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

Exam case financial accounting Essay

Solutions to Exercises and Problems Tutorial 1 IFM Case 2-2 Case 2-2 SKD Limited 1.Goodwill There is no goodwill amortization expense in Country A, so the goodwill amortization expense recognized by SKD must be added back to determine income under Country A GAAP. SKD amortizes goodwill over a longer period (20 years) than is allowed in Country B (5 years), so an additional amount of goodwill amortization expense must be recognized to determine income under Country B GAAP, which reduces Country B GAAP income. b.The goodwill adjustment affects the retained earnings in stockholders’ equity. The increase in Country A GAAP income results in an increase in retained earnings and the decrease in Country B GAAP income results in a decrease in retained earnings. c.The adjustment to income is for the current year only. The adjustment to stockholders’ equity is cumulative. The fact that the stockholders’ equity adjustment is three times as larger as the income adjustment implies that the goodwill was purchased three year ago. 2.Capitalized Interest a.The adjustment labeled â€Å"Capitalized interest† relates to the interest that is not expensed but instead is capitalized under Country A GAAP. The adjustment labeled â€Å"Depreciation related to capitalized interest† relates to the depreciation of the interest that was capitalized as part of the cost of the asset. b.The first adjustment increases income because interest is not being expensed immediately but instead is capitalized as part of the cost of the asset to which it relates. The second adjustment decreases income because under Country A GAAP, the asset to which interest is capitalized has a larger cost and therefore a larger depreciation expense. c.Both income adjustments are closed out to retained earnings and partially offset one another. The increase to income of $50 and the decrease of $20 result in a net increase in retained earnings of $30. 3.Fixed Assets a.When fixed assets are revalued to a higher amount, there is an increase in their carrying value with an offsetting increase in stockholders’ equity to keep the balance sheet in balance. The amount by which the assets are revalued is subject to depreciation, which results in a larger depreciation expense. The adjustment to recognize this additional depreciation expense decreases income under Country B GAAP. It also decreases stockholders’ equity (retained earnings). The decrease in retained earnings from additional depreciation is smaller than the increase in stockholders’ equity from revaluation of assets, which results in a net increase in stockholders’ equity. Note: if we knew when the fixed assets were revalued, we could determine the amount by which they were revalued. For example, if revaluation occurred at the end of the previous year, then the revaluation amount must have been $64 ($64 – 8 = $56) because only one year of additional deprecat ion would be included in the stockholders’ equity adjustment. 27. Holzer Company – Property, Plant, and Equipment (capitalization of borrowing costs and measurement of asset subsequent to acquisition using two alternative models) IAS 16 Cost Model Carry asset on the balance sheet at cost less accumulated depreciation and any accumulated impairment losses. Capitalize borrowing costs borrowing costs attributable to the construction of qualifying assets. Annual interest ($900,000 x 10%)$90,000 Interest to be capitalized in Year 1 ($500,000* x 10%)50,000 Interest expense in Year 1$40,000 * Expenditures of $1,000,000 were made evenly throughout the year, so the average accumulated expenditures during the year are $500,000 ($1,000,000 / 2). Cost of building: Construction costs$1,000,000 Capitalized interest50,000 Total initial cost of building$1,050,000 Annual depreciation (beginning in Year 2) ($1,050,000 / 40 years) $26,250 Year 1Year 2Year 3Year 4Year 5 Income Statement Depreciation expense$0$26,250$26,250$26,250$26,250 Balance Sheet Building (at 1/1)$0$1,050,000$1,023,750$997,500$971,250 Depreciation(26,250)(26,250)(26,250)(26,250) Building (at 12/31)$1,050,000$1,023,750$997,500$971,250$945,000 IAS 16 Revaluation Model Carry asset on the balance sheet at revalued amount equal to fair value less any subsequent accumulated depreciation and any accumulated impairment losses. Capitalize borrowing costs attributable to the construction of qualifying assets. Annual interest ($900,000 x 10%)$90,000 Interest to be capitalized in Year 1 ($500,000 x 10%)50,000 Interest expense in Year 1$40,000 Cost of building: Construction costs$1,000,000 Capitalized interest50,000 Total initial cost of building$1,050,000 Annual depreciation (beginning in Year 2) ($1,050,000 / 40 years) $26,250 Year 1Year 2Year 3Year 4Year 5 Income Statement Depreciation expense$0$26,250$26,250$25,5262$25,526 Subtotal $0$26,250$26,250$25,526$25,526 Loss on revaluation27,500 Reversal of revaluation loss(27,500) Total expense (income)$0$26,250$43,750$25,526$(1,974) Balance Sheet Building (at 1/1)$0$1,050,000$1,023,750$970,000$944,474 Depreciation(26,250)(26,250)(25,526)(25,526) Building (at 12/31)$1,050,000$1,023,750$997,500$944,474$918,948 Loss on revaluation(27,500)1 Reversal of revaluation loss27,5003 Revaluation surplus 3,5523 Building (at 12/31)$1,050,000$1,023,750$970,000 $944,474$950,000 1At December 31,Year 3, the fair value of the building is determined to be $970,000. The carrying value of the building is decreased by $27,500, with a loss on revaluation recognized in Year 3 net income. 2 Depreciation in Year 4 is $25,526 ($970,000 / 38 remaining years). 3At December 31,Year 5, the fair value of the building is determined to be $950,000. The carrying value of the building is increased by $31,052. A reversal of revaluation loss of $27,500 is recognized in income and $3,552 ($31,052 – 27,500) is recorded as revaluation surplus in shareholders’ equity.

