The Determinant Factor Of Intrinsic And Extrinsic Aging Essay

Is Aquaporin-3 a Determinant Factor of Intrinsic and Extrinsic Aging? An Immunohistochemical and Morphometric Study Iman Seleit, MD,* Ola A. Bakry, MD,* Hala S. El Rebey, MD,w Gehan El-Akabawy, MD,z and Gehan Hamza, MSc* Abstract: Aquaporin-3 (AQP3) is an aquaglyceroporin that plays a role in skin hydration, cell proliferation, and migration. The aim of this work was to investigate the expression of AQP3 in sun-exposed and sun-protected human skin from different age groups to understand the relationship between AQP3 and skin aging. Using standard immunohistochemical techniques, sunexposed and sun-protected skin biopsies were taken from 60 normal individuals. AQP3 was expressed in the basal and the suprabasal layers, sparing the stratum corneum, in all specimens. Dermal expression was detected in fibroblasts, endothelial cells, and adnexa. Sun-protected skin showed a significantly higher epidermal H-score and percentage of expression (P=0.002 and 0.001) were significantly associated with the age group (20 to 35 y) in sun-exposed skin. C, A higher H-score was significantly associated with the age group (20 to 35 y) in sun-protected skin (P 0.001). D, Comparison between the immunohistochemical expression of AQP3 in sun-exposed and sunprotected skin in different age groups. A higher percentage of expression was significantly associated with sun-protected skin in the age group of 20 to 35 years (P = 0.03), in the age group of 35 to 50 years (P = 0.007), and in the age groupShow MoreRelatedDefining Motivation : Well Known And Unsolved3147 Words   |  13 Pages2008). The nature of motivation has traditionally been separated into two qualitatively distinct forms: a) intrinsic interest and; b) extrinsic motivation (Deci Ryan, 1985). This assumption has served as the foundation of many psychological theories and experiments. Yet, when this same concept is viewed from a neurological standpoint, there is evidence to suggest that both intrinsic and extrinsic motivations activate the same areas in the striatum that are associated with rewards, implying that theyRead MoreJob Satisfaction and Employee Motivation4960 Words   |  20 Pagesliterature review and also analyse key motivational factors associated with our empirical case. This would lead to my conclusion and recommendation on how to effectively motivate employee to increase productivity and performance. A Review on Motivation and its theories Work motivation and employee satisfaction plays a more central role in the field of management theoretically and practically and it is indeed one of the most important factors affecting employee behaviour and performance. ManagersRead MorePersonality Development4478 Words   |  18 Pagesflexible, but it is rigid i.e. unalterable in adults (1).   Personality and its development are under influence of some determinants.   Environment is considered the major extrinsic one (2).   Cultural, racial, socioeconomic, educational, social guidance and health conditions could be environmental factors playing   a critical role in personality development (3).   The intrinsic factors could be biological drives,   such as the homeostatic, sexual, defensive and assimilatory drives, and hereditary temperamentalRead MoreConsumer Behavior Process2062 Words   |  8 Pagesworm infestations in the product. This directly affected sales which fell by 30% (Vivek, 2004). According to (Nelson, 1970), consumers are most likely to derive quality or safety perceptions from other product cues, either intrinsic (e.g., appearance of the product) or extrinsic cues (e.g., a quality label). In the case of Cadbury, the most effective action that was taken post the reporting of the worm infestation in the chocolate was the roping in of Amitabh Bachchan, the famous Indian movie actorRead MorePsychology14463 Words   |  58 Pagesthe combination of autonomy and competence was found to underlie intrinsic motivation (Deci, 1975) and both generated merged with a considerable amount of research on the nature of competence motivation (Boggiano Pittman, 1992; Elliot Dweck, 2005). Research combining the individual difference approach to achievement motivation (e.g., McClelland Watson, 1973) with an experimental approach to research on intrinsic and extrinsic motivational orientations (e.g., Pittman, Boggiano, Ruble, 1983)Read MoreThe Relationship Between Job Satisfa ction and Absenteeism in a Selected Field Services Section Within an Electricity Utility in the Western Cape31415 Words   |  126 Pagesbeing given to reduce workplace absenteeism and its cost. Most research has concluded that absence is a complex variable and that it is influenced by multiple causes, both personal and organisational. Job satisfaction has been noted as one of the factors influencing an employee’s motivation to attend. Studies on the relationship between absenteeism and job satisfaction seem to be inconsistent. Some research has found no correlation between these two variables whereas other studies indicate a weakRead MoreArticle: Performance Appraisal and Performance Management35812 Words   |  144 Pagesobservation scales (BOS), behavioural evaluation scales (BES), critical incident, and job simulation. All these judgments were used to determine the specific levels of performance criteria to specific issues such as customer service and rated in factors such as â€Å"excellent†, â€Å"average†, â€Å"need to improve† or â€Å"poor†. 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Quality Management Essay - 684 Words

Description of how Woolworths manages quality and determine how effective Woolworths is at managing quality. Under the strategic objective of protecting customer trust, Woolworths has a defined policy that applies to all its business units to ensure quality is maintained at the highest level and is consequently a positive reflection of the overall Woolworths brand. This policy is entitled ‘Woolworths Quality Assurance Standard â€Å"protecting customer trust†, version 6 June 2009’. Woolworths has identified that a key element to its quality management strategy for its business is a priority focus on its suppliers. Suppliers are defined as trade partners and as such elevate them to share the responsibility with Woolworths to achieve the†¦show more content†¦Woolworths demands that HACCP plans are based on ‘Product Specifications’. The fact that it regularly assesses products’ compliance to specification is another factor towards maintaining a high standard of quality management. WQA has sections which specifically cover ‘Good Manufacturing Practice’ (GMP) as well as ‘Document Control’, ‘Cleaning Procedures’ and ‘Pest Control’. In terms of GMP, the WQA lists approximately 22 policies and procedures which must be adhered to and records of verification of adherence which must be kept. These policies and procedures cover just about everything from ‘Personnel Hygiene Policy’ to ‘Packaging’. As with most sections of WQA it is very comprehensive. Training of personnel is another area which has detailed requirements in WQA. All roles relating to ensuring quality must be undertaken by suitably qualified staff. Training schedules are linked to employees’ job descriptions, training records are kept and training needs are regularly reviewed. Under the section called ‘Calibration’, WQA specifies that procedures are put in place to ensure that all equipment used for measuring, testing and inspecting gives accurate readings. The next section is ‘Product identification traceability’. Clear identification of grade, inspection status and description of all material, whetherShow MoreRelatedDefinition Of Total Quality Management1946 Words   |  8 Pages Total Quality Management is the concept of processes and integration all of functions in an organization in order that to focus on quality control and approach to long-term success will continue improvement in all aspects but not short- term goal. TQM of business plan began in 1980 in the United States. It was popular until early 1990. Nowadays, in the small business to large business, including restaurant and fast food businesses that used system quality standards to manage the organization becauseRead MoreQuality And Total Quality Management1662 Words   |  7 PagesQuality is defined by meeting customers needs. Total quality management in the company through continuous improvement of the quality of its products, services and people. 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Brand Identity and Positioning

Question: Discuss about the Brand Identity and Positioning. Answer: Introduction: The success of any business depends on the brand identity and the positioning of the company in the market. Brand identity can be defined as the ways in which the company represents themselves in front of the consumers to help them get an perceived value about the company (Kavaratzis and Hatch 2013). The ways in which the product of any company is strategically placed in the market to remain distinguishable from similar products within that market is known as brand positioning (MacInnis, Park and Priester 2014). Through this report, one strong and one weak brand have been chosen. The globally acknowledged chocolate company Cadbury has been chosen as the strong brand. On other hand, the chocolate brand from Australia named Havenhand represents the weaker brand in our report. The first part in this report gives a brief description about the background of the two companies. In the second part the report speaks about the CBBE model and the brand identity and positioning system of both the companies. Then the report tries to highlight the things that should be changed within the weaker organization to help it gain access to a wide range of markets. In other words, this part discusses about the repositioning strategy. The report is then summarized in the conclusion paragraph. Background of the companies: Cadbury: The John Cadbury in United Kingdom has founded the company Cadbury 193 years ago. Mondelez International now owns the multinational company since 2010. After Wrigleys it is the most famous brand in the world and operates in more than 50 nations (www.cadbury.co 2017). Cadbury has been head-quartered in Uxbridge region in U.K. The company has earned revenues of around $4 billion during the year 2015 (www.telegraph.co.uk 2012). The first store started by selling drinking chocolates and cocoa and the globally loved chocolate named Dairy Milk was launched in the year 1905. U.K, China, Australia and India provides the biggest market of this company for this company. On other hand, Argentina, Thailand, Egypt, Saudi Arabia and the gulf markets are the potential growing market for this company. The company had recently launched its products in three countries namely Philippines, Indonesia and Saudi Arabia. At present the company has been providing employment to over 71657 people. During 2010, Kraft Foods took over the ownership of the company and after that in 2012, they successfully increased their profit by 1.8% from their previous years (www.cadbury.co 2017). Havenhand: Havenhand is amongst the well-known chocolate company existing in Australia. It specializes in producing fruit chocolates. The company has been catering only to Australian customers with their wide range of chocolate products. It also has their own chocolate caf where people can go have breakfast, lunch and even afternoon snacks while enjoying the scenic beauty of the Murray river (www.havenhandchocolates.com 2017). They are well-known for using the best quality sun-dried fruits from Riverland. They use premium quality Belgium chocolate for preparing their unique combination of more than 300 varieties of chocolates, truffles and novelties (www.havenhandchocolates.com 2017). The reason behind choosing this company in our report is that in spite of being such a well acknowledged brand in Australia, the company still does not cater to global customers. Hence, there must be some issues that have been drawing back the company from expanding globally. Through this report, some repositionin g strategies is going to be identified which might help this company to flourish in their business. Brand identity and Positioning Strategies: CBBE Model: Professor Kevin Lane Keller formulated a model through which any company, organization or business might shape their presence in the market (Sirianni et al. 2013). His famous model has been termed as Consumer-Based Brand Equity model (CBBE). According to Prof. Kevin, the success of any brand does not take place overnight. The company needs to pass through several stages creating a positive image of their products in peoples eyes (Keller 2016). There are four major steps through which any company must pass before getting globally acknowledged. These steps have been highlighted in the diagram below. Figure 1: CBBE MODEL by Kevin Lane Keller Source: Cadbury based on CBBE Model: Figure 2: CBBE of Cadbury Source: Created by Author From the figure above it can be easily said that Cadbury has been successful in moving up the pyramid of CBBE by creating brand recognition, giving people a feel good factor and remaining affordable by almost all those who loves chocolate. The company has a wide range of product portfolio customized in accordance with the taste and preference of the nations where it operates (Gupta 2014). Out of all its products, Dairy Milk has been the most famous one which has been attracting global consumers since 1905. Havenhand based on CBBE Model: Figure 3: CBBE of Havenhand Source: Created by the Author The figure above clearly indicates that the chocolates of Havenhand are recognized and used by Australians only. There has been lack of brand recognition outside the country (Trott and Sople 2016). In spite of the fact that this company also provides a wide variety of products in different stylized packages, the company still lacks in creating a successful brand image which would help it penetrate the foreign market. Positioning of the brands: Now, with the help of positioning map the existing condition of both the company has been shown below. Through this mapping, peoples perception about different brands and its competitors are highlighted for the ease of comparison (Singh, kalafatis and Ledden 2014) Figure 4: Positioning Map Source: Created by the Author In this positioning map, the violet star indicates the position of Cadbury Products whereas the red star indicates the positioning of Havenhand chocolates. It has been observed that Cadbury has kept a wide range in its product prices. It falls under the category where it provides high quality products at low prices. This has been possible as the company caters to a large basket of consumers and production in bulk amount reduces per unit cost involved in productivity (MacInnis, Park and Priester 2014). On other hand, company Haverhand positions itself where the price of its products are higher than that of Cadbury but at the same time there has been compromise with the quality of the products. This compromise has not been done purposely on companys behalf but it occurred as a result of small scale operation dealing with chocolates and fresh fruits. Repositioning Strategy: The way in which Cadbury became globally acknowledged has been seen in the above section. Now, for Havenhand to become a stronger brand than it is, it must re-position itself in the market creating a higher brand value. The strategies that Cadbury has taken up in its long journey but Havenhand still do not use are given below: Spreading their products amongst customers through several channels like local stores, retailer, supermarkets and even chocolate vending machines Keeping a wide range of prices keeping in mind the affordability of different customer segment Advertising their products through both print and online media and attracting customers Adapting cultural diversity of the nations where it operates Targeting different segment of customers like kids, younger generation, adults and even old people through value-oriented advertisement Conclusion: The entire report can be summarized by stating that the success of any company, organization or brand depends upon several factors. Through our report it has been observed that Cadbury has been able to establish its brand identity in the global market. It has successfully followed the four step pyramid of the CBBE model. On other hand, Havenhand being a reputed chocolate brand has not been able to open itself up in the global market. By comparing the strategies of these two brands it can be said that Havenhand has some flaws in their strategy. They are not targeting their customer properly and keeping the price of their product on the higher side of the market segment. In addition they do not have a large number of stores in the market and hence distribution of their products remains constricted. Hence, it can be concluded by stating that if it can gradually adopt the above mentioned re-positioning strategy it would be able to reach out to more customers and thereby climb up in creat ing a high brand identity. References: Gupta, R.K., 2014. Secrets of Building a World Class Brand.Siddhant-A Journal of Decision Making,14(4), pp.344-356. Havenhandchocolates.com. (2017).Havenhand Chocolates. [online] Available at: https://www.havenhandchocolates.com/ [Accessed 5 Feb. 2017]. Kavaratzis, M. and Hatch, M.J., 2013. The dynamics of place brands: An identity-based approach to place branding theory.Marketing theory,13(1), pp.69-86. Keller, K.L., 2016. Reflections on customer-based brand equity: perspectives, progress, and priorities.AMS review,6(1-2), pp.1-16. MacInnis, D.J., Park, C.W. and Priester, J.W., 2014.Handbook of brand relationships. Routledge. Singh, J., P. Kalafatis, S. and Ledden, L., 2014. Consumer perceptions of cobrands: The role of brand positioning strategies.Marketing Intelligence Planning,32(2), pp.145-159. Sirianni, N.J., Bitner, M.J., Brown, S.W. and Mandel, N., 2013. Branded service encounters: Strategically aligning employee behavior with the brand positioning.Journal of Marketing,77(6), pp.108-123. Staff Agencies, T. (2012).Cadbury-owner Kraft sees profits rise after raising prices. [online] Telegraph.co.uk. Available at: https://www.telegraph.co.uk/finance/newsbysector/retailandconsumer/9244755/Cadbury-owner-Kraft-sees-profits-rise-after-raising-prices.html [Accessed 5 Feb. 2017]. Trott, S. and Sople, V.V., 2016.Brand Equity: An Indian Perspective. PHI Learning Pvt. Ltd.. www.cadbury.co. (2017).Home Page. [online] Available at: https://www.cadbury.co.uk/ [Accessed 5 Feb. 2017].

