Disintermediation in Tourism Essay Example | Topics and Well Written Essays - 1000 words - 1

Disintermediation in Tourism - Essay Example The impacts of disintermediation are various. It has impacted the travel and tourism industry significantly. The supply chain of travel and tourism industry involves tour operators, travel agencies, travel agents and others. Traditionally prospects and people have been depended on these mediators largely for their information and booking needs. Development of web technologies helped the service providers in travel and tourism industry such as airlines, car rentals, hotels and others to offer their services and information through their website. In the image below (Image 1) of WTO 2001 report on E-Business for Tourism, it clearly presents the number of intermediaries which are replaced by the Internet. However, it is evident that these intermediaries co-exist with the internet even in the countries where the internet users are high in number. The use and growth of website services depend on the number of factors like number of internet users, technological platforms available and many others. There are various reasons of disintermediation in the tourism industry. The primary reason is the development of technological platforms offering alternates to the traditional intermediates. The other reason is the cost reductions due to the removal of intermediates. The Internet offers a platform where tickets can not only be booked online but various tourism packages can be customized more effectively than the traditional methods. It makes the marketplace highly competitive as information available to the consumers as well as the options available to them is numerous. More destination choices, there detailed information including videos and availability of an interactive platform such as internet benefits the customer groups. The service providers are able to offer services at the lower cost as the commissions and charges involved for the intermediates are reduced.

The Effect of Leadership Style on Security Guards’ Performance Essay Example for Free

The Effect of Leadership Style on Security Guards’ Performance Essay The following are the specific objectives of the study: 1. To determine the job performance level among security guard in Riyadh military hospital. 2. To examine the influence of leadership style on security guard’ performance in Riyadh military hospital. 3. To investigate the security guard mean differences in job performance based on level of education and experiences in Riyadh military hospital. 1.4 RESEARCH QUESTIONS Three research questions are as follows: 1. What is the job performance level among security guard in Riyadh military hospital? 2. What is the direct significant influence of leadership style on security guard’ performance in Riyadh military hospital? 3. Is there any significant difference in security guard’ performance based on level of education and experiences in Riyadh military hospital? 1.5 SIGNIFICANCE OF THE STUDY As mentioned earlier in the present study, the objective of the study is to explore the influence of job leadership style variables on security guards’ performance. If the findings of the study turn out to be true, the study will contribute to both theory and practice. Through the present research, the researcher expects the findings to shed light on the pertinent facets of the topic and add to the body of knowledge concerning leadership style towards security guards performance in Riyadh Military Hospital. On the practical side, the study possesses significance because it will attempt to give an insight into one of the major issues in Saudi Arabia’s security sector. In addition, the stakeholders in Ministry of Defense can also benefit from the research by using it to identify, investigate as well as examine the proposed factors that are found to influence security guards’ performance. 1.6 SCOPE OF THE STUDY The study looks at leadership style towards security guards job performance at Riyadh Military Hospital, Saudi Arabia. The participants of this study were security guards of Riyadh Military Hospital in Saudi Arabia. The total number of the security guards who participated in the study was 34 security guards 30 males and 4 females. In order to achieve the research objective in the present study, a survey conducted. Questionnaires distributed to the security guards in Riyadh Military Hospital from 15 October 2012 to 9 November 2012. 1.7 SUMMARY The present chapter discussed background of the study, problem statement, objectives of study, questions of study, scope and significant of the study. The next chapter (chapter two) will expound literature review of study variables, chapter three related methodology, and finally chapter four discussions of the findings and suggestions.

Changing Cultures in the book North and South :: essays research papers

The way of life in England was quite different depending weather a person was in the north or the south. From the types of houses to living standards, working conditions to types of jobs, who you talked too to they way you buried the dead, the north and south had completely different ideas about how a person should live. The book North and South depicts the changing cultures of the north and south of England through the industrial revolution in the mid eighteen hundreds. In the town of Milton, which is in the northern part of England Strikes have aroused throughout the factories. The strikes were the immediate cause of the social unrest. The people in Milton are dissatisfied with the working conditions of the factories. They work long hours in bad breathing conditions, children and women work, and they are paid extremely poorly. These factors created a causal chain which led to the strikes. The class distinctions are the remote effect of the North and south. In the South the predominant class is the middle to upper class. It is the people who can afford to have servants. The minority in the south is the servants. In the North the predominant class is the factory workers. They are the lower class. They have a hard time making enough money to buy enough food to put on their families tables, even Edwards 2 though normally in a family the father, mother and most children work. Class distinctions are more then just working conditions they are also how the people conduct themselves. For example in the higher class when someone dies, the women do not generally attend the funeral because they are stereotyped as being too emotional to attend. Also in the higher class they do not observe the body after it has died. In the lower class everyone attends a person’s funeral. It is almost rude not too attend a person’s funeral, they celebrating the person who has just died not morn over them. The lower class also has a viewing of the body for friends and family. The Industrial Revolution played a major role in the creation of the North and of the South. Until factories started being built everything was rural. Once factory town started being built ways of life changed and class standards changed.

Over all Impacts of Hobby Lobby Case Essay

As the Supreme Court has ruled against the ObamaCare mandate recently, commonly referred as the The Affordable Care Act (ACA), many of the religious communities are overwhelmed about the decision and take it as a victory whereas others are outraged about this situation as women community will be greatly affected by the rulings of the court. It is a setback for the women society that in the name of religious liberty they will be deprived of their medical concerned issues. The companies that consist of religious ideology will be able to legitimize something that may harm others. Certainly these events will have constant series of effects on the society and as well as some changes may also occur in the legislation relating to ObamaCare. Obamacare covers twenty types of birth control, upon four of them; the court has objected (Tom Cohen, 2014). Hobby lobby states that it is showing efforts to provide religious freedom but majority of the public don’t agree with this statement. Instead people are outraged that it is interfering in their personal lives. It will not let them exercise there constitutional rights. Moreover they would be forced to obey or practice something that they don’t agree upon. People will not tolerate that there liberty and freedom will be in risk. Soon the similar types of entities like Hobby Lobby will be legitimizing discrimination against gays and lesbians by businesses (Salon.com, 2014). Defintly it would be unethical of doing so because what kind of an individual is having relationships is their personal right. In the name of faith and religion they will be creating barriers in there jobs and at work places. On the stance of ethical issues, the question arises about the religious liberty. Will it really make us a good Christian or minimizing our choices and freedom? It will be unacceptable by the public that the Supreme Court has legalized something that creates discrimination and deprives women from their medical rights. Indeed it is a biased decision made by the Supreme Court. In the light of the decisions made, employees of any company will be obliged to practice the religious beliefs practiced by their owners. Common people have a religious perspective that, every individual is responsible for his or her own deeds and will be answerable to God. But the decision that has been taken in this case by the court will certainly snatch the liberty from the company’s employees. Upper management will be able to force their religious beliefs and customs down the throats  of their employees. On the other hand, the decision will have negative effects on the women employees as majority of them may have a chance of suffering from medical problems for example in case of ovarian cancer, ovarian cysts, they won’t be able to get enough or no treatment because of the objection of contraceptives. Thousands of women employees of these companies would have to pay double or be out of their birth control plan (Tom Cohen, 2014). It would be unethical for the companies for interfering in their employee’s private personal medical matters. References Tom Cohen, C. (2014). Hobby Lobby ruling much more than abortion. CNN. Retrieved 4 October 2014, from http://edition.cnn.com/2014/07/02/politics/scotus-hobby-lobby-impacts/ Salon.com,. (2014). Hobby Lobbyà ¢Ã¢â€š ¬Ã¢â€ž ¢s secret agenda: How ità ¢Ã¢â€š ¬Ã¢â€ž ¢s quietly funding a vast right-wing movement. Retrieved 4 October 2014, from http://www.salon.com/2014/03/27/hobby_lobbys_secret_agenda_how_its_secretly_funding_a_vast_right_wing_movement/