Essay Comprehensive Nursing Care

Essay Comprehensive Nursing Care Essay Comprehensive Nursing Care Comprehensive Nursing Care Within this essay I will discuss what is meant by healthy living and the perception of health and its impact on the life of a specific patient who I have cared for within a hospital setting. When we think of being healthy we often tend to look at the physical aspects, but being healthy is about the person as a whole, their mind and body which often extends to the whole community. The term health is therefore complex and has many definitions (Forster et al., 1999). The World Health Organisation (1948) has a popular definition which has not been amended since 1948, ‘A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. This definition can assist the nurse in developing a holistic approach to understanding health. I recently completed a placement at a local trust, and cared for a lady who I thought was appropriate to focus on in relation to her health status as she had had many admissions into hospital over the past 1 2 months. I will refer to this lady as Joan, as a nurse I have a legal, professional and ethical duty to protect all confidential information concerning patients by recognising the privacy of the patient and practice MNC (2008). Joan has had asthma for all of her life, and after contracting TB 2 years ago Joan’s health and state of mind has gradually deteriorated. Joan’s breathing difficulties has caused many admissions into hospital over the past 12 months and consequently has developed MRSA in her sputum. Joan was admitted into a side ward due to her having the MRSA virus. Her condition caused her to become bed bound for the first two days, she found it difficult to move around the room and relied on the nursing staff to assist her with personal hygiene needs. Joan is a very independent woman and having to have someone else to help her made her very anxious. Moore and Woodrow (2004) state that breathless patients can become confused due to anxiety, therefore I had to ensure that Joan was made to feel comfortable and to give the opportunity for her to do as much as possible without causing added breathlessness. Joan was commenced on oxygen therapy; which relieved the symptoms of breathlessness. Administrating oxygen reduces or corrects hypoxia by compensating for the reduced minute volume (Bennett 2003). Bennett et al (2003) state that oxygen can be delivered in a number of ways, it was important to ensure the method chosen was the appropriate device. Joan had a basic o2 mask and it was decided that she would benefit from a mask providing 8 litres of oxygen. The device used for oxygen administration should reflect the patients’ requirements for oxygen as well as being comfortable for the patient to wear (Jevon and Ewens 2001). In helping Joan managing her breathlessness it was important for me to regularly assess Joan’s condition by observing her general appearance, looking for cyanosis, facial flushing and observing posture as this will indicate if the patient is anxious or afraid. Bennett (2003) states that when questioning breathless patients it is important to remember to use closed questions as talking increases breathlessness. As a nurse caring for Joan I played a big part in reviewing, monitoring and supporting her as she struggled with her breathing. It was particularly important to keep regular checks on all of Joan’s vital signs, tachycardia is common because of anxiety and hypoxia and bronchodilatory medications may increase it (Hoskins et al 2000). Most importantly in patients with respiratory related illnesses the nurse must remain calm and reassuring towards the patient, helping them to sit in an upright position to allow lung expansion. Joan has always been a busy lady, working and bringing up her children and then helping with the grandchildren. She regularly went to the shop and is a very house proud lady, enjoying all aspects of cleaning and keeping a good home. The unpredictability factor of an asthma