Urban Music In The Year 2000 Essays - Hip Hop, Music, Tupac Shakur

Urban Music In The Year 2000 Urban Music in the Year 2000 Shots ring out in South Central Los Angeles. A man screams in horror. This man has been shot in a heated gang war. This is everyday life for gang members. Gang members are used to cold blooded murder and most attend at least 5 funerals a week. Similar situations occur in Harlem, New York and in other places around the country. Why is this happening? Many people think that rap music is making kids more violent. They think that rap music is just a glorification of violence. All rap music is doing is to show how horrible and inhuman life is in the ghettos across the country. This is what's really happening out there. It's not fake. Right now, there is a major conflict between West Coast and East Coast rappers. East and West are fighting in a vicious battle that leaves hundreds of poor, helpless people dead in the street. There's no reason for this to be going on. Back in the early '90's, when rap was beginning to become popular, the East/West war wasn't quite there yet but it was slowly becoming more and more obvious that there was a conflict between rappers. Part of the reason that the war started was that West Coast rap dominated and nobody questioned their supremecy. Ice Cube, Ice T, and Eazy E were the rappers of the moment. The war slowly worsened when East Coast rappers began to get more publicity. West Coast rappers were upset that they weren't 100% in the spotlight so they started to make fun of East rappers in their music proclaiming that East Coast rap was fake and couldn't top West Coast. Then, East Coast rappers fired back obscenities at West Coast rappers and it kept up like that until someone decided that the other coast had gone too far. In 1993, Sean Combs started Bad Boy Entertainment in New York and for the first time ever, East Coast sales surpassed West Coast rap sales. Suddenly, as if out of nowhere came the peak of the West/East feud. Smaller gangs in cities took the example of the big playaz and followed what they said. Before, local gangs killed for affiliation whether you were a Blood or a Crip. Now, gangs were killing for West and East. In some cities it was so bad that you could be killed for living on the wrong side of the neighborhood. The war went on for awhile and started getting worse. The big feud was West Coast Death Row Records against East Coast Bad Boy Entertainment. Their were some personal feuds though. West rapper Tupac Shakur had a personal problem with East rap mogul The Notorious B.I.G. They often rapped about each other and were very personal. In one song Tupac claimed to have slept with Biggie's wife and the Notorious B.I.G. retaliated in his music by saying Stupid niggaz mess wit Big Poppa, mother*censored*ers get roasted if you *censored* wit B.I.G. These words became extremely important later. Then, on September 7, 1996 West rapper Tupac Amaru Shakur was shot to death in a drive by shooting in Las Vegas. His murder remains unsolved and will probably never be solved. There were over 100 possible witnesses but only 1 agreed to testify. Many gang members believe that the police can't do anything so they refuse to cooperate. And, after the funeral the gang members settle the score themselves. And almost always it is bloody. Members of Tupac's entourage thought the only way to make things better was to kill an East rapper. And in my opinion, that's exactly what they did. On March 3, 1997 East rapper Christopher Wallace aka Notorious B.I.G. was shot to death. Sound familiar? It should because that's the same thing that happened to Tupac Shakur six months earlier. Both murders are unsolved so no one except the killers know why these senseless deaths happened. Sadly, life goes on and many people in the ghetto think there is only one answer to these problems: retaliation. Now in 1998, the feud is somewhat better. No Limit Records, which is the number one West label after Death Row Records CEO Suge

Stem Cell Therapy in Colorectal Cancer

Ribbon of Faith Essay

Ribbon of Faith Essay Ribbon of Faith Essay Ribbon of Faith We plan to create a group for people that just need someone to help them out, and we will possibly do this anonymously, because most don’t want to tell their problems, because of how people will look at them for what flaws they speak of to try and get help. We also want to make posters that could make someone smile when they walk by it in the halls if they are thinking lowly of themselves. We aren’t professional therapist, but we have heard and seen so many things happen when someone doesn’t get help or answers for their problems. About being anonymous as we do this is when we ask questions they will either share out if they wish or write it down on a piece of paper, and we will not have them put names, and put it in the bucket in private so it stays with them. We will try our best with answering or giving the opinion of the subject on the note, and answer it for the person and everyone around us so they can understand, and they all can give ways of helping a s we all talk about the note, and that is how it would go on. Now, you probably want to know about why it would be anonymous asking: It is just that we like to have our question answered without being judged by others. This is possible with the way we have things set up. We will have a bucket in a separate room/closet/space so they can put their notes in it. I have gone onto a site called: beatbullying.org/ to find out if this is good, and more than half agreed that it would be very

Social Service Worker Program to Deal with Oppression Research Paper

Social Service Worker Program to Deal with Oppression - Research Paper Example This research paper investigates the oppression of women domestic workers in Canada, the consequences of this oppression and how social services can be improved upon by analyzing a number of articles on the relevant topic. Stasiulis and Baken in an article titled "Negotiating citizenship: the case of foreign domestic workers in Canada", discuss the concept of citizenship as a negotiated entity and have used the example of foreign domestic workers in Canada as a means to demonstrate that citizenship is negotiated on global and national levels. They stated that because these domestic workers in Canada are often not citizens of Canada; they are colored workers originating from different countries but they work for predominantly white and affluent Canadian women. So they are often subjected to abusive conditions at work. The authors have pointed out that in the new era of globalization, the principles of Keynesianism which were in favor of expanding the social services network, have given way to a need for a higher level of competitiveness in order to succeed in the marketplace. Therefore, many Governments are re-formulating the concept of citizenship. Stasiulis and Baken have dealt specifically with the issue of oppression of domestic workers in Canada and how their non-citizenship status has contributed to their oppression and suffering. They point out that the notion of citizenship itself may need to be renegotiated, away from its earlier view of the relationship between a single individual and the nation state.

Reggae Essay Example | Topics and Well Written Essays - 1000 words

Reggae - Essay Example Reggae is a musical style which traces its roots to the small island nation of Jamaica. It is synonymous with the former British colonial territory, the recreational use of â€Å"ganja†, the rise of Rastafarianism around the world and a man commonly known as â€Å"the first Third World superstar† (Pawka). When Reggae first emerged from the Caribbean in the early 1960’s, the United States and United Kingdom’s musical scenes were enthralled with the latest craze of rock n’ roll and R&B. But during this era of musical explosion in the slums of Kingston, â€Å"pan-Africanism merged with American R&B and Caribbean music in (the) back alleys to forever change global music† (John). And as the Jamaican record and radio industries began to gain more independence, more music began to flood out from the region. First, new musical genres emerged from the Jamaican R&B flooding the island, which shaped the sound of reggae music. â€Å"†¦around 1960, Jamaican drummers began hitting the second and fourth beats in unison with the piano and guitar, while the bass played walking quarter-notes.

Sourcing Material and Services Essay Example | Topics and Well Written Essays - 250 words - 1

Sourcing Material and Services - Essay Example hese three are related in that strategic sourcing furthers the procurement process with a greater focus on the impacts of decisions on procurement and purchasing. It works cross-functionally in the firm so as to help in the realisation of the overall business goals of the organisation. These three have undergone evolution over time. As documented by Coyle et al. (2012), the traditional sourcing process involved tactical sourcing, limited supply base and functional purchasing. Then came strategic sourcing which emphasized on supplier relationships and non-traditional supply base. The e-enabled procurement provided capability for e-sourcing, e-procurement and e-commerce. This paved way for integrated sourcing or supply chain which involves sourcing for a strategic supply chain process and seamless integration of the sourcing process and supply chain activity. To evaluate suppliers, companies should seek to establish relationships or alliances with them so as to enable them ascertain their ability to supply quality materials adequately over the given period of time and at an optimum cost (Coyle et al., 2012). Quality supplies of materials ensure quality final products. Companies should also evaluate the ability of the supplier to contribute to its competitive advantage: to promote low cost, niche orientation or differentiation. According to Mangan, Lalwani and Butcher (2008), evaluation could be undertaken through competitive bids or direct negotiations. Recently, Internet auctions have also become popular evaluation

