Hartalega Holdings Berhad Strategic Management

1. Presentation Hartalega Holdings Berhad is a gloves maker and started their business with the vision of produce gloves that ensure life (Hartalega, 2013). Hartalega has encountered huge development in the market and there are numerous issues and issues that looked by them. The main issue that looked by Hartalega is change of US dollar (CIMB Research Report, 2011). USA is a key market for glove industry and has contributing piece of the piece of the pie of Malaysian ventures. Change on US dollar has influenced the edges of the company.Besides, the financial conditions have impact the glove business will keep on being temperamental because of ascends in material and creation costs. Besides, high latex cost likewise is one of the issue that looked by Hartalega (CIMB Research Report, 2011). Latex costs keep on being unpredictable would carry an impact to its edge. Flexibly of latex might be decreased because of the climate conditions. During the dry season in Thailand and Malaysia, it would diminish the creation of latex. Therefore, cost of latex during dry season will be marginally higher contrast with other season.Furthermore, Hartalega confronted the issue about work. The ongoing governments approaches about remote work have cause an extraordinary worry for the gloves business. The gloves business has voiced out their interests towards this issue in light of the fact that recruited work would affect the manufacturers’ costs. Moreover, increasingly more glove makers are utilizing computerization and it will diminish the dependence on labor. Next, contamination is one of the most significant issues that looked by Hartalega as their company’s notoriety has influenced by the negative news or rumours.Hartalega was gotten objections from the Deputy Minister in the Prime Minister’s Dept and a couple of inhabitants of Taman Suria and guarantee that they are causing air and water contamination. Hartalega deny all the allegation and announce that th ey are working legitimately as indicated by the Malaysian condition administrative norm (â€Å"Hartalega: Aggrieved At Accusations†, 2010). This may influence the notoriety and the reliability of Hartalega and might cause the piece of the pie decline in this specific time span. 2. Remote EnvironmentRemote condition is the components that influence a type of dynamic capacities, yet are outside its ability to control. Political, financial, social, mechanical and biological factor are the components that remember for the remote condition. The principal factor is political factor. Hartalega has trades practically the entirety of their items for the most part to the created nations, for example, USA, Brazil, Japan, Germany, Europe, Malaysia and others. Hartalega additionally has extended its business effectively to China and India. Gloves deals have increment however a little drop in the selling costs. Significant yield of the organization is made up by nitrile gloves.The complete expenses of the gloves increments because of the high yield and increment in labor costs. Furthermore, the ongoing governments approaches about outside work have cause an extraordinary worry for the business. Hartalega need to alter the pay structure of their laborers because of the lowest pay permitted by law deciding that powerful from January 2013 that direct by the legislature. Rigid government administrative additionally is the danger for Hartalega. There are numerous administration guidelines and strategies should be follow by the organization, for example, the lowest pay permitted by law enactment, rules on cradle zones and more.If organizations neglect to keep or disrupt the norm that implement by government, it might bring them into inconvenience, for example, they may get punishment from the legislature. Next is monetary factor. Vacillation of US dollar, crude materials costs increment and fuel costs rising has bring an effect towards the gloves business with testing fina ncial conditions (Hartalega, 2013). Variance on US dollar has influenced the edges of the organization. The nitrile gloves have encountered declining its edges because of high crude materials cost and face rivalry with their competitors.Furthermore, interest for nitrile gloves have not influenced by financial emergency and log jam since it is a downturn evidence items and a basic thing in the medicinal services division. Hartalega expects the interest for nitrile gloves will keep up positive development later on and proceed with fare to different nations, for example, Europe, China and India. In financial factor, Hartalega may confront the danger of high latex cost. Latex costs change sporadically would make a danger to its edge. Flexibly of latex might be discounted because of the climate conditions just as measures to help elastic costs by Thailand and Malaysia.The dry season in Thailand and Malaysia would diminish the creation of latex. Along these lines, cost of latex during dry season will be somewhat higher contrast with other season. In the social factor, the yearly report of Hartalega has show that Hartalega has appreciate the 100% piece of the pie in Victoria, Australia since every open clinic in this state just utilized Hartalega’s gloves. Worldwide clinic supplies advertise likewise is one of the open doors for Hartalega. Individuals wearing gloves in the emergency clinic help to forestall spread of germs and help to shield both clinical staff and patients from infection.Hence, it additionally shows that Hartalega has a major chance to development around there. Hartalega can offer top quality and extraordinary determination of gloves to the emergency clinics or other industry, so an ever increasing number of individuals from all around the globe can pick and use Hartalega’s gloves. Opportunity that can be found in this factor is industry acknowledgment. Industry acknowledgment characterizes as the level of open mindfulness for the bran d or items. Hartalega has invested numerous amounts of energy in development, quality, R&D and great manufacturing.Thus, Hartalega has the chance to acquire acknowledgment from all around the globe as the organization constantly extends its business to more countries. Besides, mechanical factor is additionally one of the components that influence a dynamic capacities of the organization. Headways in innovation empowers Hartalega put them with an upper hand in the glove business. High effectiveness creation lines, robotized item dealing with framework, glove evacuation framework, process test system and biomass heat vitality plant are the advancements that utilized by (Hartalega, 2013).High productivity creation lines is the most recent rapid creation lines in the business which ready to deliver 40,000 bits of gloves for each hour. Computerized item taking care of framework used to evacuate deformity during travel, pressing and capacity. RFID labels are labeled in each bed, so th at can checking the item developments and ensure the items are on time conveyance to the clients. In addition, glove expulsion framework used to diminish the dependence towards the manual workforce. This framework additionally ready to expel nitrile and latex gloves rapidly from the hand moulds.Process Simulator empower the organization test their creative mind in an opportune way and guarantee brisk conveyance of another item to their clients. The open door that found in this factor is headway of innovation. Innovation progression empowers the organization produce more bits of gloves in a shorter time and better quality. In addition, computerized item taking care of framework that utilized by Hartalega additionally empower the organization can undoubtedly follow the area of the items and guarantees gives an on time conveyance to their clients. Last is natural factor.Hartalega has set up a â€Å"next age coordinated glove fabricating complex† (NGC) that contains high innovati on creation lines and basically associated with the creation of elastic gloves (Hartalega, 2013). The undertaking area is finished to be green and eco-accommodating condition. In addition, Hartalega has utilized biomass vitality plants to maintain a strategic distance from outflow of Greenhouse Gases (Hartalega, 2013). Biomass vitality plant is the main ecological inviting vitality plant in the business where it copy on the manor waste to create heat for the creation process.Hartalega additionally utilized gushing water treatment plants to guarantee the waste that the organization release is no damage to the earth. Biomass heat vitality plant permitted Hartalega to lead their business in a progressively powerful manner. Negative grumbling about contamination could a danger for Hartalega. In year 2010, Hartalega has gotten protests from Deputy Minister in the Prime Minister’s Dept and a few inhabitants of Taman Suria and guarantee that they are damage the natural guidelines th at set by government. Hartalega deny all the allegation and proclaim that they are working lawfully as indicated by the guidelines stated.Although Hartalega has express that they have autonomous investigators and advisors who consistently test water and air discharges to guarantee it is in every case full consistence with the prerequisites of government, however this additionally may happen again in the event that they didn't give adequate data and preparing that identifies with the green condition to their representatives. This likewise may influence the notoriety and the financial soundness of Hartalega and might caused the piece of the overall industry decline in this specific time period. 3. Industry Environment Industry condition is the idea to the closer view for the vital idea and business planning.This incorporates Porter 5 Forces that clarify the seriousness of the specific organization in the pertinent business. The key business director can utilize this model or technique to show signs of improvement comprehension of the business setting in which the firm includes so a powerful system to rival adversary can be created. There are 5 powers or factors to make the seriousness of the organization which is the danger of new participants, danger of substitutes, haggling intensity of providers, dealing intensity of purchasers and force of rivalry.Threat of the new contestants is the earnestness of the boundaries happened or introduced by the current contenders to the new contestants to enter the pertinent business or market. A high danger of en

Genetically Modified Food Essay Example

Hereditarily Modified Food Essay Example Hereditarily Modified Food Paper Hereditarily Modified Food Paper Definition: Genetically designed (GE) food alludes to any item containing or got from GMOs. Most as of late, biotech organizations have embedded herbicide-opposition qualities into wheat, fish qualities into strawberries, human qualities into fish and pharmaceuticals like contraception into corn. Hereditarily altered food alludes to the root of food from hereditarily adjusted living beings, created by hereditary designer. History: Scientists initially found that DNA can move between creatures in 1946. The principal hereditarily adjusted plant was created in 1983, utilizing an anti-infection safe tobacco plant. In 1994, the transgenic Flavr Savrâ tomato was affirmed by the FDA for showcasing in the US the change permitted the tomato to postpone maturing afterScientist testing food picking. In the mid 1990s, recombinant chymosin was affirmed for use in a few nations, supplanting rennet in cheddar making. In the US in 1995, the accompanying transgenic crops got showcasing approval:â canolaâ with altered oil creation (Calgene), Bacillus thuringiensis (Bt) corn/maize (Ciba-Geigy), cotton impervious to the herbicide bromoxynil (Calgene), Bt cotton (Monsanto), Bt potatoes (Monsanto), soybeans impervious to the herbicide glyphosate (Monsanto), infection safe squash (Monsanto-Asgrow), and extra postponed aging tomatoes (DNAP, Zeneca/Peto, and Monsanto). In 2000, with the creation ofâ golden rice, researchers hereditarily altered food to build its supplement an incentive just because. Points of interest of Genetically Modified Food Figure Naturally developed food Genetic modificationâ can produce bigger, hardier, more delicious, and increasingly nutritious nourishments. For instance, Strawberries are better, less acidic flavor; Soybeans have higher protein content, making them increasingly nutritious for domesticated animals and people. Better creation in lesser time, in this way giving food to more individuals. Have an expanded protection from decay with a superior time span of usability subsequently can be moved significant distances better time span of usability. : They are conceivably non-allergenic. Gives medication and nutrient inadequacy. For example, researchers have found Golden rice containing to help insufficiency of nutrient A causing visual deficiency for half of the total populace who live on rice. Normally developed food devoured by a child Provide more protection from maladies. These days, plants can be hereditarily changed to be better ready to endure abiotic boundaries, for example, chilly temperatures, heat waves, dry seasons, and poor soil sciences. Gives an expanded creation of eggs, milk and meat. Increasingly affordable to the rancher as far as creation of food. Gives improved strength of the populace and along these lines decreases the monetary weight. GE Saves the wild creatures. - Disadvantages of Genetically Modified Food Environmental activists, strict associations, open intrigue gatherings, proficient affiliations and different researchers and government authorities have every single raised worry about GM nourishments most worries about GM nourishments fall into three classes: natural dangers, human wellbeing dangers, and monetary concerns. Natural dangers: According to the World Health Organization (WHO), there is an undeniable danger of out-intersection, which alludes to the exchange of designed qualities (transgenes) from hereditarily adjusted harvests to ordinary, developed plants or to related yield species in nature. This may occur by methods for wind, creepy crawly fertilization, or other exchange. The remote qualities can cross with and sully these different species, bringing about a hybridization of the hereditarily altered yield plant with a non-GMO plant. This could fundamentally adjust whole biological systems if the crossover plants flourished. Out-intersection can likewise indirectly affect sanitation and security, as the defiled species advance into the natural way of life. Human wellbeing dangers: Perhaps the main wellbeing worry over GM innovation is itsâ capacity to make new allergensâ in our food gracefully. Unfavorably susceptible responses ordinarily are welcomed on by proteins. About each move of hereditary material from one host into another one outcomes in the making of novel proteins. Hereditary building can expand the degrees of a normally happening allergen effectively present in a food or supplement allergenic properties into a food that didn't already contain them. Outside hereditary material in a host can make other hereditary material in that host carry on inconsistently. One outcome of over articulation, for instance, can be disease. Wholesome issues can likewise result from the exchange.. GM crops have been connected to medical issues as various as conceptive harm, malignancy, Alzheimer’s sickness and diabetes. GMO isn't bolstered by numerous foundations Economic concerns: Bringing a GM food to showcase is a long and exorbitant procedure, and obviously agro-biotech organizations wish to guarantee a beneficial profit for their venture. Numerous new plant hereditary building innovations and GM plants have been protected, and patent encroachment is a major worry of agribusiness. However shopper advocates are stressed that licensing these new plant assortments will raise the cost of seeds so high that little ranchers and underdeveloped nations won't have the option to manage the cost of seeds for GM crops, therefore augmenting the hole between the well off and poor people. - Conclusion Hereditarily adjusted food (GMF) will play a significant factor in coming a long time for full filling the interest of expanding populace of universes as the food creations are not expanding as much as the populace. Notwithstanding that, GMF nourishments are increasingly conservative and brimming with supplements covering the every day need of a person which can't be give by normally delivered food Though, GMFs have confronted some emergency by various organization. However, we can't deny it’s significant as it can end up being an actual existence sparing choice for nations in Africa, which locals are confronting lack of healthy sustenance and protein insufficiency. Accordingly, GMOs ought to be viewed as an elective food as opposed to essential food classification except if more innovative work in this field is directed. List of sources 1. care2. com/greenliving/wellbeing dangers of-eating-gmo-nourishments. html#ixzz2c2VlMEok 2. naturalnews. com/029869_GMOs_dangers. html#ixzz2c2TE1wcs 3. naturalnews. com/029869_GMOs_dangers. html#ixzz2c2Ss2Bp7 4. http://en. wikipedia. organization/wiki/Genetically_modified_food_controversies 5. http://en. wikipedia. organization/wiki/Genetically_modified_food

