Health InitiativeThe WHI survey, merely considered the dosage of 0.625 milligram of conjugated equid estrogens and 2.5 milligram Provera acetate each twenty-four hours ; whilst this dose was appropriate for younger menopausal adult females get downing HRT, it was considered by many experts to transcend the sum required for older adu lt females ( Howard et al, 1981 ) . The specification for the adult females in the WHI survey differs from adult females in the MWS. Women in the WHI survey tended to be older ( mean age 63.2 ) than the adult females in MWS ( mean age 56 ) ( MWS, 2003 ) . Therefore two-thirds of adult females in WHI were over the age of 60 and hence had a higher absolute hazard of bosom disease, shot and chest malignant neoplastic disease ( all of which increases with age ) . The mean BMI for adult females in the survey is 28.5, therefore a big proportion of adult females in the survey are overweight and were hence predisposed to bosom disease and certain malignant neoplastic diseases.Million Women StudyThe methodological analysis of MWS has been criticised: Unlike the survey by the WHI, the MWS was non a randomised controlled test. The consequences were based on a self-reporting study where adult females chose whether or non to take HRT. Furthermore the adult females in the MWS were already holding a mammogram so may already hold been at a higher hazard for malignant neoplastic disease e.g. they may hold already suspected a ball. The adult females were followed-up by studies from national malignant neoplastic disease registers, non by subsequent questionnaires, so alternations in HRT usage after initial enrollment were non recorded. Both the surveies analysed the hazard of ovarian malignant neoplastic disease in the long-run surveies and were non meant to turn to the shorter-term usage of HT. Thus, the information from these surveies should be used by adult females sing usage of HT for longer than 3 or 4 old ages.Options to HRTTibolone is a selective oestrogen receptor modulator ( SERM ) , which possesses oestrogenic, progestogenic and androgenic features ( Nelson, 2008 ) . Tibolone is effectual at handling vasomotor symptoms and bettering sexual operation and may be used as an option to combined HRT in post-menopausal adult females ( Nelson, 2008 ; Roberts, 2007 ) . In adult females under 60, the hazards of taking tibolone are tantamount to that of combined HRT ( NHS Choices, 2009 ) . For adult females over 60, the associated hazards begin to outweigh the benefits, due to the increased hazard of chest malignant neoplastic disease, shot and endometrial malignant neoplastic disease ( NHS Choices, 2009 ) . Morris et Al ( 2006 ) conducted a clinical grounds reappraisal of seven RCTs, on the effects of tibolone on vasomotor and urogential symptoms. One test found that after 16 hebdomads of intervention, tibolone reduced vasomotor symptoms by 39 % compared with placebo ( p = 0.001 ) . However, two RCTs produced questionable consequences in respects to its efficaciousness when compared against traditional combined HRT. One test ( n=437 ) found that combined HRT when compared with tibolone, well reduced the frequence of hot flowers over 48 hebdomads ( p = 0.01 ) . However contradictory findings were found in another test of a smaller population ( n=235 ) , whe re no important difference in vasomotor symptoms between combined HRT and Tibolone was established at 52 hebdomads. Due to the rawness of findings another larger adjusted RCT should be conducted to clear up the effectivity of tibolone against combined HRT. Three tests were used to measure the efficaciousness of tibolone in the direction of urogenital symptoms. All of which concluded, with the understanding that tibolone significantly improved vaginal waterlessness, sexual desire and copulatory frequence compared to both placebo and combined HRT interventions. There is besides limited grounds to back up the usage of Catapres, Neurontin, paroxetine, Prozac, citalopram, and venlafaxine as effectual interventions hot flowers ( Nelson et al, 2006 ; Anderson and Redman, 2010 ) . The latest analysis of the hazards based on the findings from the MWS and WHI survey, has concluded with the following revised hazard estimations to help health care professionals appraisal of the hazards and benefits associated with HRT for single adult females:Cardiovascular Disease hazard:There is no addition in the hazard for CHD in adult females less than 10 old ages postmenopausal when given combined HRT ( Currie and Guttinger, 2007 ; Roberts, 2007 ) . Hysterectomised adult females taking oestrogen merely HRT besides showed no increased CHD hazard during the WHI test, alternatively the hazard for both appeared to worsen ( Currie and Guttinger, 2007 ) . However there us a little addition in hazard for adult females who were more than 10 old ages postmenopausal ( Currie and Guttinger, 2007 ) . The grounds to propose a cardiovascular benefit with oestrogen-only or combined HRT is hence weak ( CSM, 2004 ; MHRA and CHM, 2007 ) .Stroke hazardWHI found oestrogen-only and combined HRT increase the hazard of shot compared with placebo ( CSM, 200 ; MHRA and CHM, 2007 ) .Breast Cancer hazard:MWS indicated that a higher hazard of chest malignant neoplastic disease is associated with drawn-out usage ( CSM, 2004 ; MHRA and CHM, 2007 ) . For oestrogen entirely, the hazard is lower than combined HRT ( MHRA and CHM, 2007 ) . Some surveies on the other manus have non shown increased hazard when compared to those who had ne'er antecedently taken HRT ( MHRA and CHM, 2007 ) .Endometrial malignant neoplastic disease hazard:There is a little addition in the hazard of endometrial hyperplasia and carcinoma with oestrogen-only HRT ; due proliferated effects of oestrogen ( Howard et al, 1981 ) . Oestrogen-only HRT is hence merely recommended for usage by adult females with a womb ( MHRA and CHM, 2007 ) . The add-on of a progestin every twenty-four hours significantly reduces the hazard ( CSM, 2004 ; MHRA and CHM, 2007 ) ; due to its endothelial protective belongings. So when used i n combination with oestrogen it can cut down the hazard of this malignant neoplastic disease to the baseline ( MHRA and CHM, 2007 ) .Ovarian malignant neoplastic disease hazard:Experimental surveies indicate that extended usage of HRT may correlate with a little increased hazard of ovarian malignant neoplastic disease ( CSM, 2004 ) , which returns to baseline a few old ages after halting intervention ( MHRA and CHM, 2007 ) .DecisionDespite the legion contraindications for HRT, they are still by and large regarded as the most effectual short-run intervention for patients enduring from menopausal symptoms, and are recognised for their preventive effects in the development of osteoporosis. The benefits nevertheless from long-run use remain debatable ; research suggests that the potency for inauspicious effects happening additions with age and drawn-out use. Clinical reappraisals hence recommend that HRT should be given cyclically ; utilizing the lowest effectual dosage for its indicate d symptom for the shortest possible clip. A reappraisal and appraisal of any alteration in the balance of hazards and benefits should be done yearly. Womans with moderate hot flowers, particularly those with contraindications or concerns about HRT may take to seek alternate therapies. Tibolone has proven good in the intervention of menopausal symptoms in younger adult females, although its usage in older adult females remains questionable due to the increased hazards to wellness. Surveies of climacteric are vast in figure, but deficient in what they discover. Nevertheless, their consequences inform the recommendations of medical professional administrations and influence criterions of pattern. Therefore an improved apprehension of the menopausal passage, its symptoms, and therapies is needed in order to unknot this epidemiological quandary and license a better conformity from patients towards intervention. This can be achieved by the reevaluating the hazards and benefits of HRT in d ouble blinded tests against a placebo or a validated therapy because of the ample placebo consequence observed in randomized controlled tests.