Construction Method Statement Example

Construction Method Statement Example 1.0 Introduction This Construction Method Statement describes the development of six houses in three identical semi-detached blocks on a plot of land. The document will suffice for the majority of works undertaken during the construction but will require alterations or additions for certain projects. This method statement is a qualified assessment based on current information and is subject to refinement as the project evolves. This method statement is prepared to discuss about all the construction process and operations and also emphasize on the health, safety and environmental concerns. 2.0 Preliminary Works 2.1 Access and Material Distribution Constant flow of transport is needed during the construction period. Small access roads and driveways together with temporary roads are constructed to define site circulation routes and provide a suitable surface for plant movement (Chudley Greeno, 2008, p.118). A small access road is set up nearby the storage area of the site to transport materials that are required within a short space of time. A forklift will be used for material offloading and distribution around the site. The location of the access road shows in the Figure 1 site layout plan. Moreover, the road will be subjected to light and heavy day to day traffic such as concrete delivery, steel delivery lorries, brick and block delivery lorries and delivery vehicles generally. All the deliveries will be fitted into a delivery schedule system which is controlled by site personnel under guidance of Construction Manager. (Griffith Watson, 2004, p.392) Materials are closely phased and delivered when assembled which to achieve just-in-time management in this project. Materials that are transported with heavy goods vehicles (HGVs) are expected to take place at night and that certain works may have to be undertaken during this period so that it does not cause disruption to traffic flows, especially at peak times. 2.2 Storage Storage on site is erected to store materials, tools and equipments, spare parts for mechanical plant, and manufactured goods for incorporation in the work. (Griffith Watson, 2004, p.188) The distance between storage and activity areas keeps short to reduce transportation needs in terms of time. Timber and steel reinforcement will be stored in a dry safe place and special store for fuel oils needed by the requirement of legislation. (Griffith Watson, 2004, p.189) 2.3 Site Office A temporary site office will be provided on the site for management purposes and paperwork. These offices will be housed in modular portable units. The size of site office will be calculated based on an example below: Size Example: Office for site agent and assistant plus an allowance for 3 visitors. Assume an internal average height of 2.400. Allow 3.7m2 minimum per person and 11.5m3 minimum per person. Minimum area = 5 x 3.7 = 18.5m2 Minimum volume = 5x 11.5 = 57.5m3 Assume office width of 3.000 then minimum length required is = 57.5/ (32.4) = 57.5/7.2 = 7.986 say 8.000 Area check 38 = 24m2 which is > 18.5m2; satisfactory (Chudley Greeno, 2008, p.94) 2.4 General Site Facilities General site facilities such as toilets, changing facilities, canteen, as well as shelter from inclement weather will be provided on site. Adequate heating, lighting and ventilation are required in all toilet, washing, changing, and accommodation. The requirements of each facilities are specified the Health and Safety Executive (HSE) legislation (Griffith Watson, 2004, p.192). The location of all the facilities must be close together for easy access. The site accommodation will be located in the north corner of the site so to suit site access strategy. A row of single storey accommodation will be needed in the project. All the facilities buildings build in portable. 2.5 Site Enclosure Fencing and Hoarding A minimum height of 2.4m hoarding and fencing will be erected around the perimeter of the site for protection (Griffith Howarth, 2001, p.252). Safety measures outlined by the Albert Building Code (ABC) must be followed. An external signposting will be installed around the hoarding to enable the site to be more visible. Caution signs will also be displayed on fences and gates so that people will be aware when passing through the site. There will be a principle gate to the site along with pedestrian gates for access. 2.6 Safety and Security For both security and safety reasons, site-bases security presence will be provided during normal working hours with a visiting patrol covering nights and weekends to protect against theft and vandals of storage. Site-based security presence with a full 24 hours will be in place during the later stages of the construction works and fit out prior to occupation (Griffith Watson, 2004, p.391). All entry points will be clearly signed with appropriate warning notice. Flood lightings with 500 watts in 7.50m high are installed as a measure of night security. (Chudley Greeno, 2008, p.91) Main Construction Work 3.1 Substructure Concrete strip foundation will be used as the foundation of the houses. Foundation works include excavating, earthwork support, concreting and bricklaying of the strip foundation. Trenches are excavated under the line of the walls and the soil at the bottom of the trenches is compacted. Rough sawn timber as strutting will be temporary support for the sides of excavation for strip foundation. At least 150mm of concrete is placed at the foot of the trench with a concrete pump and brick walls are then built up to the damp proof course (DPC) which will be at least 150mm above ground level. The DPC is bedded on a layer of mortar on each leaf of brick or block cavity foundation wall. (Osbourn Greeno, 1997, p.199) The depth of the strip foundation of 1m 1.2m is adequate to ensure the soil acting as the natural foundation cannot be affected by the weather and stake will be used to determine depth of concrete foundation (Osbourn Greeno, 1997, p.181 186). The strip foundation made of a cont inuous strip of concrete with 1:3:6 mix. Hardcore will be compacted using a vibrating plate or roller and the top of the hardcore is kept below the substructure block work so that the slab can be cast inside the walls. Concrete is protected with a sheet of hessian or sand in cold weather and sheet of polythene in hot weather. (Marshall Worthing, 2000, p.57) The provision of damp proof membrane (DPM) for the entire area on top is between the over site concrete slab and it will be done on a bed of sand or ash of 12mm thickness. 3.2 Superstructure 3.2.1 External Wall Cavity wall will be used in this project as it has good thermal insulation and weather resistance properties. Cement-lime mortar mixes is used to ensure adequate bond of ties to wall. An adequate size of vertical spacing will be required for door and windows opening. 3.2.2 Scaffolding In Mitchells Intro to Building (Osbourn Greeno, 1997, p.207) states that, As the work progress beyond a height where it is unreasonable for the bricklayer to lift materials from ground level, it will be necessary to erect scaffolding to support raised working platform. The scaffolding with aluminum alloy which connected by special fitting or couplings will be used to lay the upper floor wall. 3.2.3 Doors and Windows Temporary props will be erected until lintel construction has been complete. To connect the opening frames with the wall, rigid-angled galvanized mild steel lugs screwed to their side edges as the work proceeds. (Osbourn Greeno, 1997, p.203) DPC will be bedded when the work is carried out. 3.2.4 Internal Wall Work sequence will be similar to external wall but the internal wall is in single leaf. The partition wall will be positioned and used to separate spaces within the building into rooms. Insulated plasterboard will be installed through the wall to gain thermal for the building. (EDP Energy, 2010) 3.2.5 Roof Pitch roof which erected by timber trussed rafters space about 600mm at close centres to provide direct support for roof cladding and ceiling. (Osbourn Greeno, 1997, p.221) Install the ridge board on 2 end posts with temporary bracing and set it straight and level. Each rafters is nailed to the wall-plate which ready placed on a mortar bed on top of cavity block wall. (Osbourn Greeno, 1997, p.221) Prefabricated ladder fixed to the end trussed rafter. Fascia board fixed to the feet of rafter and barge board to the outer face of gable ladder. (Marshall Worthing, 2006 p.94) Install collar ties, purlin and bracing as needed for the rafters and ridge to prevent sagging over time. Timber trusses with bracing are manufactured off-site. Clay tiles will be laid in continuously on the timber battens on sarking felt with 45 degree sloping of pitched roof. Finishes 3.3.1 Internal Wall Finishes Plaster board will be applied to internal wall as finishes with wet plaster method. Half-hour fire resistance will be provided when 5mm coat of wet plaster and 9.5mm thickness wet plaster applied on both sides of partition wall. A gap which is used to provide additional air passage is left between the back of plaster board and the face of the wall. Then the gap will be connected to the cavity to the internal environment to allow air leakage. (Emmitt Gorse, 2005, p.535) Emulsion paint with Water Based Paints Timber will be painted through the wall using the roller method. (Chudley Greeno, 2008, p.669)Skirting board with 19mm thickness will be nailed to the concrete fixing blocks at the base of walls after plastering is completed. (Emmitt Gorse, 2005, p.548-549) 3.3.2 Floor Finishes Skim coats with mix of cement and water applied with a steel float to make smooth finish on screed to allow carpet laid on it as floor finishes. Tackless strip placed around the entire perimeter rooms and shoot masonry screws into the strip and cut the strip by tin snip. Underlayment will be pour to hold the carpet padding. (Beach,1999-2010) 3.3.3 Ceiling Finishes Plasterboard ceiling made with a core of gypsum sandwiched between face sheets of strong durable paper with 2.4 x 1.2 x 9.5 mm thick at centres and it fixed to joist by nailing. Then, 5mm single coat board finish plaster over bonding grade undercoat. (Chudley Greeno, 2008, p.664) 3.4 Existing Services Existing services drawings will be obtained for the site area, which are applicable to the complete development and must be referred to at all times. Prior to any mechanical excavation commencing, each suspect area will be hand dug to confirm the depth and location of any service and clearly marked on the surface. Extreme care will be taken when planning to work in these vicinities i.e. double check with CAT and Genny and follow above procedures. (Marriott 2009) 4.0 Health and Safety 4.1 Significant Hazard Hazard:Â  Moving plant or vehicles Risk:Â  Operative have to be trained and competent to operate the plant or equipment. They should understand the emergency and evacuation procedures. ( Prifysgol Bangor University, 2001-2010) Control Measure:Â  Isolating workers or pedestrians from the moving plant. (Department of Labour, 2007) Maintenance and servicing of plant. (Department of Labour, 2007) Operator must follow all the directions in the hazard management. (Department of Labour, 2007) Hazard:Â  Falls of materials Risk:Â  Materials fall as bricks or steel through hole or gap will cause injury people working below. Control Measure:Â  Keeping working platforms clear of loose materials. Provide a way of preventing materials or other objects rolling, or being kicked, off the edges of platforms by with toe boards, solid barriers, brick guards etc at open edges. ( Prifysgol Bangor University, 2001-2010) Hazard:Â  Safe working platform Free of openings and traps through which peoples feet could get caught, causing them to trip, fall or be injured. ( Prifysgol Bangor University, 2001-2010) Risk:Â  Risk of fire may be occurred. Control Measure:Â  Good housekeeping with keeping the workplace cleans all the time. ( Prifysgol Bangor University, 2001-2010) Hazard:Â  Work at height Risk:Â  Accident as falling from height during laying brick or block at height level and also cladding and roofing. Control Measure:Â  Temporary scaffolding will be used during the height risk works. Assess weather condition before working at high take place. 4.2 Personal Protective Equipment Personal Protective Equipment (PPE) is an effective method of controlling occupational hazard. Operatives have to wear safety helmet at all times on site. Besides, suitable safety footwear such as steel-toe-capped boots will be worn by all company personnel. Casual shoes and trainers will not be permitted. All personnel are required to wear high visibility jacket or clothing at all times. This clothing must be suitable for the working environment and prevailing weather conditions. Eye goggles, hearing and respiratory protection and protective clothing will be made available for use where required and according to on site conditions. Furthermore, gloves have to be worn all the time can trap hazardous chemical against skin. 5.0 Potential Environment Impact A review of the potential environment impacts associated with construction works are being considered. Below is a table of the different environment Impacts: Issue:Â  Water contamination Potential Impact:Â  Run-off from plant or vehicle washing. Issue:Â  Material spill to drains and watercourses. Potential Impact:Â  Discharge of contaminated water. Issue:Â  Ground contamination Potential Impact:Â  Disturbing contaminated ground. Issue:Â  Wind blow contamination. Potential Impact:Â  Existing contamination of site. Issue:Â  Spillage and leakage of hazardous substances. Potential Impact:Â  Noise and vibration contamination Issue:Â  Increased road noise levels from vehicles. Potential Impact:Â  Particular methods of construction or use of heavy plant, equipment and haulage. Issue:Â  Traffic Potential Impact:Â  Traffic congestion caused by site. Issue:Â  Increased vehicle movements mainly consisting of heavy goods vehicles. Potential Impact:Â  Transfer materials from vehicles into public road as main road. Issue:Â  Disruption from abnormal or hazardous loads. Potential Impact:Â  Exhaust emissions cause air pollution. Issue:Â  Plant and wildlife contamination Potential Impact:Â  Habitat disruption or destruction Issue:Â  Disruption to wildlife activity Potential Impact:Â  Changes to natural environments ( noise, dust, light ) Issue:Â  Disruption to food or water sources. Potential Impact:Â  Historic/archaeological contamination Issue:Â  Disruption or destruction of natural features Potential Impact:Â  Disruption by temporary works like access road Table 1: Potential Environment Impact

Autism Spectrum Disorders

Autism Spectrum Disorders has in the past posed some challenges to the human race with regard to addressing the plight of the victims  Ã‚   . This disorder is a cause of severe pervasive mode of thinking impairment, individual feelings, language problems and an adverse relationship to other people.This disorder is primarily diagnosed at the early stages in childhood and progresses throughout the rest of the life of the affected individual. It is a complex disability in the developmental stages of a person brought about by neurological disorder with severe effects on the normal brain functioning.The normal brain development is impacted specifically with regard to the areas responsible for social interaction as well as communication skills. This is a real crisis in the health sector due to the fact that for every 150 children below the age of eight years, one of them is a victim of this disorder (Uta, 1991).Social welfare historyIn this society, autistic and families with autistic ch ildren were initially faced with three typical challenges namely lack of financial, emotional and educational support. The families of the children who are victims of autistic disorder were confronted by tremendous financial as well as emotional burdens they also receive little support with regard to the education of these children.The families have therefore to endure a significant financial burden relative to the families with upright children. This arises from the requirement of cutting down the schedules of work or an entire quitting of the job due to the requirement of the duty of caring for these children (Charles, 1992).Further more, there is a very high chance that the families of the children with ASD are prone to delayed or even unattended health-care requirements of their children. They are exposed to insufficiencies and obstacles with regard to the access of the medical care needed by their children.According to Anthony, no difference was noted with regard too the access to usual care, a nurse or a personal provider in normal circumstances. However on the emergency of a special problem for autistic children families, the primary contact point becomes beyond reach and the access to referrals is denied (Anthony, 1998).These families are therefore subjected to particularly enormous as well as stressful emotional situations and financial demands. To complicate the matter, majority of the insurance firms are adamant when it comes to the coverage of the demands of an autistic child.This is because of their perception of the situation as being a form of developmental disorder rather than a disease. It therefore applies that the parents of these children are required to pay large amounts of money from their pocket to access the services of occupation therapy and the speech therapy for their children.The education of the autistic children is also faced with a milliard of problems because the schools are ready to offer a half day session for these children. Therefore the majority of the parents of autistic children opt that they stay at home altogether (Simon, 1995).The history of this disorder dates back to around 1911 in Swiss. ‘Early infantile autism’ was later coined in 1943 with the much milder Asperger syndrome coming much later. These are the disorders that were put under the description of the five pervasive types of developmental disorders which are currently termed as the autism spectrum disorders, i.e., ASD (Judy & Sean, 1993).