Case Study Assessment of Angling Experience

Case Study Assessment of Angling Experience Question 1: Define and discuss using relevant example from the case, the special characteristics of services that distinguish them from tangible products. Services are one type of products with several special characteristics which are really different with tangible products. The major special features of services are more intangibility, heterogeneity, inseparability, and perishability. Those characteristics are also reflected in John’s case. 1. 1 IntangibilityCompare with the tangible products’ tangibility, the main characteristic of services is intangibility which was shown through a set of actions. Intangibility characteristic of service describes that services cannot be seen, felt, tasted, or touched thus one cannot display or store the service. However, it is usually felt by tangible goods or physical evidence. Moreover, service cannot be inventoried, easily patented, and easily displayed or communicated. From Johnâ€℠¢s case, John gives his customers guide of fishing and a series of fishing itinerary.These all are the intangible things to anglers. It cannot be touched, felt, or seen by his customers. However, his customers enjoyed their tours and gain fishes after his guiding. Thus, this can be said that customers got John’s services. Compared with his services business, John used to be selling the tangible goods, either the rods, artificial flies or oilskins the department sold are tangible. Moreover, because of the intangibility, pricing John’s services is difficult. Compared with physical goods, pricing services are not easy. Same tangible goods also sold with a same price.In this case, the two couples got different price after serviced. It seems that they gained a same series of services, but the feelings and appraisals are different. 1. 2 Heterogeneity Heterogeneity concerns the potential for high variability in the performance of services (Bitner et al. , 2009). Contrast to s ervice, tangible goods is standardization. Most of a type of physical goods is produced by one product line. There are no major differences among each one of them. However, like two leaves, there are not two same services processes.Providers’ performances are not same every time, and the customers’ requirements are not same too. In detail, service delivery and customer satisfaction depend on employee and customer action, and also some uncontrollable factors. In our case, when John worked in the fishing department, he wondered at how each piece of fishing equipment in a product line varied so little. It shows that tangible products are standardization. However, then, John provided services to two couples, and got the distinct result. First couple was very satisfaction, and second couple was unhappy, though John was same hard working.The different based knowledge, objectives and nature conditions determines the different results. The first couple have a good knowledge an d experience of fishing, they enjoy in fishing. However, the second couple was the fist time fishing and their purpose was to relax and see the country. Moreover, the weather was great during the first time, but worst during the second time. Those factitious and uncontrollable elements influenced John’s two services processes. 1. 3 Inseparability Inseparability of production and consumption involves the simultaneous production and consumption which characterizes most services.Compare with goods are first produced, then purchased, and then consumed, services are first booked, then produced and consumed simultaneously (Carmen & Langeard, 1980). It seems like that customers and employees affect each other. In this case, we can know that because of the high degree of adaptability of the first couple, John interact well with them. However, another two anglers gained the unsatisfied service because of their bad communication. All customers and employees even the partial customers p lay an important role in whole process because services’ inseparability.Furthermore, because of this feature of services, mass production is difficult. The production and consumption are simultaneous. Hence, John lost a group of anglers in December due to he cannot service two groups in a same time. 1. 4 Perishability The final characteristic of service is perishable. Tangible goods could be stocked, contrast by services cannot be saved, stores, resold or returned (Valarie & Dwayne, 2009). In this case, John used to promoted department’s inventory system and just keep the rod that can be sold later. It shows that physical goods can be stored. However, John can not saved his services and provide it later.So, he lost a group of customers in December. Hence, the service is very different with the tangible goods. By these characteristics, some problems are discussed next question. Question 2: Explain, using examples how the problems stemming from the special characteristic s of services are impacting on John’s guiding services. 2. 1 In General Due to the four characteristics of services, some problems are derived. Some problems are unavoidable and some of them can be avoidable. The problems generate from intangibility including hardly controlling, easy to be copied and unable to evaluate the quality.Heterogeneity causes problem about quality measurement. Inseparability not allows mass production of service. Moreover, perishability makes return or resold of service impossible. Several of these problems impact on John’s guiding service as well. 2. 2 Problems Created by Intangibility Intangibility shows the following marketing problems. Firstly, services cannot be stored, thus when requires reach the peak or foot it is hard for managers to control. Secondly, services are so difficult to be patented that it is convenient for its competitors to duplicate them.Thirdly, customers are not able to realize the quality of service because service is invisible and cannot be touched. John’s new guiding service is not easy to store. Thereof, during December there was a peak period of fly fishing and John are not qualified to provide efficient service. On contrary, in the next two week of November there were no customers visiting Tasmania for chasing trout. Since John provides guiding service, he cannot remove December's service to November. It is beyond the scope of his control. The guiding service that John operates is easy to be imitated.There is another fishing guide who ran in Launceston. The service it provides is similar with John’s. This is a threat to John. The market share for John in Australia is cut down. Furthermore, the feature of intangibility determines the service value is hard to be understood by consumers. John’s guiding service is not an exceptional. Customers have no idea what a guiding service is. The marketing manager of a large sporting equipment retailer in North America would not know what a guiding service is if John did not send him the information about this service. 2. 3 Problems Created by HeterogeneityThe most severe challenge that heterogeneity creates is difficulty of quality measurement. Since criteria for judging the quality of service is based on customers’ notion, managers are not possible to control it. In the case, there was an American couple who are both good anglers. They have more fishing experience than John. In this trip, John learned more from this experience and the couple also had a great time. They even pre-booked another two weeks for the next fishing season. It is just because the American couple thought this trip was so wonderful that they measured this service is worthwhile.However by November, the Canadian's week of trout fishing is no that smooth. It became less happy because of lacking experience of fly fishing causes few landed trout and entire week raining. Even worse, one of the customers sprained an ankle. In these two e vents John provided the same service however he received different results. John cannot ensure whether his supplies are original. In December John introduced the New Zealanders to another fishing guide in Launceston. This increased the chance of heterogeneity because different suppliers are not possible to offer the exactly the same services. Take the health industry for instance.Several suppliers provide a same kind of service, nevertheless consumers’ perception is different. Some customers consider it as good service whereas another do not satisfied with it. This is because different provider’s service is distinctive due to the nature of human beings. 2. 4 Problems Created by Inseparability According to Zeithaml, Dwayne and Gremeler, because services often are produced and consumed at the same time, mass production is difficult (2009). The service producers generate service and the service is consumed by customer at the same time, therefore service is impossible to b e produced in large amount.The consumers who John received accepted his service while he provided it. It is absurd that John created services such as airport picking up and dropping off first then the customers enjoyed them. For example, the helicopter sent an urgent fax to John informed him that they were not available until after mid-February. It frustrated John that he was not able to transport his clients to the best fishing area. In addition, for John it is inconvenient for him when he has several customers to pick up or drop off. It is typical in November, John received two contacts that require a fly fishing in the first week of December.The worse thing is that neither of the customers could change their original arrangement. John could not separate his services. 2. 5 Problems Created by Perishability The factor of perishability leads to the problem that service cannot be returned. Service is consumed at the same time when it is manufactured, thereby once the service is provi ded it cannot be returned or resold. In November, two Canadian customers who were doing fishing for relax received an unhappy experience. Lacking experience of fly fishing they landed few trout. The entire week’s heavy raining prevented them from lake fishing.Moreover, one of the anglers sprained an ankle while crossing wet rocks. Even though John understood that the Canadian did not enjoy their fishing trip, he had no way to go back. John cannot take the service back because time cannot be reversed. For instance, customers who have an ugly haircut cannot ask the barber to undo it, because the service of haircut is perished (Clemes, 2002). 2. 6 Problems Difficult to Avoid Due to the problems derived above, gaps generate naturally. Customer Gap Customer gap appears because of the distance between customers’ expectation and perception.Customers have their own expectations based on their experience and objectives. In this case, the Canadian customer who came to Australia for relax do not have the experience of fly fishing. They consider the service could offer them a wonderful time. However, the insufficient experience of fishing made them catch few trout. Adding the bad weather and the injury, the Canadian dissatisfied with the trip and request a reduced charge. This gap is relatively huge and John needs to improve his service. Provider Gap Firstly, John serves his customer by the same way.For the fishing skillful couple and unskillful people, John took the same measure. Secondly, John not communicated well with its customers. The customers who chose his service in the first week of December were transferred to another service provider. The problems presented above are the major reason why John’s business went down. In conclusion, because of the special features of service, there are several problems should be considered and solved. Marketers of services face some actual and distinctive challenges which should be solved by the utilization of marketing mix.Question 3: Explain how John could use the extended marketing mix elements to help manage the problems caused by the special characteristics of services. The question 2 mentioned some problems caused by the special characteristics of service. Marketers like John could use the marketing mix to manage those problems and plan a whole strategy of their business. The traditional marketing mix will help John to manage the problem from production, place, promotion, and price (Kotler & Armstrong, 2006). Because of intangibility characteristic and the limitations of John’s service, he can add both tangible products and services in his business.For example, he could be the agent between his customers and fishing departments. Then, customers can purchase fishing equipments which are fit to them, because John known them clearly. Moreover, due to intangible and perishability of service, John’s promotion ways are not enough. John can exploit more methods like put some advertising in the relevant websites, sponsor fishing competitions and some things like that. However, because of the distinct features of service, the traditional marketing mix can not cover all problems. It extended three more elements which are people, physical evidence, and process (Booms & Bitner, 1981) . 1 People People element is defined as all human actors who play a part in service delivery and thus influence the buyer’s perceptions in the service environment. Thus, customers, employees, and the customers in the service environment all play the important roles (Bitner et al. , 2009). With use this element, John can do following things to manage those problems. First, because John just has himself as an employee, he lost some opportunities. Then, John need employ more employees to help him supporting his business. After that, because guiding service is a high skill service, John should train his employees.John also can bring a reward system based on the satisfaction of employees to avoid the problems of service quality. Another role, customers, also draws marketers’ attention. Marketers should education their customers before provide service. Because guiding service need customers’ deeper involvement, John could send a video of basic knowledge and potential risk of his services to his customers. Then, they can interact better. 3. 2 Physical evidence Physical evidence is the cue that customers depend on to assess the quality of service and service providers to put forth their significant information (Lovelock, 2004).As John’s guiding service, it already had some physical evidence. However, there are still some limitations as mentioned before. Firstly, John needs to increase all kinds of materials that reflect his guided trip. Thus, customers will maximally understand his service. For example, John should enrich his website. He could upload some videos about guided fishing trips. Potential customers can be divided into two se ctions as experienced customer and inexperienced customer. For those experienced customers, the information should be about new fishing areas or new activities.For the inexperienced customers, it should provide skills or equipment for fishing. Secondly, it is suggested that John needs to have his own transporting vehicles to send customers. One side is to avoid the situation of lacking hiring sources, the other side is to fit different customers’ need. For instance, if the customers who require a short trip then John could provide them cars to go fishing. Sometimes, customers have their vocation that they get plenty of time sailing is a perfect option. Furthermore, for these long distance customers and money is not a problem for them aeroplane is chosen to send them to the best fishing area.In this way, the customer gap could be narrowed since their needs are fulfilled. Lastly, John could provide some souvenir after trips. Thus, customers may actually realize what they have o btained from the service. 3. 3 Process Process is the actual procedures, mechanisms, and flow of activities by which the service is delivered (Zeithaml, Bitner & Gremler, 2009). John could use blueprint to depict the service process. By using the blueprint, John may find out the customer segmentation. For example, John may categorize consumers as experienced ones and inexperienced ones.Then John could offer two different processes for each group. For the experienced ones, John could present a more customized process which customers could choose their favorite rod and apply their own ways of fishing. As for the immature consumers, John should provide them a standardized process. It may offer the same rod for customers and consumers have to stay in a specified area. John also needs to educate his customers especially the inexperienced customers. He could hire a fishing coach to instruct anglers the procedure of fishing. Through this way, unskillful clients will not fish blindly. 3. 4 ConclusionService as intangible products distinguishes from physical goods. Besides the traditional four Ps, the three Ps are mainly used to enhance service. John’s guiding service may become prosperous if he makes use of the three Ps. Word Count: 2496 Reference List 1. Boom, B. , & Bitner, M. , 1981, â€Å"Marketing Strategies and Organizational Structures for Service Firms†, Marketing of Services, 1981 2. Carmen, M. , & Langeard, E. , 1980, â€Å"Growth Strategies of Service Firms†, Strategic Management Journal, January-March, 1980 3. Clemes, M. , 2002, New Zealand Case Studies in Strategic Marketing, 5th edition, Dunmore Press, New Zealand . Kotler, P. & Armstrong, G. , 2006, Principles of Marketing, 12nd edition, Pearson Education Inc. , New Jersey 5. Lovelock, C. , & Wirtz, J. , 2004, Services Marketing: People, Technology, Strategy, 5th edition, Pearson Education, Singapore 6. Zeithaml, V. , Bitner, M. , & Gremler, D. , 2009, Service Marketing, 5th edition , McGraw Hill, Singapore 7. Zeithaml, V. , Parasuraman, A. , & Berry, L. , 1985, â€Å"Problems and Strategies in Services Marketing†, The Journal of Marketing, Spring, 1985 8. http://www. docstoc. com/docs/16690264/GOODS-AND-SERVICES/, Accessed at 20th, Apr, 2009