Stanley Milgram Biography His Influence on Psychology

Stanley Milgram Biography His Influence on Psychology History and Biographies Print Stanley Milgram Psychologist Biography By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Updated on October 22, 2019 Isabelle Adam/Flickr/CC BY-NC-ND 2.0 More in Psychology History and Biographies Psychotherapy Basics Student Resources Theories Phobias Emotions Sleep and Dreaming Stanley Milgram was a social psychologist best-remembered for his now infamous obedience experiments.?? His research demonstrated how far people are willing to go to obey authority. His experiments are also remembered for their ethical issues, which contributed to changes in how experiments can be performed today. Learn more about his life, legacy, and influence on psychology in this brief biography. Best Known For The Milgram Obedience Experiment??Familiar Stranger??The Small World Experiment?? Early Life Stanley Milgram was born on August 15, 1933, to a family of Jewish immigrants in New York City. Milgram attended James Monroe High School, where he quickly earned a reputation as a hard worker and a strong leader and completed high school in just three years. One of his classmates was future social psychologist Philip Zimbardo. He earned his Bachelors in Political Science from Queens College in 1954. At this point, his interests shifted to psychology, but he was initially rejected from Harvard Universitys graduate program in Social Relations since he had never taken a single psychology course during his undergraduate years. He was eventually able to gain admission and went on to earn his Ph.D. in Social Psychology in 1960 under the direction of psychologist Gordon Allport.?? Career and Famous Obedience Experiments During his graduate studies, Milgram had spent a year working as a research assistant to Solomon Asch who was interested in conformity in social groups.?? Aschs famous conformity experiment involved having participants judge the length of a line. Milgram was inspired by the study  and went on to perform a similar experiment that would make him famous. He began working at Yale in 1960 and started conducting his obedience experiments in 1961. In these experiments, participants were ordered by an authority figure to deliver increasingly strong electrical shocks to another person. In reality, the other person was a confederate in the experiment and was simply pretending to be shocked.?? Surprisingly, 65 percent of the participants were willing to deliver the maximum voltage shocks under orders from the experimenter.?? In 1963, Milgram returned to teach at Harvard for a few years  but was not offered tenure largely due to the controversy swirling around him thanks to his infamous obedience experiments. City University of New York (CUNY) asked him to head up their newly formed social psychology program and in 1974 he published his book Obedience to Authority.?? Milgram remained at CUNY until his death on December 20,  1984, from a heart attack. Contributions to Psychology The 19 different experiments that Milgram conducted on obedience demonstrated that people were willing to obey an authority figure even if the actions went against their morals. The experiments are well-known today, mentioned in virtually every introductory psychology textbook. While Milgram himself was known for his concern for the well-being of his participants, his work was often harshly criticized for the possible negative emotional impact it had on subjects.?? Part of the reason why the American Psychological Association established standards for working with human subjects and why Institutional Review Boards exist today is because of Milgrams work. In his 2004 biography, author Thomas Blass noted that social psychology is often dismissed as something that simply proves so-called common sense.?? Through his surprising results, Milgram was able to demonstrate that the things we think we know about ourselves and our behavior in social groups may not necessarily be true. In essence, Milgram was able to shine a light on a subtopic of psychology that some may view as unimportant, but that in reality reveals important truths about human behavior. A substantial proportion of people do what they are told to do, irrespective of the content of the act, and without pangs of conscience, so long as they perceive that the command comes from a legitimate authority, Milgram explained of his work.?? A Word From Verywell Milgrams research on obedience shocked people back during the 1960s, but his findings are just as relevant and stunning to this day. While recent findings have suggested that there may have been problems with his experimental procedures, replications of his work have found that people are surprisingly willing to obey authority figures - even when they know the orders they are following are wrong.

There is a general discord among stakeholders on the...

There is a general discord among stakeholders on the definition of irregular warfare and where the term and concept fits within the joint and the individual services’ doctrine. The 2010 Quadrennial Defense Review report uses the term â€Å"irregular† only once in its one hundred and five pages and only in terms of a focus on building the joint force’s capability and capacity to deal with irregular warfare while maintaining a clear conventional and nuclear global superiority. Currently, the definition is ambiguous and results in conflict or duplication of efforts across Department of Defense stakeholders. For the purposes of this paper, the stakeholders discussed are the Army and the Marine Corps. Stakeholders must reach a consensus and clearly†¦show more content†¦These threats are a combination of regular forces that are governed by the law of land warfare, military custom, tradition, and unfettered forces that act with no limitations on violence or th eir targets to reach their objective. Further, the players may involve state actors that employing protracted forms of warfare through proxy non-state forces using operational models and technological capabilities usually associated with formal states. Such diverse elements allows hybrid threats to exploit vulnerabilities with the exact capability to make them particularly effective. U.S. Army Doctrinal Publication (ADP) 3-0, Unified Land Operations, provides the basis for Army support of unified action by governmental and non-governmental entities through land operations. Army forces wage regular and irregular warfare against both conventional and hybrid threats via synchronized offensive, defensive, and stability operations, or defense support of civil authorities. Through Decisive Action, the Army the Army conducts warfare against conventional and/or hybrid threats, regardless of any joint doctrinal definition of irregular warfare. GEN Charles Krulak provides the best example of how the Marine Corps conceptualizes irregular warfare as fused together with traditional warfare. In the 3 Block WarShow MoreRelatedSSD2 Module 4 Notes Essay28478 Words   |  114 Pagesspecific culture is necessary. Individual characteristics and personalities vary greatly within one culture. To attribute one characteristic to everybody in a culture is called stereotyping. Cultural relativism is critical for understanding the locals among whom you work, but some cultural differences, particularly regarding ethics, cannot be brushed aside. Things we hold to be fundamentally wrong—abrogation of human rights, for example—may require us to impose our outsiders ethical standards on locals

The Great Recession Of 2008-9 - 1850 Words

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Simplistic approach to grouping children education essay Free Essays