Applied Business †Strand B Theory Essay

Functional Areas within the Business I am going to describe the work carried out by at least three functional areas of Asda, I will explain how these areas work together to support the business activity and I will evaluate how effectively these functional areas work together to achieve the aims and objectives of the business. The areas I am going to investigate are finance, IT and marketing and sales. There are 7 main functional areas within businesses customer services, administration and IT support, marketing and sales, human resources, research and development, finance and operations. However not all businesses use these areas. Sole traders might do every function by themselves and some businesses may use only a few functional areas or make sure that employees are able to work in each functional area In large businesses people work together in these separate functional areas. The areas concentrate on and carry out certain functions. All functional areas link together to achieve aims and objectives. Good communication and co-operation is needed. Functional areas can be organised by charts such as the one below. Fig. 1 Customer service Customer service is concerned with customer relationships. Their activity is to â€Å"identify and satisfy customer needs†. They provide information, credit facilities, after sales service, deliver goods and give advice. Examples of this include, if a person has a problem with a new product such as a washing machine, then they will phone up customer services and someone will talk them through what they have done so that they can try to correct the mistake such as not switching the washing machine on. Good customer services mean happy customers. An example of good customer services is a shop e.g. furniture. If a person bought a piece of furniture then they could get customer services in the form of the retailer suggesting other products that could be better suited to the job which the consumers want the product for. The retailer could also offer for the furniture to be delivered or installed where the customer wants it. Bad customer services annoy people and make them not want to use the company again. An example of bad customer services is if you order a phone and it doesn’t turn up on time. You then ring customer services and have to spend about 2 hours of your time and your phone bill on something that should be a simple process. Customer services is very important as if a company was only focused on selling goods or services, then people would not feel comfortable or happy with the business and so would not want to use it, the business might then loose customers. The times 100 website tells us â€Å"High quality customer service helps to create customer loyalty†. The website also tells us that customers are not only interested in buying a product, they are also interested in the services that they receive when they enter the shop such as a nice welcome and good refund polices for faulty products. Customer service also gives advice on what a customer could do if they had a problem. Companies such as Portakabin have mottos that focus purely on customer service. Portakabin’s motto is ‘Quality – this time, next time, every time’ they apply this to both products and customer services. Businesses know that if a customer gets a good service that seems to be less of a ‘chore’ than usual then they will be more likely to return and use the business again. http://en.wikipedia.org/wiki/Customer_service tells us â€Å"Customer service is the provision of service to customers before, during and after a purchase.† The GCSE Applied Business FOR OCR book tells us that â€Å"customer service is all about providing this positive experience†. Customer services are expected to provide information, give advice, provide credit facilities, deliver goods and provide an after sales service. As information required can vary from customer to customer, it is unlikely that a customer service assistant will know the answer to every question or query that a customer could ask. However, this is not drastically important, whats more important is that the query is dealt with well, this means that there is a â€Å"friendly smile† and â€Å"a promise to find out quickly† as the GCSE Applied Business FOR OCR book tells us.advice is also important as the advice is personal to the customer, wheras information is personal to the product. Credit means that items are received by the customer immediately but they pay for it over a set time, maybe several months or years. The GCSE Applied Business FOR OCR book tells us â€Å"customers often require credit when they buy an expensive item such as a car†. http://www.bized.co.uk/cgi-bin/level2/typein.pl?module=busactivityfunctional12 Administration and IT support Administration and IT support are concerned with clerical work, such as mail and record keeping, health and safety, security, cleaning and maintenance and provide support for software applications, electronic communications and electronic transactions. For example, if a person within the business accidentally downloads a virus, then admin and ICT will need to know and they will then be able to sort out the problem. If something like this goes unchecked for too long then there is a chance that the virus could spread and then the whole network could fail. This could mean major problems for the business. IT is used in businesses in many ways. Such as: * To Store information about products on databases * To make calculations such as working out the profit using spreadsheets. * To provide advertising using computer graphics packages. * To process information and other document’s using word processing programs * To communicate internally by fax, e-mail and other methods using ICT * To create presentations * To create websites to promote the business and provide information about the business. It is very useful within businesses as it saves time. For example when trying to find a document, if it was on paper and not a computer then a person may need to spend a lot of time searching through piles of paper just to find one document. Marketing and sales Marketing and sales are concerned with customer needs. They do market research, promotion and sales. So they have to research into what customers want such as if a customer wants a futuristic computer screen and power pack then marketing and sales would have to see whether such a computer had been created yet, and if not then talk to someone about creating one. They are also responsible for promoting new products and making people want to buy them. They have to differentiate the product to make it more attractive to customers, they have to skim, maximise, premium price, penetrate, capture & distribute and they have to analyse the product lifecycles. Marketing and sales use the SWOT analysis to analyse the existing position. This presents the: Strengths Weaknesses Market Opportunities External Threats The market can be segmented so that businesses can concentrate on one segment only. There is a big difference between marketing and sales as marketing is where you are trying to get the best products for your customers whereas sales is where you are trying to convince your customer that you already have the best products and where you are selling these products. Marketing the segment can help the marketing department understand its market better. Sales people have to convince their customers that the product that they are selling is the best around. The marketing department of, for example Cadbury’s, may carry out research to find out what flavour chocolate is most desired among their customers. They will ask customers which products they would like to be improved and which products they would like to see developed. E.g. Cadbury’s shortcake biscuit chocolate could be improved to make them crunchier and a new product with orange chocolate in it could be developed. Market research can be carried out by using primary or secondary research methods, or both. Primary research is where data and information is collected first hand. This ensures that the information is original and up-to-date. However, this can be time consuming and costly. Secondary research is where data and information that already exists is used. This data is usually free, and easily available. When a business has market research, they will decide the â€Å"marketing mix† for the product or service. The marketing mix, consists of product, price, promotion and place. Also known as the 4Ps. Businesses must decide what the product or service should be, including whether it needs to be packaged, what the customer wants and whether an after sales package is required. They must decide how much the product should cost. Where the product or service is promoted is also important, as-well as how it is promoted. Where the product is sold is also an issue, the product must be in a suitable location which is also easy to get transportation to. The use of the 4Ps can increase sales, if used well and correctly. It is likely that all marketing mixes will be slightly different and many factors can influence this. The product and customers are just two of these factors. Sales staff may be employed by businesses which will not only rely on promotion and advertising, to sell the product or service. Sales staff are employed to make contact with potential customers and try to sell products. Human resources Human resources are concerned with health and safety, recruitment, retention, dismissal, working conditions, training, development and promotion, employee organisation and union. This includes legal rights and responsibilities of employer and employees. So they have to hire and fire staff, make sure that staffs are happy and retained and make sure that their working conditions are satisfactory. They are in charge of training new staff and developing their skills and promoting able staff and responsible for managing all of the people who work within the business. If legal action is taken in the name of an employee, then human resources are also responsible for that along with organising employee unions so that workers can have their say. The human resources department can also be called personnel. Human resources are in charge or recruitment and have to ensure that vacancies are filled to the best o their ability, the best and most able workers are employed this means that human resources has recruitment procedures for trained staff to follow in order to recruit the most appropriate workers. Human resources are also in charge of retention which means that they are in charge of keeping staff, if they do not retain good staff then they will have to hire and train another person, this takes time and money and so it is very important that human resources keeps employees happy. Human resources are also in charge of dismissal; this means that they are in charge of monitoring workers and dismissing the ones, which are not working efficiently. Businesses usually provide an induction programme fair terms and conditions of employment, good working conditions and appraisal interviews in which employees can talk â€Å"to their managers about their performance and future prospects†. Human resources also need to ensure that physical working conditions are to a standard, which workers accept. If there is a problem with their environment and the workers are not happy, then it is likely that they will not be working to the best of their ability. Working conditions also relate to job content, which means what the job includes, promotion prospects, training opportunities and welfare policies, which include loans and medical checks. Working conditions must be maintained otherwise workers will become unhappy, which could cost the company a lot of money, especially if lots of workers decide to leave the business. Human resources also need to ensure that workers are trained suitably for their jobs. The human resources department may have a training officer or a training section. Human resources will have to keep staff training records, monitor the training budget and as the GCSE Applied Business FOR OCR book tells us, they will be responsible for â€Å"overseeing the procedures for applying for training†. Some workers may wish to develop their skills, this is usually called ‘staff development’ as opposed to ‘staff training’ because the staff are not learning new skills but developing their present skills. Companies may pay for activities that assist staff development and these may be run in the workplace. Staff may be keen to improve their abilities and skills because this may lead to a promotion and better job prospects. Human resources will also oversee promotion prospects, and will decide whether or not a worker is good enough or a promotion. Human resources will also be associated with trade unions and employee organisations. The GCSE Applied Business FOR OCR book tells us that senior members of human resources may have to â€Å"negotiate with trade unions on behalf of management.† Human resources often have to supply information on health and safety issues, and ensure that the Health and Safety at Work Act is being followed and used correctly. Research and development Research and development are concerned with developing new goods and services and updating old ones. If a person comes up with a new and good idea then research and development are in charge of making sure that that idea is looked into. If scientific or technological developments occur then there may be new products developed. A change in ‘customer buying behaviour’ can also cause this to happen. So if marketing and sales come to them with a customers query about futuristic computers then they become in charge of that. Research and development have to work with designers to design and produce good quality and good value for money products to entice customers. Research and development use many different methods of research to find out what customers or potential customers want. They may do surveys, questionnaires, and Internet research and could obtain either primary or secondary research. A lot of the time it will be of more use to the company to obtain primary research as then the company will know how up to date the research is. The company will also know, with more certainty, that the research is reliable. Finance Finance are concerned with money and future plans, preparing accounts, such as invoices, management accounts, financial accounts for shareholders and inland revenue. They are also concerned with preparing wages and salaries, obtaining capital and resources, such as money for expansion and to pay for resources such as equipment and materials. Finance is sometimes considered as the most important functional area within a business. Finance is needed at all points in a businesses life as when they are starting up they will need to buy assets. When they are â€Å"up and running† they will need finance to determine that they are breaking even, this is to say that they must ensure that the money coming in (the input) is matching the money going out (the output). It is important that businesses break even otherwise they will make a loss and can even go into debt. Finance is also important for growing businesses, as they will need to buy more assets and either break-even or make a prof it. This will cause them to expand and grow. Operations Operations are concerned with the main business activities. They obtain and convert resources of the business into goods or services. They make decisions such as what to do with land, buildings, material, and jobs for workers and buying new equipment. In a company such as Argos operations would include processing a persons order; however in a company such as Gillette, operations might include making a batch of razors. The use of IT The use of IT relates to all functional areas because of: * Electronic communications e.g. Email * Data Sharing e.g. Databases * Security systems e.g. virus protections * External communications e.g. Internet * Online support for customers e.g. Order tracking * Electronic Transactions e.g. EFT Functional variations No two businesses are the same. Functions will vary because of the: * Size and scale of the business * Activities of the business * Types of customers * Needs of customers * Preferences of owners

Alexander the Great essays

Alexander the Great essays Who is Great? In history there are few people who can be termed Great and even fewer who deserve to be called so. Alexander, the son of King Phillip of the Macedonians, was one of these truly Great people. He not merely ruled the largest know empire, was declared a God, lead his troops in battle, and conquered foreign cities, his first being at the age of sixteen, but he did it all within a thirteen year time period. Not only did he do all of this, but also it was done within thirteen years. When Alexander became the new King of Macedonia, many believed him to be to young to rule. They felt that he didnt have the experience needed to be their new leader. They had no way of knowing of the many things that he would come to accomplish in such a short time period. Alexanders first great accomplishment occurred when he was just sixteen years old. At this time, his father went away to war leaving Alexander to serve as a regent of Macedon. During his fathers absence, Alexander led an expe dition to a wild region that is now known as modern day Bulgaria. Once there, he subdued the rebellious barbarians and established his first city, Alexandropolis. On the return from his trip, King Philip was so impressed by his sons achievement that he appointed him a general in the royal army. (www.mrdowlings.com) When Alexander turned his attack towards Persia, his forces were much smaller than his opponents. Alexanders army conquered Persia anyway, by winning a series of battles in which his troops were better trained and organized than the Persian army. His soldiers also admired Alexander because of his personal participation in the battles. He led his soldiers into battle instead of remaining behind the lines as was common for military leaders to do at that time. This allowed the troops to see that Alexander was sharing their danger, and was not asking them to take any risks he wo...

Embracing the World through Hospitality Course Essay Example

Embracing the World through Hospitality Course Essay Example Embracing the World through Hospitality Course Essay Embracing the World through Hospitality Course Essay Traveling is one of the most exciting and adventuresome experiences that an person could of all time hold in his or her life. Almost everyone has a dream of going the universe to see the things beyond their skyline. It has been said that an person who travels a batch. learns and experiences a batch. This is one of the grounds why I chose to take a cordial reception class. Aside from the fact that I do love going. I besides wanted to larn and see more. I want to detect all the admirations of the universe and be able to portion it with other people. Among the greatest experiences that contribute to my desire to be involved in cordial reception service are my travel experiences in assorted states like South Africa. Senegal. Brazil. Trinidad and Tobago. and Jamaica. Through these experiences. I came to recognize how fantastic our civilisation is. I besides came to detect that there are other rich civilizations outside my district and cognizing other civilization has made me cognizant how of import the constructs of apprehension is. I grew up in a state where racism is prevailing. The differences among civilizations are the grounds why some people tend to harm people who behave otherwise from them. My travel experiences taught me the value of traveling beyond our skyline and acquiring to cognize other people as good. Their cognition and experiences might be helpful and important in one manner or another as we traverse the roads of our life. I want to detect the universe. This is besides one of the grounds why I want to take a cordial reception class. The importance of detecting the universe would do us more academically. emotionally. mentally and physically involved in advancing the good of what we have. Indeed. like workss and animate beings. we are populating a topographic point that is more mystical and complicated in many sense. But unlike these animals. we have the power to believe and move harmonizing to what would be good for this Earth. I may sound like a Miss Universe campaigner replying a inquiry that is likely to act upon my audience. yet my claim that we could make more things to do this universe more comprehendible. best managed. and taken cared of is so possible. Through cordial reception class. I know in my ego that I could be one of those persons working to advance the best of this universe. Furthermore. analyzing the different facets of our society. specifically of the different states. would do me cognizant of how these states. despite their differences. were able to construct and use an international relationship that has integrity and coherency. Knowledge in history. economic system. political relations and other of import facets or systems of different states would enable me to invent an activity or plan that would advance understanding and encourage integrity from different people. Through this. people with racist attitude might be reduced. peculiarly in many racialist states. Indeed. my love of going in different topographic points made me a more unfastened individual. with tonss of dreams for my state and for the whole universe every bit good. My travels and find of other civilizations such as what people in South Africa. Senegal. Brazil. Trinidad and Tobago. and Jamaica besides made me a more knowing and improved person such that encompassing other people’s civilization and analyzing the different systems of their state have enlightened me that it is non adequate that I am populating within my skyline because life and find beyond this is important in many ways as we are populating in a diverse universe. I do trust to go a portion of the cordial reception industry for me to be able to portion to other people how fantastic our complex universe is. how of import cordial reception industry in back uping the country’s economic system. and how understanding differences in civilization and other systems make us a better individual. In add-on. I hope to go a portion of the cordial reception industry for me to be able to function the diverse people of this universe in the most applicable and appropriate manner that would fulfill them and do them recognize how fantastic it is to go and detect the universe.

Does classical traditional art have more substances than Vik Mumiz's Research Paper

Does classical traditional art have more substances than Vik Mumiz's Waste Land - Research Paper Example The area is controlled by drug cartels, and occasional dead bodies are stashed in the dump. More than three thousand pickers of recyclable materials live on the site in makeshift shacks containing appliances gathered from the dump. These people live in families of small groups, and teenage girls raising small children. This piece of art depicts the state of the society by showing the current situation of the low class individuals. Classical traditional art was used to show the culture, sexuality, and the state of the society. This makes it contain more substance than the film by Vik Muniz. Renaissance films, paintings, and sculptures are marked by renewal of classical motifs and subjects of art (Thomson-Jones, 20). These themes were evident in the 17th century when artists represented a rigid classism. Classical art exhibits a preference for order, beauty, harmony, and completeness by representing nature according to an artist’s observation (Aristides, 10). Traditional art req uires a great deal of skills and methods for its production that have been lost in the modern art. This art is manifested in painting, crafting, and sculpturing that makes objects that gratify and ennoble their viewers (Gazda, 8). Artists of classical traditional art produced images that created a perception, narration, and visualization of culture, society, and self (Janson and Anthony, 15). Current artists depict the nature of civilization, post-modernism, politics, culture, and sexuality (Kennedy and Emily, 18). Muniz has used garbage and unusual substances in the dump as his media. The film is set in a dump site where trucks deposit several tones of refuse. Catadores collect recyclable materials from the garbage to make their living (Kino, 2010). Their houses are furnished by appliances and furniture collected from the dump. When Muniz first visits the site, he sees a site crowded with dump trucks and workers, as flocks of scavenger birds hover around. Garbage collectors and mon keys climb over mountains of colorful garbage looking for items that can be sold. Muniz has used these objects to create his art for the social project in the dump. Classical traditional art usually used wood, political figures, heroes and other popular figures as media. These figures gave this form of art more meaning in the society than the use of garbage and strange substances as media for the art. The individuals may be considered to be dregs of the Brazilian society, but Muniz paints them as survivors who have endured the difficult living conditions of the dump. Some of the garbage collectors have lived in the dump for more than two generations. They have survived and gotten used to the stench emanating from the rotting garbage (Kino, 2010). The catadores are considered to be unfit and rejected by the society, but Muniz portrays them as loving, healthy, and fit to run families. However, this film shows the simplicity of life in the dump for the garbage collectors. Classical tra ditional art is a masterpiece of intelligence and complexity (Thomson-Jones, 26). The intelligence and complexity envelopes the main theme of the art and penetrates deep sections of the society. A single piece of traditional art can carry several themes that are present in the current society. The simplicity of wasteland makes it incomparable to classical art as it addresses only the hard living conditions of the dump. Classical traditional art is based upon the rediscovery or the reaffirmation of the traditions

Flag-Draped Coffins from Iraq Essay Example | Topics and Well Written Essays - 750 words

