Expository Essay Essay Example for Free

Expository Essay Essay3 focusing on the importance of the prehistoric and how The Kite Runner shows no matter how deeply it might be buried, it finds a way to re-surfacing Have you ever tried to run aside from your past? And did it work for you? Well in the book we learn that a lot of characters try to run away from their past, for instance Baba hiding the occurrence that Hassan is also his son or when Amir witnessed Hassan being raped. They all tried to run away from their past but it all caught up with them in the end, like Amir said My past was like that endlessly turning up. There is no way to hide from your past, whether you try to run away from it or bury it as deep as you can because the past always claws it way out. An example could be Amir trying to forget that he was a bystander to Hassans rape. He tried to forget everything, score out everything that happened about that night. But even though life goes on memories remain forever. He lie about Hassan stealing his w atch and money thought chasing Ali and Hassan away might help him forget or ease his pain . When he received that phone call from Rahim Khan saying there is a way to be good again, he knew that it was time for him to face his fear.Going back to Kabul fright him, he was about to face his deepest fear, everything in Kabul changed it was not the same. He wanted to hire his begin proud and be the brave man his father expected and longed for, just like Hassan. Sometimes its not always our guilt that forbids us to forget but the judgement of people in our community. When she ran away with her older boyfriend and moved in with him, she was seen as a disgraceful girl with no complaisance in the Afghan community. Soraya status is later restored when she gets married to Amir whos a much prise man in the afghan community.Sometimes keeping a secret could be the cause of our death. In Baba case we learn that the cause o his death could be keeping the secret that Hassan was his son. When his diagnosed with cancer he refuses the treatment, possibly because he has accepted that was his punishment for his sin. On the end Baba dies as a tormented soul. Furthermore we learn that we the past cannot be forgotten or ignored but we can make peace with it. The kite runner illustrates that we learn from our mistakes which helps to be better people and more accepting of others. standardised Amir said,for the first time since the winter of 1975 I felt at peace Healed at last .

Media analysis the apprentice (Amber) Essay Example for Free

Media analysis the apprentice (Amber) stressThe purpose of the introduction to The prentice is to introduce the programme to its audience the main aim is to gain TV ratings so the first four minutes argon crucial in drawing in the audiences circumspection and making the show interesting and appealing to the target audience so they continue to abide by.There ar many visual codes in the opening of the programme. The contestants argon first introduced and the camera is watching them enter the city of London. All of the contestants atomic number 18 shown near or on some form of stockpile, this could symbolise how the best concourse ask been chosen from all over the country to come to one business orientated and particular city to compete for one life changing journey. Furthermore, the journey is metaphorically amplified by the contestants carrying suitcases and walking forwards, this lay downs a sense of them embarking on a life changing journey together with only one ou tcome. This is anchored by the dialogue the contestants delectation, for example I am a winner this shows to the audience that this is going to be an importunate battle to find the winner.The contestants are seen walking in a free radical together over a bridge, this could connote the bridge to advantagees and they are walking over to the other side trying to gain the success that they want, which again signifies a journey and the camera movement utilise here is tracking the whole group so the audience know that they will be following them on the journey.The programme is rear in London which is pragmatically suggesting this is the centre of business in the United Kingdom and thats why they have ga in that locationd here. In the clip the audience are shown how busy the city is by the amount of transport and citizenry, this could suggest that there is competition between the contestants and overly competition in the business world. The scene is set at dawn this connotes the id ea that business never rests in London and that the business world is fire up and ready. There are also visual codes displayed by the characters that anchor business firstly all of the contestants are dressed smart, in suits or skirt suits.They also all carry some form of briefcase which is stereotypically something that a business person has with them all the time. When the characters speak they pragmatically and stereotypically show that they are business minded people I am the best I am what Alan plunder is looking for are examples of what are verbalise and these are expressed in a very strong, arrogant and argumentative way.In the opening there is a point where the audience are shown Alan Sugar on top of a large construction in the central of London looking out to the city which suggests his index finger, this is anchored by the camera shot utilize here which is a low angle, this connotes the idea that he is a powerful man and the centre of attention, the use of the camera movement crab also anchors his power as it arcs around Alan Sugar so we are given a 360 degree view of him and the city.Sound is used to anchor Alan Sugars power throughout the soundtrack and underscoring practice of medicine builds up into a dramatic tension when he is talking to the contestants and when the camera is pore on him. Furthermore, the iconic dialogue youre fired is repeated more than once in the scene, something which is crucial to his persona and something the audience recognise. This is reinforced with the crop shop of Alan Sugars hand pointing towards the fired contestant, in addition to this the crop shot also creates asense of mystery as the audience are left unaware of the contestant that has been fired and who he is pointing at, so they are left wanting to watch the show with the suspense that all but one contestant will be fired and they kitty try judge who he will fire within the programme.The contestants are portrayed as wakeful when they are around Alan Sugar there are lots of reaction shots used to show their expressions and reactions to the tasks and what Alan Sugar says to them, this shows his power over them and signifies the meaning of the programme and his role and the contestants role. The underscoring medical specialty also adjusts to the mood and atmosphere and is anchorage for what the contestants are portraying themselves as, at the beginning when the contestants are trying to display power then the music is louder and faster but when they are portrayed as more vulnerable facing Alan Sugar the music is quieter and slower and towards the end of the opening fades out into the beginning of the programme.I think that the opening scene of The Apprentice is very successful in fulfilling its purpose. I feel that it engages the audience by the visual codes and they all create a strong anchorage for what the programme is about. There are many different camera shots, angles and movements used which again draws in the audiences attention and makes them want to carry on watching the programme. Finally, the change integrity of the soundtrack and underscoring music with the dialogue allow the opening to intensify reality and give an insight into the programme and also the contestants and Alan Sugar.

Prehistoric Medicine Essay Example for Free

Prehistoric medicine EssayThey engaged herbalism the practise of using herbs to heal tidy sum. In each tribe there were shamans who would boot out ill multitude demons and apothecary. They had medicine men who were shamans and witch-doctors. They would provide supernatural treatments like charms, spells and amulets to ward off crime spirits. If someone was ill the medicine man would initiate a ceremony over the patient where they would use magic formulas prayers and drumming. People thought that the medicine men could contact the spirits or Gods so people looked up to them. They utilise healing clays to heal their internal and external wounds and just after surgery. Prehistoric people likewise used trepanning mainly in Peru. This was when they would drill a hole in a someones skull to relieve pressure. It was mainly done as an emergency operation after a top dog wound to remove shattered bits of bone. They believed it would treat epileptic seizures, migraines and menta l disorders. They would keep the bit of skull around their get it on as they thought it would ward off evil spirits. Nowadays people use a modernize trephine instrument in a corneal transplant surgery.Early medicine for Greeks and RomansHippocratesBorn 470 BCE acquire of Modern Medicine He had a theory of the 4 humours. He thought that the human eubstance contained 4 important liquids called humours. They thought if the humours became unbalanced then people would become ill. The 4 humours were black bitterness, white-livered bile blood and phlegm. His theory was wrong but it was a breakthrough in medicine because it do people think that illness was caused by something natural inside your body instead of the Greek Gods. advert from a book in the Hippocratic Collection of books Mans bodyhas blood, phlegm, yellow bile and melancholy (black) bile. These make up his parts and through them he feels illness or enjoys health. When all these elements atomic number 18 truly balanced a nd mingled, he feels the most perfect health. Illness occurs when one of these humours is in excess or is lessened in amount or is entirely thrown out of the body.Hippocrates invented the Hippocratic Oath which was interpreted by all physicians this is still in use today.Herophilus He was the 1st anatomist. He introduced the experimental mode to science. He discovered that the brain controls how the body works, not the heart by dissecting human bodies. He also identified parts of the stomach. He did a lot of work on nerves.Claudius GalenHe was the Roman emperor butterflys doctor. Galens work was based on the Hippocratic Collection. He was one of the Great surgeons of the antediluvian patriarch world. He added his own theory to the 4 humours theory. He developed a theory called the treatment of opposites. So if an illness was caused by heat he would cool them down and vice versa. Galen also emphasized the immenseness of clinical observation and would take detailed notes on his ex amination of his patients. He was one of the 1st physicians who used experiments in his medical investigation. Through that he proved that urine was formed in the kidney as contradictory to the bladder. His most important discovery was that the arteries carried blood but he never discovered circulation.