The Effect of IT on the Business World essays

The Effect of IT on the Business World essays This paper is about the way information technology effects the business world today. We will also talk about how information came about and how it has evolved over the years. There are also many more innovations we will discuss, such as: programming, networking, cell phones, DSL, internet, etc. We will also analyse the way information technology has affected the way businesses function and how the have adapted over the years. Civilization has never expenenced as much change as it has over the last twenty years. This change was brought about by the Information Age. Every part of our lives are affected by information technology. Information Technology is the best thing that has happened to the business world. Our businesses, as well as out own personal lives have all been extraordinarily transformed due to technological advances over the past twenty years. Since the introduction of the computer back in the 1940s, this has changes the way we do business. Before computers you would have to do everything by hand. The pre-information age business office included information producing tools, such as typewrites, and adding machines. Most of the equipment was simple, manual in operation, big, bulky, and noisy. Clerical staff primarily used this equipment as the were the appointed information processors of the time. (Article on the effects of technology on business; vaxxine.com/hyoomk/philo/humbl.html) Then along came the office networking, which allowed everyone in the company to be up to date using an integrated networking databases, programs, and information. ...

Free Essays on Prohibition Of Underage Drinking

Dear Mothers Against Drunk Driving, As you know, alcohol abuse is a major concern to everyone, one that requires extensive problem-solving ideas to fix. However, this is not as problematic in non-temperance nations (nations in which the consumption of alcohol is not restricted). According to a survey conducted by Doctor Stanton Peele, an alcoholism and addiction expert, while the consumption of alcohol is greater in non-temperance nations (10.8 litres consumed per capita per annum compared to 6.6 in temperance nations in 1990), the number of AA groups per million persons is drastically lower (25 to 170), as well as the coronary mortality (deaths per 100,000 population), which comes to 272 in non-temperance nations in 1990, compared to the almost double in temperance nations, 421. (Peele) I propose that, in order to reduce alcohol abuse in the United States to a level equal to Italy, France, Spain, Switzerland, Denmark, Luxembourg, and many other non-temperance nations, the U.S government should remove the federal la w which prohibits citizens under the age of twenty-one years old to drink alcoholic beverages. If this is done, young adults will feel less rebellious about alcohol. As well, if the drinking age was removed, parents would be able to teach their children how to drink responsibly, to avoid the suddeness of a person's "legal age." By doing this, the nation as a whole can begin to recognize that it is not alcohol, but the abuse of alcohol, that is the true problem. Making something illegal does not stop teenagers from doing it. In fact, because of their rebellious nature, teenagers are more likely to do something if it is illegal. In 1920, the Eighteenth Amendment, more commonly known as the Prohibition Act, made it illegal to import, export, transport, manufacture, or sell any alcoholic drink with a percentage of alcohol exceeding .5 (Pohelek 2). It had been hoped that the prohibition of alcohol would lower t... Free Essays on Prohibition Of Underage Drinking Free Essays on Prohibition Of Underage Drinking Dear Mothers Against Drunk Driving, As you know, alcohol abuse is a major concern to everyone, one that requires extensive problem-solving ideas to fix. However, this is not as problematic in non-temperance nations (nations in which the consumption of alcohol is not restricted). According to a survey conducted by Doctor Stanton Peele, an alcoholism and addiction expert, while the consumption of alcohol is greater in non-temperance nations (10.8 litres consumed per capita per annum compared to 6.6 in temperance nations in 1990), the number of AA groups per million persons is drastically lower (25 to 170), as well as the coronary mortality (deaths per 100,000 population), which comes to 272 in non-temperance nations in 1990, compared to the almost double in temperance nations, 421. (Peele) I propose that, in order to reduce alcohol abuse in the United States to a level equal to Italy, France, Spain, Switzerland, Denmark, Luxembourg, and many other non-temperance nations, the U.S government should remove the federal la w which prohibits citizens under the age of twenty-one years old to drink alcoholic beverages. If this is done, young adults will feel less rebellious about alcohol. As well, if the drinking age was removed, parents would be able to teach their children how to drink responsibly, to avoid the suddeness of a person's "legal age." By doing this, the nation as a whole can begin to recognize that it is not alcohol, but the abuse of alcohol, that is the true problem. Making something illegal does not stop teenagers from doing it. In fact, because of their rebellious nature, teenagers are more likely to do something if it is illegal. In 1920, the Eighteenth Amendment, more commonly known as the Prohibition Act, made it illegal to import, export, transport, manufacture, or sell any alcoholic drink with a percentage of alcohol exceeding .5 (Pohelek 2). It had been hoped that the prohibition of alcohol would lower t...

Our newest release - 13 months in the making!

Our newest release - 13 months in the making! Our newest release – 13 months in the making! It’s been almost 13 months since our last updated, but we’ve been working hard over that time period to make a better web application. And we still have a lot to do. Thanks so much for your patience. Take a look around and get yourself acquainted with the changes that have been made. Read all about it below: Tooltip help – we’ve introduced â€Å"tooltip help† to . When entering information about your source into the form fields, hold your cursor over the field label (indicated by blue text and a dotted underline) and you will see a tooltip pop up. This will provide details of the formatting rules and guidelines that are relevant to the source you are citing. Citation tagging – you can now tag individual citations, in order to categorize them by subject, author, or any other area of interest. This feature is available on the â€Å"My Saved Bibliographies† page. Once you tag citations, you can filter by them and see a list of citations with a specific tag. You can then download this filtered list or save it as a new bibliography! Improved â€Å"My Bibliography† interface – we’ve made many changes to the way your in-progress bibliography displays. First, your bibliography is now confined to a specifically-sized section so that large bibliographies don’t make the page scroll down infinitely. Second, you can now name and rename your bibliography simply by clicking the pencil icon next to the bibliography title, which we’ve also added to the interface. Photograph support – now supports citing photographs, pictures, or images found online. Check the dropdown list from the â€Å"Other† tab to cite a photograph. Annotations – you can now append notes or general information to your citations. These annotations will appear at the bottom of your exported bibliography. Calendar interface for entering dates – thanks to a Rails plugin called CalendarDateSelect, you can now use a popup calendar to select and enter date information, instead of filling it in. Click the calendar icon next to any month/day/year fields to use it. Expanded Help and FAQ page – in response to common questions and emails we receive, we’ve added new questions and areas of concern to our Help and FAQ page. Design improvements – all across the website, you should notice some visual tweaks and changes. We’ve standardized the web site design and thrown some polish over everything. Magazine search patched – the AutoFill functionality for Magazine is restored, after having to change the way interfaced with FindArticles. Improved Blog page – we finally matched our blog’s color scheme to the rest of the website. But we also have provided an RSS feed link so you can subscribe to our blog and be automatically updated about any updates, changes, or new features that we add to . Formatting style updates – we want to thank all of our users who reported any inaccuracies in the style guide’s formatting rules. has since fixed any issues. Various bug fixes – many of the visual bugs that persisted have been fixed.