Flag-Draped Coffins from Iraq - Essay Example Whatever the costs of this war, however gruesome its details; the American people should know the real cost of this war. The Bush administration claims that its decision to forbid news organization from publishing pictures of war dead at military bases is not new. It argues that this has been the policy of administrations since the first Gulf War in 1991. The purpose of this decision it claims is to protect the feelings of the families of the victims. Scott McClellan the White House press secretary had stated that those who had made the greatest sacrifice in the service of the country should be honored and shown the greatest respect. And this she said is the president's primary concern. The administration Kathy Moakler, deputy director of government relations at the National Military Family Association, emphasized that the only purpose in banning publication of pictures of military dead being brought back to the country was to protect the privacy of the families who had lost a loved one. "At the devastating time [of loss], being sensitive to the families is what needs to be done," she said. (Madore) Another reason the administration cited for its objection to the publication of pictures of war-dead, was that this would be depressing to the families involved and attenuate the sacrifice our troops are making in the service of the country. The administration also stated that its objection to the publication by news agencies of photographs of flag-draped coffins was in keeping with the sentiments of the mourning families. It claimed that such publication invariably led to the invasion of the privacy of these families. The News Media Has its Own Conviction The news media has its own conviction. It is of the view that the American public has the prerogative to also know the cost of this war in terms of American lives. Besides the Freedom of Information Act of 1966, gives the American public the right to information relating to the operations of federal agencies. 3 It reasons that reporters in the actual field of battle are given unbridled access to the war. This being the case, it claims that the administration's ban on the publication of photographs of war-dead is its attempt to censor crucial war images. The news media claims that the policy of administrations on such matters has not been consistent. And in support of this it cites the instance of President H. W. Bush allowing media coverage of war-dead being brought back home from Panama and other wars in which the US was involved, but banned it during the first Gulf war. It also states that in 2000 the Clinton administration allowed publication of photographs of the victims of the terrorist attack on the warship USS Cole. It contends that the ban of 1991 was the consequence of some TV networks simultaneously airing split screen images of the then-president laughing in one portion, and coffin ceremonies of Gulf war I, in another. This time around the imposition of the ban on photograph publication was the Government's desire for secrecy. The news media contends that pictures of dead servicemen were being published as "a

Are E-cigarettes Healthier Than Normal Cigarettes Research Paper

Are E-cigarettes Healthier Than Normal Cigarettes - Research Paper Example This essay stresses that there are several positive aspects of using E-cigarette. One of the positive aspects of E-cigarette is that it delivers lower level of toxins that that of conventional cigarette. Toxins may be lower but it still contains some which provide the taste of using normal cigarette. The smoking of normal tobacco contains huge number of chemicals. Some of the chemicals are still unknown. But still all of the contained chemicals are harmful and dangerous. E-cigarette contains less harmful chemicals such as vegetable glycerin, propylene glycol, nicotine and other flavored chemicals. The ratio of chemicals provided in E-cigarette is much less than that of chemicals in normal cigarette. This paper makes a conclusion that E-cigarette is much healthier than that of normal cigarettes. Regardless of being healthier device, it also has some shortcomings which can cause severe harm to human beings. E-cigarette has lower quantity of toxins than that of conventional cigarettes. Normal cigarettes pollute the environment with harmful chemicals. But the use of E-cigarette reduces the amount of harmful chemical emission. This is due to the fact that it releases water vapor which contains fewer amounts of injurious chemicals. It is cheaper option and provides same experience as that of normal cigarettes. The usage of E-cigarette delivers huge threat to the children. It can be easily accessible with the help of internet and mall kiosks E-cigarette is as dangerous like normal cigarettes.

Four Things To Do to Increase One’s Level of Contentment and Happiness Essay Example for Free

Four Things To Do to Increase One’s Level of Contentment and Happiness Essay The learned Viktor Frankl contends that â€Å"chance decides what happens but we decide how to take it† (cited in Southwick, et. al. , 2006, p. 162). For someone who has been through the most tragic circumstances of human existence, Frankl is surely someone who knows pretty well how happiness is to be pursued in one’s life. While it can be argued that happiness is a state of human living which cannot be singularly defined, we – human persons that we are – nevertheless know what brings it about or how it affects our general take of life. Pursuing Happiness All throughout One’s Life The basic thrust of this paper is to argue that our state of contentment or happiness is something that we human persons can always choose to pursue. By adopting Frankl’s philosophy, we can say that a person can always choose the path towards happiness against the backdrop of different life circumstances and issues that come with one’s lifespan development. First, one can always choose to discover his or her crafts, potentials and talents as a way to appreciate one’s giftedness and uniqueness. This is a very potent element that contributes well to one’s happiness; and this usually happens during one’s late childhood and adolescent stages. The discovery of our uniqueness gives us a sense of who we are. But even when, for instance, one is not gifted enough, one can still discover certain strains of uniqueness to be appreciated. This is crucial because it can give us an initial taste of our sense of directedness and purpose. Second, a person needs to choose the kind of relationships that work in order to attain a level of happiness as well. This is especially true for those who are at the early adulthood stage. Growing up, it would be normal to feel that we need someone to complete us; and finding that suitable someone is notably crucial for this stage. Many people end up either unhappy or miserable because they did not either take the courage to pursue a person whom they love or feel powerless to break free from relationships that just do not work. But finding true happiness is about choosing the right relationships that could nurture, and not defeat life. Third, in order to secure happiness, one must always face life-crises with a brimming sense of optimism. This surely is a case of no little importance, as it is not uncommon to learn that many middle-agers suddenly lose their sense of meaning at a time when life-crises emerging from home and workplace start to take their toll. Crises, it needs to be remembered, cannot be avoided. But they are defining moments that can either make or break us. Increasing one’s state of happiness during these poignant moments therefore necessitates a commitment to hope – i. e. , one faces life problems with a sense of optimism. If one can face problems convinced that he or she can successfully get out of it, then it is like facing a battle half-winning it already. Fourth, one can look at his or her life under the lenses of accomplishment and gratitude so as to be happy. This especially applies to those who are in the twilight of their lives. When one becomes bitter every time he or she looks back at the past, it effectively robs a person with a sense of contentment and happiness. Instead, looking back at life with eyes fixed on the accomplishments and blessings that one has done or received in his or her life surely elicits an incomparable sense of contentment, happiness and pride. Conclusion This paper therefore concludes that a person is always empowered to make a choice in order to increase his or her level of contentment or happiness. In any lifespan development or stages, the choice to uphold sense of happiness is always a concrete possibility; i. e. , we can always choose to discover one’s giftedness, choose the relationships that could make us happy, choose to face life-crises with hopefulness and choose to be thankful in our lives. In the final analysis, it must be ultimately argued that we are the ones responsible for our own happiness.

The Field of Radiology: What role do you see for yourself? Essay

The Field of Radiology: What role do you see for yourself? The role of the radiologist is one that has undergone numerous changes over the years and continues to evolve a rapid pace. Radiologists specialize in the diagnoses of disease through obtaining and interpreting medical images. There are a number of different devices and procedures at the disposal of a radiologist to aid him or her in these diagnoses’. Some images are obtained by using x-ray or other radioactive substances, others through the use of sound waves and the body’s natural magnetism. Another sector of radiology focuses on the treatment of certain diseases using radiation (RSNA). Due to vast clinical work and correlated studies, the radiologist may additionally sub-specialize in various areas. Some of these sub-specialties include breast imaging, cardiovascular, Computed Tomography (CT), diagnostic radiology, emergency, gastrointestinal, genitourinary, Magnetic Resonance Imaging (MRI), musculoskeletal, neuroradiology, nuclear medicine, pediatric radiology, radi obiology, and Ultrasound (Schenter). After spending a vast amount of time on research and going to internship at the hospital, I have come to realize that my passion in science has greatly intensified. Furthermore, both experiences helped to shape up my future goals more prominently than before, which is coupled with the fact that I have now established a profound interest in radiology, or rather nuclear medicine. For as long as I remember, I only had one dream in mind, which was to become a doctor when I grow up. As I grew older, my dream did not change; in fact, it only grew more significant. However, the only aspect of my dream that did change was the type of field that I wanted to pursue. At first, I honestly did not have an inkling of an idea as to what kind of a type of doctor I wished to become. Then, I started to lean towards pediatrics and/or neurology. Now, on the other hand, I decided that I want to study nuclear medicine in medical school. This enlightening revelation came about as I began to volunteer in the Department of Nuclear Medicine at Beth Israel Medical Center. My time spent there has had an amazing impact on me because I believe that this was the time that I truly realized my dream. Nuclear medicine is medical specialty that uses radioactive substances, or radiopharmaceuticals, combined with imaging techniqu... ...ine in their work. Overall, my interest in nuclear medicine is at its peak currently, which is most likely due to my science research project for Intel. My ideas for this particular project were based on my knowledge in nuclear medicine. My research topic, deep-vein thrombosis (a blood-clot in the deep-veins of the body), actually transpired from a list of impending projects that my mentor provided me with when I first started volunteering last year. I worked very hard on this project and I even gained some recognition, but all in all, my reason for participating in Intel competition has to do with my dream of becoming a physician in nuclear medicine in the near future. I hope to successfully finish high school, university, and medical school with a Master’s Degree (MD) before crossing all boundaries and working to attain my Physician’s Degree (PhD) in radiology (nuclear medicine). Ofri, D (2000). Diagnosis and Treatment of Deep-Vein Thrombosis. Western Journal of Medicine; 173: 194-197. Wells, Philip S., Anderson, David R., Rodger, Marc et al (2003). Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis. New England Journal of Medicine; 349: 1227-1235.