string(170) " with a peculiar student or group aˆ\?not understanding what is wanted from them aˆ\?not holding support for the undertaking they have been set aˆ\?sharing resources\." Within this essay I will be concentrating on the class of emotional and behavioral troubles. I will be foregrounding many key characteristics throughout the essay such as, function of the instructors speaking about the pastoral responsibilities and the accomplishments instructors need to be able to provide for the kid with an extra demand, effects the job may hold on larning for an person and besides the remainder of the category, here I will concentrate on how their extra demand may impact the kid personally and accomplishment in school, I will so travel on and speak about how a instructor can accommodate their lessons to run into the student ‘s demands and eventually issues in labelling the pupils with the extra demand. ( Woolfolck et al, 2007, p165 ) states â€Å" Emotional and behavioral upsets are behaviours that pervert so much from the norm that they interfere with the kid ‘s ain growing and development and/or the lives of others † . We will write a custom essay sample on Simplistic approach to grouping children education essay or any similar topic only for you Order Now 30 % of primary and 38 % of secondary kids identified with these extra demands. ( DfES, 2004 ) . Students with EBD are frequently seen to hold a much clearer and greater job than moodiness or mischievousness but non so expansive to be classed as a mental unwellness. Difficult kids can deliberately interfere with or distract others, and withdrawn or dying kids may fight with concentration taking them to fall behind in category. ( Long, 2000 ) Hollahan and Kauffman ( 1994 ) suggest there are two categorise in puting kids with an emotional and behavioral upset in these are internalizing and projecting. They believe that kids who tend to be overactive, uncooperative, rebelliousness, hostile and cruel are demoing projecting behavior. However students who have jobs with, societal backdown, guilt, depression, anxiousness and hapless equal dealingss are demoing marks of internalizing behaviors. By categorizing these features you can see that projecting behaviors are a batch more open and pull most attending, whereas internalizing behaviors frequently go unnoticed as they do n’t hold the high profile of projecting behaviors. A instructor ‘s function in the schoolroom is critical, they are responsible for supplying and developing larning to provide for all kids within the schoolroom. As long suggested in his quotation mark there has been a move off from the simplistic attack of holding groups of kids separated and it has become a batch more inclusive. â€Å" Based on the impression that it is the right of all scholars to a quality of instruction that meets basic larning demands † ( www.unesco.org/education accessed on 30 November 2010 ) . Furthermore to this quotation mark the inclusion of all students in mainstream schoolrooms and schools is portion of a great world-wide human rights motion, which calls for the full inclusion of every individual student in all facets of life. One scheme a instructor may utilize to make with inclusion is if they have students with EBD is to seek and nature all kids to go friends and construct a great resonance with them, by making this the student will go to experience like he/she is portion of something and experience a batch more confident in acquiring involved in working with equals they know good. This may besides cut down misbehaviors due to the fact the kid may non desire to allow down the remainder of their equals who are now friends etc. The instructor ‘s function in descrying the troubles is important. It is of import to place EBD every bit early as possible so that support can be provided. A student with suspected EBD should hold their behavior monitored closely so that experts can measure the student ‘s demands. For illustration, you could believe of a student ( or group of students ) and look into their behavior against following typical incidents. Children with emotional and behavioral troubles require many different types of pastoral demands. Clebsc and Jackle specify pastoral attention as â€Å" assisting Acts of the Apostless, done by representative individuals, directed toward mending, prolonging, steering and accommodating of troubled individuals whose problems arise in the context of ultimate significance and concerns † ( Grossoehme, 1999, p3 ) . Children with this upset may, happen it hard to organize friendly relationships, frequently appear preoccupied and hence happen it hard to acquire involved in activities, have trouble maintaining on undertaking and even in some utmost instances have a phobic disorder of school itself. It is the instructor ‘s duty to descry these features and trade with them suitably. Teachers who have students in their category with EBD have many pastoral duties and accomplishments to be able to run into the demands of that specific kid. Apart from parents, instructors see the kid m ore than anyone else and could be an of import beginning of description for professionals outside the schoolroom. The pastoral mundane occupations of all instructors include, advancing and safeguarding the wellness, wellbeing and safety of students, supplying advice and way to pupils on issues related to their instruction, working in partnership with parents, support staff and other professionals and lending towards good order and the wider demands of the school. More focussed on assisting students with EBD there are a scope of undertakings they will necessitate to transport out, these are things like taking an active involvement in the behavior of the students, promote good behavior and offer them support and besides promote them to increase accomplishments or even maintain high degrees ( hypertext transfer protocol: //www.snct.org.uk/library/127/Glasgow_LNCT_-_pastoral_care.pdf accessed on 1st December 2010 ) . However it is the instructors function to besides run into these demands, kids with EBD do non cognize how to act and make non understand how their behavior affects other kids in the category. It is cardinal to demo them different ways to act and to be inexorable on good behavior. Normally unsuitable behavior has a trigger point. Identifying this can assist you to step in and halt the behavior happening. Common trigger points when students are working in groups or in categories include such things as: aˆ?moving around the room ( to roll up stuff ) aˆ?sitting with a peculiar student or group aˆ?not understanding what is wanted from them aˆ?not holding support for the undertaking they have been set aˆ?sharing resources. Equally bad behavior and good behavior are learned and you can pattern the sort of good behavior that all students ( and particularly those with EBD ) need in order to work expeditiously in school ( hypertext transfer protocol: //www.napta.org.uk/art_ebd.html accessed on 1st December 2010 ) . There are many policies on run intoing the particular educational demands of kids. Such as the SEN Code of Practice which was effectual from January 2002 this policy takes history of the Particular Educational Needs and Disability Act ( 2001 ) and â€Å" provides practical advice to Local Authorities, maintained schools, early instruction scenes and others on transporting out their statutory responsibilities to place, buttocks and do proviso for student ‘s particular educational demands. Nevertheless â€Å" Removing Barriers to Achievement- the Government ‘s Strategy for SEN † ( 2004 ) , is the chief policy which focuses on early intercession they outline many schemes which include taking barriers to acquisition, raising outlooks and Achievement and eventually presenting Improvements in Partnership. ( Reference ) Some emotional and behavioral jobs may be impermanent and can be dealt with utilizing standard pastoral schemes. But others are so complex that outside professionals need to be involved to assist the kid header with day-to-day life and acquisition. There are many support bureaus who work closely with schools to assist kids with their jobs, such as societal emotional and behavioral troubles association and besides immature heads. â€Å" Young Minds is the taking charity committed to bettering the emotional well-being of kids and immature people and authorising their parents and attentions ( hypertext transfer protocol: //www.youngminds.org.uk/ accessed on 3 December 2010 ) . They run many runs and undertakings to acquire the best out of the kids who are enduring from emotional troubles. Besides the kid may be referred to the Childhood and Adolescent Mental Health Service unit which is normally located at a local infirmary. Or you can inquire for the kid to be seen by the Educational Psychologist or a Pediatrician. The jobs may go so terrible the kid may hold to see a Consultant Psychotherapist one time a hebdomad or more and if it ‘s doing jobs with the whole household so they may see a Family Counsellor every other hebdomad. Unfortunately holding EBD may impact a student ‘s development and besides educational accomplishment in schools. Children with EBD are at great hazard of under-achievement, educationally and in their personal development. They can besides interrupt the instruction of others. Many jobs may happen within the school scene for both the instructor and student, they frequently experience troubles such as, have trouble maintaining on undertaking, frequently become tearful or throw fits for no evident ground, have low self-esteem and frequently become victims of toughs, become toughs themselves, be overly attention-seeking through either negative behavior or clinginess and underachieve in many countries of the school course of study. As you can conceive of a kid who performs all these features is traveling to happen it difficult to larn anything in the schoolroom and hence non accomplish his/her best. This is what causes non merely the kid to fall behind but may besides hold an impact on the remainder of the category, for illustration if a kid is persistently being riotous and naughty at some phase the instructor must step in and take action, due to this the whole category is traveling to be disturbed for nevertheless long it takes to settle the kid down or take him/her. As I suggested the kid may go a bully this causes extra jobs for the instructor and besides the other students. The UK authorities defines strong-arming as â€Å" Repetitive, willful or relentless behavior intended to do injury, although one-off incidents can in some instances besides be defined as intimidation. Intentionally harmful behavior, carried out by an person or a group. An instability of power go forthing the individual being experiencing defenseless † ( House of Commons, Education and Select Committee, 2007: 7-8 ) . This is a major issue for the instructor as the negatives of strong-arming are tremendous it may do absence, detachment, bead out physical/mental unwellness, self injury and will hold a negative impact on learning. This is why it is of import for the instructor to step in every bit shortly as possible, by following the anti intimidation policy all schools have. Interventions a instructor may utilize can be split into two groups institutional and educational, institutional tactics may be things such as better supervising needed, disciplinary action and partnerships e.g. charities, constabulary. On the other manus educational tactics are seen to concentrate more on schoolroom work and peer mentoring. This may affect the kid partner offing up with a good behaved kid in category and hopefully larn from this equal how to act whilst in the schoolroom. Evidence from the survey of advancing wellness and well-being shows that undertaking strong-arming improves behaviour, attending and academic accomplishment throughout the school ( www.nice.org.uk/niceMedia/documents/promoting_health_wellbeing.pdf accessed 5 December 2010 ) . There are many different schemes a instructor can utilize to run into the demands of the kid with the extra demand depending on whether it is an emotional demand or a behavioral job. For illustration one scheme a instructor may utilize if a student is invariably misconducting is to seek and promote the proviso of a positive schoolroom environment, the existent layout of a schoolroom is besides really of import for a instructor. As ( Kyriacou, 2001, p 74 ) states the â€Å" general visual aspect of a schoolroom indicates to the students the attention that goes into supplying them with an environment which is contributing to larning. A clean and good maintain room, with appropriate resources of grounds, comfy, light and good aired, helps set up a positive outlook towards a lesson † . It has a strong consequence on pupils larning, behavior and what will really go on inside of the schoolroom. The subject program study by ( Elton, 1989 ) found that there was a connexion between the visual aspect of their schools and the behavior of their students. He recognised that even though there is no grounds that the environment of the school may hold an impact on student ‘s behavior but states â€Å" there is a much clearer grounds of nexus between shabby, untidy schoolrooms without postings, workss or shows of pupils work and poorer criterions of behavior. Teachers on a twenty-four hours to twenty-four hours footing have to undertake a broad scope of misbehavior from bordering out and naming out, non holding right equipment, noisy and late students. Discipline is one of the most nerve-racking facets of a instructors demanding function, they need good planning and accomplishment along with a personality. Teachers identify good schoolroom control and direction ( 32 % ) , as one of the most of import qualities that a instructor should hold † ( Atici, 2007 p15 ) . A instructor ‘s personality and instruction manners have a monolithic impact on a kid with EBD. Good teacher- pupil relationship is based on common regard ( Petty, 2004 ) . Teachers must demo a echt involvement in each and every one of their pupils. Knowing their students as persons, which means cognizing at that place names, personalities, involvements and who their friends are. This can assist as if the instructor knows a student good they can possibly accommodate the lesson. Besides if a instructor is familiar with the kid personally and has encountered he/she has a job they can compromise with the student and non set as much force per unit area on the students in footings of acquiring their work done category and even prep. Teachers can besides construct a resonance with the students by happening out their involvement, what they like and what they dislike. By making this instructors can so set this into pattern whilst learning. Teachers must train their pupils when they are acting severely as I mentioned earlier on, if a instructor has a positive relationship it will be easier for the pupil to accept the countenance and to re-establish a working relationship. Another scheme a instructor may utilize to battle bad behavior is the usage of wagess and countenances. Wagess are really powerful tools a instructor can utilize. All instructors use wagess and countenances even if they do non like the thought of giving awards, congratulations, fondness and attending in a rewarding manner. It is the most effectual manner of reenforcing good behavior and to demo the kid how supplications you are. The behavioral attack believes that the most of import factor in larning behavior is what happens instantly following that behavior. Pleasant effects are more likely to reenforce behavior and do it more likely to go on once more. For instructors, this means it is critical on how they manage the usage of wagess ( Smith, 1993 ) . The wide-ranging pattern of schoolroom direction involves a figure of wagess giving to the kids on a day-to-day footing. However it is really of import particularly for a kid with a behavior job that wagess are refreshed on a regular b asis. As ( Cowley, 2006 ) states â€Å" a peculiar wages might work good with the students at first, but so may bit by bit run out of steam as the kids get used to having the same wages † . Sanctions are besides really of import, kids need to be cognizant of the effects they face when interrupting regulations. Sanctions may take the signifier of losing out on interruption and tiffin times, if a kid tends to be executing or acting severely in an unacceptable manner, the instructor must use their authorization. There are many issues a instructor may hold to be careful of in categorising and labelling pupils with an extra demand. If a instructor suspects that a kid has an extra demand they should non merely presume and name this kid with the upset. I believe there are several things to make foremost, the instructor should put up a conference with the parents to explicate his/her concerns. If the instructor has grounds that shows the kid is non executing at the degree they should be, so that grounds should be considered. As I stated earlier, instructors spend more clip with kids during the school twelvemonth than parents do, so the instructor should be able to state reasonably easy whether a kid is underperforming or non. A kid enduring from EBD may derive a label, by holding this label may do unfortunate affects for the childand attracts a broad array of labels, which in themselves can be really harmful to kids. As Rutherford et Al, 2004 pg 39 suggests â€Å" First many kids identified as h olding an EBD do non like there label, Second a label may motivate instructors to follow lower behavior and achievement outlooks for the labeled kid † . If the kid becomes cognizant of this they may get down to execute to the lowered outlook the instructor has given them which is known as ego carry throughing prognostication. This could reflect on the kids and there future places within society, seeing it has normal and expected to be looked down upon. The manner in educating kids with particular educational demands has changed drastically over the old ages, e.g. segregation, integrating and inclusion. First the position was that SEN ‘s students should be segregated into specialist SEN schools which are specially built installations to suit there extra demands which are accessed by other students with a similar extra demand. There are many pros and cons for this type of instruction, as some see this as the best solution due to the students holding specialised instruction and schools set up for their extra demands nevertheless some disagree and argue that pupils learn from their equals so in footings of the extra demand of emotional and behavioral troubles if kids are in categories full of other kids with similar jobs so they will merely larn from them whereas if they were in mainstream categories they could pick up good behavior features from their equals. As the instruction procedure moved on integrating based schools go mor e popular. Schools are connected at a individual point and portion right to utilize to common installations such as dining halls. The connexion points between schools and the activities that can be accommodated at that place give a strong feeling of the relationship between the two and their attack towards the integrating of pupils. So this attack would hold students with extra demands being taught in a separate portion of the school but so will be involved in assemblies and have dinner the same clip as the other kids in that school. Finally there is the inclusion position this is where all students are educated in the same classes despite of the fact they may hold extra demands. This is the position that Long supports and what are common today. Within instruction there has been an increased emphasis on inclusion through a figure of statute laws such as national course of study ( 2000 ) , statuary inclusion statement, SENDA and the revised codification of pattern. Evidence from the DFES ( 2007 ) suggests that there is a greater focal point on inclusion and that from twelvemonth to twelvemonth the figure of kids with a SEN who are go toing a mainstream school is lifting. ( Hodkinson and Vickerman, 2009 ) My findings show that the function of the instructor is critical when it comes to working with kids with EBD. They must non merely spot the job the kid is making but besides trade with it efficaciously. This means they have a great duty and many accomplishments to guarantee they provide the best possible attention of the kid. A instructor with good accomplishments are able to set up good relationships with their students, they have the accomplishment in being able to make a schoolroom clime which students are able to derive popularity without doing problem. I besides found that holding EBD non merely affects the kid ‘s wellness and good being but besides causes them to underperform within school because of things such as low outlook and ego regard. Finally I established that labelling kids can besides hold a major consequence non merely in school but it can besides be taking outside of the schoolroom into ulterior life. REFERENCES – One complete alphabetical list with no sub-headings Atici, M ( 2007 ) . A small- graduated table survey on pupil instructors perceptual experiences of schoolroom direction and methods for covering with misbehaviors, Emotional and Behavioural Difficulties, Volume 12, Issue 1 March 2007, pages 15 – 27 Cowley, S ( 2006 ) . Geting the sodomites to act, London, Continuum International Publishing Group Elton, L ( 1989 ) . Discipline in schools, London, Her Majesty ‘s Stationary Office. Grossohme, D ( 1999 ) . The pastoral attention of kids. New York: The Howarth pastoral imperativeness. Hallahon, D and Kauffman, J ( 1994 ) . Exceeding kids: Introduction to particular instruction. 9th Ed. New York: Pearson Education. Hodkinson, A and Vickerman, P ( 2009 ) . Key issues in particular educational demands. London: Sage publications. House of Commons, Education and Select Committee, 2007: 7-8. Kyriacou, C ( 2001 ) . Essential instruction accomplishments, Cheltenham, Stanley Thorne ‘s Publishers Long, M ( 2000 ) . The psychological science of instruction. Oxon: Routledge husbandman. Petty, G ( 2004 ) . Teaching today, Cheltenham, Nelson Thorne ‘s ltd Rutherford, R, Quinn, M and Mothur, S ( 2004 ) . Handbook of research in emotional and behavioral upsets. New York: The Guilford imperativeness. Smith, C and Laslett, R ( 1993 ) . Effective Classroom Management, London, Routledge Woolfolk, A, Hughes, M and Walkup, V ( 2007 ) . Psychology in instruction. Essex: Pearson Education. hypertext transfer protocol: //www.napta.org.uk/art_ebd.html www.nice.org.uk/niceMedia/documents/promoting_health_wellbeing.pdf hypertext transfer protocol: //www.snct.org.uk/library/127/Glasgow_LNCT_-_pastoral_care.pdf www.unesco.org/education hypertext transfer protocol: //www.youngminds.org.uk/ How to cite Simplistic approach to grouping children education essay, Essay examples

Murders in the Rue Morgue Essay Example For Students

Murders in the Rue Morgue Essay And with three quick moves they are in checkmate. Dupin masterfully explains the details of what happened, how the intruder climbed up to the fourth story windows and becoming frenzied killed both of the LEspanaye women, throwing one out of the window and stuffing the other up the chimney. Dupin does not concern himself with motive but rather looks at the details and makes an educated inference. Using all the evidence and the oversights of the police he is able to resolve the case with ease. He proves that the polices basic surface plan of attack didnt work, and that there is no method to their proceedings, beyond the method of the moment. He proves that they are not worthy components. And in the last paragraph we see the final defeat, the checkmate and match. Dupin has saved Le Bon (which ironically means the good), the man charged with the murders, and has defeated the police in their own game even though they tried to castle. 1 The police unconsciously tried to protect the Ourang-Outang by blaming Le Bon, but the truth (Dupin) prevailed, or in other words, the superior acumen prevailed even over a vigilant concentration. The functionary, however well disposed to my friend, could not altogether conceal his chagrin at the turn which affairs had taken, and was fain to indulge in a sarcasm about the propriety of every person minding his own business. Let him talk, said Dupin, let him discourse; it will ease his conscience. I am satisfied at having defeated him in his own castle. It seems these two sides have played before and that Dupin always prevails even when the other side always tries to castle to protect their ideas and pride. Poe revels in the extraordinary, and his attention to every minute detail is what makes his stories a game, a wild puzzle to solve. His characters thrive on enigmas, conundrums, and hieroglyphics; exhibiting in their solutions each degree of acumen which appears to the ordinary apprehension praeternatural. His results, brought about by the very soul and essence of method, have, in truth, the whole air of intuition. And this is the whole game of life, to live and to write the future and to figure out mysteries that baffle us. This is Dupins clever technique to solving mysteries and the conundrum of this story, and is one maybe we should employ once we grasp it:De nier ce qui est, et dexpliquer ce qui nest pas: to deny what is, and to explain what is not. 1Castling is a move in chess where a player will protect his king from checkmate by moving his castle over and next to the king forcing the king out of his middle position and over to either side of the board.