Marketing Methods About Cadbury Chocolates Essays

Marketing Methods About Cadbury Chocolates Essays Marketing Methods About Cadbury Chocolates Paper Marketing Methods About Cadbury Chocolates Paper Essay Topic: Marketing The biggest challenge facing existing companies globally is sustaining continued growth and expansion. The two main methods that can be adapted by companies to expand their operations are the introduction of new products in the market or expanding organically by updating on the already existing product. The Cadbury Chocolate Company has decided to use the former method whereby the company wants to introduce a new slimming chocolate bar into the Australian market. The Cadbury Chocolate Company was founded in 1932 and it remains the biggest manufacturer of chocolate in products in the world. The company has other product portfolios and other famous brands like snack, dairy milk range, time out bars, milk tray, crà ¨me egg and crunchie. To ensure that the customers become aware of the new slimming chocolate bar that the company is introducing in the market, intensive market research need to be carried out(Stone Desmond, 2007). The type of market research methods Market research is simply the collection and analysis of data to ensure that the customer needs and wants are satisfied. Market research helps in decision-making and reduces the risk the Cadbury Chocolates Company may encounter when introducing the new slimming chocolate bar. Market research is vital in every business because the marketing executive learn about potential customers, potential competitors, consumer wants and consumer needs. Consumers have different tastes and preferences, which determine the needs and wants. Carrying a market research will help the company to establish a target market hence providing a focus for marketing activities. The company will also be able to estimate the correct amount of the new slimming chocolate bar to manufacture and supply in the market. The type of research methods that would be the most appropriate for the Cadbury chocolates to use will be the primary data. Primary data collection method is more focused and effective than the secondary research method. Primary research can be conducted by use of questionnaires, contacting consumers directly and carrying out general market observation (Grbich, 2004). There are various methods that can be used to conduct a primary market research and they are discussed below. Conducting Interviews This is the most common method that is associated with market research. The interview can be face-to-face, telephone or over the internet. The advantage of telephone interviews is that it can cover a wide geographical area and it is cheaper than face-to face interviews. On the other hand, face-to-face interviews are conducted between a market researcher and a respondent. Conducting market research using this method ensures that the researcher gets a lot of information. Face-to-face also allows the use of pictures and products that need to be introduced in the market. The Cadbury chocolate company can also use internet whereby individuals who access the company’s website are requested to fill electronic questionnaires (Stone Desmond, 2007). Mail survey In most countries, the most appropriate method to use for the collection of primary data is mail survey. The Cadbury chocolate company can design questionnaires and mail them to a number of respondents. To improve the level of response from the respondents the company may prompt or remind the respective respondents. Focus group A focus group is made up of respondents who are based together in the same room. The market researchers from the Cadbury chocolate company should work with the focus group to gather in depth qualitative feedback. The focus group can be composed of 20 to 30 respondents. Personal opinions, discussion and beliefs are encouraged and the market research will explore precise areas that are of interest to the Cadbury chocolate company. The area of interest in this case will be to hear the views of various respondents concerning the introduction of the new slimming chocolate bar onto the Australian market. This method is more effective because the research can be covered in depth. The researcher and the respondents have a chance to interact hence colleting the true personal opinions (Zikmund Barry, 2013). Product test The Cadbury chocolate company can display the new slimming chocolate bar to the market. Potential customers are given a chance to visit the store and their purchase behavior is observed and recorded. The market researchers will then contemplate the response of the customers towards the new slimming chocolate bar. The market executives will also learn more about the packaging of the product and the way the customers would like the product to be packaged (Zikmund Barry, 2013). Use of Diaries The Cadbury chocolate company can choose a number of customers and request them to complete a diary that lists and records their purchasing behavior on the new slimming chocolate bar at a specified period either weekly, monthly or annually. This method demands for substantial commitment from the respondent but it is very effective. After collecting this information, the company’s marketing executive will have a clear picture on the purchasing behavior of the customers (Adams Birn, 2004). The use of the above discussed market research methods is more effective than the use of secondary method of data collection. This is because primary data collection method provides the marketing executives with the clear and real picture of how