The Brief Wondrous Life of Oscar Wao by Junot Diaz Essay

The Brief Wondrous Life of Oscar Wao by Junot Diaz - Essay Example In this novel, Oscar is a character that can not maintain a physical relationship with a girl because of his obesity. (Diaz) has emphasized that sex is the fundamental element that an individual must exhibit in order to be a Dominican male. Dominican male in the novel has been described as an individual that has charm, physical attraction, and virility. All of these qualities have been replaced in Oscar’s persona by his obesity. Other characters in the play like Yunior and Rudolfo are able to make girlfriends and maintain a physical relationship with them because they are smart, and have captivating looks. Thus, Diaz has placed a lot of emphasis upon the significance of looks of men. When Oscar’s mother, Belicia reaches puberty and develops large breasts that appeal to all the boys around her, she chooses to date nobody but the most handsome boy in the school named Jack Pujols. The fact that this happens between the year 1955 and 1962 reinforces the concept that menâ₠¬â„¢s beauty has not just recently gained importance, but has been of significance for a long time in the past. Clare Spurrell has expressed the consequences of obesity on the physical relationship in her article Obesity and relationships. Spurrell supports the notion that people have been weight conscious for long. â€Å"Since the 1960s the population as a whole has become more sedentary with greater hours spent in front of the television, and an increasingly automated lifestyle† (Spurrell 1). ... The idea compares well with the issue of obesity in the present age. Proponents of obesity control programs are of the view that obesity lowers an individual’s confidence level and may put the individual into social exclusion. In a society that stereotypes obesity as a symptom of sloth, overindulgence and a lack of self-control, sufferers are often left with feelings of social exclusion and isolation. Even more so in a relationship, the psychological implications of the 'fat stereotype' can be equally disruptive. (Spurrell 1). Diaz and Spurrell have both maintained that obesity has negative effect on people’s physical relationships, though Diaz has gone a step further by not letting Oscar make love with anyone because of his obesity whereas Sara and her boyfriend, do make love with one another, but their relationship is complicated by the obesity that both suffer from and eventually, they part ways. Oscar develops several affairs in the novel by Diaz, though the intimac y never grows up to the physical level. First, Oscar finds Ana Obregon in the SAT preparation class. He finds her attractive and the two make friends with each other. However, Ana is taken over by Manny because he is physically intimate with Ana unlike Oscar, who is only good in conversing with her. Later, Oscar finds Jenni Munoz, a Puerto Rican girl. He does the same to her what he did to Ana i.e. kill the time speaking to her and never making love. Because of that, the end of their relationship is also like before. Jenni finds a boyfriend and breaks all ties with Oscar. Once again, Oscar is left alone. Break up of Ana and then Jenni with Oscar as well as the breakup of Sara with Jonathon essentially tells that sex is fundamental to the survival and sustainability of a relationship.

Online Gambling Essay Example | Topics and Well Written Essays - 3000 words

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Description Assignment Example | Topics and Well Written Essays - 500 words

Description - Assignment Example Moreover it is place in an open are with a wonderful view of the city so everything can enjoy a picturesque stay at this place. Hello uncle, how have you been? Is everything good at home? The reason I am writing to you is because of the simple issue that I miss my home these days. Earlier, I remember how desperate I was to move out of my place and get a job and have a place of my own. Now, having accomplished that I do not feel that I am complete even though I have everything a person can wish for. My house is still not my home. When I was a child, I was always excited to come back to my home and stay with my closed ones. The warm atmosphere of the place gave me a sense of protection and a feeling that nothing can happen to me now since I am staying in my home. Some one or the other will always be there to protect me. That sense of protection and joy is missing these days uncle. Wish I could leave everything right now and come visit you and my home. Please take care and let me know how everything is going with you. I will come visit you soon. In the above two paragraphs each of them are different in its own away. The first paragraph is giving us a sense that I am promoting my home so that other people get interested and purchase it to stay. There is no sense of my feeling or emotions attached with the place. I have not even described the place as my home. However in the second paragraph the discussion changes completely as I have a different intention in it altogether. A sense of feelings and emotions are attached to it while writing a letter to my home. Each of the paragraphs has a different approach in their own way. In the first paragraph my intention is to sell the place so I promote the place in my own way. However in the second paragraph, I am missing my home and emotions attached with it are completely different, which is why I am writing to my uncle to make

Financial Accounting Analysis term projuct Paper

Financial Accounting Analysis projuct - Term Paper Example The findings are presented in a tabular format supported by comprehensive discussion of results. The horizontal analysis of Balance Sheet does not show any worrying trends or majorly fluctuating balances from 2011 to 2012. Inventories remain at the same level and while there is 12.84% increase in Property and Equipment it is offset by the 16.78% decrease in the Cash and Cash equivalents. Other large changes include an increase in Goodwill, decrease in Long term loan which is offset by an increase in the current portion of the Long term loan. The horizontal analysis of the balance sheet is set out below: The horizontal analysis of the Income Statement also does not show any worrying trends from 2011 to 2012. The Sales have increased by 1.8% but that is due to a corresponding increase in the Cost of Sales which has increased by 2.14%. The net earnings have increased by 3.3%, this is due to the fact that other income has increased and the financial costs have decreased during the period. The horizontal analysis of the income statement is set out below: The vertical analysis of the income statement for the years 2011 and 2012 set out below shows all balances as a percentage of sales. As illustrated the cost of sales and other expenses have both increased as a percentage of sales, even though minutely. This is worrying because ordinarily the cost of sale should be kept in line with sales. Conversely the net income is 2.09% of sales in 2012 and 2.03% in 2011. There is a slight increase, which all in all is a positive sign for the entity (Rajasekaran, 2011). Looking at the trends in the past five years’ financial statements of the company, it can be seen that the net sales have been increasing steadily for the past four years. The increase in sales for this year has been less than those compared to previous years, 1.6% from over 3%. The cost of