Steinbeck, John Parallels Essay Example For Students

Steinbeck, John: Parallels Essay Common GroundIn many of John Steinbecks works there are themes and elements thatparallel his other works. Steinbeck often tackles the result of peoplesbad fortune and the realization that their dreams have been destroyed. Wecan see that in his Pulitzer Prize winning The Grapes of Wrath and hiscritically acclaimed novel Of mice and Men Steinbeck shows us the results of people having their dreams destroyed. Steinbeck shows us that in his work hegives different characters similar goals and aspirations and has themdestroyed in similar ways. In both of the above mentioned books key characters have their dreamsdestroyed. Steinbeck often created characters possessing lofty goals;lofty goals in a world of despair and corruption. His characters did not havea dream of tangible luxuries, but a dream of corporal well being andrefuge with loved ones(Thomas 238). In Of Mice and Men, Lennie and George travel to California in order to find work. Once they salvage up enough money,Lennie and George pl an on being independent and not worrying about the outsideworld and its enigmas. George stated Someday were gonna get all thejack together and were gonna have a little house and a couple of acres an acow and some pigs. (Roberts, 187). Georges dream ran deeper than a lovefor farming and independence. The motivation for this dream was not just aproduct of the poor state of the country and widespread unemployment,but it was a dream that could ensure a happy ending for Lennie. George isanxious to secure his own place so that Lennie can live the type of life wherehe can be happy and not be hurt by people who do not understand his simpleways. George would run the farm; Lennie would tend the rabbits. This wasLennies dream, to tend the rabbits. He could think of nothing else moreenjoyable than tending the rabbits. Lennies dram is to have all the rabbits that hecan take care of, and his attempts to do the right thing are motivated by hisfear that George wont let him take care of the rabbits. (Tedlock 243). In TheGrapes of Wrath the Joad family also dreams of moving out west. They do this inhopes of escaping the direful situation in Oklahoma. Gonna buy a carand shove out west where its easy living. (Steinbeck 57). The Joads likeLennie and George plan on saving up enough money for their own plot of land. We will write a custom essay on Steinbeck, John: Parallels specifically for you for only $16.38 $13.9/page Order now Once this task is accomplished they hope to live a self-sufficient life andrely on one another. They believe that once in California they will find lifeeasier and find all they need in surplus. Jus let me get out to California whereI can pick me an orange when I want it. Or grapes, theres a thing I aintnever had enough of. Gonna get me a whole bunch of grapes off a bush, or whatever,an Im gonna squash em on my face an let em run off my chin.(Steinbeck105). There is clearly a parallel between the themes of these two books. Asboth works have the same basis for the characters dreams. How the dreammwas destroyed George and Lennie never had their dreams come true. Whenthey arrived at the homestead for work; George and Lennie at once felthostility from the ranch owners son Curley. Curley was a sinistershort-tempered man possessing little physical stature. From Curleysfirst encounter with Lennie, Curley was looking for an excuse to fight thesimple-minded Lennie. Curley develops a hatred for the bigger man whichwill be expressed in his desire to mutilate Lennie in the final scene.(Magil 4296) Lennie ended up killing Curleys wife. This was not a malicious acthowever. It was an accident that had an unfortunate consequence. .ufd476a9ea7ff16b2097a9591455d9366 , .ufd476a9ea7ff16b2097a9591455d9366 .postImageUrl , .ufd476a9ea7ff16b2097a9591455d9366 .centered-text-area { min-height: 80px; position: relative; } .ufd476a9ea7ff16b2097a9591455d9366 , .ufd476a9ea7ff16b2097a9591455d9366:hover , .ufd476a9ea7ff16b2097a9591455d9366:visited , .ufd476a9ea7ff16b2097a9591455d9366:active { border:0!important; } .ufd476a9ea7ff16b2097a9591455d9366 .clearfix:after { content: ""; display: table; clear: both; } .ufd476a9ea7ff16b2097a9591455d9366 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ufd476a9ea7ff16b2097a9591455d9366:active , .ufd476a9ea7ff16b2097a9591455d9366:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ufd476a9ea7ff16b2097a9591455d9366 .centered-text-area { width: 100%; position: relative ; } .ufd476a9ea7ff16b2097a9591455d9366 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ufd476a9ea7ff16b2097a9591455d9366 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ufd476a9ea7ff16b2097a9591455d9366 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ufd476a9ea7ff16b2097a9591455d9366:hover .ctaButton { background-color: #34495E!important; } .ufd476a9ea7ff16b2097a9591455d9366 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ufd476a9ea7ff16b2097a9591455d9366 .ufd476a9ea7ff16b2097a9591455d9366-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ufd476a9ea7ff16b2097a9591455d9366:after { content: ""; display: block; clear: both; } READ: Protection Of Endangered Species EssayLennies greatest difficulty is remembering. While he never plans to do anythingwrong, he simply cannot remember what is wrong and what is not. (Magil89). That consequence being the death of Curleys wife, and that Curleyordered the men to kill Lennie. The workers assembled and took up arms. George knew that the men were not out to right a wrong, but out to seekvengeance. George decided that he must kill Lennie. George knew thatthis was the only solution that would spare Lennie the misery that would beinflicted on him by Curley and his men. Like George and Lennie the Joadsnever saw their dreams materialize. They to were victims of the greed ofthis time period. The people of the west were averse to change. They wereafraid of the migrants because of their different life styles. Sure they talkthe same language, but they aint the same. Look how they live. Think any of uswould live like that? Hell no! (Steinbeck 302). The Joads soon learned thatthe people of the west actually hated the Oakies. A man returning back tothe Midwest from California told of the troubles to be found ahead. Peoplegonna have a look in their eye. They gonna look at you an their facesays, I dont like you, you son-of-a-bitch. Gonna be deputy sheriffs an theyllpush you aroun. You camp on the roadside an t heyll move you on. You gonnasee in peoples faces how they hate you.(Steinbeck 306). As the Joads arriveinto California they see that their dreams will go unanswered. The landlooked beautiful but the circumstances would not allow for prosperity. Lookinginto the valley the Joads regret that theirs cannot be the tranquil life thatit promises.(Tedlock 40). The dreams of George of and Lennie weredestroyed as a result of apathy. Throughout this novel we can see how Steinbeks characters have atotal lack of interest in others well being. In the first chapter thebus driver drops George and Lennie off miles from their destination. The driver didthis just to spare himself a few minutes of work. The dream was not destroyeddue to killing of Curleys wife at the hands of Lennie. But as a resultof Curleys lack of empathy. If Curley were more understanding andconsiderate of Lennies condition the dream may have grown and bloomed into reality. However given the circumstances George had no choice but to sacrifice heand Lennies dream so that Lennie would not suffer at the hands ofCurley. George decided that the only solution was to kill Lennie. The Joads alsohad their dreams destroyed at the hands of apathetic people. The Joads weretreated and looked at by the ranch owners like a team of oxen. They wereexpected to work long and hard hours for insulting wages. The authorities didnot have any concern for the poor who were being taken advantage of. Children were not even spared from the work and, like their parents wenthungry. The kids yo ought to see them. Little boils, like comin out,an they cant run around. Give em some windfall fruit, an they bloated up.(Steinbeck 363). They turned their heads away from the atrocities thatwere taking place in front of them, and bowed their heads to the almightydollar. The migrants had no choice if they wanted to work. If they refused thewages somebody else would be glad to take the job. Sup pose you got a job anwork, an theres jus one fella wants the job. You got to pay him whathe asts. But suppose them men got kids, an them kids is hungry. Spose adimell buy a box of mush for them. An you got a hundred men, jus offer em anickel. Why, theyll kill each other fighting for that nickel. .u0eab4a858f68d60c94344c7443f2c695 , .u0eab4a858f68d60c94344c7443f2c695 .postImageUrl , .u0eab4a858f68d60c94344c7443f2c695 .centered-text-area { min-height: 80px; position: relative; } .u0eab4a858f68d60c94344c7443f2c695 , .u0eab4a858f68d60c94344c7443f2c695:hover , .u0eab4a858f68d60c94344c7443f2c695:visited , .u0eab4a858f68d60c94344c7443f2c695:active { border:0!important; } .u0eab4a858f68d60c94344c7443f2c695 .clearfix:after { content: ""; display: table; clear: both; } .u0eab4a858f68d60c94344c7443f2c695 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u0eab4a858f68d60c94344c7443f2c695:active , .u0eab4a858f68d60c94344c7443f2c695:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u0eab4a858f68d60c94344c7443f2c695 .centered-text-area { width: 100%; position: relative ; } .u0eab4a858f68d60c94344c7443f2c695 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u0eab4a858f68d60c94344c7443f2c695 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u0eab4a858f68d60c94344c7443f2c695 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u0eab4a858f68d60c94344c7443f2c695:hover .ctaButton { background-color: #34495E!important; } .u0eab4a858f68d60c94344c7443f2c695 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u0eab4a858f68d60c94344c7443f2c695 .u0eab4a858f68d60c94344c7443f2c695-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u0eab4a858f68d60c94344c7443f2c695:after { content: ""; display: block; clear: both; } READ: Buddhist Art In Japan Essay(Steinbeck 324). It was a rat race. The only way to get ahead in the world portrayed bySteinbeck was to turn your back on your fellow man. In these to works of Steinbeck the plight of the migrants is examined. Often its the wealth of the landowners pitted against the poor. In bothworks this wealth has molded the authorities into cold heartless men. Thesegreedy individuals destroy the dreams of the migrants. The villainouscharacters he portrayed only had a sense of present pleasure. They had no concern forthe fact that at the present moment a child had no life or food. The lowerclass had no way of getting ahead. Steinbecks charecters never had theirdreams materialize into achieved goals. This was true in both of Steinbecksabove mentioned works. George and Lennies followed their dream only to have itturn into a nightmare. The Joads journey led them from the barrenandsterile land, to the green, fertile yet poisonous land. In the end dreams turnedout to be just that, dreams, nothing more.

The Salem Witch Trials Essay

The Salem Witch Trials Essay The Salem Witch Trials Essay The Salem Witch Trials The Salem Witch Trials were a series of court hearings and prosecutions of people accused of performing witchcraft and other supernatural abilities in colonial Massachusetts. These occurred between February 1692 and May 1693. Although they are referred to as the Salem witch trials, the preliminary hearings were done in various towns: Salem Village, Ipswich, Andover, and Salem Town. These trials had a lasting effect on a multitude of things in the formation of the United States of America and its colonies. The trials brought about warnings of isolationism, religious extremism, false accusations, and profiling based off of social class. Thanks to these trials, America was able to take caution in them to help them eventually form the great country it is today. In order to completely understand the effect of the trials it is necessary to have a little information from the trials. Salem was originally founded in 1626 by a group of European fisherman. Over the years it had gotten a little larger of a town, but never too big. Overall in the incident, around 24 people died because of their accusations of being a witch; whether from being executed, tortured in order to get information, or being killed while in prison. Isolationism really added in influencing the mass hysteria of the people of Salem. They were all so far away from everyone else they essentially had no ways of communicating with anyone at all and they rarely got any news of anything. They were never being updated with cultural norms and were all very traditional. So when they noticed something out of the ordinary, they would all assume that it was something not normal and evil. Supposedly, the witch mania began when two little girls started playing around with fortune telling that their slave had told them about. The girls started having strange fits, and according to a doctor, this was happening because they had been bewitched. Instead of going towards a reasonable response, they automatically go towards any answer that just seems okay. They are not used to cultural norms and what now may be accepted and what may not be, and since they were out in the middle of nowhere, nobody could stop them. Eventually it goes to tell that the sl ave was arrested (along with two other women who were assumed to be witches because one had drinking parties and the other had been married three times) and were put on trial for the â€Å"horrible crime of Witchcraft†. This isolationism lead to eventually make the United States realize that you cannot leave a town alone because then they would have no idea what is going on. You need communication with everyone to help maintain a healthy and strong community. Religious extremism most likely had the biggest effects on the trial being that they were the basis of most accusations. Massachusetts’s government was dominated by conservative Puritan secular leaders. Specifically in Salem Village, the church governed their life. Being that they were primarily Puritans, they had a strong tie associating Satan with sickness, misfortune, and anyone going against their religious beliefs. If they then associated you with Satan, they would associate you with witchcraft. They believed that witches had made a pact with Satan and that they should be punished for dealing with the devil. These religious extremities lead to the executions and prison sentences of a multitude of women, men, and children. They let their religious belief overcome them and wouldn’t even resort to common sense to deal with a fairly reasonable problem. The people also wanted to be able to feel comfortable that they had an answer to these problems, instead of leaving it unsolved completely and be worrying about it and being scared of these people. They wanted to prove themselves superior to others. In modern United States court of law, it is highly illegal to base an accusation against someone based off of supernatural and