The Four Surviving Maya Codices

The Four Surviving Maya Codices The Maya - a powerful pre-Colombian civilization who reached their cultural zenith around 600-800 A.D. before falling into steep decline - were literate and had books, written in a complex language including pictograms, glyphs, and phonetic representations. A Maya book is referred to as a codex (plural: codices). The codices were painted onto a paper made of bark from the fig tree and folded out like an accordion. Unfortunately, zealous Spanish priests destroyed most of these codices during the conquest and colonial era and today only four examples survive. The four surviving Maya codices mostly contain information about Maya astronomy, astrology, religion, rituals, and Gods. All four of the Maya books were created after the downfall of the Maya civilization, proving that some vestiges of culture remained after the great city-states of the Maya Classic Period were abandoned. The Dresden Codex The most complete of the surviving Maya codices, the Dresden Codex came to the Royal Library in Dresden in 1739 after being purchased from a private collector in Vienna. It was drawn by no fewer than eight different scribes and it is believed that it was created sometime between 1000 and 1200 A.D. during the Postclassic Maya period. This  codex deals primarily with astronomy: days, calendars, good days for rituals, planting, prophecies, etc. There is also a part which deals with sickness and medicine. There are also some astronomical charts plotting the movements of the Sun and Venus. The Paris Codex The Paris Codex, discovered in 1859 in a dusty corner of the Paris library, is not a complete codex, but fragments of eleven double-sided pages. It is believed to date from the late Classic or Postclassic era of Maya history. There is much information in the codex: it is about Maya ceremonies, astronomy (including constellations), dates, historical information and descriptions of Maya Gods and spirits. The Madrid Codex For some reason, the Madrid Codex was separated into two parts after it reached Europe, and for a while was considered two different codices: it was put back together in 1888. Relatively poorly drawn, the codex is probably from the late Postclassic Period (circa 1400 A.D.) but may be from even later. As many as nine different scribes worked on the document. It is mostly about astronomy, astrology, and divination. It is of great interest to historians, as it contains information on Maya Gods and the rituals associated with the Maya New Year. There is some information about the different days of the year and the Gods associated with each. There is also a section on basic Maya activities such as hunting and making pottery. The Grolier Codex Not discovered until 1965, the Grolier Codex consists of eleven battered pages of what was likely once a larger book. Like the others, it deals with astrology, specifically Venus and its movements. Its authenticity has been questioned, but most experts seem to think it’s genuine. Sources Archaeology.org: Redating the Madrid Codex, by Angela M.H. Schuster, 1999. McKillop, Heather. The Ancient Maya: New Perspectives. New York: Norton, 2004.