Petrobras and cost of capital Essay Example | Topics and Well Written Essays - 3000 words

Petrobras and cost of capital - Essay Example Petrobras was operating in a higher risk environment due to Brazil’s economic turbulence. The cost of debt for any given company is the cost of raising extra revenue by issuing the debt. Likewise, the cost of equity refers to that extra revenue associated with issue of the equity shares. The cost of capital therefore is derived from the average value of issuing the two in the proportion capital they present and this is what is referred to as the WACC (weighted average cost of capital) as to be discussed later in this paper. For a company like Petrobras, the financing costs can be derived by use of the WACC. The major players in the multinational oil industry as indicated in exhibit 1 of the case have almost a similar cost of capital ranging from 7.6% of BP to 9.0% of ocean energy indicating an average difference of 1.4%. Petrobras’ cost of capital is further up at 15% reflecting a massive difference of 6%. This is largely attributed to the company’s distinct domestic involvement in terms of its operations. The company is largely owned by the government and hence it was solely producing for a Brazilian market in the quest to eliminate its over dependence on international oil imports. This is despite the economic turbulence of the country’s economy that has been characterized by fluctuations in interest rates, inflation rates, local currency depreciation among other economic downfall, which is further reflected into the company’s CA.... erations made investors assign it the country risks assigned to similar firms operating in the country and as a consequence, the cost of capital was significantly raised. There are sentiments by analysts that the company’s CA ought to have been excluded from the â€Å"burden† of the respective additional costs incurred from Brazil's sovereign spread during the derivation of kd (cost of debt) and derived capital or equity (Antweiler 2005). This will ensure that the risk bored or characterized by the company’s operations are optimally constituted hence bringing its cost of capital at par with similar companies. This is the main reason why the company embarked on expansion in the South American markets like Argentina, as mentioned in the case. Petrobras's WACC Analysis To begin, there are two ways that companies may use to evaluate their cost of capital: the first one is by use of expected equity cash flow and the required rate of return whereas the second approach focuses on the use of free cash flow and the weighted average cost of capital. The WACC calculation for Petrobras uses comparable companies to produce a single discount rate. This is despite of the fact that an industry average WACC is the most appropriate for Petrobras on a long-term basis. Suppose there exists any short-term differences between the industry WACC and Petrobras's WACC, then it goes that Petrobras will be more likely to go back to the industry WACC on a long-term basis. The company’s WACC calculation uses Petrobras's highest risk free rate, because no investment can have a cost of capital that is better than risk free. This situation may occur if the beta is negative and Petrobras uses a significant proportion of equity capital. While the company had decided to implement an

Financial Accounting Analysis term projuct Paper

Financial Accounting Analysis projuct - Term Paper Example The findings are presented in a tabular format supported by comprehensive discussion of results. The horizontal analysis of Balance Sheet does not show any worrying trends or majorly fluctuating balances from 2011 to 2012. Inventories remain at the same level and while there is 12.84% increase in Property and Equipment it is offset by the 16.78% decrease in the Cash and Cash equivalents. Other large changes include an increase in Goodwill, decrease in Long term loan which is offset by an increase in the current portion of the Long term loan. The horizontal analysis of the balance sheet is set out below: The horizontal analysis of the Income Statement also does not show any worrying trends from 2011 to 2012. The Sales have increased by 1.8% but that is due to a corresponding increase in the Cost of Sales which has increased by 2.14%. The net earnings have increased by 3.3%, this is due to the fact that other income has increased and the financial costs have decreased during the period. The horizontal analysis of the income statement is set out below: The vertical analysis of the income statement for the years 2011 and 2012 set out below shows all balances as a percentage of sales. As illustrated the cost of sales and other expenses have both increased as a percentage of sales, even though minutely. This is worrying because ordinarily the cost of sale should be kept in line with sales. Conversely the net income is 2.09% of sales in 2012 and 2.03% in 2011. There is a slight increase, which all in all is a positive sign for the entity (Rajasekaran, 2011). Looking at the trends in the past five years’ financial statements of the company, it can be seen that the net sales have been increasing steadily for the past four years. The increase in sales for this year has been less than those compared to previous years, 1.6% from over 3%. The cost of

Metamorphosis Essay Example | Topics and Well Written Essays - 500 words

Metamorphosis - Essay Example He lived to find food, provide shelter, eat rubbish, just to survive and protect the species. According to Karen Bernardo's commentary (n.d.), his metamorphosis confronted him with "the greater questions of existence." When Gregor awoke to find himself "transformed in his bed into a horrible vermin" (Kafka, 1), he reacted as if he had to work and fulfill his duty, a surprising attitude, in the circumstances. Instead of being horrified at the changes in his body, Gregor dealt with it, first as a dream, then just an odd transformation that would not stop him from working and being the same person. He continued to think of ways to get over the problem and get to work, which is a confusing reaction for the reader, as it was a terrifying situation to be in. It was absurd that he continued to think and feel as both beetle and man, but in reality, the person who was Gregor still existed, trapped in that awful body. The metamorphosis gave him time to think and examine his life, the family, and his own place in the world and showed he was still human. When his mother and sister cleared out his room, he felt "they weretaking away everything that was dear to him" (Kafka, 24). He crept out to listen to Grete's music, asking "Was he an animal if music could captivate him so" (Kafka, 33).