Physical chemistry Essay Example | Topics and Well Written Essays - 2000 words

Physical chemistry - Essay Example An understanding of the Le Chateliers principle and catalysis is essential for proceeding with this study. Increase in temperature: Exothermic reaction favours reactants, as the heat is absorbed to counterbalance the increase in temperature. Endothermic reaction favours products as the absorbed heat facilitates a larger amount of reactants to convert to products (Atkins & de Paula, 2006). Change in reactant concentration: An increase in concentration of a reactant in a dynamic equilibrium causes the reaction to favour products, as the excess reactant reacts with other reactants. A decrease in concentration of a reactant favours the reverse reaction as the products are converted to reactants in order to balance the decrease in reactant concentration. (Clark, 2002; Morrison & Boyd, 1992) Change in product concentration: A decrease in product concentration favours the forward reaction to balance the decrease. An increase in product concentration favours the reverse reaction. (Atkins & de Paula, 2006) Change in pressure: Increasing the pressure of a system at equilibrium causes changes in the partial pressures of reactants and products. The rate constant is independent of the change in pressure of a system, but depends on ratio of partial pressures of the reactants and products. The reaction moves in the direction where number of moles is less. (Atkins & de Paula, 2006) A catalyst accelerates a chemical reaction without undergoing a net chemical change. The catalyst reduces the energy of activation by altering the path of reaction to avoid the rate determining step, which is the slowest step in a reaction (Atkins & de Paula, 2006). For example, decomposition of hydrogen peroxide, which is a slow reaction at room temperature, requires activation energy of 76 kJ/mol. In the presence of iodide ions, this activation energy drops to 57 kJ/mol and rate constant

HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management - Essay - 4

HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management - Phase 3 Discussion Board - Essay Example In case of Arizona v. Maricopa County Medical Society, 457 U.S. 332 (1982), the â€Å"Supreme Court held that these maximum fee schedules represented per se unlawful price-fixing agreements.† (Austen, 2008). The issues involved in limiting both patients’ choices for providers and vice versa would be in terms of a perceived compromise in quality and standards of health care provision since individualized client attention and monitoring would be lower in such cases. This is evident in Government run health care centers where a single provider is assigned to take charge of large group of patients. In such cases the following issues could arise: Apparently, in efforts to control the administration of (new) drugs, the Federal government may issue strictures on the kind of drugs physicians could prescribe and the kind of drug stores which could dispense these drugs. Control of these kinds may actually be detrimental to the interests of both patients and providers since â€Å"they impose one-size prescriptions in an area of science that is marked by variation." Further, it could be said that "...solutions to any of the health care problems that government is trying to mitigate will not rest in Washingtons constraining fixes but with [medical organizations] working with agencies to promote practice standards and safety measures that do not sacrifice medical autonomy and patient choice." (Kaiser, 2007). The Bill or Rights is an important step towards seeking social equality and fairness in medical treatment. Under this it is possible for patients to â€Å"sue for injury resulting from denial of care.† (Hashimoto, 2001). However, much as this bill may appear to professs equality and protect underprivileged class interests, it fails to acquire implementation value since the poorer sectors are not included since it does not cover the poorer sections of society who are covered under Medicaid. Thus it is setting its sights on citizens who seek private medical care. Therefore,