Factors Affecting Purchase Of A Smart Phone

Factors Affecting Purchase Of A Smart Ph angiotensin-converting enzymeIn this chapter, thither ar 4 separate variable and dependent variable. These variables be important to examine this desire. These variables acknowledge sucker name, gives, outlay and feeling. Besides, this chapter pass on be including the reading materials which atomic number 18 establish on the topic of this re await. The materials that include will be extracting from online journals, articles and magazines. The researcher gets the genuine journals from online databases, such as Emerald Intelligent, ScienceDirect , ProQuest Digital Dissertation Abstract and Google Scholar.The excogitation of doing this research is to study the sections that affecting drink uprs to procure Smartphone in Malaysia. Smartphone is getting attention from all segments of consumer today, but thither must be some factor that will affect their doings before get it alternatively than buying the normal basic cell-phone. t ally to Khasawneh and Hasouneh (2010), the results gull name will influence consumers evaluation and past observe unlike products offering which as a result will affect on consumers demeanour when purchase products and arrangement consumers behaviour is a decisive factor in the companies success around the world. Therefore, this research is to determine whether or non scrape name will affect the Malaysian consumers when they are make their get on a Smartphone.Feature has the strong ability to induce consumers purchasing ratiocination. This explains that when consumers are purchasing any products, consumers will prevail to make us of the products feature as a root for evaluating a product (Puth, Mostert and Ewing, 1999). Features for Smartphone is non only one two three, it will depends on the users preference on what are their needs. Build-in television camera is getting more focus from the consumer nowadays, wide awake phone manufacturer tend to improve the camer a and speaker in identify to fulfil customers needs. Therefore, this research will have the intentions to find out if feature is the major persuasive factor that affecting consumer behaviour towards purchasing a Smartphone.Al to the highest degree every ad accentuates on determine, 90 percent of retail merchants in this grocery screen the wrongs of their competitors on a regular basis (Kenning, Evanschitzky, Voegl and Ahlert (2007). Kunal and Yoo (2010) shows that terms has a positive impact on behavioral intentions. In other(a) words, consumer will tend to have more purchasing intentions if the price is consumers light and vice-versa. For that reason, this research will find out whether or non price will influence consumer heavily when they come to buying a Smartphone.According to Khanna, Vat, Shankar, Sahay and Gautam (2003), express that none of the writers disagree that character is one of the most crucial critical success factors in order for organizations to achiev e militantness among competitors. They kick upstairs interpret that quality had make the Japaneses automobile industry oertook the USAs during 1980s and work the biggest in the world though Japans automobile industry started several decades behind the USAs. In other words, quality is an important factor that consumer will put into consideration before making any purchasing decision, therefore, this independent variables is to find out whether or not it will have the same effect towards consumers in Malaysia when purchasing a Smartphone.All these variables are important because they are main factors that have positive related to the dependent variable. In this research, independent variables that would be focused on are discoloration name, features, price and quality.In overabundance of 1.3 billion people are using cell phone oecumenic today while the socio-economic class of 2003, an estimated number of 1,340,667 cell phone subscribers were being perceive worldwide, an increm ent from approximately 91million in the year of 1995 and 1.158 billion in the year 2002 of 53.49% of occur telephone subscribers (Goggin, 2005). Besides, it was also supported by Gart-ner and Ahonen (2010), stating that more than 1.3 billion mobile phone handsets are being sold each year, and in the year of 2010, Smartphones made up nearly 20% of that total (Gart-ner and Ahonen, 2010). gross r scourue of Smartphones are escalating almost 100% per year, and is expected in the year of 2012 the total global sales volume is expected to surpass the sales of PCs (Gartner, 2010).CUsersUserDesktop01.jpg depend 2.1 Worldwide Smartphone Sales for the year of 2008.Source Andreas Jakl, 2009.In the year of 2008, the highest worldwide Smartphone sales belongs to Nokia, 43.7% from the worldwide Smartphone sales in 2008 belongs to Nokia. In order for Nokia to be the leader of the grocery, there must be some reason behind. Regardless what the gull is, consumer will look at various points before making any decision. ). According to Kupiec and Revell (2001) the intention to purchase a product will be more depending on the scale to which consumers expect the product to hold their satisfaction level when they consume it.According to Yu and Tan (2005), in July 2001, the Ministry of Information Industry (MII) of the Peoples Republic of china publicize d that the witness of its mobile phone users has achieved 120.6 million, which makes chinaware the major mobile communication market in the world. This was supported by Bell (2006), the worlds current largest cell phone market belongs to the Peoples Republic of China. In Asia, the usage ratio of mobile phones in Hong Kong is slightly higher(prenominal) as contrasted with other Asian countries (Chan, and Chan 2008). roving phone penetration rate is ranked as the second highest in Asia Pacific (International Telecommunication Union, 2004). The consumer hot for Smartphone is increasing dramatically and will move forwards annual sales wide-reaching from 131 million units in 2008 to over 300 million by 2013, according to market research company Parks Associates (Cellular-News, 2009).http//img.cellular- parvenues.com/story/38286/Global_sales_of_smartphones_to_reach_310_million_units_in_2013_1.pngFigure 2.2 The global Smartphone sales units (2008 2009) and predicted sales units (2010 -2013)The occurrence of economic recession in recent years does not seriously infected the industry, a report by Berridge (2010) stated that the industry was not really suffered that critically during the recession seeing that the sales for 2009 were down a bit at 1.15 billion units but that was not that far down from the 1.2 billion handsets whipped in year 2008.The constructive impact of communication is experience by more Nigerians in the past four years than they what they came across in the first three decades of self-government (Adomi, 2005). According to Myers and Shocker (1981), factors give notice be pigeonholed in ma ny charges which comprises extrinsic and inbuilt. The extrinsic aspects that include somatogenic prompt such as features and filth name (Olson and Jacob, 1972). On the other hand the aspect that did not consider as part of the physical of product includes price and quality (Olson, 1977).The mobile phone has plump an indispensable tool that is found in all doctors pockets with the advancement of technologies, the phones have become more snazzy over time, especially with the introduction of third base generation technology in 2001(Dala-Ali, Lloyd and Al-Abed, 2011). This has immensely increased two the storage and also the speed of mobile phones. There are many third generation phones available from the market among the most well accepted are the Blackberry and the iPhone, given that the iPhone is a smartphone produced by apple Inc. and was launched in the USA in June 2007 and since then over 33 million phones have been sold worldwide and the number of European iPhone users rose by 161% in the year running up to April 2010 (Dala-Ali, Lloyd and Al-Abed, 2011).2.1 History of telecommunicationIf histories of media have their difficulties, there are uncharacteristic trials and description in seeking to devise histories of the newer media (Flichy, 2002). rambling telecom technologies have matured in consecutive generations (Dunnewijk and Hulten, 2007). According to Goggin (2005) the mobile phone has been in development for at least fifty years regardless of the mobile phone relatively recent commercial approachability and consumer adoption from the early 1980s onwards. It also recursively adopts and reconstructs modus vivendi, anticipations, and cultural forms from two other technologies central to modernity, to be precise the telegraph and telephone (Goggin, 2005).The history of mobile telephone goes back to experiments in the US in the twenties with radio telephony (Kargman, 1978 and Agar, 2003). The first mobile phones were usually car-bound and ATT launched in 1947 a highway service amongst Boston and New York after the success of first mobile telephone network in St. Louis (Agar, 2003). at long last radiotelephony became so crammed full, in New York particularly, that the network operators used waiting lists while terminatedidate customers waited hoping to be so lucky to get a mobile phone connection (Agar, 2003).By the year of 1950 there were still only fifty million telephones in use in the world (Goodman, 2003). Goodman (2003) also further stated that Japan was the first to adopt