Bollywood and Cricket Essay Example for Free

Bollywood and Cricket Essay The two things that unite the rich and the poor, the educated elite and the illiterate, the city-dwellers and the villagers in India are undoubtedly – Bollywood and Cricket! Both have their own share of success and star factor – Shah Rukh Khan has a big fan following in Germany, while Sachin Tendulkar was gifted a Ferrari by Michael Schumacher. Both are big businesses – the Bollywood stars as do the cricketers appear regularly on TV to endorse everything from under-garments to life insurance to passenger cars. How about bringing them together – and that’s what happened in 2008 when the Indian Premier League (IPL) was inaugurated. Cricket, in its traditional form, usually being a day-long or a five-day game, because of the the duration of the game, was always seen by the Europeans and Americans as something boring that only cricket-crazy Indians could watch. How about making it shorter, spicing it up with some Bollywood masala adding a huge entertainment and star factor to it – and this in short is the definition of IPL. This format of the game has many similarities with both the traditional game of cricket as well as Bollywood. First, the duration – this format of the game, more popularly dubbed T20 (for Twenty-20 as it has 20 overs (1 over = 6 balls) a side), runs for around 3 hours – the same duration of a typical Bollywood movie. And the heroes are both on and off the field. The on-field heroes are the cricket stars from around the world who entertain the audience with their cricket skills. While the teams with fancy names like Delhi-Dare-Devils, Chennai-Super-Kings, etc. , have a mix of Indian and international players are mostly owned by Bollywood stars or big Indian business houses. The off-the-field heroes are thus the Bollywood stars and other page-3 regulars (the ‘socialites’) who add to the star quotient. The only thing that is left from a typical Bollywood movie are the ‘item numbers’. These are substituted for by the grooving cheer-leaders with skimpy outfits employed by each team. Not to mention the IPL Nights-after party that brings in more glitz and glamour. In short, this combination of two big business machines – Bollywood and cricket resulted in a bigger business – the IPL. So, where is technology in all these, given that my writings are connected to technology most of the time. Here we go – in 2010, IPL became the first ever sports event to be telecast live on YouTube – and I thoroughly enjoyed it. In a way this is indicative of the future of television – given that cricket events are closely associated with commercials and TRPs. We already see the convergence of mobile, desktop and more recently television devices. I am confident that not so far from now, we would be watching all sporting events and movies through the internet. The other technology marvels include the use of Spider-cameras (which was actually borrowed from other sporting events like soccer) and the high-definition reviews. And yes, there are iPhone apps too!