Chronic Pain Management: An Insight Into Neuropathic Pain

Chronic Pain Management: An Insight Into Neuropathic Pain Many people suffer from chronic pain. In these patients, the most common wish is to be pain free. Even though modern Medicine has advanced at an unprecedented rate over the past century, approaches to chronic pain management is still not completely satisfactory. I have recently seen a patient who has been living with neuropathic pain for many years. Neuropathic pain is a type of chronic pain that is considered to be the most difficult to treat and manage, due to its complex nature in etiology and clinical manifestations. Despite the improvement in scientific understanding of pathogenesis of neuropathic pain, and utilization of newer pharmacological, surgical and cognitive approaches, diagnosing and treating neuropathic pain still poses a challenge clinically. This essay will be presenting a case history of a patient with neuropathic pain being treated at the Kent and Canterbury Hospital and this case will form the basis of discussion on the current understanding of neuropathic pain m echanisms and its management. Patient case Mrs L is a 58 years old medically retired office worker who has a 25-year history of multiple sclerosis. She has been coping well until 8yrs ago when her left foot suddenly experienced a shooting pain on weight bearing. At first, she was maintained on paracetamol and nurofen by her GP with limited pain relief and then referred to the podiatrist, where an ultrasound scan revealed the presence of Mortons neuroma (a benign swelling of the intermetatarsal plantar nerve causing neuropathic pain), which was causing intense pain with a severity 10/10 across her left forefoot. To help alleviate the pain, it was initially decided that surgically removing the neuroma could achieve adequate pain relief, but this was proven to be an unrealistic goal. During the surgical intervention period, she had altogether three neuromas removed on separate occasions, with additional shaving off the bones to reduce compression on the nerve and resultant inflammation. She was then referred to be managed at the pain clinic. While Mrs L has been under the care of the pain physicians, she was given local anaesthetics steroid infiltration into her forefoot, cryotherapy (ice cold packs applied to tibial nerve), guanethedine block, lumbar chemical sympathectomy (with midazolam fentanyl), acupuncture, lidocaine patches, capsaicin cream, duloxetine and co-codamol. Despite temporary pain relief provided by these therapies, there was not a long-lasting effect that allowed Mrs L to stay pain-free. Understandably, living with an excruciating pain chronically can severely damage an individuals psychological as well as physical health. She could no longer enjoy her hobbies, such as dancing and going to antic fairs; even daily activities such as shower would make her scream in pain. As a result, she became extremely depressed and suicidal. Currently, she is receiving a multidisciplinary input from her GP, the specialist pain physician, specialist pain nurse, clinical psychologist, and physiotherapists and is maintained on gabapentin and diclofenac for her neuropathic pain, citalopram for her slowly recovering depression and baclofen for controlling her ongoing multiple sclerosis symptoms. She is also regularly attending chronic pain management programs, through which she believes that she gains better appreciation for her condition and is in a better position to be in charge of her own symptoms. This case nicely demonstrates the difficulties encountered in clinical practice in treating chronic pain. First of all, neuropathic pain is exceptionally difficult to treat, with unpredictable outcomes; secondly, most methods of pain management can only provide symptomatic relieve of pain temporarily, rather than offering a permanent cure; thirdly, chronic pain is an extremely debilitating condition to live with and its psychological impact should not be underestimated; and finally, to enable the best pain management a multidisciplinary approach is evidently the most successful and gives the patient most control over their symptoms. What is pain? We are all familiar with the term pain. The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (IASP 2007). It is important to note that pain is a very subjective experience, which varies enormously from one individual to the next. To emphasize on the subjectivity of pain perception and the need for individualized approach to pain management, Margo McCaffery who specialized in pain management nursing in 1968 described pain as whatever the experiencing person says it is, existing whenever the experiencing person says it does (Rosdahl Kowalski, 2007). It is undeniable that psychology and physiology are interwoven in the perception of pain. To understand pain, it is helpful to know what causes pain; as mentioned above, normally our perception of pain is triggered by a specific stimulus, such as hot, cold, or sharp objects, which could cause potential tissue irritation or injury. It is obviously advantageous in evolutionary terms to be able to sense the potential cause of injury and act via spinal reflexes to achieve self-protection, e.g. withdrawal of fingers from hot pan. This form of pain is called nociceptive pain, where the stimulus is known to be harmful in nature. This type of pain warns us of impending damage; therefore, it is regarded as the good type of pain. Of course, most of the long-term pains are certainly not good or friendly. What distinguishes between friend and foe in the field of pain is determined by the time-course, the intensity, the cause of and the social and economic consequences of the pain. An excellent example of a bad pain is neuropathic pain (Figure 1): Figure 1. Diagram showing the mechanisms behind the processing and perception of three different types of pain. Phase 1= nociceptive pain; Phase 2= inflammatory pain; Phase 3= neuropathic pain. (Cervero F, 2009) Neuropathic pains are resulted from disease or trauma to the central or peripheral nervous system; common causes include stroke, spinal cord injury, multiple sclerosis, surgery, diabetic neuropathy, and herpes zoster virus (Jensen et al., 2007). The Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP has recently redefined neuropathic pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system (Treede et al., 2008). As a result, neuropathic pain produces very unusual pain sensations beyond the range produced by the normal nociceptive system; these include spontaneous pain, reduced pain thresholds, and mechanical allodynia (Cervero F, 2009). As illustrated in figure 1, abnormal sensory processing is one of the landmarks for diagnosing neuropathic pains; patients often experience pain in the absence of any noxious stimuli (allodynia) and additionally produces an abnormally heightened sensory input, changing a non-noxious stimulus int o a painful stimulus, producing a state called hyperalgesia. Therefore, the main characteristic is the nearly complete lack of correlation between peripheral noxious stimuli and pain sensations perceived. There are many types of neuropathic pain (Table 1), which can be broadly classified into four groups based on their aetiology and anatomy: peripheral nervous system focal and multifocal lesions, peripheral nervous system generalized polyneuropathies, central nervous system lesions, and complex neuropathic disorders (Freynhagen Bennett, 2009). It is outside the scope of this essay to discuss these different types of neuropathic pain in further detail; rather, neuropathic pain as a distinct group of pain will be explored. Table 1. Examples of neuropathic pain syndromes (Freynhagen Bennett, 2009). How is neuropathic pain diagnosed? Despite its frequent occurrence, neuropathic pain still constitutes as a major diagnostic problem in clinical practice because it can present with a variety of signs and symptoms, which vary greatly even within one particular disease entity (e.g. in postherpetic neuralgia) (Geber et al, 2009). Clinical examination and expert judgment is still the best way to make a clinical diagnosis of neuropathic pain, despite the recent development of various screening tools, such as the LANSS questionnaire (Bennette, 2001) and the Neuropathic Pain Scale (Galer and Jensen, 1997) that assist in making a diagnosis. Bedside examinations for hyperalgesia and dysthesia include assessing the effect of the same stimuli on painful areas compared to the contralateral side or an unaffected site. Allodynia is demonstrated by the experience of pain when performing light touch with cotton wool; exaggerated painful response to pin prick suggests hyperalgesia, therefore lowered pin-prick threshold. These are the typical components that define a pain as neuropathic type. Patients are most likely to present with a mixture of pain types with a neuropathic component to it. It is important to identify the presence of such a component as the treatment recommendations are different for these. With the introduction of the new grading system for neuropathic pain by NeuPSIG group (Treede et al 2008), it is becoming increasingly recognized that chronic pain is often presented as a combination of different types of pains, rather than a clear-cut nociceptive or neuropathic type of pain. In Treede and colleagues new recommendation for the diagnosis of neuropathic pain, options of definite, probable or possible are available for the diagnosis of a component of neuropathic pain in the disease presentations in the clinical setting, which aims to aid more accurate diagnosis of neuropathic pain (Figure 2). Figure 2. Flow chart of grading system for neuropathic pain. The grading system is based on four criteria: pain distribution (criterion 1), the link between pain distribution and the patients history (criterion 2), confirmatory tests of neurologic status demonstrating positive or negative sensory signs confined to the innervation territory of the lesioned nervous structure (criterion 3), and further confirmatory diagnostic tests to identify the lesion or disease entity underlying the neuropathic pain (criterion 4). Criteria 1 and 2 must be met to initiate the working hypothesis of possible neuropathic pain. *Patient requires follow-up and/or additional confirmatory tests. à ¢Ã¢â€š ¬Ã‚  The point at which the diagnosis of possible neuropathic pain should be abandoned has not been defined (Treede et al 2008). Mechanisms of neuropathic pain Broadly speaking, neuropathic pain arises from the peripheral nervous system (ectopic impulse generation due to abnormal sodium channel expression), or from the central nervous system (central sensitization, disinhibition and plasticity) (Scadding, 2003). The key behind the generation of neuropathic pain is the abnormal neurological changes to the sensory system resulting in an abnormal hyperalgesic state, achieved through three processes: 1) the activation and sensitization of peripheral nociceptors, which are responsible for sensing peripheral noxious stimuli; 2) the abnormal amplification, rather than the suppression as in the normal states, of the central nervous system, known as central sensitization, caused by the strengthening of the synaptic connections between the peripheral and central nervous systems, producing a persistent pain state; 3) the change in the central actions of the undamaged afferents, so that a non-noxious tactile stimulus sensed by these receptors are converted into nociceptive information and processed as pain, rather than a light touch (Cervero F, 2009). This also further leads to secondary hyperalgesia, which means that instead of relieving the nociceptive pain by rubbing on the painful area (tactile stim ulus), the tactile movement of rubbing will actually produce the opposite effect of enhancing the existing pain. Figure 3. The pain signaling and modulation pathways. F Cx: frontal cortex; SS Cx: somatosensory cortex; Hyo: hypothalamus. (Ro Chang, 2005) As shown in Figure 3, the physiological pain mechanisms include the pain signaling pathway from nociceptors to peripheral nervous system to spinal dorsal horn cells to thalamus and finally to the cortex, and the pain control system from the cortext to periaqueductal grey to raphe nucleus to spinal dorsal horn (Ro Chang, 2005). In normal circumstances, there is a balance between signal transduction and pain modulation, therefore the individual recovers from that episode of pain. However, when this balance is disturbed, i.e. when there is a lesion within the primary somatosensory system, then the individual experiences neuropathic pain. The lesion may occur anywhere along the pathways of the somatosensory system, and it could be as a result of compression, inflammation, ischaemia, trauma, tumour invasion, nutritional deficits, or degenerative processes to the neurons (Ro Chang, 2005). Some of these important mechanisms will be discussed individually below. Local nerve injuries After the occurance of local nerve damage, in an attempt to repair, a neuroma forms at the proximal stump of the damaged nerve. A neuroma is a tangled mass of regenerating axons embedded in connective tissues. The axons within a neuroma not only fail to regenerate properly, but also develop abnormal electrical activities (England et al, 1996). This neuroma sprout then begins to fire abnormal signals with a heightened excitability, which stimulates regenerating C-fibers. After a period in the growth of these fibers, erratic impulse generator will develop, which sends abnormal signals into the central nervous system, perceived as dysthesia, parasthesia, itching or electrifying sensations (Liu et al, 2002). Sodium channel accumulation Sodium channel density is increased in areas of axons proximal to the injury site, as shown by England et al (1996) when the excised neuromas were studied from patients who suffered from painful traumatic neuromas (Figure 4). This specific type of sodium channel accumulated have a faster recovery time after inactivation, therefore, they are able to conduct ectopic impulses in neuropathic states. The ectopic activity then maintains the central sensitization process, resulting in great amplification of peripheral afferent signals. In neuropathic pain, there is a change in ionic channels composition and functions, such an accumulation of sodium channels which leads to hyperexcitability of these nerve terminals. These are found to be accumulating in neuropathic damaged areas of the nerve, such as in neuromas and demyelinated areas (Devor, 2006). In a normal axon, the transportation of sodium ion channels is preprogrammed via endoplasmic vesicles along the axons to be distributed in the n odes of Ranvier and peripheral sensory endings; there is a low density of sodium channels on the myelinated axonlemma. However, as a consequence to neuropathic damage, the set program of ionic channel settlement is disturbed, and these ion channels end up being located at a high concentration at the areas of neuromas, demyelination and sprouting (Aurilio et al, 2008). Such important roles played by sodium channels means that by blocking these channels, neuropathic pains could be reduced. Indeed, sodium channel blockers open up a major therapeutic channel for neuropathic pain treatment. Figure 4. Sodium channel immunocytochemistry of neuromas. (a, b, c) Sodium channel-specific immunoreactivity is present throughout the axons of th these neuromas. (d) Control showing the nonspecific immunofluorescence. Scale bar = 10 micrometer (England et al, 1996). Calcium channels and signaling in injury Calcium channels are also involved in contributing to neuropathic pains, as intracellular calcium determines the phosphorylation of the membrane proteins (Aurilio et al, 2008). The inflammatory neuropeptides, calcitonin gene-related peptides (CGRP), are released from injured nerve endings. They have a role in acting as co-transmitters in the spinal cord, therefore are involved in the central sensitization and hyperalgesic states found in neuropathic pain. An in vitro study identified that the release of CGRP entirely depended on the presence of extracellular calcium ions; this process involves particularly the N- and L-type calcium channels (Kress et al, 2001). Selective calcium channel blockers, such as gabapentin and lamotrigine may have significant potential in treating neuropathic pain. Cytokines in neuropathic pain Cytokines such as interleukins and tumour necrosis factors are well known mediators of inflammatory responses. Additionally, they are involved in neurogenic inflammations and are thought to play a role in the generation of neuropathic pains. In an established experimental model of neurogenic hyperalgesia and allodynia, mice with chronic constrictive injury to one sciatic nerve, the usage of interleukin-1 antagonist has been found to significantly yield in a reduction in the pain responses (Sommer et al, 1999) (Figure 5). Since TNF- Ã‚ ¡ immunoreactivitiy is found to be higher in nerve biopsies from patients with neuropathic pain, directing treatments to reducing the level of cytokines in the nervous system may also be helpful in relieving neuropathic pains (Empl et al, 2001). Indeed, combined neutralizing therapies against IL-1 and TNF- Ã‚ ¡ produced additive effects in experimental models (Schafers et al, 2001). Figure 5. Hyperalgesia to thermal stimuli following unilateral sciatic nerve injury in six groups of mice. a negative difference score is an indicator of hyperalgesia in the experimental/treatment limb. Hyperalgesia is present throughout the experimental period in the sham-treated group of mice. Treatment with anti-IL1 reduces hyperalgesia in a dose dependent manner (Sommer et al, 1999). Central inhibition inefficiency and sensitization The pain transmission system is under continuous inhibitory control from the brainstem centers, such as periaqueductal grey and locus coeruleus. Many studies have been conducted in laboratory animals for studying the pain mechanisms in neuropathic pain. It is found that in animals with neuropathic pain their central descending inhibition is nearly 50% lower than normal (Zimmermann 2001). Additionally, there is a hypersensitized central nervous system in neuropathic pain. Normally central sensitisation process would return back to baseline level when the tissue heals and inflammation subsides (Dworkin et al, 2003), but in neuropathic pain states this is not the case. The plasticity and sensitisation following peripheral nerve injury was thought to be caused by the long-term potentiation mechanism (Liu Sandkuhler, 1995). It is thought that after local nerve damage peripherally, growth factors such as nerve growth factors (NGF) can no longer be taken up into the dorsal ganglion neurons; this alters the nervous system at the transcription and protein synthesis level. NGF is a trophic molecule essential in the development maturation of the nervous system, and it is found to be elevated in conditions which pain is a predominant feature. This change to the composition to the nervous system also results in changes in the activities of aspartate and NMDA, which leads to an i nflux of calcium ions that indirectly contributes to the sensitisation and hyperalgesia of the spinal cord dorsal ganglion cells (Ro Chang, 2005). Peripheral inhibition inefficiency In addition, there also is a reduction in the response to endorphin molecules in patients with neuropathic pain than other pain mechanisms (Terenius 1979); therefore, there is a reduction in the sensation of pain relief centrally. Peripheral nerve lesion was simulated in rats by rhizotomy, a technique which severs the spinal roots, and this has demonstrated a decreased opioid receptor binding in the spinal cord (Zajac et al, 1989). Living with neuropathic pain From a patents perspective, pain is something they have to learn to live with, however bad