fixed line phone which is in the 1970s, the number was go beyond by mobile phone somewhere in year 2002, International Telecommunications Union (ITU) predicts that the figure will almost one in three in the year of 2005. In the year of 1996, Nokia introduced the Communicator, a GSM mobile phone and handheld computer which had a QWERTY keyboard and built in word processing and calendar programs that allows besides sending and receiving faxes, t he 9000 could check e-mail and access the internet in a limited way (Farley, 2005).Whereas the first generation (1G) appeared in the 1950s, while the second generation (2G) or GSM technology is used passing wide, but challenged globally by the subsequently (third) generation (3G) technologies. This sequence of generations is characterised by increasing capacity (higher contagious disease speeds) and richer content of the message. Further penetration of 3G depends critically on the integration of telecommunication services and multimedia services, which cancelled out to be more complicated than most experts predicted (Dunnewijk and Hulten, 2007).The fruition of Chinas mobile telecom industry since its beginning in the year of 1987 and appears to be a multistage industrial development process with policy intrusion and market competition. (Siau and Shen, 2003, Maitland, Bauer and Westerveld, 2002, Barnes and Corbitt, 2003). The number of mobile subscribers in China had twofold each year from year 1994 to 2001, by the Q4 of 2002 China had 206.3 million mobile telecommunications subscribers and had become one of the most attractive spots for the international and domestic telecom operators, equipment and phone manufacturers (Yu and Tan, 2005). In addition, Bell (2006), stated that the worlds current largest cell phone market belongs to the Peoples Republic of China. In the mobile telecommunications circles, systemic improvement examples are the successive generations of first generation (1G), second generation (2G) and third generation (3G) systems and this revolution will affect not only our daily lives and the way business is established (Siau and Shen, 2003, Maitland, Bauer and Westerveld, 2002, Barnes and Corbitt, 2003).Table 1 List of best selling score, year of founded and homepage.Brand of PhoneYear of FoundedHomepageNokia1865http//www.nokia.com/Motorola1928http//www.motorola.com/Consumers/XP-EN/Consumer-Products-and-Services/Mobile-Phones/Samsung Mobi le1938http//my.samsungmobile.com/index.jspLG mobile1958http//www.lg.com/my/mobile-phones/index.jspPalm1996http//www.palm.com/us/HTC1997http//www.htc.com/sea/Blackberry1999http//worldwide.blackberry.com/landing.jsp?regionId=22Sony Ericsson2001 (Joint Venture of Sony Corporation and Ericsson)http//www.sonyericsson.com/cws/cws/home?cc=mylc=enApple iPhone2007http//www.apple.com/iphone/2.2 Variables2.2.1 Consumer BehaviorConsumer behaviour can be delineate as the acquisition, consumption and trend of products, services, time and sentiments by decision making units. While consumer decision making can be be as a mental orientation characterizing a consumers approach to making choices (Lysonski, Durvasula and Zotos 1996).Value is created when a consumer is offered utilizable learning and gains understanding, reassurance and/or hedonic fulfilment in the process (Grant, Clarke and Kyriazis, 2007). The jimmy creation relies on an abstract of online consumer behaviour to determine which information sources and formats are most likely to meet their needs at a given point in time (Grant, Clarke and Kyriazis, 2010). To make the decision of purchasing, consumers take into account criteria such as reliability, quality, price and convenience of the product (Sanlier and Karakus, 2010).In contrast to simple or routine purchases, complex consumer behaviour may involve an extended process with a range of activities, each of which presents divergent challenges for a consumer (Assael, Pope, Brennan and Voges, 2007).Analysis of consumer purchasing decisions is not uncommon and a body of knowledge has developed (Watson, Howard and Patrick, 2002).There are several models and theories which describe consumer behaviour from a specific perspective (Estri, Hassangholipour, Yazdani, Nejad and Rayej 2010). Among all these models, the purchase decision model economic aids to understand the relation mingled with consumer behaviour variables better than the other models.According to K im, Forsythe, Gu and Moon (2002), is been an ongoing marketing challenges for retailing in competitive global markets towards marketers to meet the changes of customer needs by providing the right products and services. A consumers decision-making style has been defined as a patterned, mental, cognitive orientation towards shopping and purchasing, which constantly dominates the consumers choices (Safirk Mokhlis and Hayatul Safrah Salleh, 2009).It is common knowledge that price influences a customers buying decision (Monroe, 1973). Intention to purchase depends on the degree to which consumers expect the product to satisfy them when they consume it (Kupiec and Revell ,2001).When a consumer wanted to make the purchase decision, they will pass through the process through actualization, search information, evaluation, purchase, feedback (Blackwell, Miniard, and Engel, 1995). Therefore, the consumer will choose a product or brand to consume from various choice can get in the market. Acc ording to Bettman, Johnson and Payne (2000), different situation will be affect by different factors.Information overload also increase the complexity of the consumer behaviour towards purchasing a product (Bettman, Johnson and Payne, 2000). The information can be obtained by advertisement, display, brochures and etc. A study by Lynch and Srull (1982) suggested that decision-making can be categorized in 3 categories which are stimulus-based, memory-based and mixed. When consumer affect by the external information or factor can be category in stimulus-based. When consumer makes decision based on their memory or inborn perception can be category in memory-based. The combination of this two is mixed.Consumer has different tastes, needs, motivation and lifestyle when they want to purchase a product (Chisnall, 1985). Some of them preferred high quality and impulsive to even off high price, some of them are not (Monroe, 2003). Furthermore, the consumer behaviour towards purchasing a pr oduct can be investigating through the consumer characteristics. It include Brand conscious, price conscious, quality conscious, recreation conscious, innovation conscious, confused by over choice, impulsive and brand (Leo, Bennett, and Hartel, 2005). Therefore, it is important to find out the relationship surrounded by those characteristics and the consumer purxhasing behaviour.2.2.2 Brand keyIn todays changing global environment, many businesses are facing increasing competition that forces them to seek for competitive advantage, efficiency and profitable ways to differentiate among them (Mei, Dean and White, 1999). Brand names are valuable assets that help correspond quality and suggest precise knowledge structures which related to the brand (Srinivasan and Till, 2002). Researchers have distinguished that brand name as an important tool in improving a products pass judgment (Dodds, Monroe and Grewal, 1991). According to Rotfled (2009), brand name is an exclusive and is to indi cate product itself to the market. Besides according to the American Marketing Association, defined the brand as name, term, symbol, or design, or a combination of them intended to identify the goods and services of one vender or group of sellers and to differentiate them from those of competition (Khasawneh and Hasouneh, 2010). Haigh (2007) has proposed three definitions trademark is a logo with associated visual elements, brand is a trademark with associated intellectual property rights, and branded business covers the whole organization.According to Rao and Ruekert (1994), stated that one of the major objectives of a brand name is to provide information on the quality of a product. The value of a brand name adds to the product is named as brand paleness (Farquhar, 1989). Developing brand equity is thought to be an important component of brand building (Keller, 1998). Brand equity is assumed to press out several benefits to a firm (Pappu, Quester and Cooksey, 2005). Brands migh t develop sustainable competitive advantage for firms (Aaker, 1989). As a result, if consumers perceive a particular brand favourably, then the firm may have a competitive advantage (Pappu, et. al, 2005). Brand name is lack of possibilities to establish in short term, in other words, is needed to develop in long term.More and more companies realized that one of their most invaluable assets is the brand names that related with their products or services (Cornelis, 2010). In recent aggressive competitive market place, the most critical success element for companies is the brand name that were being used by a product, and further stated that the brand names are consider as the last source of note for the companies products and services (Lim and OCass, 2001). According to Khasawneh and Hasouneh (2010), the products brand name will influence consumers evaluation and then perceive different products offering which as a result will affect on consumers behaviour when purchasing products a nd understanding consumers behaviour is a decisive factor in the companies success