buy custom The Mentally Ill Chemical Abusers essay

buy custom The Mentally Ill Chemical Abusers essay The Mentally Ill Chemical Abusers (MICA) patients are those individuals who abuse drugs because of their mental ill health (Reid Silver, 2003). Those individuals who exhibit severe mental illness suffer from medical disorders and other psychiatric problems presents a variety of social, individual, political, and financial challenges both for program funding and the planning and implementation of effective reconstructive treatment programs (Reid Silver, 2003). In addition to severe mental illness, the MICA patients may suffer from severe behavioral, personality, addictive, physical, or cognitive disease, which will require a treatment program to be extremely effective in treating the patients. The wide range of diseases that affect MICA patients has called for the development of a great deal of treatment models to cater for the multiple needs of the patients (Reid Silver, 2003). There is need for evaluating the clinical effectiveness of the treatment models so that to avoid wastage of the limited treatment resources and to improve the clinical treatment strategies for those patients who undergo positive dual diagnosis (Reid Silver, 2003). This study looks into the clinical impact of various program models on the mentally ill chemical abusers. Researchers select specific study variables and outcome indicators to demonstrate the effectiveness of each model in meeting the therapeutic goals for patients, and to reject outcomes that result from the differences between the treatment programs, such as number of delivered services, level of MICA patient participation, and population differences. These indicators facilitate comparisons of the outcome efficaciousness between treatment programs. As such, the indicators directly relate to the stated goals of the programs under study. Since the staffing pattern, location, goals, and outplacement resources of the treatment programs are identical, and the patient population possessing similar characteristics, the results of the study should illustrate the impact of the integrated and disease specific program models as the best approaches in treating MICA patients. Different treatment models may not be equally effective in the treatment of the MICA patients. Therefore, the program evaluation outcomes would be useful to administrators, program developers, policy planners, and legislators who must design and put into practice the most effective treatment program that will rely on the limited resources (Kloss, Lisman, 2003). In addition to determining the most effective treatment and programmatic approach, this information can also be useful in improving the quality of care for MICA patients with severe problems. The programs for treating the dually diagnosed MICA patients primarily belong to two categories, namely, integrated program model and disease specific program model (Kloss, Lisman, 2003). A disease specific program focuses treatment on distress as the primary area and minimizes the urgency or importance of other areas of MICA patient dysfunction. A great deal of hospital based mental health programs and substance abuse and addiction tre atment programs model treatment programs model their treatment in this manner (Lessa Scanlon, 2006). Research by Lessa Scanlon (2006) shows that An integrated program model is common in both community based settings and hospitals, and its main purpose is to provide individualized treatment that can cater for all areas of dysfunction in a single program. Governments base the development of the program models more on political interests in the treatment of specific MICA patient populations and availability of funding, and to some extent on clinical efficacy (Lessa Scanlon, 2006). There has been perpetuation of the program models fragmentation through the development of arbitrary and artificial administrative divisions at the local, state, and federal levels without considering the clinical measures of the effectiveness for various treatment program models (Reid Silver, 2003). Therefore, it is possible that most of the grant financed and public sector programs continue to benefit financially through various funding streams without provable clinical success. This leads to the siphoning of critical finances from those treatment programs that employ more clinically feasible models. Programs that embrace a self-medication philosophy consider chemical dependency to occur either as a coping mechanism for primary psychopathology or as symptoms of mental illness (Reid Silver, 2003). They view patients as those individuals who use chemicals for the purposes of alleviating the symptoms of mental disorders such as anxiety and depression. The treatment goals for these programs put more emphasis on improvements in mental functioning (Lessa Scanlon, 2006). Clinicians expect the mentally ill individuals and chemical abusers to change to psychologically healthy. The integrated and disease specific treatment programs possess a major advantage of diagnosing psychiatric problems and offering treatment along with the symptoms of substance abuse. However, this is the main disadvantage of the models as well. Making assumptions that mental illnesses cause chemical abuse contradicts the possibility that can cause the psychopathology (Reid Silver, 2003). Because the focus of trea tment is on the outcome of the primary mental illness, problems of chemical abuse that may be actual clinical etiology may not undergo treatment. Lessa Scanlon (2006) have confirmed that social deficit philosophies of treatment consider mental illness and chemical addiction as due to cultural, environmental, family or peer influences. Most people view the mentally ill individuals and drug abusers as the products of drug availability, poverty, family dysfunction, and peer pressure. Lessa Scanlon (2006) suggest that the objective of treatment in the integrated and disease specific treatment programs is to improve the social functioning of MICA patients by altering their environment or coping reactions to perceived stressors. Interventions may involve residential treatment, attending self-help groups, interpersonal therapy, and group therapy, whose goal is to improve social skills of the MICA patients (Lessa Scanlon, 2006). According to Lessa Scanlon (2006), the main disadvantage of embracing a social deficit philosophy for treating the MICA patients lies in the sole treatment of social factors for the multi-factored problems. This again means the need for acceptance of additional treatment schemes that depends on the competing philosophies. By accepting any of the primary assumptions alone, and depending solely on a single philosophic stance, practitioners and researchers perpetuate the state of affairs by staying uncritical regarding the problems underlying their models. Consequently, this process has produced service roadblocks that have excluded or discouraged a great deal of dually diagnosed MICA patients from getting admission to, seeking, or successfully finishing appropriate treatment programs (Lessa Scanlon, 2006). Instead of producing additional philosophic and subpopulation barriers, the vital question for both researchers and MICA treatment providers should be how the clinicians can best match patients in the course of their treatment to various models and programs so that to maximize outcomes in multivariate and bio-psychosocial treatment programs (Kloss, Lisman, 2003). The dually diagosed MICA patients possess complex interactive symptomatology and treatment needs that call for more integrated approaches than are generally employed (Reid Silver, 2003). Therefore, it is more likely that the integrated treatment program would be more effective in the treatment of dually diagnosed MICA patients as compared to a disease specific program. However, because substance abuse and addiction present severe therapeutic challenges, a more restrictive substance abuse model may offer increased efficaciousness for the MICA patients (Reid Silver, 2003). Evaluation of the treatment outcomes that various program models produce, treatment of the MICA patient population, should show the relative cost efficiency and clinical effectiveness of each treatment program model. Within the integrated treatment model, each system of care must include elements that meet the needs of MICA patients in every phase of rehabilitation and recovery (Lessa Scanlon, 2006). In addition, treatment programs must address levels of disability and severity with each rehabilitation phase. For instance, treatment programs must provide the services of acute detoxification for both non-psychotic and psychotic patients; provide group and individual therapy services for alleviating various levels of dysfunction in both mental illness and substance abuse; and deliver services for stabilizing psychosis, whether the MICA patient is under active substance withdrawal or not (Lessa Scanlon, 2006). Therefore, the integrated treatment program must contain a variety of types and sufficient numbers of clinicians to ensure that there is customized and comprehensive treatment inherent in the program. An integrated treatment program for MICA patients involves more comprehensive treatment strategies and philosophies than the disease specific treatment programs (Lessa Scanlon, 2006). Integrated approaches enable clinicians to use the most appropriate type and level of treatment technologies in the rehabilitation of MICA patients at their level of need. Therefore, through customization, integrative treatment program will meet both the addiction needs and mental health of the patient (Lessa Scanlon, 2006). The disease specific treatment program is naturally more generic, requiring MICA patients to meet its expectations, as opposed to the program meeting the patients needs. A number of substance abuse programs emphasize individual and group counseling in a restrictive, substance free, and highly structured environment (Kloss, Lisman, 2003). Both integrative and disease specific treatment models impose abstinence from all types of substances, which includes psychotropic medication. I n mental health, disease specific treatment program concentrates on functional rehabilitation and adaptation in less restrictive surroundings, but minimize the consequences of addiction (Kloss, Lisman, 2003). There is an assumption that the two treatment programs will facilitate the motivation of MICA patients to participate in treatments with an aim of alleviating their distress. Those patients who fail to meet the expectations of the programs are treatment refractory or treatment resistant, they should seek help in other programs, or the clinicians should discharge them from the treatment programs (Lessa Scanlon, 2006). According to Lessa Scanlon (2006), clinicians encounter a number challenges from the clinical presentation of the MICA patients. The concurrent expression of symptoms from both mental illness and chemical abuse and addiction makes conceptualization, diagnosis, and treatment decision-making problematic, and in most cases leads to poor treatment reaction and outcome. Research has shown that when MICA patients go to agencies that offer treatment to patients with addictions, responsible personnel is likely to view the patients within disease model, because the perspective predominates among the institutions and providers of alcoholism treatment in the United States (Kloss, Lisman, 2003). Conversely, individuals with psychoses receive treatment in mental health settings, and this is where the focus is pharmacological and medical. The adherence of clinicians to either of the one-dimensional frameworks may possibly be counter therapeutic for treating MICA patients. Enrolling the MICA pati ents in two different agencies may give desirable results. The goal of this study is to identify the most appropriate treatment programs for mentally ill chemical abusers. However, the literature review shows that the integrated and disease specific treatment programs are the best for treating the MICA patients. It is easier to develop possible research questions after reading through the literature review. The researcher will used purposive sampling method by administering questionnaires as quantitative research instruments to clinicians. The questionnaires ensure that information such as names from the clinicians is confidential. The investigation will look into patient outcomes for the integrated and disease specific treatment program models at Bellevue Hospital Center, which deal with the treatment of homeless, male MICA patients. The researcher will compare the clinical outcomes in the integrated MICA mental health program with the outcomes in the disease specific substance abuse and addiction treatment program. The goals of the two residential treatment programs are to rehabilitate MICA patients for a six-month period and to place the recovering patients in community based housing. The researcher will perform comparisons of MICA patient outcomes for efficaciousness indicators to determine the relative value of the integrated and disease specific treatment models in the treatment o f MICA patients. There are limited questions to help the participating clinicians stay accurate and focused in the answers they provide. The questionnaire is only asking those questions that will try to evaluate the experiences of clinicians who treat mental illness and substance abuse problems. The researcher will administer a questionnaire on one specific issue to ensure that the results and findings are extremely accurate. The questionnaire contains 17 questions, which considers the outcomes of patients in the two programs across seven indicators, namely successful community placement, cost efficiency, service hours, recidivism, subpopulation outcomes, treatment failures, and patient satisfaction. The researcher will hand the questionnaires to the clinicians on the same day and ensure that the participants complete them at the same time in order to reduce the possibility of biasness in the answers they provide. It is necessary for the researcher to gain approval of a clinical director before administering the questionnaires. This will ensure that all clinicians in Bellevue Hospital Center will participate in completing the questionnaires. It will also allow the clinicians to provide accurate and clear answers, which will ready to a successful study. The questionnaire should possess content validity, external validity, and internal validity. A researcher can achieve face validity of the questionnaire through careful inspection and determination of its viability. The researcher ensures that the questionnaire possesses content validity by checking whether it has questions that address possible interventions that Bellevue Hospital Center offers. The use of questionnaire willl lead to external validity threats to this study, especially when the researcher involves few participants. The researcher will administer the questionnaires to a few clinicians who serve community, which will result in lack of the ability to relate outcomes to other communities. When the participants are aware that the questionnaire is for the purposes of a school assignment, they may fail to take it serious and provide less accurate responses. The use questionnaires experience many validity threats, which require a researcher to be very careful before and after handing them out. When a researcher has ensured that questionnaires possess both internal and external validity, the outcomes of the study will be reliable. However, it is important to keep in mind that a valid measure is not necessarily a reliable measure. Therefore, even if this study may suffer from threats of validity such as small population and lack of randomized assignment of questionnaires, researchers goal is to ensure reliable study outcomes. Reliability testing such as a test and re-test technique is necessary because it will enable a researcher to achieve more accurate results from the study. A researcher can achieve this by administering the questionnaires to the same groups of participants at two or more different times to show whether he will get the same outcomes. Another test for reliability includes the rearrangement of the order of questions on th e questionnaire and administration to the same group of participants. This would be the best way of assuring reliability but it would be impossible because of time and resource limitations. However, in spite of the threats, the researcher can collect meaningful information for analysis. The findings of the study can be show the effectiveness of integrated and disease specific treatment program models in treating the mentally ill and substance abusers, and in collecting information subsequent research in the future. The researcher can then be able to create a valid measure for further improvements in the condition of MICA patients. The investigation will include the male, MICA patients who entered the integrated and disease specific treatment programs after 11/21/2009 and who left by 7/21/2011. Both programs will use similar admission measures homelessness as well as a major Axis I diagnosis and a substance abuse and addiction diagnosis. The patient referrals to the two programs will come from the same New York City homeless shelter programs and Bellevue inpatient psychiatric units. Therefore, the patient population for the programs under study is likely to be indistinguishable for the purpose of the study. The researcher will confirm this through the analysis of variance and by comparing the demographic features between the groups using the dimensions of substance abuse severity, diagnosis, prison history, age, number of hospitalizations in the past, medication, suicide history. Since the researcher determines the subject pool to be equivalent, he will compare the success of treatment program and determine a c omparative rate across indicators. In this studys context, a Global Assessment Functioning (GAF) level of about 80 is necessary for successful rehabilitation and graduation of MICA patients. The researcher will record the functional level on the functional assessment forms of New York City Department of Mental Health. The addiction severity index as a survey instrument is a suitable research instrument in recording the type of abused substance, duration of substance abuse, work history, and prison. The clinical case managers will determine the functional level during graduation and the extent of addiction severity within the two programs. Clinical case managers from the afflicted case management programs will subsequently confirm the levels and scores. The MICA patients will complete a self-report questionnaire as the suitable instrument for collecting quantitative data. The case managers are responsible for patient follow-up of the MICA patients who will have recovered, graduated, and found a place in the community b ased housing. The clinical case managers, who put down the outcomes on the New York State Office of Mental Form 143a, Part 1 and 2, will perform a three-month post graduation outcome information on MICA patients in the community based housing. This data acts as the basis for recidivism and post graduation placement data. The selection of Subjects The study will include about 300 male patients, 200 from the MICA TLC and 100 from the TLC. The researcher will base the selection of the patients for the two programs on their meeting the criteria of both diagnosis and homeless admission. For instance, when the patients are homeless for more than three months, possess major depression and substance abuse and addiction, and are ambulatory and never require an acute care. The researcher will not impose other conditions for admissions. The study will include only the MICA patients, even if the TLC program admits patients without substance abuse diagnosis. However, the study included all admitted MICA TLC patients. In either program, the MICA patients will be included. Calculations, analysis, interpretation, and presentation of the data will take place after data collection. Statistical Package for the Social Sciences will be a necessary program during the analysis and calculations. This study investigates the relative impact of an integrated program model and disease specific program model on the treatment results for MICA patients. The goal of the research is to determine the effectiveness of the two treatment programs. The outcome results for the patients will demonstrate the difference between the two programs and the therapeutic models. The therapeutic failure and success rates, patient-satisfaction survey results, the differences in recidivism rates, and the cost efficiency level can be significant in differentiating the two treatment programs and their respective therapeutic models. Studies show that the integrated model is very effective in treating the MICA patients. However, the integrated program model can leave some problems unresolved. Full and comprehensive intervention can only take place simultaneously for the dually diagnosed MICA patients when there is sufficient program organization, staffing, and staff training. There is need for additional p rogrammatic strategies to discourage substance abuse and to treat compromising medical disorders. The integrated programs can effectively deal with a wide variety of therapeutic issues, once the professional level training includes integrative treatment strategies and technologies for multiple and interacting symptoms. Education programs for mental health include some form of training in psychotherapeutic paradigms. The psychotherapeutic paradigms may include client centered, cognitive behavioral, psychoanalytic, interpersonal, family, and systems treatment technologies and modalities. Additional professional training in an integrative and eclectic use of the therapeutic technologies with various dually diagnosed patients can enable clinicians to accurately evaluate and treat multiple types of dual diagnosis in the same mental health center. Careful integration of treatment program services will facilitate the normalization of coexisting disorders. Buy custom The Mentally Ill Chemical Abusers essay