it is. Patients who suffer from chronic pain not only have to go through the physical anguish exerted by the pain, but being in pain also hinders them from normal day to day functioning; from not being able to stay independent or taking care of themselves, to losing jobs, family and friends, lack of support and results in social isolation. A patient has once told me that: because what Im going through (pain) is not readily recognized by others, the way other people acted towards me put me under lots of frustration and made me socially unaccepted. It is crucial to bear in mind the wider impact of living with neuropathic pain when formulating a management plan for that individual. Not surprisingly, neuropathic pain is linked to significant reduction in the patients health-related quality of life (HRQoL) as well as creating substantial costs to the health service. It is reported that generally, patients with neuropathic pain have higher pain rating scores and lower HRQoL (Jenson et al, 2007). In a cross-sectional evaluation of the impact of neuropathic pain on patients and their quality of life conducted in the Spanish population, it was found that pain substantially interfered with work and family life in these patients. Over 95% of the 1519 patients recruited for this study had either neuropathic pain or a mixed neuropathic and nociceptive pain. Younger patients tend to report a lower quality of life than that of the elderly population in both the physical and mental components of life (Figures 6a 6b); possibly due to having fewer comorbidities in younger patients helps to exaggerate the perceived deleterious effects of neuropathic pain on their daily functioning. Using the Sheehans disability scale, the younger patients are also shown to have generally a higher perceived stress compared to the older patients (Galvez et al, 2007). It is important to analyse the effects that neuropathic pain exerts upon its sufferer, not only because we start to appreciate the level of impairment on the quality of life this chronic illness can cause to the patients, but also to further explore areas that could be perhaps better dealt with in terms of treatment (Jenson et al, 2007). As was reflected by the outcome of the Spanish study, 43% of patient had extreme disability; these included disability for work (51%), 47% for social life, 42% for family life. 38% of the patients also reported extreme stress and 19% perceived that they received little or no social support (Galvez et al, 2007). This shows that living with neuropathic pain is not just leading to physical disability, but also psychological and social dysfunctioning. Having known this nature of neuropathic pain, it important to consider both a pharmacological and psychosocial approach when prescribing treatment and formulating management plans. Figure 6. Scatter graph showing the linear relationship between age (years) and quality of life of the patient; physical (6a) and mental (6b) components, given as a standardised score relative to the reference Spanish population (SDS). SDS score is shown for each patient adjusted for type of neuropathic pain, center, and present pain intensity, age, and sex. SD, standard deviation; 95% CI, 95% confidence interval. (Galvez et al, 2007) b. a. Management of neuropathic pain The management of neuropathic pain involves a number of well-established pharmacological therapies, as well as utilizing the psychosocial aspects of the neuropathic pain nature fully to best control the patients pain symptoms. Non-Pharmacological approaches As the symptoms of pain are not just derived purely from a physical entity, psychotherapy should be considered as part of the management program for neuropathic pain. At an early stage, patients should be educated on the nature of the condition and to have realistic expectations with regards to treatment options; especially the current management for neuropathic pain is still mainly palliative in nature, with main aims to reduce symptomatic complaints of pain, but not a curative fix. To be able to alleviate the pain and achieve symptomatic relieve, even if only temporarily, may be the only attainable goal (CREST, 2008). Since non-pharmacological treatments have the lowest risks of adverse side effects these must be offered early. These include a combination of physiotherapy, occupational therapy, psychotherapy and pain management programs that are adjusted to the individuals psychological and physical needs. The main aims for physiotherapy is to provide pain relieve wherever possible, but also focuses on the restoration of normal functioning and helping the patient to return to normal physical activities, such as going back employment (Serpell et al, 2008). The low risk physiotherapy modalities include TENS (transcutaneous electrical nerve stimulation) and acupuncture are offered, along with appropriate education, advice and exercise. Functional difficulties in areas of personal care, work and leisure could be managed best by the input of occupational therapists, who may work around the needs of the individual in adjusting the arrangements at home/work to best allow the patient to function despite t he pain. In Mrs Ls case, she had shower rails and hand-held tools to pick up distant objects without exerting strain on her back/affected limbs; these were extremely helpful to her. Of course, to maximize the outcome of pharmacological treatment, psychological therapy is essential in addressing the disability, emotional impacts and general life interruptions that are consequences of neuropathic pain. Apart from pharmacotherapy, psychotherapy is the best evidence-based therapy for the treatment of chronic pains like neuropathic pain (Morley et al, 2000). Additionally, patients living with chronic pain often suffer from other comorbidities. Frequently these are not treated alongside the treatment for the chronic pain, therefore, a limited effect of the pain treatment may be observed. Behavioral and psychiatric conditions are especially common in patients with neuropathic pain; recognizing and treating these will aid in improved quality of life and better pain relief overall (Fishbain, 1999). An recent eight-week study of the effects of cognitive behavioural therapy (CBT) on chronic pain-induced insomnia has found that patients who received CBT exhibited significant reductions in sleep latency, number of awakenings during sleep and overall quality of sleep (Jungquist et al, 2010). This offers further hope for patients who suffer from pain-related insomnias. Finally, the Pain Management Program is a multi-disciplinary approach to pain control that is tailored to each patients individual needs. Patients are typically referred to this program if they have been living with chronic pain for a number of years and suffer from significant physical, social and psychological functional difficulties. Many have become dependent on medications and acquired a number of side effects from these medications which are slowly eroding the quality of their lives. In the pain management programs, the goals are to reduce the subjective experience of pain, learning new coping strategies to control pain and improve physical and emotional functioning. Indeed, the pain management programs have been found to achieve a reduction in medication and enhanced rates of returning to work (CREST 2008 NRH 2009). Pharmacological therapies for neuropathic pain In most cases, patients with neuropathic pain will need to be started on analgesic medication after failure to respond to non-pharmacological treatments. Although opioid and non-opioid analgesics, such as codeine and diclofenac respectively, have a role in dampening pain transmission in within the CNS in neuropathic pain states, it is far more effective to target the sodium, calcium and NMDA receptors, which are altered during nerve injury. Generally speaking, the clinical effectiveness of these drugs is limited by their narrow therapeutic indexes, i.e. the difference between the number needed to treat (NNT) and the number needed to harm (NNH) is very small (Rice Hill, 2006). Neuropathic pain is appreciably a very complex condition and treatment for this can be a real challenge, as most patients do not respond to conventional analgesics. The main problems lie within the inadequate diagnosis, lack of understanding of the pain mechanisms, inappropriate selection of therapies, and insufficient management of comorbidities that could delay the response to neuropathic pain therapies (Ro Chang, 2005). Recently a review of the guidelines by OConnior Dworkin has resulted in the formulation of a stepwise approach to neuropathic pain management in primary care (Table 2). It is important to highlight that the first step of the management plan includes the identification of comorbidities, and relevant patient education as discussed above in the non-pharmacological managements of neuropathic pain to fully prepare the patient for adequate treatment. Table 2. Stepwise pharmacologic management of neuropathic pain (OConnor Dworkin, 2009) According to a recent review and recommendation by Dworkin et al, three lines of pharmacological treatment have been advised for neuropathic pain treatment. The first line treatments include tricyclic antidepressants (TCA), selective serotonin noradrenaline reuptake inhibitors (SSNRI), Ca2+ channel ligands (e.g. gabapentin pregabalin) and topically applied 5% lidocaine; second line treatments including opioid analgesics tramadol; and third line treatments are the other antiepileptics (e.g. Carbamazepine, lamortigine), other antidepressants (e.g. citalopram), N-methyl-D-aspartate (NMDA) antagonists and topically applied capsaicin (Dworkin et al, 2007 and OConnor Dworkin, 2009). TCAs The administration of TCAs such as amytriptyline and nortriptyline will benefit patients with neuropathic pain as TCAs have been shown consistently to be more efficacious than placebos in a number of randomized controlled trials (Saarto Wiffen 2007), and especially beneficial for patients who have a comorbidity of depression. They act via histaminic, muscarinic and serotoninergic receptors both peripherally and centrally. However, one should note that the possibility of cardiac toxicity hinders its administration in patients with pre-existing cardiac conditions, especially arrhythmias; they should also be avoided in patients who have suicide risk or poor impulse control (Serpell et al, 2008). A large, retrospective cohort study reported that there was an increased risk to sudden cardiac death at dosages higher than 100mg/day (Ray et al, 2004). Because the recommended dose of TCA can range from 25mg at the starting dose to 150mg/day as the maximum dose (Dworkin et al, 2007), administ ering TCA should be a cautious exercise. In general, TCAs should be started at low dosages, administered at night to minimize sedative effects, and titrated up slowly to be continued for 6-8 weeks to allow analgesic effects (OConnor Dworkin, 2009). SSRNIs SSNRIs such as duloxetine and venlafaxin are less effective than TCAs, but have a better safety profile. Duloxetine has consistently demonstrated efficiency in treating painful diabetic peripheral neuropathy (Dworkin et al, 2007), although its effects in other types of neuropathic pain have not been studies extensively, therefore its efficacy in those types of pain are still uncertain. Calcium channel ligands Calcium channel ligands, e.g. gabapentin and pregabalin, bind to the voltage-gated calcium channels at the ÃŽÂ ±2- Ã‚ ¤ subunit to modulate neurotransmitter release from presynaptic nerve terminals (Figure 7). Both drugs have been shown to be efficacious South Africa: Language and Culture South Africa: Language and Culture What is South African Culture? South Africa is known as the rainbow nation as it has complex and diverse cultures. (South African Languages and Cultures. It is a melting pot of culture; here are a few cultural aspects to admire about South Africa: Mapungubwe, Limpopo Province, is one of the richest archaeological sites in Africa. Two globally important battles namely, The Anglo Boer War and the Anglo Zulu War were both fought on South African soil. Since the freedom from Apartheid, dance has become a prime means of artistic expression. The Magaliesberg mountain range is said to be the oldest mountain range on earth. The Drakensberg mountain range runs the length of the country and is a Unesco World Heritage site. The Vredefort Dome is the oldest and largest visible meteorite impact site in the world. South Africa has a celebration for every event, place, art form, food, drink and agricultural commodity. South Africa has a wide variety of arts and crafts, as well as a wide range of craftwork styles; tribal designs, Afro-French wirework, wood carvings, world-class pottery and bronze casting, stained glass, basket weaving, clay and stone sculpting, dung paper and waste ornaments. The Drakensberg mountain range is the worlds largest art gallery and is a monument to the San Bushmen. Jukskei, a game which involves a player throwing a wooden pin at a peg in the ground. It has been identified as one of the seven indigenous games that should be encouraged and developed. After the Apartheid era, the youth of South Africa started to find their own voice in a style of music called Kwaito. Nguni cattle, they are indigenous to South Africa and might possibly be the most beautiful cattle in the world with their variously patterned and multicoloured hides. The Owl House, Nieu Bethesda, is a fascinating world of sculptures made from concrete and glass. The Cradle of Humankind has one of the worlds richest concentrations of hominid fossils. The Quagga, was extinct but has been rebred. It is a zebra-like animal but only has stripes on the front half of its body. Mark Shuttleworth was the first African in space. South Africa is home to seven Unesco World Heritage sites. South African cultural villages allow visitor to experience firsthand the cultures and traditions of our country, including food, drink and accommodation. South Africa produces 3.1% of the worlds wine and ranks number nine in overall volume production. The above text was referenced from: The A to Z of South African Culture 2010:1 During the Apartheid era, the government divided this diverse country into four population groups, namely white, black, coloured and Asian. (South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa]) These population groups were grouped as follows: White: English, Afrikaans, Jewish, Portuguese, Greek and Lebanese. Black: tribal groups, namely Xhosa, Zulu, Ndebele, Swazi, Tswana and Sotho. Coloured: people of mixed origin, mainly Afrikaans speaking and also a lot closer to the white cultural trends. Asian: people of Indian decent. The above text was referenced from: South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa] South Africa has eleven official languages, namely English, Afrikaans, Tsonga, Zulu, Tswana, Xhosa, Venda, Swazi, Southern Sotho, Ndebele and Sepedi. (South African Languages and Cultures [sa]) South Africas language distribution is as follows: Figure: Language distribution chart (South Africa Info) Xhosa Language: The word Xhosa is derived from the Khoisan language, which means angry men. South African Languages and Cultures [sa] There are about eighteen percent of Xhosa speaking people in South Africa, and are mainly found in the Eastern Cape. (South African Languages and Cultures [sa]) This makes Xhosa the second most spoken language in South Africa. (Languages of South Africa 2010:1) There are nine Xhosa speaking groups, some chiefdoms are larger than others, but there is conformity among them, the conformity can be seen in the homestead layouts. (Magubane 1998:10) Culture: The Xhosa speaking people were one of the first chiefdoms to be exposed to European explorers, hunters, traders, missionaries, soldiers and colonial administrators. (Magubane 1998:12) This exposure therefore altered the culture of the Xhosa people. Xhosa marriage is a polygynous affair as the chiefs and wealthy men, who had lots of cattle married more than one woman and in some instanced has as many as four wives. (Magubane 1998:20) These wives were distinguished in rank according to different houses. (Magubane 1998:20) The Great Wife was responsible in bearing a son, and of course heir who would eventually take over his fathers possessions, i.e. cattle. (Magubane 1998:24) Labola is a big part of the Xhosa culture, labola also meant that different groups could forge alliances as marriage within a clan is prohibited. (Magubane 1998:28) In a modern day Xhosa marriage negotiation it is common that money instead of cattle will be accepted. (Magubane 1998:25) Traditional rituals are performed throughout the life-cycle of the Xhosa people, from birth to puberty, marriage to menopause and filly to death. (Magubane 1998:32) One of these rituals is that of male initiation through circumcision. This ritual came about as men had to be circumcised to become a warrior, and had to be a warrior before he could marry. (Magubane 1998:33) Architecture: Dwellings consisted of a circular frame of poles and saplings, which were bent and bound in the shape of a beehive and thatched from top to bottom with grass. (Magubane 1998:18) this structure was then plastered with a mixture of mud and dug to provide adequate insulation. (Magubane 1998:18) screened off cooking areas, had an earthen oven for baking. (Magubane 1998:18) Zulu Language: Zulu people form the largest ethnic group in South Africa (Languages of South Africa 2010:1) and therefore Zulu is one of the most spoken languages in South Africa and is also understood by half of the South African inhabitants. (South African Languages and Cultures [sa]) South African English has adapted and was also inspired by many of the Zulu words, and therefore incorporate it into the English language. (South African Languages and Cultures [sa]) Culture: The Zulu nation arose in the 16th century; the Zulu warrior Shaka raised the nation to prominence in the 19th century. (Languages of South Africa 2010:1) The classic novel Chaka, by Thomas Mofolo, reinvents king Shaka into a heroic figure. (Languages of South Africa 2010:1) The current monarch is King Goodwill Zwelithini. (Languages of South Africa 2010:1) the present kings powers are essentially symboliche carries a sacred axe on important state occasions and he presides over key rituals, (Magubane 1998:37) Zulu children are exposed to nature at an early age which encompasses a deep understanding and empathy for the environment they live in. (Magubane 1998:45) Traditional foods include amasi (curds of milk) which is eaten either with maize meal or vegetables. Maize meal is either boiled into a thick porridge or eaten with vegetables. Meat was only eaten on special occasions, such as a wedding. (Magubane 1998:47) The Zulus are very crafty. The women are responsible for mat-making, beadwork and pottery. The men do woodwork and specialise in spoons, meat trays and milk pails which are crafted out of one piece of wood. (Magubane 1998:47) Traditional medicines in the Zulu culture are ancient, these medicines are divided into two parts, the Traditional Herbalist who administers medicine made from plants and animals, and the Diviner who smells out the complaints using bones, shells, seeds or other artefacts. (Magubane 1998:61) A category in the Diviners is the isangoma, who is a medium that makes contact with the ancestral spirits and prescribes medicine according to their dictates. (Magubane 1998:62) Music, song and dance have always been important in Zulu culture as it helps maintain a sense of group solidity especially in times of strees, joy and change. (Magubane 1998:62) The Zulu society had many stringed instruments, such as the uGubu which stringed bow with a calabash attached to the end. (Magubane 1998:62) Architecture: The extended homestead was roughly