customers will respond to the new slimming chocolate bar when it is finally introduced in the market. How the Cadbury Chocolate Company make use of Qualitative and Quantitative research? Justify your choices. Qualitative and quantitative researches are the two kinds of research employed in marketing research that will assist Cadbury chocolates to be successful in their new product. Quantitative and qualitative research will be useful since they come up with data that is valuable in understanding the needs of consumers. The usefulness of quantitative and qualitative research in Cadburys is discussed below: Qualitative research When trying to introduce a product into a new market qualitative research is very effective. This is because it assists in getting to know what is inside the customer mind. Cadbury chocolates will make use of Qualitative research as an exploratory research aiming at determining the consumer’s value and altitudes towards the new slimming chocolate bar. Through qualitative research, there will be an in depth understanding on the need of introducing the chocolate bar in the Australian market. Qualitative research will help to explain the purchasing logic, which explains why individuals will buy the product. This will be the basis of identifying the real market segments for customers who will purchase the product. The research will also help in understanding the behaviors of customers and how they will respond to the new product (Grbich, 2004). Qualitative research will also be a useful tool for determining the importance of the new product to a customer. In most cases, people are faced with difficulties of what to ask during the research but with qualitative research there will be a process, which identifies the issues and discovers what is important to customers and why. Since qualitative research relies on some interaction with the customer like observation, depth interviews and focus group a full range of responses will be given revealing areas that are either negative or positive. The research will also determine the ideas that generate a number of responses. This is very useful to the ongoing introduction of the product because new ideas concerning the product will be generated (Stone Desmond, 2007). Qualitative research is familiar in the market research business and companies make use of the focus group to test their products. Focus group in this case will help Cadbury test their products and explore if the chocolate bar they want to introduce in the market will meet customers’ needs. Focus group delivers data that is descriptive and very rich; views of the respondents concerning the new product are also gathered. Through the focus group, people who will be consumers share their insights since they have a lot of experience. Their attitude towards the product will also be examined and it will assist Cadbury venture in the new market (Zikmund Barry, 2013). Quantitative research The main reason for a business to conduct a quantitative research is to become aware of how people in a population share certain characteristics and ideas towards a certain product or service. Quantitative research is designed to produce reliable and accurate measurement that will allow statistical analysis. In their introduction of a new product in the market Cadbury will use quantitative research to measure the behavior, performance and attitude of their will be customers. They will become aware of the people who use their products and those who have interest in the chocolate bar that they will be introducing. Quantitative research is used to estimate the potential of a business and measures its size and the segments that exist in the market. This will assist Cadbury conducts the need assessment and understand human behavior towards the new product (Adams Birn, 2004). Quantitative research through advanced statistical techniques like regression, cluster analysis and correlation will be used to create models that predict the consumer’s opinion towards the new sliming chocolate bar. Since it is deeply rooted in the statistics and numbers data is easily changed. This will be effective in measuring product awareness, determining the market size and establishment of customer profiles. Prudent recommendations will be compiled since quantitative research involves a large sample size of customers who are surveyed. There is added advantage of making use of quantitative research because Cadbury will come up with projectable data that is essential in defining their long term strategy (Zikmund Barry, 2007). Quantitative research makes use of questionnaires that are administered to a large number of respondents. This is important because it allows some statistical analysis such as calculating the percentage or mean score. Through the questionnaires, Cadbury will be given a representative picture of what consumers think regarding the new chocolate bar. This means that there will be an understanding of the response of consumer’s towards the new product (Stone Desmond, 2007). Quantitative research makes use of survey to collect information regarding the customer’s views towards a product. Speaking to a large number of customers is effective because clear views are given. The survey can be repeated several times to monitor change in opinion regarding the new product. Face to face will work very well for Cadbury because an explanation is needed and the new product needs to be shown to the customer. Making a survey by use of telephone is also effective because it gives the customers a chance to give their views regarding the new product (Grbich, 2004).