Cognitive Impairment And Alzheimers Disease Health And Social Care Essay

Apathy is one of the commonest symptoms in Alzheimers disease and is associated with frontal lobe disfunction. Apathy is associated with high health professional load and has several negative effects.Purposes:The primary purpose of this survey is to analyze an association between apathy and frontal lobe disfunction in patients with memory jobs. We besides aimed to look into the association between apathy badness and health professional load along with the relationship between apathy and practiceMethods:This was a retrospective cross sectional survey. We selected 162 back-to-back patients diagnosed with Alzheimer ‘s dementedness and Amnestic Mild Cognitive Impairment who had comprehensive battery of neuropsychological trials and a behavior evaluation graduated table of involvement for this survey recorded in the database. Correlation between apathy with and without depression were tested against frontal lobe trial including Trail doing A, Trial doing B, Letter Fluency, Ideationa l Fluency, Category eloquence, Abstract Thinking and Executive working subtest of CAMGOG-R. Similarly correlativity analysis was besides done to look into association between apathy and caregiver load every bit good as practice.Consequences:Statistically important relationship were found between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. Relationship between apathy and health professional load were extremely important. Further bomber analysis, found apathy to be significantly associated with health professional load in both AD and aMCI patients.DecisionsApathy is associated with frontal lobe disfunction particularly impaired executive map and conceptional eloquence even when controlled for depression. It is extremely associated with health professional load both in AD & A ; aMCI.Hence early acknowledgment and direction of apathy is of import bettering the forecast of patients with AD & A ; aMCI.Table OF CONTENTSABSTRACT 3Chapter 1: Overview OF APATHY 5- 18Chapter 2: Introduction 19 – 20Chapter 3: AIMS & A ; OBJECTIVES 21Chapter 4: Methodology 21 – 28Chapter 5: RESULTS 28- 40Chapter 6: DISCUSSION & A ; CONCLUSIONS 40 – 44REFERENCES 45 -48APPENDIX A: Clinical RESEARCH PROTOCOLAPPENDIX B: ETHIC APPROVAL LETTERAPPENDIX C: NHS R & A ; D APPROVAL LETTEROVERVIEW OF APATHYDefinitionApathy is derived from the Grecian term apatheia intending deficiency of poignancy, or passions, and is normally referred as absence of feeling, emotions, involvement, or concern. ( Marin, 1990 ) Marin was the first to gestate apathy at both symptomatological and syndromal degrees and defined apathy as â€Å" deficiency of motive non attributable to decrease degree of consciousness, cognitive damage, or emotional hurt † ( Marin, 1990 ) .Motivation is a psychological construct and therefore it hard to quantify and measure up it.Hence to do it more clinically qualifiable and quantifiable, Apathy was proposed as a behavioral alteration from the person ‘s baseline and measured as a decrease in spontaneous and purposeful activity. ( Levy and Dubois, 2006 ) . A Starkstein and co-workers have developed a set of diagnostic standards for apathyA these standards specify the undermentioned as nucleus characteristics of apathy: lessened motive, inaugural and involvement, and blunting of emotions ( Starkstein and Leentjens, 2008 ) . In malice of assorted definitions of apathy being proposed, confusion continue to reign sing the nosological place of apathy.Nevertheless progressively apathy is being recognised as an of import constituent of neuropsychiatric research and that ‘s why dependable instance description and designation is necessary, to help communicating, research and intervention. This led to the development of consensus diagnostic standards for apathy in Alzheimer ‘s disease and other neuropsychiatric upsets ( Robert et al. , 2009 ) .DIAGNOSTIC CRITERIAThe revised consensus standards for apathy follow the same general construction as the standards proposed by Starkstein et Al in 2001 ( Robert et al. , 2009 ) . For a diagnosing of Apathy the patient should carry through the standards A, B, C and DStandards ALoss of or diminished motive in comparing to the patient ‘s old degree of operation and which is non consistent with his age or civilization. These alterations in motive may be reported by the patient himself or by the observations of others.Criteria BPresence of at least one symptom in at least two of the three following spheres for a period of at least four hebdomads and present most of the clipDomain B1: Loss of, or diminished, purposive behavior as evidenced by at least one of the followers: Loss of self-initiated behavior ( for illustration: starting conversation, making basic undertakings of daily life, seeking societal activities, pass oning picks ) Loss of environment-stimulated behavior ( for illustration: responding to conversation, take parting in societal activities )Domain B2: Loss of, or diminished, purposive cognitive activity as evidenced by at least one of the followers: Loss of self-generated thoughts and wonder for modus operandi and new events ( i.e. , disputing undertakings, recent intelligence, societal chances, personal/family and societal personal businesss ) . Loss of environment-stimulated thoughts and wonder for modus operandi and new events ( i.e. , in the individuals abode, vicinity or community )Domain B3: Loss of, or diminished, emotion as evidenced by at least one of the followers: Loss of self-generated emotion, observed or self-reported ( for illustration, subjective feeling of weak or absent emotions, or observation by others of a dulled affect ) Loss of emotional reactivity to positive or negative stimulations or events ( for illustration, observer-reports of unchanging affect, or of small emotional reaction to exciting events, personal loss, serious unwellness, emotional-laden intelligence )Criteria CThese symptoms ( A-B ) cause clinically important damage in personal, societal, occupational, or other of import countries of operation.Criteria DThe symptoms ( A-B ) are non entirely explained or due to physical disablements ( e.g. sightlessness and loss of hearing ) , to drive disablements, to decrease degree of consciousness or to the direct physiological effects of a substance ( e.g. drug of maltreatment, a medicine ) .PrevalenceApathy is an of import and often happening symptom in a assortment of neuropsychiatric upsets. Dementia and schizophrenic disorders are among the common causes of apathy ( ref ) . The prevalence for apathy in Alzheimer ‘s disease ranged between 32.1 % ( Holthoff et al. , 2005 ) and 93.2 % ( Sr ikanth et al. , 2005 ) . Point prevalence for apathy in Alzheimer ‘s disease ranged from 32.1 % 19A to 58.7 % ( Aharon-Peretz et al. , 2000, Holthoff et al. , 2005 ) . Table 1: Prevalence of Apathy Across Disorders ( Ishii et al. , 2009 )DisordersPrevalenceMild Cognitive Impairment 14.7 % a?’39.8 % Parkinson ‘s disease 17.0 % a?’45.7 % Progressive supranuclear paralysis 22 % a?’91 % Huntington ‘s disease 59 % a?’82 % Corticobasal devolution 40 % A Frontotemporal dementedness 89 % a?’100 % Dementia with Lewy organic structure 52 % Multiple induration 20 % a?’31 % Stroke 15.2 % a?’42 % Vascular dementedness 22.6 % a?’93.6 % Traumatic encephalon hurt 20 % a?’70 % Amyotrophic sidelong induration 55.6 % Hiv 12 % Cardiovascular disease 29 %CONDITIONS ASSOCIATED WITH APATHYApathy can be a symptom in a figure of neurological or psychiatric syndromes. Neurological Disorders include Traumatic encephalon hurt, Stroke affecting the frontal-subcortical circuit, Alzheimer ‘s disease ( AD ) , Dementia with Lewy organic structure ( DLB ) , Creutzfeldt-Jakob disease, Frontotemporal dementedness ( FTD ) , HIV dementedness, Parkinson ‘s disease ( PD ) , Progressive supranuclear paralysis, Anoxic brain disorder, Cerebral tumor, Chronic subdural haematoma, Huntington ‘s disease, Limbic phrenitis, Multiple induration, Bingwanger ‘s encephalopathy, Wernicke-Korsakoff syndrome, Kluver Bucy syndrome, Hydrocephalus, Delirium Psychiatric Disorders such as Depression, Schizophrenia, Psychoses and Adjustment upset Psychotropic drugs: . Dopamine adversaries are by and large associated with lessened motive, whilst agonists can increase it. Cannabis dependance, pep pill and cocaine backdown have all been implicated as a causative factor. An amotivational, or apathy, syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary. This inauspicious consequence has been noted to be dose-dependent and reversible, but is frequently unrecognised ( Garland and Baerg, 2001 ) . Medical Disorders such as Apathetic thyrotoxicosis, Drug intoxications/withdrawal, Hypothyroidism, Lyme disease, Pseudoparahypothyroidism, Chronic weariness syndrome, Testosterone lack, Vitamin B12 lack, Other enfeebling conditions ( eg, malignance, CCF, nephritic or hepatic failure ) .IS APATHY AND DEPRESSION THE SAME?Apathy has frequently been treated as a portion of depression and it can frequently be diagnostically disputing to distinguish between the two due to frequent carbon monoxide morbidities and a considerable convergence in cardinal symptoms. However they are different concepts and it is of import to distinguish them because of predictive and intervention deductions. Apathy can besides ensue from the intervention for depression. There are theoretical concern that serotonergic re-uptake inhibitors ( SSRIs ) may impact the counterweight of 5-hydroxytryptamine and Dopastat, which can take to apathy, and SSRI-induced apathy has been progressively reported.Table 2: Differences and convergences in the clinical symptoms of apathy and depression ( table adapted from Landes et al. , 2005 )Apathy SymptomsDepressive SymptomsShared SymptomsLack of emotional response Indifference Diminished motive Lack of productiveness Poor Persistence Low societal & amp ; occupational battle Person is by and large satisfied Low temper Feelingss of guilt, Suicidal ideations Insomnia Reduced appetency Pessimism Self-criticism Hopelessness Worthlessness Loss of involvement Psychomotor deceleration Fatigue/hypersomnia Lack of penetrationEffectss of ApathyApathy has important negative effects and therefore early designation and diagnose is critical. In Alzheimer ‘s Disease ( AD ) patients, apathy is associated with hapless penetration into cognitive and behavioral alterations ( Derouesne et al. , 1999 ) along with greater cognitive every bit good as functional diminution ( Holtta et al. , 2012 ) . Apathetic patients are frequently misperceived as lazy by the household taking to increasing resentfulness. Apathy may impact patient perceptual experience of quality of life ( Gerritsen et al. , 2005 ) and is significantly associated with activities of day-to-day life ( ADLs ) damage ensuing in increased patient and health professional distress.. It is besides significantly associated with older age and a higher incidence of depression and craze ( Holtta et al. , 2012 ) . Apathy has been shown to be associated with frontal lobe disfunction particularly executive map in dementedness ( Ready et al. , 2003 ) and these frontal lobe maps are indispensable to a individual ‘s ability to transport out mundane planning and determination devising along with health-promoting behaviors, such as medicine direction, dietetic and lifestyle alterations, self-monitoring of responses, and follow-up with wellness attention professionals ( Kuo and Lipsitz, 2004 ) . Apathy affects the quality and degree of familiarity in a relationship and hence enjoyment of each other ‘s company. This leads to impairment of the relationship, increased health professional load and an increased the hazard of institutionalisation ( Spruytte et al. , 2001 ) ( de Vugt et al. , 2003 ) . Apathy besides has of import diagnostic and intervention deductions.It may forestall patients from seeking an early formal appraisal and may interfere with attachment to pharmacologic intervention for memory loss and engagement in compensatory schemes, such as keeping an accurate and up-to-date memory notebook ( Ready et al. , 2003 ) . Apathy may hold important predictive value.Apathy has been described to increase the hazard of patterned advance from MCI to dementia. In nursing place patients with Alzheimer ‘s dementedness, apathy has been associated with physical damage, dependence, hapless nutritionary position and significantly increased 2-year mortality rates ( Holtta et al. , 2012 ) .PATHO-PHYSIOLOGY OF APATHYApathy has been shown to be associated with a break of the frontal-subcortical neural circuit. Assorted surveies have concluded that the neural circuit that originates from the anterior cingulate cerebral mantle, so proceeds to the ventral striate body, globus pallidus, and thalamus, with a concluding cringle back to the anterior cingulate cerebral mantle is related to apathy ( Bonelli and Cummings, 2007 ) .Autopsy surveies have shown that neurofibrillary tangles load were significantly higher in the anterior cingulate cerebral mantle in apathy ( Marshall et al. , 2006 ) .Similarly structural magne tic resonance imagination ( MRI ) surveies have shown that apathy badness correlated with wasting of bilateral anterior cingulate and left auxiliary motor country ( Apostolova et al. , 2007 ) .Studies with Single photon emanation imaging have besides shown that apathetic AD patients had significantly decreased perfusion in the anterior cingulate, the inferior and median convolution frontalis and the orbito frontal convolution ( Robert et al. , 2006 )FigureA 1.A Behavioural and cognitive alterations associated with break of specific frontal-subcortical circuits ( Ball et al. , 2010 ) .Dopamine is the principle neurotransmitter of purposive behaviour, modulating motive, rousing, motor response, and sensorimotor integrating. There is a strong relationship between D2 receptor stimulation and anterior cingulated cortex metamorphosis. The anterior cingulate cerebral mantle appears to be of importance in motive and wages ( Devinsky et al. , 1995 ) and receives exceptionally heavy dopaminer gic ( DA ) excitation originating from ventral tegmental country ( VTA ) nerve cells ( Williams and Goldman-Rakic, 1998 ) . Cholinergic and serotonergic tracts besides play a neuromodulatory function in the motivational circuitry. Acetylcholine ( ACh ) and DA systems appear to organize striatal wages map in a feed-forward, complementary mode ( Williams and Adinoff, 2008, Zhou et al. , 2003 ) . Serotonin is chiefly an repressive neurotransmitter can straight impact frontal lobe activities and they can indirectly modulate frontal lobe activity by suppressing the release of Dopastat ( Daw et al. , 2002 ) . Positron Emission Tomography surveies have important decreases of 5-HT2AA receptor densitiesA in the frontal lobe in patients with apathy ( Franceschi et al. , 2005 ) .ASSESSMENT OF APATHYThere are assorted graduated tables available to determine and quantify apathy. A recent literature reappraisal has identified around 14 graduated tables of which seven were full apathy graduated ta bles and eight were apathy subscales embedded in larger graduated tables ( Clarke et al. , 2011 ) . The most widely used graduated table were the Apathy Evaluation Scale AES ) and the Neuropsychiatric Inventory ( NPI ) .Neuropsychiatric Inventory ( NPI )The NPI is a graduated table that assesses and quantifies neurobehavioral perturbations in dementedness patients and besides quantify health professional hurt caused by such behaviors ( Clarke et al. , 2011, Cummings et al. , 1994 ) . The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy ( Cummings et al. , 1994 ) . The NPI, and therefore the NPI-apathy subscale, is depe ndable, widely used, and has been validated in many different scenes.Apathy rating graduated table ( AES )The AES is an Eighteen-item graduated table capturing symptomatology over last 4 hebdomads. This scale buttockss and quantifies the affectional, behavioural, and cognitive spheres of apathy. It specifically assesses apathy and discriminates it from depression. Each point can be rated on the 4 point likert Scale. It takes around 10-20 min to be completed by a trained interviewer. This trial has a good interrater dependability and is widely usedPOTENTIAL TREATMENT OPTIONS FOR APATHYNonpharmacologic Treatment of ApathyThere are many non pharmacological intercessions that have anecdotal and qualitative grounds of effectivity in the apathy but merely a few of them has quality research confirmation in footings of effectivity ( Brodaty and Burns, 2011 ) . Open-label surveies have shown that multisensory behavior therapy and music therapy have positive consequence in cut downing apathy and could hike the consequence of anti dementedness drugs ( Ferrero-Arias et al. , 2011, Staal et al. , 2007 ) . Cognitive stimulation therapy that provides activities affecting cognitive processing, within a societal context, with an accent on enjoyment has been shown to be effectual in cut downing apathy in early Alzheimer ‘s Disease ( Buettner et al. , 2011 ) . Treatment of apathy requires multidisciplinary attack along with health professional psycho instruction about the pathological nature of apathetic province. The health professionals should besides be encouraged to present new beginnings of pleasances, involvements and stimulation along with increasing chance for socialization. It is besides of import that the patient ‘s general medical conditions are assertively treated and centripetal shortages corrected along with environmental alterations such as usage of adaptative devices such as wheelchair, seeable Clocks, calendars and equal lighting to increase the reward potency of the environment and thereby enhance motive. Although there is presently lack of research grounds, it is possible the other non pharmacological intercessions such as originative activities, cookery, Montessori methods, and behavioural elements, frequently separately tailored, exercising, multisensory stimulation, favored therapy, and particular attention unit s have the possible to cut down