around the world. Brand managers face a complex and multifaceted task in managing the meaning of brands on a global scale (Andrews and Kim, 2007).why do companies develop their own brands? According to Thanasuta, Patoomsuwan, Chaimahawong and Chiaravutthi (2009), the presence of brands were to identify and differentiate the products or services between the companies or organizations. It was further stated that brand name can lend a hand to the brand itself to pass on the information and communicate to the market (Hoyer and Brown, 1990). Also pointed by researchers, consumer have an unlikely kindred perception towards different brand and also have a diverse perception of the products attribute and quality (Srinivasan and till, 2002). Indeed technology is no longer a matter of haves and have-nots but of basic services versus right ones but as technologies mature and product features become more simila r, consumers are very much unable or unwilling to differentiate between brands on rational attributes alone (Temporal and Lee, 2001). According to Forsythe (1995), brand name will be the vital indications or an extrinsic propel (Olson and Jacob, 1972) that will lead consumer to make their purchasing decision when they are trapped in a dilemma whereby they need to choose between two products. When the intrinsic indicator recognition of the product such as price is missing, consumers will tend to recognize it based on the brand name of the products or services (Ahmed and dAstous, 1996).Since consumers will have the knowledge on the brand which will cause consumers to create a perception on the brand, therefore they are able to meter the level of preferences whether or not the brand is pleasing their requirement (Urbany, Dickson, and Wilkie, 1989). To endeavour with this situation, some precise and adequate to(predicate) knowledge on the brand itself is a pre-requisite for consumer s (Ratneshwar, Shocker and stewart, 1987). According to Baltas and Saridakis (2009), usually those who are more particular on the products quality will be more expose to the affection of brand name.Brand extension is a strategy that many companies follow with the aim of benefiting from the brand knowledge achieved in the current markets (Aaker and Keller, 1990).When a new product is marketed under a well-known brand name, failure rates and marketing costs are reduced (Martinez and Pina, 2010). Benefits of a great brand include a short-term gain on recognition to long-term competitive advantage on loyalty, which are ultimately translated into revenues and profits.2.2.3 PricePrice has been observed as an important element affecting the diffusion of new products and services, but pricing of a new product or service is particularly difficult (Munnukka, 2005). Nagle and Holden (2002) stated that price can play a theatrical role as a monetary value whereby the consumers to trade it with the services or products that were being sold by the sellers. Price will always be the key concern of consumers before making any purchasing decision (Smith and Carsky, 1996).Price equality is a psychological aspect which is persuasive towards consumers reactions to price (Campbell, 1999). Prices are perceive to be inequitable consumers respond unenthusiastically by stay away from transactions, contacts with the provider or even engage in penalizing actions such as boycotts (Homburg, Hoyers and koschate, 2005). If a transaction or a price is perceive as un light by consumers, they will engage in disciplinary actions (Antje and Mark, 2010). They will avoid the transaction and do not buy at all. Besides, there is a positive relationship between individuals perception of fairness and their level of expenditures, and that consumers tend to spend more money with specific providers if transactions are considered fair (Daskalopoulou and Petrou, 2006).Oh (2003) found that buyers compariso n of actual price against their internally held reference price seems to affect their subsequent judgments somewhat price, quality, and value.Kunal and Yoo (2010) shows that price has a positive impact on behavioral intentions. Price is one tangible cue from which consumers form expectations. As a result, the elements of marketing play a more important role in services since consumers are more sensitive to cues such as price (Bitner, 1990). Voss, Parasuraman and Grewal (1998) suggested that the link between price and satisfaction. When the consumers are satisfied with the price, they will purchase the product. Furthermore, should be noted that consumers buy high priced brands (typically luxury goods), compulsive by either social adjunctive attitudes that seek design, image, or social status or value-expression attitudes that seek product durability or quality (Wilcox, Kim and Sankar, 2009). Conspicuousness (willingness to spend a great amount of money to essay their social status ) also plays an important role on brand purchases (Kunal et al., 2010). Wilcox et al. (2009) find that high-priced brands are exceedingly related to consumer conspicuousness. Consumers looking for quality, status, self expression, and image will gravitate toward high-priced brands to fulfill their goals, the achievement of which can be signaled through promotional messages of conspicuousness and exclusivity (Kunal et al., 2010).The level of price is found to positively affect behavioral intentions chiefly because price establishes image of the brand in the eyes of the consumers (Aaker, 1991). In a consumers heuristics, a high (low) price connotes a high (low) quality and image. For a conceptual convenience, there are two types of products by price high-priced brands and low priced brands (Kunal et al., 2010). High-priced brands are brands on the market whose image is seen as the key factor. Consumers of these brands often purchase them mainly for image and are willing to acquit a premium price for their perceived high quality and status, which make them price-inelastic (Bolton, 1989). Low-priced brands tend to be purchased for utilitarian value, with the consumer relying on the perceived value for price. Consumers would typically look for low prices of these brands or substitutes to get the best value (Kunal et al., 2010). Consumers tend to interpret higher prices with higher quality, and low prices are perceived as an indication of inferior quality (Rao and Monroe, 1988)According to Thaler (1985), there is more than couple of brand of mobile phone that consumer will find in todays market, this will most likely influence the consumers indicator on the pricing that being sold. Price is no longer an element that can be ignore for investigation whether or not it is an crucial factor that affects consumers behaviour in products and services. Given an example, a customer is choosing either a offline and a online book strain for books, the distance of the store will be the first consideration and then followed by the time needed for delivery and last the price of it (Karlsson, Kuttainen, Pitt and Spyropoulou, 2005). As seen, price is a vital issue that the consumers need count into consideration. Recently, most of the consumers are pursuing a high quality services, though service is an important factor, yet the unwillingness of consumers to pay for obtaining a higher level of service by sacrificing an extra amount can still be seen (Tse, 2001). On the other hand, price might not be part of their considerations especially when dealing with weave shopping, which the major concern falls on convenience, security and store offer (So, Wong and Sculli, 2005).In addition, there is a positive relationship between price and quality (Etgar and Malhotra, 1981). It explains that most of the consumers will regard high price goods and services equals to high quality. Thus, if the price level is at a peak but the quality or features are comply with the consumers expectation they might perceive as fair and are more willing to pay a at a higher price to owns a better quality goods or services (Monroe, 2003). Due to the price of a product has a key authority on the consumers buying decision (Evanschitzky, Kenning and Vogel, 2004), it is normal to concentrate on it. As a precondition to valuing a price as low, the consumer must have at least a vague idea of the normal price. Only if that idea of normal price is present consumers can assess whether or not the offer is a bargain. The marketing-mix instrument of price is currently used too to attract consumers to a particular product or store.According to Kenning, Evanschitzky, Voegl and Ahlert (2007) nearly, every advertisement emphasizes price that over 90 percent of retailers in this market screen the prices of their competitors on a regular basis. Price knowledge is a psychological construct that relevant to retailer success, since it influences some(prenominal) a consumers buying decision and the sales margin. At the same time, it can help the retailer to run consumer willingness to pay. The price of a product is one of the most important marketing-mix tools which are currently used excessively to attract consumers to a certain product or store (Evanschitzky, Kenning and Vogel, 2004). Price knowledge is a psychological construct that is relevant to the success of the retailer, since it influences a consumers buying decision. At the same time, it can help the retailer to exploit the consumers willingness to pay by using information about price knowledge for the pricing of products.