circular in form and was build on sloping ground facing east wherever possible, with the slope falling away to the main entrance, so that the chief dwelling would be on the highest ground. (Magubane 1998:40) In the centre of this homestead would be the cattle byre which is also linked to the temple, which is where traditional rituals would take place. (Magubane 1998:40) The building of these dwellings were the mens job and would often be a social event where the women would brew beer and neighbours, even passers-by, would come and lend a hand in erecting these dwellings. (Magubane 1998:43) The dwellings were either beehive or dome shaped. Saplings would be embedded into a circular dug trench; the saplings were then bent over and tied down to create framework which would then be tightly thatched. (Magubane 1998:43) There were no windows but the door was very low, people had to entre on their hands and knees. This door was then closed at night by means of a wicker door that was fastened with a cross-stick. (Magubane 1998:43) Afrikaans Language: Afrikaans is spoken by a majority of South Africans, either as a first or second language. Afrikaans is a rich cultural languages with much heritage from the Dutch, Afrikaans even means Africa in Dutch. (South African Languages and Cultures [sa]) Afrikaans is mainly spoken by white Afrikaners, coloured South Africans and a section of the black population. (Languages of South Africa 2010:1) Venda Language: Venda is also known as Luvenda or Tshivenda and is mostly spoken in the Northern parts of South Africa. (South African Languages and Cultures [sa]) The people who speak Venda have a Royal Family and show women great respect, therefore women are allowed to become Queens and Chiefs of their own tribes (South African Languages and Cultures [sa]) Culture: For a Venda person, music is one of the most important aspects to their culture, especially drum beats. (South African Languages and Cultures [sa]) They are hard working people but after working all day on a field, there is always music, a few drinks and dancing. (South African Languages and Cultures [sa]) A drum, named Ngoma Lungundu, is the centural feature in Venda culture. (Magubane 1998:82) Status and power are expressed through music, dance, and song. (Magubane 1998:87) Venda people use many musical instruments, even instruments that have vanished from other cultures in Africa; they use xylophones, thumb pianos, reed flutes, and three different types of drums. (Magubane 1998:87) The Venda pottery style was established in the 14th and 15th Century. (Magubane 1998:82) The young Venda men and old Venda men were highly regarded, as the Venda people believe that the young men are still close to the ancestors, while the old men are about to rejoin the ancestors. (Magubane 1998:84) Initiation played a big role in Venda culture, as with most South African cultures. (Magubane 1998:84) Initiation ceremonies were held for the many stages in life and would be made possible through external forces such as the ancestors, good and bad spirits, as well as witches. (Magubane 1998:84) A python, in Venda culture, is associated with fertility and the movements of a baby in the womb. (Magubane 1998:87) Venda women were held in much regard, unlike most African women. (Magubane 1998:89) venda women were in absolute control if in her courtyard, and elderly women played an important role in Venda society by telling the children traditional stories. (Magubane 1998:89) Venda women are able to own property and can become ruler of a clan if there was no male heir. (Magubane 1998:89) Architecture: Traditional Venda villages are surrounded by stone walls, which can still be seen near/under cliffs. (Magubane 1998:84) These villages are laid out so that the King is on the highest part of the land, with his wives and children around him, who are then surrounded by the rest of the inhabitants, who will protect the King and his family if there were to be a threat. (Magubane 1998:84) Ndebele Language: Ndebele language is split into two chief dialects namely, Southern Ndebele and Northern Ndebele, but the more common spoken dialect is Southern Ndebele. (South African Languages and Cultures [sa]) Ndebele is only spoken at home, and therefore only moves through generations, therefore it is thought to be a vanishing language. (South African Languages and Cultures [sa]) Culture: To tourists, the Ndebele culture is best known for their vibrant geometric patterns which decorate their houses, clothes and can also be seen in their beadwork. (Languages of South Africa 2010:1) These vibrant patterns embrace a variety of forms and symbols, such as natural objects, geometric forms and now days letters of the alphabet, numbers, representations of urban buildins, windmills and aeroplanes. (Magubane 1998:76) Ndebele life is characterized, life many other African groups, by the spirit world. (Magubane 1998:67) The spirit world is made up of the Ndebele ancestors who require constant sacrificing to keep them placid. (Magubane 1998:67) The Ndebele society is patriarchal; this was intensified by the white farmers who looked to Ndebele family labour where the men had to work for the white farmer. (Magubane 1998:70) The Ndebele man then moved away from the white farms and started their own businesses as taxi drivers or builders. (Magubane 1998:70) The Ndebele women would work as domestic servants in Pretoria but always returned home to look after the children and set up the homestead. (Magubane 1998:70) While the women were at the homestead, they would be supported by their husbands as well as making and selling beadwork, mats and dolls. (Magubane 1998:70) There is much deliberation on if the adornments worn by the Ndebele women are strictly for their own sensuality or whether their husbands want their wealth to be shown on their wives. (Magubane 1998:76) The most popular adornemnts worn by Ndebele women are the beaded wire hoops and/or copper or brass rings that they wear around their necks, arms, legs and stomach. (Magubane 1998:77) Sepedi Language: Sepedi is also known as Sesotho or Northern Sotho. (South African Languages and Cultures [sa]) But this language is best known for their wedding ceremonies. (South African Languages and Cultures [sa]) Culture: In the Sepedi culture, it is well known that the brides father ask the groom for lebola. Lebola is item/s exchanged for their daughter, for example money or livestock. (South African Languages and Cultures [sa]) The wedding is held at the brides or grooms home, but before the ceremony, the bride (dressed in a cows hide dress) has to go down to the river and collect water and wood for the ceremony. (South African Languages and Cultures [sa]) Once the ceremony is done, a sheep is then slaughtered in the back yard and the meat is equally divided between both families. (South African Languages and Cultures [sa]) Setswana Language: Setswana is commonly known as Tswana, which is related to the other Sotho languages. (South African Languages and Cultures [sa]) Setswana was mostly spoken in Botswana, but migrated into North Western South Africa. (Languages of South Africa 2010:1) Dr. Robert Moffat built the first school in Botswana and realised that he needed to use and write Setswana in his teachings, therefore Setswana was the first Sotho language to be in a written format. (Languages of South Africa 2010:1) Culture: Setswana is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Setswana totem is a fish. (Magubane 1998:11) In the Setswana culture, wealth is measured by how many cattle they have in their possession; this is then ranked and put into a document called the Setswana Forbes, which lists all the names of the wealthy Setswana people. (South African Languages and Cultures [sa]) Setswana culture is also widely known for their Traditional healers, or sangomas, which play an important role in their culture. (South African Languages and Cultures [sa]) Southern Sesotho Language: Southern Sotho is spoken by more than five million South African inhabitants. (South African Languages and Cultures [sa]) It is a very complicated language, but once you get to understand it, it is a beautiful language. (South African Languages and Cultures [sa]) Sesotho originally was spoken in Lesotho, but moved into South Africa. It was also one of the first African languages, along with Setswana and Zulu, to be put into a written form as well as into literature. (Languages of South Africa 2010:1) Culture: Southern Sotho is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Southern Sotho totem is a crocodile. (Magubane 1998:10-11) The Southern Sotho culture is one that believes strongly that Children benefit from serving their elders. (South African Languages and Cultures [sa]) Marriages are more often than not pre-arranged but in todays day and age, this has become less of normality as they are now able to pick their life partners. (South African Languages and Cultures [sa]) Swati Language: The Swati language is also known as the Swazi language. (South African Languages and Cultures [sa]) It is a very similar language to the Ndebele, Xhosa and Zulu language, and often gets confused with these languages. (South African Languages and Cultures [sa]) The language and culture of the Swati was highly influenced by the Zulus. (South African Languages and Cultures [sa]) Culture: The Swatis have many traditional events and the culture is one of colourful outfits with red feathers, carrying shields and wearing multicoloured necklaces. (South African Languages and Cultures [sa]) The Reed dance festival is one of their great festivals. (South African Languages and Cultures [sa]) The ceremony is held for eight days which runs through the end of August till the beginning of September. (South African Languages and Cultures [sa]) This ceremony is for all unmarried women and is to protect the womens chastity (South African Languages and Cultures [sa]) Tsonga Language: The Tsonga language is spoken throughout southern Africa. (South African Languages and Cultures [sa]) Tsonga is a language that does not use the English alphabet, but instead the Latin alphabet. (South African Languages and Cultures [sa]) Therefore it is a difficult language to learn or understand. Culture: The first Tsonga speaking people were traders of cloth and beads for ivory, copper and salt that was eventually joined by co-linguists pushed from the coast by Nguni raiders. Magubane 1998:90 The birth of a child is a great time for all Tsonga speaking people. (Magubane 1998:95) Babies are doctored with medicines and decorated with charms and beaded bangles. Magubane 1998:95 A Tsonga marriage is not just a relationship of two individuals, but an agreement and new relationship between the two families. (Magubane 1998:96) There is a sacrifice before the bride leaves her family and her ancestors to join her new family, her new family will now take her in as one of them and she will have to learn their etiquette and rules of behaviour. (Magubane 1998:96) Most of the agricultural work was done by women, but the harvesting was done in collaboration with the surrounding communities, with the owner/host of the land providing beer and refreshments therefore making it a festive occasion. (Magubane 1998:98) Venison was a vital part in Tsonga diet, so was fish as fishing was an important community activity. (Magubane 1998:98) Tsonga men have through the ages started working in the South African mines and send money home to their families. (Magubane 1998:99) They have to spend copious amounts of time on busses and trains, and have to live in hostels near to the mining towns. (Magubane 1998:99) The Tsonga people are able to play wind, stringed and percussion instruments, the string instruments being the most important. (Magubane 1998:99) The two other instruments they are able to play, but fall out of the mentioned catagories is the hand piano and the xylophone. (Magubane 1998:99) The stringed instruments they are able to play: Vibrating Bow Stringed bow attached to a calabash Hollow reed bow Wire stringed bow with a thickened handle plucked with a flat piece of wire The above text was reference from: (Magubane 1998:99) The wind instruments they are able to play: Cross flute Shepherds pipe Antelope horn trumpet The above text was reference from: (Magubane 1998:99) The percussion instruments they are able to play: Tambourines Drums The above text was referenced from: (Magubane 1998:99) Architecture: A Tsonga homestead comprises of the man, his wife/wives, their children and their sons families. (Magubane 1998:94) The houses are cylindrical with earthen walls and conical thatched or reed roofs. Magubane 1998:94 The homestead is generally circular with a central cattle byre and a main entrance on the eastern side, there may also be sub-entrances on the side of the water and fields. (Magubane 1998:94) English Language: South African English is rich and peculiar as it is influenced by most of the other ten languages. (Languages of South Africa 2010:1) For example: ..cars stop at robots, not traffic lights. A pickup truck is a bakkie, sneakers are takkies, a hangover is a babbelas, (Languages of South Africa 2010:1) English is understood across South Africa and is generally the chosen language in business, politics and media. (Languages of South Africa 2010:1) English is only spoken by 10% of South Africans, but is the primary language tought at primary, secondary and tertiary educational centres. (Languages of South Africa 2010:1) What artefacts are unique to each culture? Archaeology is important as it is able to tell us when and where people settled and how they lived. Archaeology is also able to link different cultural groups through the artefacts they leave behind. (Magubane 1998:8) Archaeological time periods and artefacts found from each period: Early Stone Age stone artefacts such as hand axes and cleavers. Middle Stone Age stone artefacts such as points and scrapers, as well as grindstones. Later Stone Age new technologies made way for the bow and arrow, and traps and snares. Early Iron Age new technology made way for hoes, axes, decorative pots and bowls, ornate metal work and complex terracotta sculptures. The above text was referenced from: Magubane 1998:8 The Bantu-speaking people have been thought to emerge from the Iron Age communities; the bantu-speaking people are divided into two groups, the Nguni speaking and the Sotho-Tswana speaking people. (Magubane 1998:10) These two groups are linguistically and culturally distinct (Magubane 1998:10) What is a Boutique Hotel? There are a number of characteristics and attributes that constitute a Boutique Hotel. Firstly a Boutique hotel is much smaller than a chain-hotel as the maximum amount of rooms a Boutique Hotel has is one-hundred. (Nobles Thompson 2001:1) Atmosphere is very important in a Boutique Hotel as it creates a memorable experience. (Nobles Thompson 2001:1) Management and staff need to anticipate guests needs and wants, knowing what a guest wants, when they want it and how they want it. (Nobles Thompson 2001:1) Unique and interesting themes, design and architecture. (What is a Boutique Hotel? 2003 2010) Stylish appearance (What is a Boutique Hotel? 2003 2010) Equally appropriate for business, honeymoon or vacation. (What is a Boutique Hotel? 2003 2010) Target market for Boutique Hotels is 25 55 age range and middle to upper income level. (What is a Boutique Hotel? 2003 2010) Boutique hotels offer a completely unique experience. Boutique Hotels can be hip and happening or historic in theme. (What is a Boutique Hotel? 2003 2010) Boutique Hotels offer comforts, such as bathrobes and fireplaces; spa-like services, such as healthy food choices, mind and body cleansing; the latest technology, as well as on-site dining, bar and lounge areas that are open to the public. (What is a Boutique Hotel? 2003 2010) How do you reuse an old building to create a new exciting interior? By preserving historic buildings and by updating the building and its interior for a new use (Bijelic 2006:1), the population and generations to come will be able to understand and appreciate South African heritage and culture. (The WBDG Historic Preservation Subcommittee 2010:1) By reusing existing buildings and transforming them into a new purpose, the architects and designers are in essence being environmentally responsible. (The WBDG Historic Preservation Subcommittee 2010:1) Existing buildings are in essence energy efficient as they already exist and therefore there is no need to create new building materials, which leave a carbon footprint behind. (The WBDG Historic Preservation Subcommittee 2010:1) Minor modification to the exterior or interior of these historical/existing buildings are possible and plausible as this will then create a new use for these buildings as well as upgrade these buildings in order to meet the modern building requirements and codes. (The WBDG Historic Preservation Subcommittee 2010:1) Converting historical buildings to meet modern demands might be a challenge, but there are advantages as clients will eventually realise the potential financial, cultural and marketing advantages of preserving architectural history. (Bijelic 2006:1) Practical benefits of preserving existing/historical buildings: Preservation of the history and authenticity. Increases the commercial value of the building and its ornaments/material which are more often than not high quality and not affordable. Sustainable building practice as there is less construction and demolition, and less need for new building materials as the existing infrastructure will be used. Energy efficient as there will be no energy waste on demolition and new construction. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Identify, Investigate, Develop, Execute and Educate are the five basic steps of preserving a historical building. (The WBDG Historic Preservation Subcommittee 2010:1) The four treatment approaches for historic buildings are: Preservation maintenance, stabilisation and repair of existing historic materials. Rehabilitation to alter or add to historic property. Restoration depicting the property at a particular period of time while erasing the evidence of other eras. Reconstruction re-creates non-surviving parts of the property. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Before preserving or reusing an existing building, the architect and/or designer needs to make sure that the original function of the building and the proposed new function of the building coincide and/or are compatible in order to reduce the deconstruction of the historic materials and ornaments. (The WBDG Historic Preservation Subcommittee 2010:1) In order to maintain the integrity of the historical building, the following preservation design goals need to be implemented: Update building systems this requires striking a balance between original building features and accommodating the new technologies and equipment. Life safety and security needs accommodate new functions, changes in technology and improved standards of protection. Comply with accessibility requirements provide access for persons with disabilities while meeting preservation goals. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Relevant Codes and Standards Previous research that has been done on the topic Field Research Data capturing I have sent out questionnaires to a number of architectural firms and travel agencies, as well as the Department of Tourism, Department of Home Affairs, The City Council of Johannesburg and the City Council of Tshwane. Explain in detail who, what, where, how and why The above mentioned parties will be able to advise me on (1) if there is a need for Boutique hotels in South Africa and (2) how to go about reusing/renovating existing buildings in order to preserve the environment as well as create a new, fresh Boutique hotel with the correct regulations.