Glaxo Smith Kline Pakistan Limited Commerce Essay

Glaxo Smith Kline Pakistan Limited Commerce Essay GSK Pakistan Limited was created on January 1st 2000 through the merger of SmithKline Beecham Pakistan and Glaxo Wellcome Pakistan and it stands as the largest pharmaceutical company in Pakistan today. GSK leads the industry in value, volume and prescription market shares. Some of their key brands include Augmentin, Panadol, Seretide, Betnovate, Zantac and Calpol in medicine and renowned consumer healthcare brands include Horlicks, Aquafresh, Macleans and ENO. GlaxoSmithKline (GSK) is one of the Pakistans largest research-based pharmaceutical corporations that discovers, develops, manufactures and markets branded human health products. GSK has two main business divisions, pharmaceuticals and consumer healthcare. This profile deals with the pharmaceuticals division, which generates 85% of GSKs sales. GlaxoSmithKline (GSK) is also Pakistans leading research-based pharmaceutical company with a powerful combination of skills and resources that provides a platform for delivering strong growth in todays rapidly changing healthcare environment. GSK also has leadership in four major therapeutic areas anti-invectives, central nervous system (CNS), respiratory and gastro-intestinal/metabolic. Company produce medicines that treat six major disease areas asthma, virus control, infections, mental health, diabetes and digestive conditions. In addition, GSK is a leader in the important area of vaccines and are developing new treatments for cancer and has a growing portfolio of oncology products. The company also has a Consumer Healthcare portfolio comprising over-the-counter (OTC) medicines, oral care products and nutritional healthcare drinks, all of which are among the market leaders. GSK is primarily focused on the development, production and distribution of its own products. GSK is an important contributor to the national skills pool in areas of chemical and pharmaceutical research, manufacturing, management practice and sales marketing. FACTORY LOCATIONS: Registered Office: 1. GlaxoSmithKline Pakistan Limited 35-Dockyard, West Wharf, Karachi -74000. Telephones: 92-21-2315478-82 Fax: 92-21-2313632 Other Offices: 1. GlaxoSmithKline Pakistan Limited F-268, S.I.T.E., Near Labour Square, Karachi-75700 Telephones: 92-21-2570665-69 Fax: 92-21-2572613 2. GlaxoSmithKline Pakistan Limited 18.5 km, Ferozepur Road, P.O. Box No. 244, Lahore Telephones: 5811931-35 Fax: 5820821 GSKS FINANCIAL DATA: Five Years Sales YEARS SALES (rupees in billions) 2002 6.9 2003 8.1 2004 8.8 2005 9.4 (Growth by 6.2%) 2006 10.1 (Growth by 7.1%) GRAPHICAL REPRESENTATION OF SALES (in millions) Companys Five Years Profit YEARS PROFIT (rupees in billions) 2002 0.54 2003 1.02 2004 1.47 2005 1.81 (Growth by 23.3%) 2006 1.66 (Decrease by 8.2%) GRAPHICAL REPRESENTATION OF PROFIT (in millions) Revenue breakup Benchmarking Ratio Name WYETH SEARLE ABBOTT GSK Current Ratio 4.10 1.714 4.76 4.4 Inventory Turnover 1.69 times 10.11 times 4.69 times 3.0 times Total Asset Turnover 60% 10.2% 1.17 times 1.1 times Profit Margin on Sales 0.182 0.032 0.17 0.16 Earnings Per Share 112 3.53 10.21 12.2 Return on Assets 10.9 3.2 19.9 21.5 CORE VALUE OF GSK GSKs value is based on its research strength linked to production marketing. The core of value creation is from the inventories of new chemical entities and it captures value through a high intensive sales and marketing process. Essential to the overall value proposition is the synergy of RD, production and commercial activities. GSK has been committed to its social and health related activities. Good Corporate Citizen is core value of GSK. Core values of GSKs can be summed up as a belief in performance with integrity, coupled with entrepreneurial spirit, focus on innovation, a sense of urgency and a passion for achievement. GSK are working to ensure the culture guides and informs everything they do by adhering to these core principles, they seek to create a climate in which the best people can always achieve to their full potential, and in turn help millions of people live longer, healthier and happier lives. NEW CHEMICAL INVENTROIES Production and commercial activities Synergy of RD GSK High intensive sales . Core Competencies of GSK : GSK has the core competencies in genetics, to enable them to integrate genetics effectively and responsibly into their current practice. Competency in these areas represents the minimum knowledge, skills, and attitudes necessary for health professionals from all disciplines (medicine, nursing, allied health, public health, dentistry, psychology, social work, etc.) to provide patient care that involves awareness of genetic issues and concerns. BUSINESS PROFILE GlaxoSmithKline (GSK) is one of the Pakistans largest research-based pharmaceutical companies that that discovers, develops, manufactures and markets human health products. It is an innovative company that produces branded products only, which it has developed itself. The company has two main divisions, pharmaceuticals and consumer healthcare. The consumer healthcare businesses of GSK consist of over-the-counter (OTC) medicines, oral care products, such as the toothpaste brands Aqua fresh, MacLeans and Sensodyne, and nutritional healthcare drinks. The pharmaceuticals division is the largest part of GSKs businesses and can be divided into prescription drugs and vaccines. The headquarters of GSK are located in the UK. The company operates in some 160 national markets. GSK conducts RD at more than 20 sites and employs 15,000 employees in RD. GSK is involved in many different RD partnerships with academic institutions, biotechnology companies and other pharmaceutical companies. The compa ny has a leading position in genetics and in new drug discovery technologies. BUSINESS PROFILE Pharmaceuticals Consumer healthcare Vaccines Prescription drugs Over-the-counter (OTC) medicines Oral care products Nutritional healthcare drinks Viral Vaccination Toothpaste Bacterial Macleans Aqua fresh Heart disease Infection Skin condition Sensodyne BUSINESS STRATEGY: GSKs business goal is to be a world leader in pharmaceutical industry. In order to achieve this, the company seeks to improve its RD pipeline, using a focused drug portfolio strategy and selective in-licensing agreements for the external contracting of RD. The company links RD closely to commercial operations to maximize the value of its RD portfolio. Furthermore, GSK seeks to increase brand name recognition among customers and to develop improved versions of older products, on which new patents can be obtained. It is a common strategy of branded drug producers to develop improved versions or more convenient formulations of drugs on which the patents have expired, and to persuade doctors and patients to use the enhanced version. Business strategy Being best place for best people to do their best work Optimising the performance of key products Delivering the product pipeline for patients Improving access to medicines Supply Chain of GSK Supply Chain Management according to GSK, is a process for ensuring continuity of supply through the rapid identification of actual and potential supply chain issues enabling pro-active management and the prevention of low and out of stock situations. SUPPLY CHAIN MISSION OF GSK: GSKs Supply Chain mission is to construct, harmonize and improve quality of all the product and go with the intend of satisfying the chain of suppliers suppliers and customers customers by providing right product, at the right time, in the right quantity, to the right place and becoming highly recognized by our employees, customers and shareholders and abiding by Government laws and regulations GSKs Objective of Supply Chain Issue Management à ¢Ã¢â€š ¬Ã‚ ¢ To prevent low and out of stock situations occurring. à ¢Ã¢â€š ¬Ã‚ ¢ Pro-actively identify any potential supply chain issues with the purpose of preventing low stocks and stock outs occurring. à ¢Ã¢â€š ¬Ã‚ ¢ Resolve supply chain issues, at a local level where possible, excepting issue types categorized for immediate escalation. à ¢Ã¢â€š ¬Ã‚ ¢ Provide a fast and effective mechanism for escalation where issues cannot be resolved at local level. à ¢Ã¢â€š ¬Ã‚ ¢ Enable delivery of root cause analysis complete with follow up action to ensure the causes of actual and potential low stocks and stock outs are understood. à ¢Ã¢â€š ¬Ã‚ ¢ To have one information source for all supply chain issues. à ¢Ã¢â€š ¬Ã‚ ¢ To have global visibility of all supply chain issues. à ¢Ã¢â€š ¬Ã‚ ¢ To enable rapid tactical response to commercial opportunities Supply Chain Integration P R O D U C T F L O W sales force activity (SFA) Transportation Supplier factory Warehouse Manufacturing Sales stations/Warehouse Customer Pharmacies Distributors I N F O R M A T I O N F L O W GSKs Supply Chain Structure Mr. Ahmad Jamal Qudsi (Commercial) Distribution Manager DISTRIBUTION MANAGER MASTER SCHEDULER MASTER SCHEDULER CAPAPCITY PLANNER PRODUCTION PLANNER PRODUCTION PLANNER Mr. Sajjad Zahid Shaikh (GMS) Manager Procurement, Shipping, Contracts, Regulatory