4 Ways That Business Writing Courses Can Improve Your Grammar

4 Ways That Business Writing Courses Can Improve Your Grammar Even the best writers the ones who make six figures writing for the most prestigious magazines and websites slip up with their grammar; though, fortunately for them, they have full-time editors who catch those rare mistakes. But for the hard-working business employee who is juggling six different projects at once, sitting down for long hours of proofreading the kind of intense refining process that a professional writer undergoes is simply not practical. But the hard truth is that in the business world impeccable writing skills is a must, whether you're writing marketing pitches, internal reports, or a proposal. That's where business writing courses come in. Writing courses can improve your awareness of grammar, for example, to such a degree that your work does not require much proofreading. Before you know it, you become a grammar master who instantly knows the answers to common grammar conundrums like these four: 1. Affect vs. Effect Possibly one of the most common errors in business writing (or any writing, for that matter) is the confusion over using "affect" or "effect." Fortunately, the usage follows a simple rule. If you memorize it, this grammar pitfall will never trouble you again. "Affect" is a verb. "Effect" is a noun. Example: The presentation affected my understanding of sales. However, if you try to phrase the sentence this way, "The presentation had an effect on my sales," you are no longer using the verb "affect." You've switched to the verb "had." The word "effect" is a noun because it is the thing that the presentation "had." 2. Sink, Sank, and Then I Sunk - Help! This is another example of confusing verb tenses. In an email your colleague writes, "Our profits sunk last quarter, but that company's earnings also sunk." With the verb "to sink," the present tense is "sink." The past tense is "sank," and the past participle is "sunk," which is always paired with the auxiliary verb "had." Your colleague is using the past participle instead of using the past tense. The correct version: "Our profits sank last quarter, but that company's earnings also sank." 3. Should I Use "Shall" or "Will?" This is a situational problem. If you are using "shall" in the third person i.e. he shall complete that report then it obliges the subject of the sentence to perform the verb. In other words, it is a command. It's like when your mother says, "You shall clean your room," in a very authoritative tone. However, if you're using "shall" in the first person, there is no sense of obligation. It means simply that you intend to do that action sometime in the future: "I shall go to the cafeteria today." When you use the word "will" in the first person I will complete this spreadsheet it expresses a sense of determination. It is meant to convey your strong desire to do whatever is necessary to complete the task. But when you use "will" in the third person i.e. he will leave work early today it simply indicates that the person will do something in the future. 4. I "Sit," But She "Set" An easy way to remember when to use "sit" or "set" is to ask this question, "Is someone placing an object somewhere?" If the answer is yes, you use "set." For example, someone wants to bring some indoor plants into the office. They ask you where to put them. You would use the transitive verb "set" which always requires a direct object: "Set them on the window sill." If there is no direct object involved if no one is placing anything anywhere and you're just talking about people being in a location you would use "sit": "He sits at the conference table." This also applies to nouns that are not being moved by anyone i.e. The computer sits on the table. But if Bob comes over and moves the computer to the table, you would say, "Bob set the computer on the table." All of our business writing courses include instructor review of your individual grammar issues, resources, and correction strategies. Improve your grammar so that you spend less time proofreading and more time working. Not sure which course is right for you?

A nuclear family unit Essay Example | Topics and Well Written Essays - 1000 words

A nuclear family unit - Essay Example One can describe the ages of this family unit as chronological in order. First, the father is 42 years, works as a carpenter, and appears healthy and strong. The mother is 36 years old, a truck driver, and smokes one packet of cigarettes per day. The girl is 12 years old, attends school as required, and no petty issues were noted except the fact that she appears a bit overweight for a girl of such age but no obesity as such to be reported. The boy is six years old and plays well, meaning he is physically fit. It would be accurate to describe this family’s social group as middle working class particularly with the ability to afford their children’s education, medical insurance, and a four bed-roomed house. Although the father did reach 11th grade, he did not manage to graduate while the mother has knowledge in attending heavy machinery. Thus, the educational background of this family is obsolete and this could be the reason they are seeking to have their children study h ard in order to break that chain of low levels of education (Doane & Varcoe, 2005). Generally, the family has a great deal of strengths given that the father was treated for alcoholism and resolved to become a responsible husband and a father while the mother was treated for a health issue that could affect her delivery system. Additionally, both parents are regular cigarette smokers but the children are doing great which leads to the conclusion that the whole family is physically fit (Doane & Varcoe, 2005). ... The setting of this home is intact and has the relevant requirements of such kind of a family. The house has four bedrooms and two bathrooms. It is also very clean and neat signifying that it is always tidy. Q2 As of this point, the family looks prepared both psychologically and physically since they have made tremendous progress regarding the incoming baby. Pertinently, the mother is looking forward to stop working when she is one month due to the speculated date of the actual birth. The father is working tirelessly and has an insurance cover against any health risks that may befall the family. Generally, the whole family is considering the presence of the unborn child as a blessing rather than a burden a factor that shows that it is ready for another member of the family (Doane & Varcoe, 2005). With comparison to the textbook, a fully prepared family both physically and psychologically is that which has almost all the necessary things that a pregnant woman needs as well as the esse ntial items that a born child requires. What was the topic that  stood  out Nutritional status Nutritional status This family’s nutrition status is incredible following the fact that they keep a healthy diet. Their breakfast composes of peanut toast with yoghurt and fruits as snack. They take nutritious lunch full of proteins and supper involves red meat, vegetables, and ice cream as snack. Hence, this family’s nutrition status stands out as the best topic of discussion during the interview. Bonding behaviors First, the relationship between the mother and father is healthy. Second, the children go to the same school and play together pointing out that they relate to each other well. Therefore, the research concluded that the overall family relationship is in the best

Management Interim Report Essay Example | Topics and Well Written Essays - 500 words

Management Interim Report - Essay Example This would subsequently guide them in the future and avoid the hurdles of developing a new project plan each time a new project idea is conceived and due for implementation. The objective of this project is to develop a project plan for the organisation a one day music festival to be held in Greenwich Park. For the organisation of the musical festival to be a success on the part of the promoter, a detail project plan would be developed to incorporate all the activities and guide the promoter on what steps and decisions to make. To meet up with these objectives, the following plan would be followed and proposed to the organiser: For the scope of this project, it is being undertaken for a target audience of 5,000 people. In addition to this, the plan is being developed for the musical festival to take place one month from today. Detailing the team structure has to do with resource loading and task scheduling. The structuring of the clients team to handle this project would depend on the number of employees it has. If the number of employees were given then I would have proceeded to making a resource loading chart so that the client would strictly follow. However, my team is an eleven-man team comprising the overall project director, and ten other persons.

Assignment - Discussion Example | Topics and Well Written Essays - 250 words

- Discussion - Assignment Example Apple’s product can be marketed to a single general audience, yet Apple still targets specific segments. In targeting the parents of small children, Apple has found probably some of the most willing buyers of their product. This segment has more money, more interest in the utility of the product, and may even buy more than one. Demonstrating the applications on the iPad and their positive influence for children as a learning tool is an excellent strategy that targets that market—these parents want a toy that also provides educational value. Finally, the product positioning of the iPad, for this segment, stresses how it is revolutionary among modern computer technology as well as learning software. Alone, use of computers and software is not a new idea—but Apple shows that the iPad as a whole is entirely new. Overall, we see that this is a case of differentiated marketing, and this specific article talks about Apple’s appeal to a certain segment by making their product appear youthful, educational, revolutionary, and completely

Isabel Allendes An Act of Vengeance and Zora Neale Hurstons Sweat Essay

Isabel Allendes An Act of Vengeance and Zora Neale Hurstons Sweat - Essay Example Both Isabel Allende’s An Act of Vengeance and Zora Neale Hurston’s Sweat address the theme of feminine vengeance. Despite the fact that the approaches employed by the female main characters to vengeance varying, it is important to note that one of the most underlying similarities between the two short stories is the issue of female empowerment in a society that is mostly dominated by the male. The author makes the story incredibly dramatic mainly brought out at the moment where Dulce Rosa’s father not only realizes that his friends have fallen, but that he is also forced to kill his daughter in order to spare her from men like Cespedes. The author has been successful in presenting this as not only unexpected, but also quite heartbreaking. The author has also been successful in balancing out the different emotions in the story and has most importantly been able to ensure that the audience does not feel melodramatic. Additionally, the use of imagery has been succes sful though not subtle especially at the moment where the author presentsthe image of Dulce Rosa shedding the shreds of her bloodied gown and consequently immersing herself in the water which makes her come out clean. This is a clear representation of both rebirth and baptism. Additionally, the act of holding her dying father is a clear manifestation of transformation from a girl to a woman. The author, Dulce Rosa, in the An Act of Vengeance holds not only the power of her independence, but also the power of self-sufficiency. Despite the neighbors making suggestions about her â€Å"going to live with her godmother in a different town where her story is not known after being raped† (23), Dulce Rosa opts to stay behind and instead build a life that is comfortable out of the ruins left of her fathers house. In Sweat, Delia is also presented as a strong woman who holds the economic power in her relationship with her unemployed husband. Delia still finds much comfort in the home b ought by her despite the abuse and infidelity of his husband. Delia stands her ground even when her husband, Sykes, tries to get her to leave her house to enable him move in with his mistress. She further stands her ground and leaves the husband to die from the snake bite that had earlier been meant for her. It is evident that vengeance by Delia is a decision not aimed at helping Sykes when the opportunity arises, but rather a decision that is aimed at causing Sykes direct harm herself. In An Act of Vengeances, Dulce Rosa was quite determined to kill Tadeo as a revenge for the death of her father. However, there is a twist when she later realizes that what she feels for Tadeo is love, hence making him torn between marriage and murder which are in real sense the two male expectations. Dolce Rosa later opts to kill herself instead of playing into either of these stereotypically male solutions. Her death leads into Tadeo losing all the hope he had for both love and redemption in his li fe. While the vengeance of Dulce Rosa leaves Tadeo alive, the vengeance by Delia leaves Sykes dead. These examples of feminine Vengeance is an indication of overlapping of the