apathy ( Brodaty and Burns, 2011 ) .Pharmacologic Treatment of ApathyAcetylcholinesterase InhibitorsAChIs are chiefly used for handling cognitive symptoms in dementedness but recent surveies have shown positive effects on noncognitive symptoms such as apathy, depression, anxiousness, and purposeless motor behaviours. Consequences from randomized controlled tests have shown that AChIs including donepezil, galantamine and rivastigmine are clearly good in the intervention of apathy. There is no clear indicant that any one AChI is superior.NDMA Receptor AntagonistMemantine is a specificA N-methyl-D-aspartate receptor adversary and is the lone drug approved for handling terrible AD.A It appears to work by modulating the activity of glutamate, leting a controlled sum of Ca to flux into nerve cells ( enabling information processing, storage, and retrievalA 98 ) protecting nerve cells against glutamatergic excitotoxicity and, potentially, holding a neuroprote ctive consequence by cut downing toxic Ca inflow. There is grounds from randomized, double-blind, placebo-controlled tests, which indicated important betterments in apathy degrees for patients treated with MemantineMajor tranquilizersTypical Consequences from Randomized, double-blind, placebo-controlled test in nondepressed inmates with dementedness found no alteration in apathy degrees Atypical Surveies look intoing the effects of untypical major tranquilizers on apathy have reported important betterments in symptomsA farther 12-week open-label survey 130 of risperidone in 135 patients with AD showed increasing and important betterment in apathy. An RCT of 652 nursing place occupants with terrible AD reported betterment in apathy for occupants treated with olanzapine 5 mg/day but non with 1, 2.5, or 7.5 mg/day, and there was no accommodation for multiple comparingsAntidepressantsBupropion is aA dopamineA andA norepinephrine re-uptake inhibitorA and releaser. It is approximately twice as potent an inhibitor of Dopastat re-uptake than of norepinephrine reuptake.A Besides reuptake suppression of Dopastat and noradrenaline, bupropion besides causes the release of Dopastat and noradrenaline. Hence theoretically should profit apathy but there have been no good quality tests with Bupropion. There is grounds signifier clinical instance series that bupropion may profit apathy ( Corc oran et al. , 2004 ) Assorted tests of antidepressants in the interventions of apathy have mostly been negative, supplying extra support that depression and apathy are different concepts. There is good quality grounds from assorted randomised controlled trails that antidepressants do no alteration in apathy degrees. Interestingly apathy syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary and hence SSRI must be used with cautiousnesss clinicians need to be proactive in supervising for this inauspicious consequence ( Barnhart et al. , 2004 )PsychostimulantsEvidence from instance studies and little open-label surveies in non demented populations suggests that psychostimulants such as dextroamphetamine and Ritalin may be effectual in the intervention of apathy.Results from a recent double-blind, randomized, placebo-controlled crossing over test of Ritalin for the intervention of apathy suggest modest benefit s in a subset of AD patients, but that tolerability may be a concern in this population ( Herrmann et al. , 2008 ) .A There are instance studies that have reported that Modai ¬?nil may profit apathy syndrome in the older patients and is more tolerable ( Camargos and Quintas, 2011 )Dopaminergic agentsThere are merely few surveies on the effectivity of dopaminergic agents as a intervention for apathy and such surveies have been chiefly focussed on Parkinson ‘s disease and station shot conditions.Bromocriptine, aA Dopastat agonist, in case-series studiesA have been found to be effectual in cut downing apathy symptoms in shot and hypoxic encephalon hurt patients ( Barrett, 1991, Debette et al. , 2002, Krishnamoorthy and Craufurd, 2011 ) . There is nevertheless no good quality research grounds of their effectivity in handling apathy in Alzheimer ‘s disease ( van Reekum et al. , 2005 ) .Amantadine is aA N-methyl-D-aspartic acid receptor adversary, which may indirectly height en dopaminergic transmittal and confer neuroprotective effects, similar to its parallel, memantine has been shown to be effectual in bettering executive map and apathy symptoms in chronic encephalon hurt, dementedness and Parkinson ‘s disease ( Drayton et al. , 2004, Wu and Garmel, 2005 ) . Levodopa/carbidopa besides appears to better motive in assorted neurological and psychiatric upsets harmonizing to instance surveies of patients ( Bakheit et al. , 2011, Drubach et al. , 1995 ) Pramipexole, another Dopastat agonist with D3-preferring receptor adhering profile, is used in the early-stage Parkinson ‘s disease ( PD ) .A meta-analysis of placebo-controlled surveies have shown good consequence on temper and motivational symptoms in PD patients ( Leentjens et al. , 2009 ) . Similarly Ropinirole, Dopastat D2/D3 receptor agonist been reported to better apathy and temper in patients with Parkinson disease ( Czernecki et al. , 2008 )IntroductionApathy is a neurobehavioral syndrome which is defined as quantitative decrease of voluntary, purposive behavior ( Levy and Dubois, 2006 ) .It extremely prevailing across a big assortment of neurological, psychiatric, and medical conditions and is the most common neuropsychiatric symptom of Alzheimer ‘s disease with an mean point prevalence of 60 % in outpatients with Alzheimers Disease. ( Clarke et al. , 2011, Robert et al. , 2004 ) Apathy is a major hazard factor for transition to dementia in MCI topics and follow up surveies have shown that rates of transition to dementia in MCI with apathetic symptoms were up to 60 % as compared to 24 % for MCI without apathy and depression ( Vicini Chilovi et al. , 2009 ) . Apathy was thought to be upset of sub cortical encephalon construction but interestingly it appears to be really commoner in cortical encephalon upsets with averaged point prevalence of about 60 % as compared to 40 % in upsets of sub cortical constructions ( van Reekum et al. , 2005 ) . The frontal lobes play an of import function in back uping higher-level cognitive map, dwelling of executive accomplishments and working memory. Executive maps are higher-order cognitive procedures that orchestrate simple thoughts, motions and actions into complex purposive behaviors. They include be aftering, induction, coincident information processing, ordinance, judgement, abstraction, and job resolution. Damage of executive working consequences in disinhibition, concrete thought, perseveration, deficiency of enterprise, apathy, and loss of cognitive i ¬Ã¢â‚¬Å¡exibility ( Tsoi et al. , 2008a ) . A significant organic structure of grounds suggests that apathy typically occur following harm to prefrontal cortical-striatal circuits in the encephalon, and are seen in many neurological and psychiatric upsets, including all of the common signifiers of dementedness: Alzheimer disease ( AD ) , vascular dementedness ( VaD ) , and Frontotemporal dementedness. ( Craig et al. , 1996 ) .Studies have shown that Apathy in AD patients was associated with more terrible hypoperfusion in frontal parts on functional imagination ( Craig et al. , 1996 ) . A few surveies have tried to look into the relationship between apathy in dementedness and frontal lobe disfunction. Apathy in AD has been shown to be significantly associated with hapless public presentation on executive map trials, such as the Trail-Making Test and the Stroop colour intervention trial ( McPherson et al. , 2002 ) . Executive disfunction, particularly shortages impacting verbal eloquence and conceptional eloquence, was a important forecaster of apathy in dementedness ( Tsoi et al. , 2008a ) . There has been really small literature about relationship between practice and apathy in Alzheimer ‘s disease. It is known that frontal systems behavioral jobs are associated with higher health professional load after commanding for dementedness badness and health professional depression. There has been conflicting studies about part of apathy towards caregiver burden. Few surveies have shown that apathy was associated with greater grade of health professional load ( Chow et al. , 2009 ) ( Leroi et al. , 2012 ) while another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were prognostic of load and apathy was considered less troublesome to health professionals ( Davis and Tremont, 2007 )AIMS & A ; OBJECTIVES:The primary purpose of this survey is to analyze the association between apathy with or without depression and frontal lobe disfunction in patients with memory jobs. The secondary purpose is to look into association between apathy badness and the health professional load In add-on, this survey will look into the association between apathy and practice in AD and MCI as there are presently limited surveies that have looked into association between them.DESIGN/ METHODOLOGY:Ethical motives Approval: A The survey was approved by The National ResearchA EthicsA Service ( NRES ) Committee for East of England, King College London every bit good as the NEPFT NHS R & A ; D officePutingThe survey was done at the West Essex Neurocognitive Clinic which is third referral Centre and is based at three locations viz. St Margaret ‘s Hospital, Epping, Princess Alexandra Hospital, Harlow and Rectory Lane Health Centre, Loughton. The catchment country serves population of aged people of greater London and Essex, UK. The Clinic provides a specialised, multidisciplinary, hospital-based appraisal for people with cognitive jobs Majority of the patient ‘s referred are those with mild cognitive damages or patients hard to name due to combination of medical, neurolog ical, societal and neuropsychological factors. The clinic is focused on research and preparation and is involved in assorted imagination, cognitive and intervention surveies, every bit good as encephalon contribution programme. Referral standards are based on a history of cognitive damage, which is likely to be caused by degenerative alterations of the encephalon with the MMSE mark of at least 20/30, complex presentations due to interplay of varying degrees medical, neurological and neuropsychological factors and hard to name instances. Patients must be aged in surplus of 40 old ages ( reflecting appropriate referral of people with possible immature onset dementedness ) and must be able to give informed consent. The appraisal is done by a trained and experient clinician along with a psychologist/assistant psychologist. Assessment encompasses a assortment of trials aimed at set uping diagnosing and badness of unwellness. The appraisals of involvement for this survey includes A standard psychiatric interview Behavioural Pathology in Alzheimer ‘s Disease Scale ( BEHAVE-AD ) sum 75 where higher mark indicates more disturbed behavior ; Apathy/Indifference sub-scale ( NPI ) total/12 – higher mark indicates greater apathy ; Hospital Anxiety and Depression Scale ( HADS ) -total on each scale/21 -score of 7 or less indicates no important symptoms, mark of 8 – 10 indicates mild symptoms, mark of 11 + indicates moderate symptoms ; Instrumental Activities of Daily Living Scale ( IADL ) total/31 -higher tonss indicates increased dependence upon the source or ‘carer ‘ ; Clinical Dementia Rating ( CDR ) total/5 -higher mark indicates more badly affected cognitive and occupational/social operation ; Screen for Caregiver Burden ( SCB ) total/100 – higher mark indicates client is perceived to be a greater load by the source or ‘carer ‘ ; Neuropsychometric Assessment is done by the Psychologist/Assistant psychologist. The battery of neuropsychometric trials done of involvement to this survey includes: Estimated pre-morbid rational operation ( National Adult Reading Test – NART ) , Cambridge Cognitive Examination-Revised ( CAMCOG-R ) Trail doing A & A ; Trial devising B Letter Fluency, Category eloquence, Ideational Fluency Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) Subjects: This was a retrospective Cross-sectional survey. The survey population comprised 160 back-to-back patients with newly-diagnosed Alzheimer ‘s disease and amnestic-MCI, All the patients at the clip of their initial neurocognitive clinic appraisal had a thorough neurological and psychiatric scrutiny by a trained and experiences clinician along with extended neuropsychometric appraisal by a psychologist. Health professionals and next-of-kin were besides interviewed.At the clip of the appraisal all patients had capacity to give an informed consent to undergo the appraisal. Their capacity was assessed by a member of clinical squad familiar with, and trained in usage of the Mental Capacity Act. In add-on, patients have either agreed or disagreed to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. Eligibility standards: All patients diagnosed with Alzheimer ‘s disease and amnesic Mild Cognitive Impairment who had the undermentioned probes recorded on database: NPI apathy mark, frontal lobe map trial i.e Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking, CAMCOG-R, age, gender, HAD Depression mark, Care giver load and Praxis. All these patients would be eligible to take a portion in the survey. Inclusion standards: Eligible patients who gave an informed consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Exclusion standards: Patients who did non consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Patients whose depression scores on HAD were more than 8 were besides excluded.MeasuresApathy will be measured as the apathy sub-score on the NPI. The NPI was developed to measure and quantify neurobehavioral perturbations in dementedness patients and to quantify health professional hurt caused by such behaviours. The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy. The NPI, and therefore the NPI-apathy subscale, is widely used and has been validated in many different samples such as ambulatory patients with dementedness, outpatients with AD, multicultural samples, and nursing place occupants. Cognitive damage will be measured by the mark on Cambridge Cognitive Examination-Revised ( CAMCOG-R ) . This neuropsychological battery steps cognitive shortage in a figure of cognitive spheres – mark & lt ; 80/105 suggests the presence of a dementedness, mark of 80-90/105 is fringy. Frontal Lobe disfunction will be measured by the tonss obtained from the undermentioned frontal lobe map trial i.e. Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) . The Trail Making Tests ( TMTs ) are popular neuropsychological instruments used either entirely as a showing instrument for observing neurological disease and neuropsychological damage or as portion of a larger battery of trials. The trials are believed to mensurate the cognitive spheres of treating velocity, sequencing, mental flexibleness and visual-motor accomplishments Part A is by and large presumed to be a trial of ocular hunt and motor velocity accomplishments, whereas portion B is considered besides to be a trial of higher degree cognitive accomplishments such as mental flexibleness. TMT-A requires chiefly visuoperceptual abilities, TMT-B chiefly reflects working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, supplying a comparatively pure index of executive control abilities.Average DeficientDrag A 29 seconds 78 seconds Trail B 75 seconds 273 seconds Letter Fluency undertakings require coevals of words get downing with specific letters within a limited clip it has been. Letters F, A, and S ( FAS ) version of the The Controlled Oral Word Association Test is used in this survey. The trial disposal takes about five proceedingss. The mark is the amount of all admissible words for the three letters ( Loonstra et al. , 2001 ) . Category Fluency undertaking require persons to bring forth examples of specific semantic classs such as the names of animate beings or fruits. CF trial is a really speedy ( normally taking 1 min ) , easy to administrate trial that proved to be utile in the diagnosing of mild AD. The most common version involves the semantic class of animate beings. Surveies have shown that tonss below 15 in the CF ( animals/min ) had a sensitiveness of 88 % and a specificity of 96 % , in distinguishing AD patients from normal controls, bespeaking that a 1-minute trial can be helpful to clinicians to place persons in the early phases of the disease ( Caning et al. , 2004 ) . Category Fluency and Letter Fluency require frontally mediated executive retrieval mechanisms. Both besides require entree to phonological/lexical shops. But, merely class eloquence besides requires entree to more widely distributed semantic shops as the topic searches for examples suiting the mark class ( Cerhan et al. , 2002 ) .Datas AnalysisDependent variable is Apathy mark. Independent variables are CAMCOG-R tonss, tonss of the undermentioned frontal lobe testsTrail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual concluding ) every bit good as tonss of health professional load and practice. All these variables will be analysed as uninterrupted informations. The consequences will be graphed to look into if the distribution is about normal and the spread secret plan used to measure the one-dimensionality of the association. Correlation analysis, measured as a correlativity coefficient R, will be used to look into for the presence, the strength and way of a relationship between these variables. Cut-off point of 0.4 will be considered to be important. Depending on the one-dimensionality one of the two correlativity coefficients will be calculated. Ranked correlativity will be used in the statistical analysis if the relationship between the two variables in non-linear. Rank correlativity coefficients, such as Spearman ‘s rank correlativity coefficient measures the extent to which, as one variable additions, the other variable tends to increase, without necessitating that addition to be represented by a additive relationship. If, as the one variable