affairs. PROCUREMENT MANAGER Exports mANAGER Local/ IMPORTED PURCHASE mANAGER Warehouse mANAGER Mr. Obaid (GMS) Purchase Manager b-65 F-268 w.w LHR Sales Force Activity ( Demand Generated)Supply Chain Process Manufacturing Planning (Demand Generated) Procurement Planning Vendors (Quotations asked) LC Follow up import dispatches Clearance Transit Time Material in Warehouse Material Available For Production Production Released by LTR FO Batches Packing line FO Quarantine Central Depots Dispatches Institutions Lab Test Results (LTR) Satellite Depots Distribution Wholesalers Retailers GSKs Global Manufacturing Supply Procedure GMS site disposals will be co-ordinated within a consistent process alongside communication plans. A consistent process will enable GMS in meeting the business case objectives. The process proposed will generally recommend decisions to the CET based on a balance between: à ¢Ã¢â€š ¬Ã‚ ¢ Realising the synergy benefits from transferring production à ¢Ã¢â€š ¬Ã‚ ¢ Maximising sale proceeds à ¢Ã¢â€š ¬Ã‚ ¢ Minimising local labour redundancy à ¢Ã¢â€š ¬Ã‚ ¢ Ongoing supply security à ¢Ã¢â€š ¬Ã‚ ¢ Managing political and other local sensitivities Key features of the site disposal process are: à ¢Ã¢â€š ¬Ã‚ ¢ It is GMS-managed with involvement of key stakeholders at the sites and in Legal Entities à ¢Ã¢â€š ¬Ã‚ ¢ External contracted assistance will enable global marketing of the sites A phased and co-ordinated approach: Phase 1 preparation Phase 2 search Phase 3 negotiation The Escalation Process Step 1:Daily (regular) The regular dialogue between Demand and Supply managers is the foundation of SCIM. SCIM is only invoked when the agreed supply plan cannot be achieved and a resolution cannot be found by the demand and supply managers. Low stock and out of stock events are entered into the SOLS system or generated automatically. Demand and Supply Managers discuss entered events as appropriate. Supply Managers make proposals to resolve the event. Demand managers read proposals and agree by accepting the suppliers response to events with the customer satisfaction flag as a default value of yes or disagree and move the flag to no. If no is selected then commentary may be entered into the escalation field. This enables a report to be run selecting any items marked for escalation. Demand and Supply Mangers proactively view trends, and any issues which might potentially impact the supply of product. Step 2: Wednesday The Supply Manager prepares for the PCM. Reports are available from SOLS and other supporting computer systems identifying all issues. In particular, the SCIM report from the Data Warehouse. This is to be run for All Issues (in SOLS issues are referred to as events). The Supply Manager cuts his report in preparation for the PCM at the latest this is done on the Thursday morning. Step 3: Thursday The PCM is held. At sites of supply the PCM review all Low Stocks, Out of Stocks and any issues and their potential impact on the sites ability to supply. Where no resolution to actual and potential issues is found then the Supply Manager invokes the escalation procedure with the ALM or equivalent. N.B. Issues can be escalated by either the Demand Manager or the Supply Manager Step 4 Thursday/Friday The ALM (or equivalent) is brought in by either the Demand or Supply Manager to help resolve the issue identified. The ALM (or equivalent) runs the SCIM report from the Data Warehouse filtering on Unresolved Issues. If resolution can still not be made then the ALM progresses the issue with the Regional Logistics Director (RLD). RLD chair conference call with ALMs (or equivalent) and any guest Demand or Supply Managers required. RLD compiles consolidated market view for region of issues. RLD tries to find network solutions to supply issues. RLD flags unresolved issues as critical issues in SOLS. Step 5 Monday The Area Logistics Managers / Directors are brought into the discussions to assist resolution if necessary especially where a potential stock rationing situation might occur. VP of Global Logistics (VPGL) runs the SCIM report from the Data Warehouse filtering on Critical Issues. VPGL chairs conference call with RLDs and any guest ALMs, Demand or Supply Managers required. VP compiles consolidated market impact for issues. VPGL flags any unresolved critical issues as exceptional in SOLS. VPGL makes decision escalate critical issues and engage commercial and manufacturing executives. Step 6 Tuesday Formal review by RSDs, Vice-President Global Logistics, Senior Vice President Global Logistics and Strategy and any other appropriate senior manager. The SCIM report is run from the Data Warehouse filtering on Exceptional Issues. An output from this meeting (or teleconference) can be the establishment of a virtual team to resolve the issue. It will exist until the issue is resolved and is lead by the ALM (or equivalent) supported by the RLD. Where stock rationing is required the RLD will trigger the Rationing process VPGL reports on the commercial impact of exceptional issues. The RLD assumes overall responsibility for resolution of the exceptional issue. Supply Chain Process: Supply Chain Issue Management (SCIM) is a process for ensuring continuity of supply through the rapid identification of actual and potential supply chain issues enabling pro-active management and the prevention of low and out of stock situations and regular communication occurs between demand and supply managers. The process is driven from bottom up rather than top down. Issues are to be resolved at the lowest level. Trending analysis is to be done by the Supply Managers. The process is two way between demand and supply. Both supply performance and forecast accuracy are to be reviewed. SCORE MODEL P L A N N I N G BUYING USING STORE SELLING RM Manufacturer Make Deliver Source Make Deliver Make Source Deliver Source Deliver Source Plan Indenters GSK, Pakistan Distributors Return Return Return Return Return Return Supplier Suppliers Supplier Company Customer Whole salers Customers Customer PLANNING: Planning in GSK, Pakistan, is done by the demand function unit of the finance department. Below is a general diagram which shows how the planning takes place: The Process: The process starts with the doctors which prescribes medicines to the patients. The patients then ask for the drugs from the chemist which is basically a retailer. From retailer an order is then passed on to the distributor which then simultaneously ask for the drugs from the company. Now the daily data on sales is sent to the SMART Department of GSK which uploads the information in the database. Finally the queries and reports which are generated by the SMART Software help the Demand Managers, in the finance department, to predict the future demand for the specific drug. SMART Software basically creates the trend which help managers see the rise and fall in a drugs demands over the years. This helps them to accurately tell the procurement managers the demand required for the raw materials to be purchased for a specific drug. BUSINESS PLANNING: The corporate executive team of GSK does strategic planning on every last day of week which is co-ordinate within a consistent process alongside communication plans. The process proposed will generally recommend decisions to the CET based on a balance between realizing the synergy benefits from transferring production, Maximizing sale proceeds, Ongoing supply security. Corporate executive team (CET) Meeting Finance Department Discuss CET VP, Planning Sourcing Negotiation CET approval Corporate executive team . DEMAND FORCAST: As mentioned above the demand in GSK is forecasted by the Demand Function Unit of Finance Department. Finance department provides 24 months rolling aggregate demand forecast, which is known as ADS (Approved Demand Statement). This statement shows individual demands for all product lines demanded by end users. The softwares used by the finance department to predicts demands are BIPEX (also known as BPCS) and JD-Edwards. On the demand side markets review their sales plans on a regular basis (at least monthly depending on size of market) and feed into the supply sites Production control Meetings through the Supply Managers UNPLANNED DEMAND Unplanned demand is a demand, which comes unexpectedly Like at the time of War, NATURAL DISASTERS OR ANY EPIDEMICS According to GSK, they have a policy to maintain four weeks safety stock to handle the uncertainties. Stock, in the three categories, intended to maintain supply continuity resulting from a significant event that is unplanned. Top 20 Products (as defined by GSK annual sales, Pharma/Consumer Healthcare) Medically Critical and Access to Medicines products New Chemical Entities (NCEs), including Product Line Extensions (PLEs) SUPPLY STRUCTURE: Supply Issues (potential and actual) are reviewed formally each week. At the supply sites this is done at the weekly Production Control Meeting. Supply Issues are managed on a daily basis but the formal weekly meeting brings all aspects of supply and demand together for review; it adds a