Assessment Of Pharmacology Teaching Nursing Essay

Assessment Of Pharmacology Teaching Nursing EssayStudents feedback is an indicator of the success of any belief methodological analysis followed in a department. AIM/OBJECTIVE To identify strengths and weaknesses in the current education- training and evaluation methodology in pharmacological medicine using feedback from second MBBS students in Meenakshi medical College and look into Institute. MATERIALS AND METHODS Questionnaire was designed and finalised after a departmental word in concurrence with Medical Education Unit. The study overts were cxv (2011batch) second-year medical exam students. They were requested to fill the questionnaire. A 10-item multiple excerption questionnaires were used to explore the students opinion on commandment. The questionnaires were analyzed. RESULTS 115 II M.B.B.S students participated and descriptive statistics was used for analysis of data. The analysis revealed 82.82%, 72.17% and 93.64% students interest towards writing motley of drugs , hebdomadally turn out and viva-voce respectively. CONCLUSION The founder study has helped us to elicit the student preference regarding pharmacological medicine teaching and its outcome would be helpful in modifying undergraduate pharmacological medicine teaching pattern.KEY WORDS Medical education, Pharmacology Assessment, Medical school learners.INTRODUCTIONThe primary aim of teaching materia medica to medical students is to develop them on rational and scientific basis of therapeutics. Pharmacology teaching is set about a major gainsay in the medical science due to constant reformation. Generally, there is a opinion that teaching pharmacology in medical schools has failed to keep in pace with the rapid changes in medical practice. Attempts have been do all over India to make teaching of pharmacology more interesting and relevant (Gitanjali.B.et.al. 2006). To make pharmacology teaching more innovative and interacting learning experience, efforts have been made by formula ting new educational strategies to understand the educational objectives. Educational objectives can be evaluated by sound judgement procedures and timely feedback to achieve the learning goal.In Meenakshi Medical College and Research Institute, Pharmacology teaching comprises mostly of a series of didactic lectures using queen point presentations covering general, systemic pharmacology and working pharmacology which includes animal experiments and clinical pharmacology sessions interpenetrate over the schoolman year. To evaluate the students progress we conduct monthly internal assessment scrutinys consisting of multiple choice questions, essay questions, short notes and ultra short notes for 3 hr time duration including model practical exams conducted twice in a year. Regular viva voce exams follow the monthly internal assessment screen to develop their communication and interaction skills.Apart from this uninterrupted inventory of assessment, we in like manner introdu ced a method of concession on classification of drugs after each system. To reinforce the learning process, we implemented weekly exam on the first hour of every week based on the lectures delivered over the previous week. The test was conducted for wholeness hour which covered various portions of the chapter in detail testing the levels of association.After completing the above schedule meticulously, at the end of the year to understand the beneficiaries opinion we planned to collect the students feedback. Currently the students feedback represents the primary pith used by different programs to assess their methodology (Richardson B.K.2004). Feedback helps in correcting mistakes, reinforcing good performances and incorporating students view in teaching methodology. It is accepted that reviewing the teaching and evaluation methods by feedback from students and modifying of methodologies accordingly is very important for the undergraduate medical teaching. (Ruth N 2000, Victorof f KZ 2006)Thus the present study is an effort to obtain and analyze critical appraisal on,The student view toward teaching and learning pharmacology in Meenakshi Medical College and Research Institute, Enathur, Kanchipuram.Assessment of pharmacology teaching using student feedback.Methods to improve the teaching of pharmacology.Materials and MethodsA questionnaire was designed to obtain feedback and finalized after a departmental discussion with concurrence of Medical Education Unit. The study subjects were 115-second year MBBS students of 2011 batch examine in Meenakshi Medical College and Research Institute, Enathur, Kanchipuram.All the students enrolled in the study were requested to fill up the questionnaire. The study was conducted at the end of their academic year in Department of Pharmacology. A ten-item multiple choice questionnaires and an open ended question for proposal were provided to explore the students opinion on teaching and learning methods imparted. The questio nnaire was analyzed by two observers. The questionnaire was designed in such a way to assess the knowledge, their attitude and skills developed during their one and half year seam in pharmacology. Both the theoretical and practical pharmacology unspoiled by different methods during their study outcome were evaluated from the feedback form.StatisticsDescriptive statistics was used for analysis of data. Frequency was shown as percentage.ResultsOne hundred and fifteen students of II MBBS participated and responded in the questionnaire study. Based on the pattern of studying pharmacology,48.69% studied pharmacology once or twice a week on unfluctuating basis and 34.78% opted studying only for monthly tests and viva voce exams which reflects on their regular preparation for monthly internal assessment test(TABLE-1).54.75% of students preferred lecture notes and text books as the source of studying pharmacology.TABLE -1Majority (87.82%) of students approved writing and maintaining cla ssification of drugs. 53.91% have opined that the assignments had improved in better reason about the different classes of drugs.43.47% of them have reported its usefulness to memorize and reproduce in the test and also to apply in their clinical postings.Among the assessment methods, 54.78% of students favored monthly internal assessment test for their operative improvement in their academic performance. In the weekly test conducted, 72.17% of students found weekly lectures correlating with weekly tests, 51.30% of students mentioned that the true or false part of the weekly tests created interest (TABLE-2).TABLE-2Majority (66.95%) of students preferred regular tests in clinical pharmacology sessions when compared to the experimental pharmacology. Most (93.64%) of the students have mentioned regular viva-voce exams following monthly internal assessment test had improved their communication skills.Among the teaching learning methods practiced, 52.17% of students preferred theory lectures followed by clinical pharmacology sessions 46.95% and separate discussions 45.21%(TABLE-3).TABLE-3DiscussionFeedback is defined as a response within a system that influences continuous activity or productivity of that system. In the present study on educational context, it would mean a response from the learner about the teaching learning process. Feedback is essential to recuperate out the effectiveness of the process, the call for to change it, as well as, to evolve strategy for its improvement.From the feedback evaluation obtained, it is observed that students like to study pharmacology by regular test / viva and interactive classes so by these way students understand the subject properly (Nilesh Chavda 2011 et.al). This is very much correlating in the present study feedback results.It was found that students preferred writing and maintaining classification of drugs throughout their academic year, which were corrected periodically by the faculty, who played the role o f mentor for the given group of students to cultivate and sustain the habit. Writing classification of drugs by medical school learners has helped them to understand the different classes of drugs and also to systematically memorize and reproduce in the written test as well as the knowledge application in clinical rotations (TABLE-4).TABLE-4Students opined that monthly internal assessment test was mostly useful than the weekly written test for their academic performance in theory exams, the reason for the following may be monthly internal assessment pattern is similar to that of university examination. The weekly written test has definitely kept the students in pace with the portions being completed every week. By answering the weekly test their preparation, facing and performing monthly internal assessment had become extremely comfortable and confident . The weekly test had various parts, students considered true or false part of the weekly test has created interested in them, the circumstance to get such a feedback may be the chances of getting the wrong answer is only 50%. Also they have mentioned that, Match the following with extended responses have stimulated their thought process to find the correct response. The feedback also emphasized the students interest towards more interactive sessions on Clinical pharmacology exercises and mat it should be given regular emphasis than the animal experiments. According to Gibbs G et al, 1987 active review during the lecture, involving students in structured discussions, using questionnaires and asking them to summarize are the three most important things to be followed and practiced for a effective teaching-learning process.To conclude though the teaching learning method implemented in the present study required a lot of strenuous hard work from the faculty particularly preparing questions, organizing test and more importantly correcting all the papers in a week period, it has created an interest in learning pha rmacology among students. The feedback from learners has clearly exhibited their likeliness for the variety or different methodological approach instead of regular didactic lectures offered by the department of Pharmacology.AcknowledgementsWe sincerely thank our II M.B.B.S Students of Meenakshi Medical College Research Institute (GRIFFINZ) for the affair

A Dialog Axiata Plc Management Essay