Do we need to believe in a God or does God need us to exist Essay

Do we need to believe in a God or does God need us to exist - Essay Example What is the origin of life and mankind Not only are a lot of these questions being answered by scientists, but even miracles and other such occurrences attributed to divine intervention are being explained away by physics. "From its origin with Galileo, Copernicus and Newton, through Darwin and Einstein, to the age of computers and high-technology, modern science has cast a cold and somewhat threatening light on many deep-rooted religious beliefs. () scientists have demolished a lot of cherished religious beliefs and have come to be regarded by many as faith-wreckers." (Davies, 5). And yet intelligent, articulate people the world over believe in the one true God, a super power or a cosmic force that guides our existence. So, why do people want to believe this curiously elusive and unsubstantiated God It could simply be to give some kind of meaning to, or put into some kind of order, the chaos that surrounds us. After all, the existence of a God fulfils the need to credit someone with the creation of the world around us, with its sheer inexplicability and its irrational apportioning of happiness and sorrow. Digging deeper, the yearning that overtakes a human being for an exploration of the spiritual dimension of life stems from a desire for oneness of mind and body, and ultimately, an aspiration towards perfection. "Human beings, knowing they are not perfect, desire perfection and search for a better life" says T'ai Chi Master Waysun Liao (5). He points out that in spite of the tremendous advances made by us in the fields of technology the motivation that drives a human being remains mysterious. Whizzing along as we are in the space age, yet even our theories of evolution are in doubt. We still look up at the immense sky and wonder how it all started. So, how much have we actually progressed over the centuries As far as necessities go, we still need the same basic food, shelter, clothing, and though we might be eons ahead of the caveman, how much have we actually evolved spiritually It is in pursuance of this desire to evolve spiritually that God has been invented (or perhaps, He exists!). Artistic and creative people, those who march to a different beat from the rest of us, instinctively pursue this 'ultimate' through their work, the nature of their work being such that needs no rationalization to anyone other than themselves. In the work of these outstanding painters and poets, musicians and mystics intellect takes the back seat. In their art one sees their real experiences distilled, and more, one catches a glimpse of something indefinable. Whether it is the element of wonder in Alice Walker's The Color Purple when she exclaims that it is God who is trying to please us, not us who are expected to live up to His rules, or the naked truth in Borges Afterglow, or even the fatalistic note in Yeats' poetry. Because, in spite of advances made in science and technology, we still gaze up at the Milky Way, and wonder at its magnitude and glory. We still respond to the beauty of a piece of music or a painting without rationalizing it. We even watch the flight of a jet, fascinated, forgetting that the aerodynamic principles underlying the technology are as old as the birds. Poets like Yeats, Octavio Paz, Luis Borges and Rilke move us because they bring us closer to the eternal. They are more obviously attracted to the

Isabel Allendes An Act of Vengeance and Zora Neale Hurstons Sweat Essay

Isabel Allendes An Act of Vengeance and Zora Neale Hurstons Sweat - Essay Example Both Isabel Allende’s An Act of Vengeance and Zora Neale Hurston’s Sweat address the theme of feminine vengeance. Despite the fact that the approaches employed by the female main characters to vengeance varying, it is important to note that one of the most underlying similarities between the two short stories is the issue of female empowerment in a society that is mostly dominated by the male. The author makes the story incredibly dramatic mainly brought out at the moment where Dulce Rosa’s father not only realizes that his friends have fallen, but that he is also forced to kill his daughter in order to spare her from men like Cespedes. The author has been successful in presenting this as not only unexpected, but also quite heartbreaking. The author has also been successful in balancing out the different emotions in the story and has most importantly been able to ensure that the audience does not feel melodramatic. Additionally, the use of imagery has been succes sful though not subtle especially at the moment where the author presentsthe image of Dulce Rosa shedding the shreds of her bloodied gown and consequently immersing herself in the water which makes her come out clean. This is a clear representation of both rebirth and baptism. Additionally, the act of holding her dying father is a clear manifestation of transformation from a girl to a woman. The author, Dulce Rosa, in the An Act of Vengeance holds not only the power of her independence, but also the power of self-sufficiency. Despite the neighbors making suggestions about her â€Å"going to live with her godmother in a different town where her story is not known after being raped† (23), Dulce Rosa opts to stay behind and instead build a life that is comfortable out of the ruins left of her fathers house. In Sweat, Delia is also presented as a strong woman who holds the economic power in her relationship with her unemployed husband. Delia still finds much comfort in the home b ought by her despite the abuse and infidelity of his husband. Delia stands her ground even when her husband, Sykes, tries to get her to leave her house to enable him move in with his mistress. She further stands her ground and leaves the husband to die from the snake bite that had earlier been meant for her. It is evident that vengeance by Delia is a decision not aimed at helping Sykes when the opportunity arises, but rather a decision that is aimed at causing Sykes direct harm herself. In An Act of Vengeances, Dulce Rosa was quite determined to kill Tadeo as a revenge for the death of her father. However, there is a twist when she later realizes that what she feels for Tadeo is love, hence making him torn between marriage and murder which are in real sense the two male expectations. Dolce Rosa later opts to kill herself instead of playing into either of these stereotypically male solutions. Her death leads into Tadeo losing all the hope he had for both love and redemption in his li fe. While the vengeance of Dulce Rosa leaves Tadeo alive, the vengeance by Delia leaves Sykes dead. These examples of feminine Vengeance is an indication of overlapping of the

The Battle of Algiers Essay Example | Topics and Well Written Essays - 1250 words

The Battle of Algiers - Essay Example Just as in the film, the violence, which we have seen arise periodically between Muslim immigrants and French-born people since the 1970s – perhaps even earlier – begins with bias, racism, disenfranchisement of one people while favoring the well being, rights and dignity of another people. In the film, as in France, this is French nationalism and Muslims. The Battle of Algiers opens with the arrest and incarceration of a Muslim – a petty thief, taking advantage of people with an age old card game. The man, Ali, who is illiterate, experiences an epiphany of sorts during his incarceration. He is witness to the execution of a man who as been arrested, marched through the prison calling out â€Å"Ala Akbar,† (God is great), and is being led to his execution by French police. At this point in the film we do not know why the man has been arrested, it doesn’t matter, because the man’s execution is by guillotine, a gruesome and archaic death sentence that is unthinkable when you reconnect to the fact that the film is during the 1950s! It is unimaginable that during that time people were put to death in that way. This serves as Ali’s epiphany, and following the execution, Ali spends time with a religious man, who explains to Ali his connection to God and to his country. That one day, the Algerians will retake their country from the French. While French Muslims are not attempting to take France from the French, we see the French reacting to French Muslims in an equally biased and hateful way as they during the colonial period in Algeria. (Keep in mind, the uprising in the film was during the 1950s to 1960s). The violence that exploded in France, outside of Paris, in late 2005-2006, is almost the way the film opens; a response to disenfranchisement. Other images in the film are strikingly familiar to events in today’s world. The execution of the Algerian prisoner by guillotine, an archaic and horrific manner in which to execute a death

Illustrative Essay Essay Example for Free

Illustrative Essay Essay In society today we look at magazines and movies and strive to be just like the people we see. The guys in these magazines have six packs and arms with muscles the size of Mt. Everest. And the girls are all size double zeros with no meat anywhere on their bodies. A lot of Americans work out and diet to accomplish the goal of having these body types, but some go to drastic measures to get it. Many eating disorders and their side effects are taking over the lives of Americans every day. Anorexia Nervosa is the number one eating disorder in America. One in every one hundred woman suffers from this disorder. Anorexia is where you deprive your body from any food. This can create many problems with the body. In the beginning, minor problems can occur like fatigue, dizzy spells, and weakness. But later on, you can do so much as to give yourself certain heart diseases and some women even lose their menstrual cycles. Anorexia has controlled the lives of many celebrities like Karen Carpenter (who actually died from it), Mary Kate Olsen, and Tara Reid. Another eating disorder wide spread through the United States in Bulimia. Three in every one hundred woman suffer or have suffered from Bulimia. This disorder is where you still eat, but you cause yourself to vomit. Statistics show that many women will turn to this disease because it is â€Å"less threatening† than anorexia. Bulimia can cause slight abdominal pain and bloating. Long term side effects of this disorder can be broken blood vessels in your eyes, rotting of your teeth, and even some types of colon and throat cancers. The last eating disorder that is an issue in the USA is obesity. Many people don’t think obesity is an eating disorder, but in fact it is. Everyone’s standard of obesity is obviously ifferent, but on a national scale PBS says that seventy three percent of Americans are overweight or obese. Obesity can cause diabetes, strokes, heart attacks, and high blood pressure which are all life threatening problems. In conclusion, many eating problems are taking over America. There are healthier ways to get the body image you want. Don’t put your body at risk just to be what society wa nts you to be. You should be healthy, but you should become healthy, in a healthy manner. If you or anyone you know is struggling from an eating disorder, you should seek help as soon as possible.