framework. Then after the supply plan has been made it is forwarded it to the Procurement Department. Master Production Schedule The entire production is based on this plan weather it is Tablet, syrup, or injectables manufacturing. This is set up on the bases of forecasted and some times unplanned demand as well. Date for all the batches is set up according to this plan but when there is a sense of urgency then there are some changes made. The figure below shows this process is generated: Master Production Arrival This is the inventory, which is going to arrive in bulk, and it is the job of Master Production Scheduler to arrange the bulk. This bulk can either be for export or for the market demand done through forecast. He also sets up when to make the required batch on which date. STOCK MANAGEMENT: GSK used inventory management system First in First out (FIFO). Inventory management (FIFO) of strategic stock to ensure proper rotation and reduce the potential of data used. Items at stock keeping unit level where, based on the forward sales forecast/ sales orders, the level of inventory is predicted to fall below 50% of the agreed safety stock within the next 90 days. SAFETY STOCK: GSK stores stock in ware houses for maximum flexibility of supply purpose. The stock is taken into account within 1 month of time. Material Management Planning: GSK, Pakistan is using BIPEX (also known as BPCS) to effectively and efficiently handle the Material issues. All transactions are made electronically into BPCS known as Business Planning Control System. If there is an additional requirement due to abnormal demand then there are some changes made in MRP. Capacity Planning Capacity means a measured ability to accomplish work. Capacity planning is a process in which capacity is planned based upon expected demand and it needs to be balanced with required capacity utilization and it also outlines the capacity requirements for the production, availability of machines and what are the standard hours, which they are required to meet the forecasted demand. And to manage the capacity control process GSK Pakistan is using 2 systems known as JD-Edwards and BIPEX which is also called as Business Process Control System (BPCS). SUPPLY CHAIN CONFIGURATION: Supply chain manager act upon the process enabling pro-active management of potential and actual supply issues in order that the impact on lost sales is minimized. Supply chain manager resolve supply chain issues, at a local level. The Supply Manager prepares for the PCM. Reports are available from SOLS and other supporting computer systems identifying all issues. In particular, the SCIM report from the Data Warehouse. . MAKE OR BUY DECISION: GSK Pakistan is currently importing 72 drugs, which includes all its vaccines and expensive oncology medicines such as Hycamtin. The reason why GSK imports these products are because there manufacturing is very expensive and Pakistan is not self sufficient in the raw materials which are required to make these products. Infact the climate of Pakistan makes it very hard for GSK to manufacture vaccines here. Thus all its vaccines are imported from Belgium. Also, these products cater to a very small market segment and manufacturing them here would not be profitable. SOURCING: Gsk Medicines contain active ingredients. They also contain other, additional ingredients called Excipients that help ensure the stability, safety and effectiveness of the medicine. They are also added to improve the medicines taste and appearance and to make it easier to take. Some may be used to prolong the life of the medicine Pharmaceutical ingredients include both synthetic chemical substances as well as material with biological orgin. Various control methods with chemical, microscopic and microbiological testing is covered during the course. In addition, the different national and international quality control regulations for pharmaceutical ingredients are taught. SOURCING PROCESS The Weekly Process At the day-to-day level the Demand and Supply Managers are engaged in managing the fulfillment of the order book, ensuring forecasts are kept up to date, handling any un-forecasted (abnormal) demand, and resolving any issues. This is normal daily activity. Any issues arising must be discussed with the objective of resolving at local level. Issues can come from either the Demand or the Supply side. The Stock Out and Low Stock (SOLS) Data Warehouse system is the main vehicle for recording and reporting issues and actions taken between Demand and Supply Managers. It is used as a formal means of identifying and tracking issues and the actions taken to resolve them. It is a dialogue application for use by the Demand and Supply Managers. Demand nodes will accept the proposals or escalate through the hierarchy. Data can be manually entered into SOLS. Supply sites must respond to recorded stock-out and low stock events according to SCIM time table PROCUREMENT GSK has an extremely large procurement organization largely left over from the 2001 merger between Glaxo Welcome and SmithKline Beecham. The purchasing group set a goal of developing what it called best value purchasing strategies, ensuring that GSK is getting the best possible price and cost for everything it buys. That means negotiating the best prices and making sure those contracts are adhered to. GSK has two types of purchases i.e. local purchases and foreign purchases PURCHASES LOCAL PURCHASES FOREIGN PURCHASES Raw Packing Material Group purchases Non Group purchases (party purchases) ) NIP (non inventory purchases) PROCESS FLOW FOR PURCHASE PR incorporated in:Incorporated By:Against Requisition of:BIPEXPPICPurchasesJD EdwardsConcern dept.NIPPurchase of inventory is approved through Firm Plan Order (FPO) by Purchase Planning and Inventory Control Dept (PPIC) and incorporates in system N.I.P. Concern department generate approved Purchase Receipt. Procurement Department (P.D.) received signed copy of FPO by PPIC and PR for N.I.P. Type of PurchasePURCHASE FLOW OF PRODUCT A FOREIGN PURCHJASES LOCAL PURCHASES Purchases Raw Material Packing Material N.I.P. Fixed Assets Consumable items Quotation calling Selection of Supplier through Quotation Evaluation Form Placement of Purchase Order (PO) by P.D. Information in PO: Supplier name Delivery schedule Quantity Required Rate (as decided with supplier) A SUPPLY of GOODS: Nature of MaterialMaterial Supplied at:PurchasesStores.NIPConcern Dept. 3way check: Invoice WITH P.R. P.O. by Commercial Finance Issuance of INVOICE by Supplier. Information in invoice: Delivery Challan #. P.O.# Recording of Liability depends on LTR. DOCUMENTS ISSUED BY DEPT.AFTER RECEIPT of MATERIAL from SUPPLIER Supply of:Documents IssuedBYTOPurchasesReceivers Ticket.(RT) Delivery Challan.Stores Dept.Quality Control (QC) Dept.NIPMaterial Receipt Note (MRN)Concern Dept.Incorporated in System. Lab Test Report (LTR) Incorporation of approved lots in BIPEX by QC Up to the Quality Accounts Dept. runs an auto report identify NEW LTRs Entries made by Accounts Dept. for new LTRs: DebitCreditENTRY for NEW LTRStock (@Standard rate)xxxPurchases Price Variance (PPV)-GSTxxx PPV- Other than GSTxxx Provision for purchases(actual payable amount)xxx PPV variance (with the Diff.) Fav/ (Un-Fav)xxxxxxPurchases (actual payable amount)xxx Purchases ContraxxxENTRY for NEW INVOICE (after approval of QC)Provision for Purchasesxxx Vendor Control A/Cxxx B Entries made by Accounts Dept. for new MRN: DebitCreditENTRY for NEW MRNExpense A/C (NIP)xxx NIP Commitment A/C xxx ENTRY for NEW INVOICE NIP Commitment A/C xxx Vendor Control A/Cxxx Payment to VENDOR Entries made by Accounts Dept. at Payment Stage DebitCreditVendor Control A/Cxxx Bankxxx Tax Liabilityxxx Raw Material Packing Material Purchase FROM Quotation Calling 3RD PARTY Selection of Supplier Raw Material Finished Goods GROUP Prices are already decided between GlaxoSmithKline Pakistan Limited Group Companies. Placement of Purchase Order (PO) by PD they incorporates PO, in BIPEX. Receives PERFORMA INVOICE (an agreement to sell) by Supplier. Type of L/C Opening of Letter of Credit (L/C) with Bank. Information in L/C: L/C #. Mode of transportation. Type of L/C. (Usance / Sight) Receipt of Shipment Schedule (SS), Suppliers Invoice Bill of Lading [B/L] (Negotiable Non-Negotiable Copy). Information in SS: Date of Shipment. Type of freight paid. At usage at sight C Submission of Negotiable Copy of B/L to Shipping Co. Submission of Non- Negotiable Copy of B/L to Ministry of Health for Approval of Material (as required under Drugs Act). Delivery Order (Delivery Challan) receives from Shipping Co. Submission to Custom for Clearance of Shipment. Receipt of SHIPMENT Certificate of Approval for Material by Ministry of Health alongwith exemption certificate (if any). LTR Up to the Quality Receipt of Agents Bill Testing of Shipment by QC Materials Average Lead Time GSK Pakistan only uses air freight to acquire imported materials and its lead time is approximately 120 days. Note that when materials arrive they also take clearance time which is about 4-5 days for air freight