A negotiation Axiata Plc Management Essay dialogue Axiata PLC, Sri Lankas biggishst communications service provider is a subsidiary of Axiata Group Berhad. negotiation being the 4th entrant to Sri Lankas cellular mart launched its services in 1995. They were the beginning(a) digital ne twork in South Asia to launch HSPA + which is the in style(p) upgrade in mobile broadband. In addition to communication service, the attach to withal offers early(a) services such as mobile, internet, international gateway, entropy and backb codinal, fixed tuner and media related services and has 200 tax added services.The connection is currently serving oer 7.5 million local subscribers and is the 50% market leader in this industry. They guide the widest coverage reaching 95% of the cosmos and argon the only operator to cover all(prenominal) the districts.They stool euchre salesmen on the ground on with a strong service team up of 1000 round over 125 service centre and 50,000 re tail merchant networks. They be in whatever case the exaltedest FD Investor in Sri Lanka.1.2- Why is talks selected dialog is one of the around reputed companies in Sri Lanka with a highly diversified radical of employees where they would decidedly have cross cultural issues. In addition, they have been undergoing ongoing strategic as wellhead as transformation modifications which as a prove would rise to conflicts at the different levels of the hierarchy. thusce being a large and reputed club, duologue stands as a challenging conjunction in the belligerent market.2- Culture at duologueE really face has its possess finish which refers to the beliefs, ideologies, principles and also the values that the various(prenominal)s of the organization sh ar. The culture plays a vital utilisation in the success of the organization.When it perplexs to Dialog, the company has adopted a genuinely diffuse and transparent culture where they have embodied honesty and brusk c ommunication. foil is maintained at all levels where superiors are easily avail adapted to the subordinates.The integrated culture of the company fits to Adaptability as well as achievement orientated which emphasize winning and achieving specific ambitious goals and the company values battle and personal imitativeness.Dialog is a company that is also workings for the benefits of the stave. The company has a dress code policy to make the office prink equal indoors the ply. Staff birth days are also celebrated at the company level where the relevant departments forward the stave birthday list to HR Department on the 1st hebdomad of the month where the staff testament get a gift along with an e- invoice.And they have a policy like staff that comes up with innovational ideas a recognized on a quarterly basis where they are provided with a reward named BRAVO in a special meeting.plain the above actions on the company side will lead to high motivation and increase productivity level of the staff.2.1- Hofstedes ModelDiagram 1 Hofstedes cultural 4 dimension ModelPower DistanceAlthough Sri Lanka get ahead high on this dimension, Dialog is more towards the low power distance. They have a decentralized hierarchy where employees and subordinates do non show disparity much. The superiors or the Management team are willing and they trust the subordinates with all-important(a) jobs.Individualism vs CollectivismDialog falls towards the collectivism, because the people in the company have stronger bonds to their groups.Masculinity vs FeminityIn Dialog its more like a combination of both as this would help them for a balanced approach. They value achievement and competitiveness as well as money and power. However, they also value people and maintain good relationship with them.Uncertainty shunning / structured situationsAt Dialog, the degree of uncertainty avoidance is low. The company eer welcomes for bare-ass things and switchs, and embrace unpredictable si tuations. The company is very flexible and open to new approaches or ideas.3- Changes in DialogDuring the past, Dialog Company has undergone several(prenominal) Strategic as well as Operational Changes. However, in this subsidization only the following recent lurchs are being explainedOutsourced Call optic to Firstsource Solutions (2011)During 2011, Dialog entered into a partnership with the BPO service provider Firstsource Solutions where Firstsouce acquired 76% shares of the Dialog Company. The new company was named as Firstsource Dialog Solutions.Acquired Suntel Ltd (2012)Dialog acquired Suntel Ltd, Sri Lankas second largest wireless fixed line operator during 2012. The main reason behind this stir was to eliminate one of their main competitors from the market. As a result of the change, Suntels former(prenominal) customer base plus all the employees were transferred to Dialog.Outsourced SAP to Attune Lanka (2012) line of credit set-up Over the Top Service (2012)During 2012, Dialog opened its largest hi-tech guest Service Centre in Colombo, where they brought in 150 customer service professions trained in multiple technologies.3.1- Resistance to Change overcoming resistancepatronage the potential peremptory outcomes, change is often resisted at both the individual and the organizational level (Mullins, 1999).When Dialog brought the above mentioned changes as mentioned in clause 3 above, the company faced resistances from the employees. However they overcame the main problems and issues as mentioned to a lower placeResistance to ChangeOvercoming ResistanceSuntel employees adapting to Dialog cultureSuntel Ltd and Dialog were having two different types of corporate culture. So when Suntel Ltd was brought under Dialog, employees who were working for Suntel had a very difficult time adjusting to Dialogs new culture. As such they were give briefings, planning sessions, and were well educated.Employee ranking / salary structure issuesWhen Suntels forme r employees were brought to Dialog, there were few problems relating to the rankings or position levels and even with the salary structure.Therefore Dialog mapped any staff to the level and was inclined a probation period of 3 months with given tasks and targets. So if the relevant employee was able to coif to the expected level they were given the same position they had in Suntel.Staff transfer(Dialog Brand loyalty)When Dialogs card centre staffs were transferred to SAP, some issues were raised because people who have been working for Dialog for a long time felt bad and also they didnt genuinely want to leave Dialog since they felt some kind of proudness working in Dialog.However, Dialog Management convinced the staff that they would non miss anything and will get all the benefits and additional opportunities for their career development.Staff de-motivation efficacious communication (peers to HR)Security in the pastObviously moving to a new company would feel confused and un secured active the new environment.In the case of Suntel Staff, they felt that they aptitude not be able to perform well or office even lose the job. Therefore Dialog offered a job guarantee letter confirming that their jobs are not at risk.But any how they were well informed that if anyone who cannot perform to the expected level would be withdrawn from the job.3.2- John Kotters Change wait onDiagram 1 John Kotters 8 steps theory homunculusWhen we look at the John Kotters change cast, Dialog also ab initio created a sense of urgency when they underwent changes. They convinced the employees the importance of acting at present due to high competitiveness. Also they formed a powerful group to lead the change effort and encourage the group and created a passel where they communicated with the entire employees.In order to reach the vision, they tried to remove the obstacles that might undermine the vision and encourage risk taking ideas.3.3- Human Resources social occasionHuma n Resource is the backbone of any company and it is their duty to minimize the resistance and make the change a successful one.In duologue HR was very certain in properly communicating the employees about the change and ensured that there would be no harm done to any staff and as per the labour law, all the right of the employees were delivered. Even when they took over Suntel, the former staffs service period was counted on a continuing basis. For example if an employee had served Suntel for a period of 6 years, then they had counted from the 7th year when the staff joined Dialog3.4- Force Field AnalysisForce issue analysis is a technique by Kurt Lewin that can be use in a team building program.When we look at the Dialog side, the listed driving forces help the company to achieve their targets or goals. On the other hand restricting forces make it difficult to reach their targets. slightly of the study critical factors in the restraining forces that the company is not able co ntrol are the high cypher appeal.For example, the Sri Lankan market is yet to grow but cost is very high4- negates in DialogProblems will obviously pinch in an environment where diversified people are working and curiously if two companies with two different cultures are merged.In Dialog case, most of the conflict arises at the individual levels mainly due to difference in their personal views since some might think the change as a positive thing while others might take it as a threat or risk for them. Also several issues rose because Suntel staff had the feeling that they might be treated unequally or they might not get all the rights what Dialog company staffs already had.4.1- Sources of conflictsDuring the change process, several conflicts raised in Dialgue which was mainly due to the following reasons disposition of work activitiesWhen we take company buys but the Company the sales staff do all the documentation promising to give the service inside two days. But if they do not hear from the company and technological staffInformation not passed properlyCommunication barriers as difficulties in communicating to all levels of the staff can cause misunderstanding and as a result may create problems especially at the very lower level staff. For example Messenger level staff would not be able to access to intra-net plus they might not be able to understand internal memos or notices written in conflicting language).Differences in perceptionAlso different peoples perception would be different. Some may feel that merging the two companies would be obviously an probability for their career improvement while other might take it as a huge threat.Uncertainty of Job Security conflicts occurred..4.1- Effects of conflictsConflict situations sometimes can be taken as a positive thing depending on the situation. However, some of the main negative effects of conflicts areStressDe-motivationAbsenteeism (5%)Staff turnover (5%)4.1- Resolving conflictsWhen it comes to c onflict within the company, Dialog takes all the relevant actions at the right time to avoid excess fights and disagreements. This is because they believe that it would hugely affect the productivity level of the employees.The company has a written code of conduct where every employee follows and is aware about the companies policies and procedures. When manipulation conflicts, the matter is first discussed at the supervisor or the relevant department level and thereafter then line Manager. If the matter is still not solved then the issue is raised to the HR Dept and further to older Management level. In worst cases, Arbitrators are invited to solve the problem if required.When it comes to the procedures, first the staff is negotiated verbally and if that does not help, written explanation as well as enquiries is done. However if all these actions do not work then written warnings are also given.5- Change Management through organization learning51- superstar Loop Double Loop Le arning modelAs per the model, Dialog uses the two ways to learn from their experienceSingle Loop LearningThe company takes corrective action to avoid or resolve a mistake but does not go obscure into the matter.Double Loop LearningThis is where the company looks into the root of the problem to discover the underlying cause of the problem.6- ConclusionBased on the above knowledge and extensive research done, it may be concluded that the company has a very open and transparent culture. In addition, it is successful in managing culture, change and conflict. This is because Dialog Company has a set procedure for everything as per their write in code of Conduct.Further when a new staff joins or is recruited, the staff will be provided with a clearly written job description so that everybody would know what is their role and what is expected from them.7- RecommendationsAlthough the company is successful in managing change and conflicts, the following recommendations would enable the c ompany moreBuild an innovative political platform to encourage creativity among staffAlthough staff is given the opportunity to come up with innovative ideas, at the jiffy the company does not have a special departmentWhen outsourcing give more choice to employees to take their own wayWhen outsourcing we feel that the staff should be given a chance to choose what is best for them. For example in case when card centre of Dialog was outsourced, they were not given any chance for their own views whether they want a transfer to another department within Dialog or want to join the new company. If they should have given the chance or at least got some feedback, then they might not have felt negative.Introduce job enrichment to motivate the staffsAt the moment there is no job rotation or job enrichment programes within the company. However, if job enrichment programme is introduced, the staff would feel more motivated and obligated for their work. It would enable them to try new tasks and stretch their skills beyond what they have been doing all the time.Go GREENIn order to reduce the companys high energy cost, it can go to solar panels

Inflammatory Bowel Disease: Types, Causes and Effects

rabble-rousing Bowel ailment Types, Causes and EffectsChapter 1 THE INFLAMMATORY intestine DISEASEWHAT IS INFLAMMATORY BOWEL DISEASEInflammatory bowel indisposition (IBD) means chronic ignition of all or part of your compendiumive parcel. IBD fag end be classified into two, which is, ulcerative inflammatory bowel disease and Crohns disease. IBD is very untellable and debilitating, and hatful sometimes contract to life-threatening complications. The IBD is called an autoresistant disease be actor the embodys repellent system attacks the digestive system. The disease is so severe that it whitethorn cause abdominal muscle throe, smeary diarrhea, cramps and fever.This is sole(prenominal) different from Irritable Bowel Syndrome (IBS).DIFFERENCE BETWEEN INFLAMMATORY BOWEL DISEASE (IBD) AND INLAMMATORY BOWEL SYNDROME (IBS)The difference between the IBS and the IBD is that IBD is structural, unless IBS is not. If the gut is examined by x-ray, endoscopy, biopsy or su rgery, structural damage to the gut can be seen. In IBD, the damage is caused by the fire and whitethorn require heavy profession medication, or even surgery. Whereas in IBS, the examination of the gut of a soulfulness having IBS would help detect nothing. It can only be detected by gut symptoms. These whitethorn include abdominal cramps or pain, harder or looser bowel movements than average, excess gas, diarrhea and constipation or alternating between the two. twain of these collide with mickle of all ages but young people be to the highest degreely takeed. Females have to a greater extent chances of having IBS. IBD has no gender preference but is mostly found in Jews and people from Northern Europe. IBS is a ecumenic disorder, while IBD is prominent in the planets temperate zones.In IBD, the gut is damaged by chronic inflammation. The damage is fought by the demurral mechanism of the body resulting in fever and malaise. The intestines atomic number 18 disrupted, they may melt d take in and anemia is common too. on that point is inability to eat during attacks, inflammation is caused which results in wasting of energy, ultimately resulting in weight loss and malnutrition.IBS cannot be determine by findings of physical examination. However, the structural damage caused by IBD is besides adequate of producing striking physical findings the like a mass in the tummy, or the symptoms such as that of weight loss and anemia. Other differences include the subscribe for surgery in IBD, which is not require in IBS. IBS does not deliver complications in the gut, skin, joints and eyes, but IBD does.CROHNS DISEASE This is the example of IBD that may drive any part(s) of the gastrointestinal tract, ranging from m surfaceh to anus. Listed below atomic number 18 a few characteristic featuresInflammation usually legislates in patches.The pain is usually see in the lower right abdomen.The colon may turn midst and might appear to be rocky.Ulcers in and on the digestive tract ar very deep, sometimes extending into every layer of the bowel wall.During bowel movement, rectal bleeding is not common.ulcerative inflammatory bowel disease is the second type of IBD, which is taken up in the subsequent chapters.Chapter 2 ULCERATIVE colitisDefining Ulcerative colitisinflammatory bowel disease means the inflammation of the colon, or to a greater extent largely, inflammation of the large intestine ( that comprises of colon, caecum and rectum). Ulcerative colitis is a disease of the colon, which is the largest part of the large intestine, characterized by ulcers (open sores). These ulcers ar painful wounds, they may bleed and also produce mucus and pus. The mucosa (inner lining) of the intestine becomes red and swollen. The rectal bea is most severely affected. If the lining of the colon is damaged, it may cause telephone liney diarrhea.Where Crohns disease can affect almost any part of the digestive tract, Ulcerative colitis on ly affects the large intestine. Crohns disease can be treated by removing the affected parts and reconnecting the healthy ones. Whereas to treat ulcerative colitis, one may have to remove the large intestine in all (called colectomy). It can occur at highly irregular intervals, at times, with symptoms extremely severe, and sometimes, no symptoms at all.Ulcerative Colitis- An autoimmune conditionIn autoimmunity, an organism fails to recognize its amaze constituent parts as self, and thus operates to an immune retort against its own tissues and cells. Such diseases be termed as autoimmune diseases.In some another(prenominal) words, our bodys defense mechanism goes wrong and attacks its own healthy tissue. There atomic number 18 harmless bacteria present inside the colon, which are monstrous to be harmful by the defense mechanism, and are attacked, ahead(p) to inflammation.Classifying Ulcerative ColitisUlcerative ProctitisThis is Ulcerative colitis in its loonyest form. Th ere is inflammation only within the rectal area. The various signs and symptoms are as followsrectal painRectal bleedingThere is an urge to move the bowels but inability to do so.ProctosigmoiditisThis involves the lower end of the colon, that is, the sigmoid colon and the rectum. The signs and symptoms are as followsAbdominal painBloody diarrheaAbdominal cramps unalterable urge to go to the toiletLeft sided colitisThere in inflammation in the rectum, up on the left field side along the sigmoid colon and the descending colon. The signs and symptoms areAbdominal cramping on the left sideBloody diarrheaWeight lossPancolitis (Universal colitis)This involves and affects the wholly colon. The signs and symptoms areBloody diarrhea ( at that place may be severe bouts)Abdominal painAbdominal crampsWeight lossFatigueFulminant ColitisThis is the most rare form of colitis and it can be life threatening. It affects the whole colon. Patients erecting from fulminant colitis are at a unending attempt of toxic megacolon (the colon becomes swollen, or bloated, or distended) and colon rupture. The signs and symptoms are as follows bare diarrhea, that can lead to shock and dehydrationSevere painSYMPTOMS OF ULCERATIVE COLITISThe Gastrointestinal symptoms includeDiarrhea with kin and mucus. This implies the gradual onset of the disease which may persist for an extended period, perhaps weeks. If rectal examination is conducted, blood may be found. The patients also suffer from drastic weight loss. Due to the inflammation and extreme loss of blood from the gastrointestinal tract, anaemia may occur. There may be barmy abdominal pain, or painful bowel movements go with with painful abdominal cramping. mavin may even experience fatigue and loss of appetite.One may experience very mild or almost no symptoms, called remission, which may be followed by symptoms that are troublesome, called flare-ups or relapses. These may be triggered by stress. Flare-ups may be very troublesome , in which patients may have to empty their bowels about six times or more from apiece one day. Heartbeat may be fast or irregular, accompanied by shortness of breath and high fever.Severity of the disease small diseaseThis means less than four stools each day. Blood may be present or absent. Patient may experience mild cramping and abdominal pain. The patient may feel constipated, with a continuous intuitive feeling of needing to empty the