Knowledge and importance of exclusive breastfeeding

Knowledge and importance of exclusive breastfeeding Breastfeeding is the most precious gift a mother can give her infant. When there is illness or malnutrition, it may be a lifesaving gift; when there is poverty, it may be the only gift. Ruth Lawrence, M.D. 1.1 Background of research Exclusive breastfeeding starts from a new born to the age of six months. It is an ideal and incomparable to any infant formulas created for them recently. As it has been known that breastfeed contains the perfect food for a newborn which has immunization to diseases, easy to digest and at the perfect temperature to be fed to infants. Breast milk is the natural first food for babies which provides all the energy and nutrient that the infant needs for the first months of life. The first breastfeed milk is known as the colostrums which can only be found in breast milk that contains all best nutrients for the new born babies. Colostrums contain antibodies that protect the baby from bacteria and viruses in the early age. It helps to increase the babys intelligence and growth and strengthen the close bond between mother and the baby ( Gartner et al. 1997). It strongly proven that breastfeed is the best food for a baby that no other food has the same nutrients values. Pregnant mothers should have the knowledge and awareness of the benefits of breastfeeding to newborn infants. This study is to find out how much the awareness and knowledge of 30 pregnant women in the antenatal and postnatal wards through questionnaires. They should be aware of the benefits of breast milk to infants and to their own health. Many women make infant feeding decisions before delivery and before any contact with healthcare professionals. Although health promotions campaigns are influential in educating women about breastfeeding, they often do not dissuade women from formula feeding once the decisions has been made. Antenatal preparations of pregnant women for breastfeeding rises awareness of the importance of breastfeeding, empower them with practical knowledge and skill in breastfeeding techniques, and prepare them for possible difficulties. Though many campaigns and seminars were done nationally to educate the public, yet the rate of exclusive breastfeeding is still to the unsatisfactory level. The rate of exclusive breastfeeding in Malaysia has been decreased from 92% ( in 1950s) to 78% (in 1970s) but there was a slight of increment in the early year of 1975( Da Vanzo, 1991) although for only less than 10%. Report done by the World Alliance for Breastfeeding Action (WABA, 2005) , showed that millions of babies fell sick every year as they were not breastfeed. The World Health Organization (WHO, 2002) estimated that more than 1.5 million babies died yearly may be avoided if the babies were given exclusive breastfeed, from birth to six months and continuously until the age of two years old. Malaysia has been doing a lot of promotions and activities lately to give the knowledge and importance of exclusive breastfeeding through activities such as World breastfeed week and Baby friendly Hospital. 1.1 Problem of statement Breast feeding have multiple benefit to the mother and child but there are still postnatal mother that are not confident and not interest to breast feed their baby. This problem might be due to lack of knowledge on information sources regarding breastfeeding. This research is done to elevate the knowledge between antenatal and postnatal mothers in this hospital. Breastfeeding offers irrefutable and long-lasting health benefits for both mother and baby, which are supported by a comprehensive scientific research. Many research and evidence base has been conducted and proven that the benefits of breastfeeding are undeniable. Ministry of Health has set and implements various strategy in promoting exclusive breastfeeding. One of the strategy is the Baby Friendly Hospital Initiative on 1993.The aim is neither than to develop an environment that support mother to breastfeed their baby, create a policy that control exclusive breastfeeding. On Mac 1998, Malaysia had been announced as the 3rd country in the world which all the government hospital has been given the Baby Friendly Hospital status. Over time, the percentages of births to subgroups with higher rates of breastfeedingparticularly Malays and more highly educated womenhave increased. However, there is also evidence of changes in rates of breastfeeding within these subgroups. Many Malaysian infants have a total duration of breastfeeding (including with supplementation) considerably shorter than WHO recommended six months of exclusive breastfeeding. The national breastfeeding policy has been revised in 2006, according to WHO all mothers are encouraged to breastfeed their babies exclusively from birth until 6 months of age and thereafter to continue until their child is 2 years old. Complementary foods should introduce when the baby is 6 month old. 1.2 Hypothesis The postnatal mothers have a higher level of exclusive breastfeeding knowledge compared to the antenatal mothers. 1.3 Significance Of Study The benefits of breast milk is undeniable, manufacturer are trying to create a milk that are at least having similar benefits and nutritional value as the breast milk, yet no strong research study has been conducted to prove it. Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mothers bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 600 extra calories a day in producing milk. The composition of breast milk depends on how long the baby nurses. Research shows that the milk and energy content of breast milk actually decreases after the first year. Breast milk adapts to a toddlers developing system, providing exactly the right amount of nutrition at exactly the right time. In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of a mothers milk provide these percentages of the following minimum daily requirements: Energy 29% Folate 76% Protein 43% Vitamin B12 94% Calcium 36% Vitamin C 60%10 Vitamin A 75% . 1.4 Research Objective 1.4.1 General Objective The aim of this study is to identify all antenatal and postnatal mothers have the confidence and knowledge to exclusive breastfeeding. 1.4.2 Specific Objectives 1.3.2.1 To examine the knowledge of antenatal and postnatal mothers towards exclusive breastfeeding 1.3.2.2 To educate antenatal and postnatal mothers with exclusive breastfeeding knowledge and understandings. 1.5 Significant of Project 1.5.1 The importance of this study is to find out the difference knowledge level between antenatal and postnatal mothers on exclusive breastfeeding. 1.5.2 This study needs to assess the knowledge level of the antenatal and postnatal mothers after informations, campaign and educations given by health care staff and to show the teaching techniques by them are effective. 1.5.3. The is to esure that it will increase the knowledge and improvements to induviduals involvements in exclusive breastfeeding 1.6 Scope of Project 1.6.1 The study sample is limited to antenatal mothers who was come for screening in labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward. 1.6.2 Antenatal mother who was not delivered baby from 30 January to 30 Mac 2011 1.7 Definition 1.7.1 Assessment Assessment is a process that follows a continuous cycle of improvement based upon measurable goals, involving data collection, organization and interpretation leading to planning and integration. 1.7.2 Knowledge Knowledge is the awareness and understanding of facts, truths or information gained in the form of experience or learning. Knowledge is an appreciation of the possession of interconnected details. 1.7.3 Exclusive breastfeeding Exclusive breastfeeding defined as no food or liquid other than breast milk , not even water, is given to the infant from birth until six months of age. 1.7.4 Antenatal mother Occurring or present before birth; during pregnancy 1.7.5 Postnatal mother post meaning after and natalis meaning of birth- is the period beginning immediately after the birth of a child and extending for about six weeks. CHAPTER 2 LITERATURE REVIEW 2.0 Introduction Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3-4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register quoted by Kramer MS , Kakumar R.( Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada) Mothers often are uninformed about the health benefits of any amount of breastfeeding, their ability to continue breastfeeding while employed, and the convenience and cost differential of breastfeeding as compared to formula feeding. Although there is a tendency in the literature to stress the time-intensive nature of breastfeeding, in fact it may require less time and attention than bottle-feeding (Barber-Madden, 1990). First, the promotion of breastfeeding without practical help and knowledge which led to many frustrated, unsuccessful breastfeeding attempts with subsequent backlash. Second, a much shorter hospital stay which does not provide adequate time for mothers milk to come in or for appropriate education and support. In Australia in 1993, a country which is known for its support of breastfeeding, the average hospital stay for vaginal delivery was still 5 to 7 days, and for C-section, 7 to 10 days. Australia also has the foresight to send home health visitors once the mother is discharged to offer further assistance and support. Third, the continued increase of women in the workplace, many times by necessity and not by choice, has influenced the incidence and duration of breastfeeding. A non supportive work environment makes breastfeeding difficult at best. Finally, the decline of breastfeeding has been assisted by the ambivalence of some health care professionals. This ambivalence is based on the lack of familiarity with current breastfeeding research, reliance on formula company nutritional information, and the very well meaning issue of not wanting to push breastfeeding because it might make the Mom who chooses artificial feeding feel guilty. Despite these initiatives, only 14.5 per cent babies were exclusively breastfed below six months in 2006, . In addition, only 19.3 per cent babies were exclusively breastfed below four months. Jaafar,2008 Compared with the findings of the National Health and Morbidity Survey 2 (1996), there was a significant decline of 9.7 % in the prevalence of exclusive breastfeeding below four months and a concurrent rise in the prevalence of babies who were predominantly breastfed but given additional water. Analysis of the breastfeeding pattern showed generally that exclusive breastfeeding rates were high in the first two months but dropped rapidly after the age of two to three months .It was also found after the age of two months, more than half of the breastfed babies were supplemented with infant formula and given other foods like commercial baby foods or home-cooked baby food while 20 percent of breastfed infants were supplemented with plain water.Few factors that contribute to early discontinuation of breastfeeding as follow : 2.1 Cultural Beliefs And Myths Of Breast Feeding The cultural beliefs, myths and ignorance have to be blame for the countrys poor breastfeeding performance. The myths that breastfed babies need water in addition to breast milk are wide spread in the country. Lack of knowledge and skill of mothers on when to start complementary food and how to maintain breastfeeding are other prohibitive factors, Complementary food, including water, should ONLY be introduced after the age of six months 2.2 Lacks Of Benefit And Facility Other factors according to Jaafar ( 2008 ) are the lack of benefits and facilities to promote and facilitate breastfeeding practices amongst women who also make up some half of the countrys working population. These include the absence of longer maternity leave, the lack of flexible working hours and missing childcare centers at work places. Breastfeeding patterns in Malaysia suggest that inadequate maternity leave may in fact be denying babies their right to mothers milk, and one of the reasons why only 1 in 7 infants were exclusively breastfed for the first six months of life in 2006. (Nadchatram ( 2008 ) According to Ministry of Health analysis of national breastfeeding data, exclusive breastfeeding rates in the country were high in the first two months but dropped rapidly after two or three months, roughly the period when maternity leave ends and working mothers return to paid employment.   In Malaysia, women are entitled to 8 weeks (60 days) paid maternity leave, 6 weeks short of the recommended 14 weeks by the International Labour Organisations Maternity Protection Convention 2000 (No. 183). Malaysia is not a signatory of the Convention. 2.4 Not Enough Milk Hussain (2003) has revealed that other factor for early discontinuation of exclusive breast feeding is not enough milk .In his study,54% of the sample express that this is one of the reason. The reason for not having enough milk might be highly influenced by the mothers emotional and psychological well-being. Low levels of stress, healthy nutrition, plenty of fluid intake, emotional support and nipple stimulation through babys sucking are all important contributors to breastfeeding success. However, living circumstances often dont allow perfect breastfeeding conditions: another child in the family, the death of a loved one, money worries etc. all add to an increase in stress levels. Other factors such as breast surgery can contribute to low amounts of breast milk. It has also been found that more women who gave birth by caesarean section Encountered breastfeeding problems, this may have various reasons such as the initial separation between mother and baby or the physical pain as a result of the surgery which ultimately affects the mothers ability to enjoy the breastfeeding experience. Chen ( 2006 ),conclude in his research that breastfeeding-friendly policies can significantly affect breastfeeding behaviors. However, an unfavorable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that womens work productive role and family reproductive role be respected and accommodated by society. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life. The length of maternity leave is positively associated with the duration of breastfeeding The International Labour Organization (ILO) recommends a period of maternity leave of not less than 14 week. However, the typical maternity leave in many Asian and Middle Eastern countries falls below these levels, only offering less than 12 weeks paid leave. In Taiwan, most companies provide only eight weeks of maternity leave. A national survey in 2005 showed that the rate of exclusive breastfeeding in Taiwan at one month postpartum was only 22.3%, and dropped to 16.7% at three month. To bring Taiwan in line with WHO guidelines, effective worksite strategies needed to be implemented to encourage new mothers to breastfeed in the workplace. 2.5 Levels of Influence and the Breastfeeding Decision 2.5.1 Health Professionals Roles Multiple studies indicate that health professionals support of breastfeeding is important in increasing breastfeeding rates (Lawrence, 1993, Winikoff Baer, 1980; Winikoff, Laukaran, Myers, Stone, 1986, 1987). Health professionals have made important promotion contributions, yet many health professionals who provide care to pregnant women and infants do not demonstrate explicit support of breastfeeding; nor do they have adequate knowledge about breastfeeding. In an American Academy of Pediatricians study, only 65 percent of pediatricians recommended exclusive breastfeeding for the first month and only 37 percent recommended breastfeeding continue for the first year (Schanler, OConnor, Lawrence, 1999). Many women do not initiate breastfeeding because they know they will be returning to full-time employment that will entail separation from the baby. Perhaps they believe that they will not be able to continue breastfeeding once they return to work, and they adopt an attitude of Why start something I will not be able to continue? (Fein Roe, 1998). Furthermore, women who return to full-time work wean their infants earlier than other women. It has been found, however, that expecting to work part-time following the birth of a baby did not affect initiation of breastfeeding. Part-time work of four or fewer hours a day did not affect duration of breastfeeding. Part-time work for more than four hours per day affected duration of breastfeeding less than full-time work (Fein Roe, 1998). Because of economic necessity and the need for other benefits such as health insurance, many women cannot afford to work less than fulltime. When possible, however, delaying separation from the infant and reducing the amount of time mother and infant are separated during the infants first six months increases the likelihood that breastfeeding will be successful (Stuart-Macadam Dettwyler, 1995). In a qualitative study carried out by MacLaughlin and Strelnick (1984), many women suggested it would be helpful to receive breast-feeding information about combining breast-feeding with working and to have open discussions of the topic with other mothers. A survey of 567 women who breastfed while employed outside the home showed that the most significant difficulty was role overload, a result of the multiple demands to which they were responding. This aspect does not differ markedly from what is found for non-breastfeeding, working mothers (Auerbach Guss, 1984). About 60 per cent from 451 mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies birth. The mothers age, education or parity, did not affect the rate of breastfeeding. Low birth weight, especially birth weight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottle feeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birth weight (Shiva , 2003 ) 2.6 Advantages of breast milk to babies Breast milk is best for newborn baby, and the benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients baby needs in the first six months of life, breast milk is packed with disease-fighting substances that protect baby from illness. American Academy of Pediatrics recommends exclusive breastfeeding for the first six months (although any amount of breastfeeding is beneficial). And scientific studies have shown that breastfeeding is good for mothers health, too. Numerous studies from around the world have shown that stomach viruses, lower respiratory illnesses, ear infections, and meningitis occur less often in breastfed babies and are less severe when they do happen. Exclusive breastfeeding (meaning no solid food, formula, or water) for at least six months seems to offer the most protection. A study by the National Institute of Environmental Health Sciences showed that children who are breastfed have a 20 percent lower risk of dying between the ages of 28 days and 1 year than children who werent breastfed, with longer breastfeeding associated with lower risk. The main immune factor at work here is a substance called secretor immunoglobulin A (IgA) thats present in large amounts in colostrums, the first milk mothers body produces for the baby. (Secretors IgA is present in lower concentrations in mature breast milk.) The substance guards against invading germs by forming a protective layer on the mucous membranes in the babys intestines, nose, and throat. 2.7 Advantages to breastfeed mothers A study of more than 33,000 Danish women who had given birth between 1999 and 2002 evaluated the effect of breastfeeding on maternal weight at 6 and 18 months postpartum compared to reported pre pregnancy weight. The authors calculated that a Danish woman with normal or obese pre pregnancy weight who gained 11-12 kg during the pregnancy and exclusively breastfed her infant for 6 months would be back to her pre pregnancy weight by then. At 18 months postpartum, women who exclusively breastfed for 6 months and continued breastfeeding until their infant was 12 months of age had the lowest probability of retaining 5 or more kg of weight no matter how much weight they gained during the pregnancy (Baker, 2008) 2.8 Conceptual framework The research conceptual framework will be carried out as shown in the flow chart below. INTERGRATED WARD HOSPITAL TUANKU AMPUAN NAJIHAH POSTNATAL MOTHERS ANTENATAL MOTHERS QUESTIONAIRE RESULT ANTENATAL MOTHERS POSTNATAL MOTHERS CHAPTER 3 RESEARCH METHODOLOGY 3.0 Introduction In this chapter the researcher will discuss the main aspect of the research methodology in detail. There are five aspects that consist of the research design, population, sampling and methods, study instruments, collection of data and limitation of study. 3.1 Study design The study uses a descriptive and quantitative method. The researcher will distributes the questionnaires to the respondents as the main instrument to collect data for the study. The collection and the analysis of data is done in two weeks. 3.2 Population and sample The population is all antenatal mothers who will be come for screening in the labour room from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward in Hospital Tuanku Ampuan Najihah. 3.3 Study subject All 15 antenatal mothers who will come for screening in integrated ward from 30 January to 30 Mac 2011 and 15 postnatal mothers discharge from labour room during the study period. . 3.4 Sample size calculation The sample size will be calculated so that the study has the capability to detect clinically importance difference as statistically significant. The sample size also will be calculated to estimate effect with stated precision. Only 30 cases will be selected as the sample. 3.5 Study participants 3.5.1 Inclusion criteria All antenatal mothers who are conceiving their second child and above that warded from 30 January to 30 Mac 2011 and postnatal mothers discharge from integrated ward. 3.5.2 Exclusion criteria All antenatal mothers who are conceiving their first baby from 30 January to 30 Mac 2011 was not included in this study. 3.6 Data collection procedures 3.6.1 This study will be using questionnaires that will be given to the antenatal and postnatal mothers before and after the campaign. 3.6.2 Permission to carry out the study will be obtained from the Hospital Director and the Chief Matron. An inform consent will also being obtained from the respondents ( Appendix II / Lampiran II). 3.6.3 Self Administered Questionnaire (SAQ) Self Administered Questionnaire will be used to determine the medical personal knowledge as shown in Appendix III / Lampiran III. 3.7 Sampling methodology Sampling refers to the process of selecting a portion of the population to represent the entire population (Polit Hungler, 1999). In this study only 30 participants will be selected among the antenatal and postnatal mothers in HTAN from January till March in the year of study. The study was done with pilot test 10 antenatal and postnatal mother and the cronbachs alpha= 0.732 3.7.1 Statistical analysis The result of this study was based on the responses from 30 of the antenatal and postnatal mothers. The independent variables identified namely were designation. The data was analyzed and presented in percentage. 3.7.2 Research tools Data was collected by using structured questionnaire. See Appendix III and Appendix IV. 3.8 Expected results Antenatal mothers have the knowledge and understanding of the importance in exclusive breastfeeding. Antenatal mothers will be making decisions on exclusive breastfeeding before delivery. CHAPTER 4 RESEARCH RESULTS 4.0 Introduction In this chapter the collected data is analysed from the questionnaires given to the respondents. The demographic factors usually tested as it is often used as the inference study as it is easy to get and easily analysed the effect (Jack Fiorito et el 2007) . The first part is a demographic data about the respondents for example race, age , education level and their exclusive breastfeeding knowledge. 4.1 Characteristics of demographic respondents Section A Table 1 : Ethnic :- Antenatal mothers Antenatal mothers Post natal mothers Ethnic Number of respondents Percentage Number of respondents Percentage Total number Malay 11 73.3 % 13 86.7 % 24 Chinese 1 6.7 % 0% 1 Indian 3 20.0 % 2 13.3% 5 Referring to the table above, majority of the respondents are from the Malay ethnic which gives 73.3% for the antenatal mothers while the postnatal respondents gives 86.7%. The second higher percentage of ethnic comes from the Indians that give 20 %for the antenatal mothers and the postnatal mothers contributes 13.3 %. The least is the Chinese that gives only 6.7% that is only one respondent for the antenatal but none for the postnatal mothers.. As usual majority of the respondents are the Malays as most of them preferred to give birth in government hospitals comparing to the Chinese who prefer going to the private hospitals. Table 2 : Age of the respondents Age range Number of respondents for both ante and postnatal mothers Percentage 20 -25 years old 9 30.0% 26 30 years old 12 40.0 % 31 35 years old 6 20.0 % 36 40 years old 3 10.0% The age range for this study is done to get a better view to the majority of the ante and postnatal mothers involved. As shown in the table above the age range between 26 to 30 years of the antenatal and postnatal mothers gives the majority which contributes 40.0 %. The least comes from the age range of 36 to 40 years that gives only 10% which only 3 respondents involved. Table 3 ; Education Level Academic level Number of respondents Percentage Non- schooling 1 3.3 % Primary school 2 6.7% Secondary school 17 56.7% College/ University 10 33.3% As shown in the above table, the majority of the educational level comes from the secondary school level which contributes 56.7 % from all the respondents. This shows that this group of respondents have the great trust in the government hospital so does the college/ university level respondents that gives 33.3% of all. Table 4 : Occupation Occupation Number of respondents Percentage Housewife 17 56.7 % Self employed 4 13.3 % Government servant 5 16.7% Private sector 4 13.3% Referring to the above table, the housewife is the majority respondents in this study that carries 56.7% which is more than half of the respondents involved. The government servants contributes 16.7% while the self employed and the private sectors employees give the same percentage of 13.3% each. Table 5. : Exclusive breastfeeding prior knowledge YES NO Number Of respondents 25 5 Percentage 83.3% 16.7 % Referring to Table 5, 83.3% of the respondents have the prior knowledge of exclusive breastfeeding which means that they had the experience and knowledge to breastfeeding. Five respondents, contributing 16.7% had no knowledge of exclusive breastfeeding. Table 6 : Number of child Number of child (conceiving/ give birth) Number of respondents Percentage 2 12 40% 3 11 36.7% 4 3 10% 5 2 6.6% 6 2 6.6% As shown in the table above , 12 respondents conceiving or giving birth to their second child that gives 40% of the study. 36.7% conceive or give birth to their third child, 10% or 3 respondents conceive or give birth to their 4th child and 6.6% contributed by respondents who conceive or give birth to their 5th and 6th child. SECTION B Knowledge on exclusive breastfeeding Question number 1