addition, the other lessenings, the rank correlativity coefficients will be negative. If the two variables appear to hold additive relationship Spearman correlativity coefficient will be calculated. The closer the coefficient is to either a?’1 or 1, the stronger the correlativity between the variables. Correlation Negative Positive Small a?’0.3 to a?’0.1 0.1 to 0.3 Medium a?’0.5 to a?’0.3 0.3 to 0.5 Large a?’1.0 to a?’0.5 0.5 to 1.0 If the variables are independent so the correlativity is 0. However, the antonym is non true because the correlativity coefficient detects merely additive dependences between two variables.Power computationStatisticalA powerA analysesA wasA doneA byA usingA G*PowerA 3.1 ( Faul et al. , 2009 ) TypeA IA error=0.05A TypeA IA error=0.01A TypeA IA error=0.001 Power=80 % A 34A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 56A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 84 Power=90 % A 47A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 72A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 106 Power=99 % A 85A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 117A A A A A A A A A A A A A A A A A A A A A A A A A A A 159 ThisA indicatesA thatA inA orderA toA determineA aA correlationA ofA magnitudeA 0.4A atA P & lt ; 0.05A atA aA powerA levelA ofA 80 % , A thisA studyA needsA aA minimumA ofA 34A participants.AConsequenceOne hundred and 60 patients with AD or amnesic MCI who met the above-described standards were enrolled in the survey. Of these 68 patients had a diagnosing of Alzheimer ‘s disease and 92 had a diagnosing of amnesic MCI. The demographic information of the topics are summarized in Table 1. No statistically important differences in age, instruction, gender, premorbid intelligence, or old ages in instruction consequences were observed between the two groups. However as expected, there was statistically important difference in footings of the IADL, CAMCOG-R, CDR & A ; MMSETable 1: Demographic and clinical featuresAverage AD ( SD )Average MCI ( SD )P valueNIADL10.34 ( 5.52 ) 8.11 ( 3.42 ) & lt ; .001 160CAMCOG-R76.8 ( 12.66 ) 86.98 ( 8.71 ) & lt ; .001 156MMSE22.19 ( 5.13 ) 25.81 ( 2.55 ) & lt ; .001 158NART105.33 ( 10.00 ) 106.26 ( 12.23 ) .319 124CDR0.82 ( 0.41 ) 0.55 ( 0.17 ) & lt ; .001 159Age74.37 ( 8.61 ) 73.37 ( 8.70 ) .339 160Old ages Ed.11.14 ( 2.91 ) 11.16 ( 2.60 ) .655 154AdMCIChi SquareP valuePercent female51.5 47.8 0.21 .65Percentage with intoxicant history63.2 65.9 1.47 .69Percentage with smoking history42.6 50.0 2.33 .31 The frequence distribution box secret plan suggested that NPI apathy bomber graduated tables are non usually distributed. We did normalcy trials to find whether apathy informations set is well-modelled by a normal distribution or non. We used the Shapiro-Wilk trial as our numerical agencies of measuring normalcy and found that the apathy informations significantly deviate from a normal distribution. Shapiro-Wilk Statistic df NPI Apathy sub graduated table .624 160 As our information ‘s were non parametric, utilizing the Spearman rho correlativity coefficient, correlativities between variables for whole group and subgroups was generated. The Spearman rho correlativity was repeated with depressive subgroups removed. All trials were one-tailed since hypotheses were directional. The exclusion to this was the trial look intoing the relationship between gender and apathy. These hypotheses were non-directional and therefore two-tailed trials were used.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter FluencyClass EloquenceTrail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.222**-.180*.477**-.136*-.071-.166*.009 .010-.213**-.102 Sig. ( 1-tailed ).003.012.000.045.189.019.456 . 464.004.103 Nitrogen157157145156155157152 84156156ConsequencesTable 1: Correlations between variables for whole group and subgroupsCorrelations between variables for whole group and subgroups with depression removed.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter Fluency Class Eloquence Trail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.169*-.125 .475** -.067 -.041 -.123 -.052 .089-.186*.019 Sig. ( 1-tailed ).027.077 .000 .223 .321 .080 .279 .229.017.417 Nitrogen131131 121 131 130 131 127 72130131Relationship between apathy and executive mapIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 157 patients. In these patients, NPI apathy mark was significantly related to executive operation ( rs = -.222, P = .003 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained significantly related to executive operation ( n=131, rs =-.169, p=.027 )Relationship between apathy and trail devising trialsIn the combined sample ( AD and A-MCI ) , informations on trail doing trial A was available for 152 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .009, P = .456 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing A tonss ( n=127, R -.052, p=.279 ) In the combined sample ( AD and A-MCI ) , informations on trail doing trial B was available for 84 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .010, P = .464 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing B tonss ( n=72, R.089, p=.229 )Relationship between apathy and verbal eloquenceIn the combined sample ( AD and A-MCI ) , informations on missive eloquence ( FAS ) was available for 150 patients. In these patients, NPI apathy mark was non significantly related to eloquence ( rs = -.047, P = .284 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to eloquence tonss ( n=130, R -.041, p=.321 )Relationship between apathy and class eloquenceIn the combined sample ( AD and A-MCI ) , informations on class eloquence ( animate beings ) was available for 157 patients. In thes e patients, NPI apathy mark was significantly related to category eloquence ( rs = -.166* , P = .019 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence ( n=131, rs -.123, p=.080 )Relationship between apathy and conceptional eloquenceIn the combined sample ( AD and A-MCI ) , informations on conceptional eloquence was available for 156 patients. In these patients, NPI apathy mark was significantly related to conceptional eloquence ( rs = -.213** , P = .004 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=130, rs -.186* , p=.017 ) .Relationship between apathy and cognitive mapIn the combined sample ( AD and A-MCI ) , informations on CAMCOG-R was available for 156 patients. In these patients, NPI apathy mark was significantly related to cognitive operation ( rs = -.136* , P = .045 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=131, rs -.067, p=.223 )Relationship between apathy and abstract thoughtIn the combined sample ( AD and A-MCI ) , informations on abstract thought was available for 152 patients. In these patients, NPI apathy mark was significantly related to abstract thought ( rs = -.180, P = .013 ) .Relationship between apathy and health professional load.In the combined sample ( AD and A-MCI ) , informations on health professional load was available for 145 patients. In these patients, NPI apathy mark was significantly related to caregiver load ( rs = .477** , P = .000 ) . NPI apathy mark remained significantly related to caregiver burden even when the depressive subgroup of patient was removed ( n=121, rs =.475** , P = .000 ) . The correlativity between apathy and caregiver load were so tested in Alzheimer ‘s disease and amnesic MCI individually and in both subgroups NPI apathy mark was significantly related to caregiver loadNonparametric Correlations: NPI Apathy and Caregiver Burden in AD & A ; aMCIaMCIAdNPI Apathy sub graduated table Correlation Coefficient .458** .480** Sig. ( 1-tailed ) .000 .000 Nitrogen 68 53 A arrested development analysis was carried out to understand the relationship between a health professional load and MMSE, Depression Scores, Apathy, Behave -AD Scores, executive map mark, IADL.Arrested development Analysis CoefficientsaModel Unstandardized Coefficients Standardized Coefficients T Bacillus Std. Mistake BetaNPI Apathy sub graduated table1.130.240.3944.703IADL.360.167.1812.155Behave -AD mark .303 .211 .113 1.438 HADS-depression mark .016 .212 .006 .074 Executive map mark -.113 .200 -.047 -.566 MMSE mark .024 .193 .010 .125 a. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline It is clear from the multiple arrested development analysis that merely NPI apathy tonss and IADL were significantly related to caregiver load. However the other variables which included Behave AD tonss, HADS depression tonss, Executive map tonss and MMSE were non significantly related to the health professional load tonssModel SummaryModel Roentgen R Square Adjusted R Square Std. Mistake of the Estimate Change Statisticss R Square Change F Change df1 df2 1 .542a .293 .288 7.668 .293 59.353 1 143 2 .592b .350 .341 7.377 .057 12.488 1 142 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline ANOVAc Model Sum of Squares df Mean Square F 1 Arrested development 3489.675 1 3489.675 59.353 Residual 8407.663 143 58.795 Entire 11897.338 144 2 Arrested development 4169.290 2 2084.645 38.305 Residual 7728.048 142 54.423 Entire 11897.338 144 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline c. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline Further sub analysis suggests that NPI apathy contributes to about 29 % of the health professional load and IADL contributes to around 5 % of the health professional loadRelationship between apathy and practiceIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 156 patients. In these patients, NPI apathy mark was non significantly related to praxis ( rs = -.102, P = .103 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained non significantly related to praxis ( n=131, rs =.019, p=.417 )Relationship between apathy and genderMann-Whitney TrialRanksgenderNitrogenMean RankNPI Apathy sub graduated table male 81 85.38 female 79 75.50 Entire 160Test StatisticsaNPI Apathy sub graduated tableMann-Whitney U 2804.500 Wilcoxon W 5964.500 Omega -1.621 Asymp. Sig. ( 2-tailed ) .105 a. Grouping Variable: gender From the above saloon graph, with mistake bars, it appears that males have higher apathy tonss as compared to females. We used the Mann-Whitney U trial to look into if the relationship of apathy with gender is statistically important. However this did non accomplish statistically significance ( U = 2804.500, P = 0.105 )DiscussionApathy is one of the commonest symptoms in Alzheimer ‘s disease. Evidence from assorted clinical, radiological and neuropathological surveies suggests that apathy in Alzheimer ‘s disease is frontally mediated and has important negative deduction. Our survey is a realistic survey with moderate power affecting both Alzheimer Disease and Amnestic-MCI. This is the first survey as per our cognition in which the relationship of apathy with and without depression in a combined sample of AD & A ; aMCI were tested against a scope of frontal lobe map trials which included executive map mark, abstract believing mark, Category Fluency, missive Fluency, conceptional eloquence mark and test doing A & A ; B trials. Few surveies have at the same time investigated the relation of apathy with such a big scope of frontal lobe map trials.Relationship between apathy and executive mapWe found statistically important tie ining between apathy and executive map with and without depression corroborating findings from other surveies ( McPherson et al. , 2002 ) . Deficits in frontal lobe map were significantly worse when symptoms of apathy were combined with depression corroborating the determination from a Nipponese survey with a smaller figure of pati ents ( Nakaaki et al. , 2008 ) .This determination has of import clinical significance because hapless tonss in executive map influence memory abilities by forestalling people to use compensatory schemes that can assist them retrieve information and maintain functional abilities. It is besides associated with greater neuropsychiatric perturbations particularly a greater grade of agitated and disinhibited behaviors ( Chen et al. , 1998 ) . Assorted surveies have shown that impaired executive map is associated with increased pace variableness ensuing in higher incidence falls in patient with AD ( Allali et al. , 2010 ) . In Amnestic MCI, executive map damages is associated with early functional diminution in older grownups ( McGough et al. , 2011 ) . Badness of functional damage is good recognized forecasters of institutionalization ( Rozzini et al. , 2006 ) .Relationship between apathy and conceptional eloquenceSuccessful completion of Ideational eloquence undertakings require speede d productiveness every bit good as the accomplishments of self-monitoring, working memory, scheme coevals, and divergent thought ( Vannorsdall et al. , 2012 ) . We found statistically important tie ining between apathy and conceptional eloquence with and without depression.This is similar to the determination from another survey where Ideational Fluency was found to be significantly associated with apathy ( Tsoi et al. , 2008b )Relationship between apathy and Category FluencyWe found that NPI apathy mark was significantly related to category eloquence but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence. There are conflicting consequences about the relationship between apathy and class eloquence. One survey ( n=72 ) found no important relationship ( McPherson et al. , 2002 ) but another more recent survey ( n=42 ) found statistically important relationship ( Tsoi et al. , 2008b ) .Relationship between ap athy and abstract thoughtWe found that NPI apathy mark was significantly related to abstract believing but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to abstract believingRelationship between apathy and cognitive mapSimilar to consequences from other surveies, NPI apathy mark was significantly related to cognitive working proposing that apathy was related to poorer cognitive map.However when the group of patients with depressive symptoms were removed, the NPI apathy did non stay score significantly related to cognitive map.Relationship between apathy and missive EloquenceNo statistically important relationship was found. This is consistent with current literature grounds ( McPherson et al. , 2002 )Relationship between apathy and test doing A & A ; B trialsNo statistically important relationship was found between apathy and both TMT- A & A ; TMT-B in our survey. However another survey had found a statistically important relationship between TMB trial and apathy tonss in Alzheimer ‘s dementedness ( McPherson et al. , 2002 ) In drumhead among the frontal lobe trial we found that statistically important relationship between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. When the groups were reanalysed after taking patients with depressive symptoms, the relation between apathy and abstract thought every bit good as category eloquence became non important.We think that this may be do the power of the survey has reduced when the depressive subgroups were removed.The 2nd possible ground is that apathy and depression portion many common symptoms and therefore the patients we removed utilizing a rigorous diagnostic standards of HAD depression standards were truly patients with apathy.Relationship between apathy and health professional loadIn our survey, series of explorative Spearman rho correlativity confirmed the important relationship between apathy and health professional load with and without depression. We did farther bomber analysis and found apa thy to be significantly related to caregiver load in both AD and aMCI patients. Our survey is the first as per our cognition that confirms that apathy is significantly related to caregiver load in amnestic MCI reverse to the popular belief. The relation of apathy to caregiver load was confirmed by other surveies ( Chow et al. , 2009, Leroi et al. , 2012 ) nevertheless another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were most prognostic of load instead than apathy itself ( Davis and Tremont, 2007 ) . However we did a arrested development analysis and found that apathy approximately accounted for 30 % of health professional load but found no important relationship with behave AD tonss, HADS depression tonss, Executive map tonss and MMSE tonss We besides found a higher incidence of apathy in females as compared to males but farther statistical testing showed no important relationship. In our sample NPI apathy mark was significantly related to cognitive operation as confirmed by other surveies but when patients with depressive symptoms were removed the relationship with cognitive damage was nonsignificant. Our survey has few restrictions.First of all this was a retrospective cross sectional survey and so has its drawbacks, nevertheless it realistic, cross-sectional survey. Another possible job is that the subjective nature of the information ‘s nevertheless the information ‘s were collected as a portion of comprehensive neurocognitive appraisal in a third Centre by trained and experient clinicians. Prospective surveies would hold been better but would hold needed extended resources and clip. The sample size was moderate and consisted of assorted sample of Alzheimer ‘s disease and Amnestic MCI, nevertheless it was reasonably powered and amnesic MCI is considered as prodromic Alzheimer ‘s disease. We had used merely one graduated table for mensurating apathy.The NPI Apathy subscale is a portion of NPI devised to buttockss and quantifies neurobehavioral perturbations in dementedness and non specifically developed to mensurate apathy.AEP would hold been a better pic k as it is specifically developed to mensurate apathy, nevertheless the trial would necessitate preparation and would take a well longer period which would non hold been practical in a normal clinic scene This survey has shown high association of apathy with health professional load both in AD & A ; aMCI and given our anterior cognition of the significantly inauspicious effect, we would go on screen actively for apathy and utilize more specific apathy graduated table along with the NPI graduated table in future