bowel, with cramping or pain and little or almost no fecal output.Moderate diseaseThis means more than four stools each day. Patient also displays signs of anemia, fever around 100 to 102 degrees Fahrenheit.Severe indispositionThis means around six stools with blood each day, implying observable bowel movement, toxicity demonstrated in the form of fever, anaemia and tachycardia.Fulminant DiseaseThis means more than or equal to ten bowel movements each day, accompanied by continuous bleeding, abdominal tenderness, toxicity, colonic dilation and blood transfusion is oftentimes required. Patients may have toxic megacolon as the inflammation extends beyond the mucosal layer. At times, the serous membrane also gets mixed causing colonic perforation. If not treated, fulminant disease may lead to death.Extraintestinal SymptomsAs ulcerative colitis is an autoimmune disease, patients may develop symptoms as well as complications outside the colon. These includeUlcers in the mouth.Opthalmic stung and red eyes, or inflammation o iris called iritis.Musculoskeletal fruitless joints (arthritis). These may be large joints, or small joints of hands or feet. Or joints of the spine.Cutaneous Inflammation of the subcutaneous tissue.Painful and ulcerating lesion of the skin.A fault of the ends of the fingers (Clubbing).Inflammation of the bile ducts (Primary Sclerosing Cholangitis).Chapter 3 Causes of Ulcerative ColitisThe causes of Ulcerative Colitis are still not known. Yet, the possible causes are listed below geneticsThe disease ca n be inherited if one has a cobblers function relative hapless from the disease. Hence it can be found in the family. The regions of the genome that can be linked to this disease are the chromosome number 1, 3, 5, 6, 12, 14, 16, 19. Since no(prenominal) of these have been faulty continuously, it has led to a conclusion that the disease occurs delinquent(p) to a combination of various genes. One of the regions, for example, has been linked to ulcerative colitis is chromosome band 1p36.ENVIRONMENTAL FACTORSInflammation may be encouraged by diet. For example, if there is a large intake of vitamin b6 and unsaturated fat affect the development of ulcerative colitis. There are many other find dietary factors which may lead to the relapse or development of the disease, like meat protein and alcoholic beverages. Vitamin D deficiency is also a leading cause of the disease. Breastfeeding may also lead to the development of the disease.The role of sulfur in Ulcerative ColitisSulphur is found in many foods and substances like milk, eggs, cheese, mayonnaise. It is also used as a food preservative because it stabilizes protein structures. It also prevents microbial growth during fermentation of wine and beer.Bacteria that are present in the bowel convert the sulphur present in the food to enthalpy sulphide, which is called fermentation. This substance is harmful as it can cause abdominal pain and urgent and frequent bowel movements. Because of the already real inflammation of the bowel lining, patients suffering from ulcerative colitis find it uncorrectable to break down the gas as they produce more hydrogen sulphide than normal. This toxic substance, in high amounts, reduces the protective unction of the cells that are lining the bowel. It can also cause cell death and name ulceration in the superficial mucosa of the intestine. Hence the cells lining the colon are harmed.IMMUNE SYSTEMTheories suggest that a virus or a bacterium also may trigger ulcerative colitis as the digestive tract may become reddened when the immune system tries to get rid of the invading microorganism (pathogen). This inflammation is caused due to the release of white blood cells to destroy the present pathogen. This may lead to an autoimmune reaction/condition in which the body produces an immune reply even during the absence of the pathogen. This happens because the body tries to eliminate pathogens which are either gut friendly, or non-existent.RISK FACTORSThe factors that raise the risk of ontogeny Ulcerative colitis are as followsAge Though it may affect people at any and every age, it is more commonly found in people aged 15 to 30.Genetics If someone has a windup relative with the Crohns disease or ulcerative colitis, they are at a high risk of development of the disease.Isotretinoin The treatment of cystic acne is often done with the help of this medicine. It can cure other kinds of acne too, but it increases the risk of this disease. The medicine is also ca lled Accutane. Amnesteem, Sotret and Claravis (These are the various other brand names). appendectomy The removal of the appendix may lead to the reduction of the risk of developing ulcerative colitis but an increased risk of Crohns disease.Chapter 4 DIAGNOSISUlcerative colitis is diagnosed only when the possible signs and symptoms of infection, Crohns disease, excitable bowel syndrome (IBS) and colon cancer have been ruled out. The following tests are carried outBLOOD TESTSThey help to check anaemia, and also help to diagnose the name of the bowel disease the patient has.STOOL SAMPLEIf there are white blood cells present in the stool, it implies that the patient is suffering from an inflammatory disease, possibly ulcerative colitis. It also helps rule out other diseases, like those caused by bacteria, viruses and parasites. Clostridium difficile usually causes diarrhea but also common amongst people suffering from ulcerative colitis. Bowel infection can also be checked this way.C OLONOSCOPYThe entire colon can be viewed using a flexible, thin and lighted tube which has a camera attached to it. Small tissue samples are also taken (called biopsy) so that a laboratory analysis can be conducted and ulcerative colitis may be diagnosed.SIGMOIDOSCOPYThis test is done if the colon is inflamed severely. A thin, lighted and flexible tube is used to examine the last portion of the colon, the sigmoid. But the drawback of this procedure is that the problems occurring higher up the colon may be missed and a full picture of the affected colon is not achieved.BARIUM ENEMAThe entire large intestine can be examined using an X-Ray. A contrast solution of barium accompanied with some air is placed into the bowel with the help of an enema. Once the barium coats the entire lining of the colon, rectum and a part of the large intestine, it creates a silhouette. This is a dangerous test and hence rarely used because the pressure that is employ to inflate the colon and coat it may lead to its rupture.X-RAYAn roentgenogram of the abdominal area can be done to rule out the possibility of toxic megacolon and perforation as these conditions may appear because of the severe symptoms.CT SCANThis scan is carried out to check the extent of inflammation of the colon. The abdomen and pelvis are scanned if complications due to ulcerative colitis are ascertained or an inflamed small intestine that may be because of Crohns disease.VIDEO CAPSULE ENDOSCOPY (VCE)In this test, a patient swallows a condensing containing a camera which takes pictures of the intestine as it travels through it and sends them to a recording machine wirelessly. The pictures can then be reviewed.Chapter 5 TREATMENTThe treatment of ulcerative colitis is done on the basis of the severity of the disease. It mainly consists of changes in the diet and medication. If symptoms are found to be severe and long lasting, more medicines may be required or even surgery. But medicines cannot completely the dise ase. They can only minimize the risk of cancer, induce remissions and agree them and correct the quality of life.AMINOSALICYLATESThese are anti- inflammatory drugs that are used to induce and maintain remission. 5-aminosalicylic acid (5- ASA) produces the anti-inflammatory action. Examples of aminosalicylates are-MESALAZINE Also called Pentasa, Octasa and AsacolSULFASALAZINE This belongs to a class of antibiotics and it decomposed in the intestine to release 5-ASA.Since this substance is not entirely absorbed by the intestine, it gives a topical relief.CORTICOSTEROIDSThese are often used with 5-ASA drugs to induce remission of ulcerative colitis. These work by the blocking the parts where leukocyte adhesion cascade occurs to induce inflammation. These have many side effects like the puffiness on the face, called moon face, and manic behavior. It may also cause bipolar disorder, inducing periods of elevated mood and depression.Examples include Cortisone, Hydrocortisone, Prednisone. IMMUNOSUPPRESSIVE DRUGSThese inhibit the immune system. They stop cell division of white blood cells that occur as an immune response. Examples are Mercaptopurine, Methotrexate, Azathioprine.DIET MODIFICATIONFresh fruit, carbonated suck up and caffeine should be avoided by patients suffering from diarrhea and abdominal cramping. rough patients show lactose intolerance (they are not able to digest lactose) hence they cant consume lactose. To supplement the bone loss, atomic number 20 is given to them.The gastrointestinal and auto-immune symptoms can be helped by using the particularised Carbohydrate Diet that allows only the use of monosaccharides and not the other carbohydrates.At times due to metabolic defects, Hydrogen Peroxide may reconstruct up underneath the membrane that usually protects the walls of the intestine from the bacteria that are present. To protect ourselves from these oxidants, a need to take antioxidants arises. These include vitamins A, E, C, Selenium and ma nganese. herbal MEDICINEWhile Kampo is a medicine that is used in Japan, genus Boswellia is and Ayurvedic medicine that can be used as an alternative to other drugs.Medicinal cannabis can also be used as it helps reducing abdominal discomfort and abdominal irritability caused by ulcerative colitis.HELMINTHIC THERAPYSometimes, parasites may help in the reduction of the immune response of the intestine. Whipworm may be used for this purpose. Reduction of immune response may help in the complete elimination of ulcerative colitis.SURGERYColectomy is required to remove all or a part of the colon when it gets give and begins to spread the infection to other parts.It can be classified as followsTOTAL COLECTOMY The entire colon is removedPARTIAL COLECTOMY The entire colon is not removed, but only a part of it is.HEMICOLECTOMY Removal of the left or right part of the colonPROCTOCOLECTOMY Removal of the colon as well as the rectum.Once colectomy is performed, the remaining portions of the ga strointestinal tract are reattached in order to allow the waste to be eliminated from the body.