Demasiado Spanish Word Usage

Demasiado Spanish Word Usage Demasiado is a common adjective or adverb that usually carries the idea of too, too much, too many, excessive or excessively. When used as an adjective, demasiado precedes the noun it refers to and agrees in number and gender with it. Demasiado can also appear in the predicate of a sentence following a form of ser. Tres partidos polà ­ticos son demasiados. Three political parties are too many. Hay demasiado azà ºcar en los cereales de los nià ±os. There is too much sugar in childrens cereals. Fue demasiada la tentacià ³n. The temptation was too much. Tener demasiados amigos en Facebook provoca estrà ©s y culpa. Having too many friends on Facebook causes stress and guilt.  ¿Se puede tener demasiado amor, demasiada fe o demasiada honestidad? Considero que no. Can one have too much love, too much faith or too much honesty? I think not. As an adverb, demasiado is invariable - that is, it doesnt change in form. It typically comes before any adjective or adverb it affects the meaning of but after any such verb. El verano llegà ³ demasiado rpido. Summer arrived too quickly. El expresidente habla demasiado y sus declaraciones son desatinadas. The former president talks too much and his statements are foolish. Dicen que los coches ecolà ³gicos son demasiado caros. They say green cars are too expensive. Soy demasiado inteligente para creer en esas cosas. Im too smart to believe in those things. Las reas brillantes pueden aparecer demasiado blancas en las fotos. Bright areas can seem too white in the photos. El problema es que mi marido trabaja demasiado. The problem is that my husband works too much. In popular speech, you may sometimes hear demasiado as an adverb made to agree with an adjective it refers to, but this is not considered grammatically proper Spanish. As an exception to the rule, however, it is correct to make demasiado agree with forms of poco: Pasan demasiadas cosas en demasiadas pocas pginas. Too many things happen in too few pages. Sample sentences are adapted from a variety of sources. Among those used in preparaing this lesson: Tiempo (Honduras), ABC (Spain), San-Pablo.com.ar, Bogo de la web, Actualidad Motor, Reina del Cielo, Ideeleradio, Sony.es, ForoAmor.com, Cinemascope.

Case study of Netaporter and Topshop Essay Example | Topics and Well Written Essays - 1000 words

Case study of Netaporter and Topshop - Essay Example As Net-a-porter is based on online retailing, it is providing the services 7 days a week, 24 hours a day (refer as '24/7') with 120 international designers' luxury goods (clothing, shoes and accessories) to its customers throughout world. During the year 2005 sales was 21.3 million, which was 9.5 million increased compared to the previous year (Net-a-porter Limited, 2006). On the company's website, the front page links to "Home", What's New", "Magazine", "Designers", " Clothing", "Bags", "Shoes", "Accessories", "Gifts", "Sale" and "Explore" pages. These pages provide a wide array of information depending on the links that an individual may click. Among the web pages the most informative and a direct link for the customers is the "Magazine" page. It provides customers the overviews of each month fashion tendencies in six sections; "Most wanted", "IT list", "Get the look", "Style report", "Features" and "Profiles". There are also fully-explained information about the product by size chart (US, UK, FR, IT size), various images, fabrics, washing guide and price. These information adds value to the products and services of the company. Direct links are also provided when a customer clicks on the item in the fashion news sections, it automatically uploads the product information page. In that page you could see the pictures of the products, the detailed description of the product and the small shopping bag just on the top of the product you are reviewing. Once you click the shopping bag it automatically sends the products price and adjust the total in the Shopping Bag on the upper right corner of the page. This gives added convenience to the customer concerned. The customer does not have to waste their time seeking an item among thousand of items that the company carries. Natalie Massenet, founder of Net-a-porter said, "It was always my dream to be able to click on the pictures in a magazine and buy" (Anonymous (e)). 4.2.3.3 Choice The company carries a wide collection of designers products as we could see in its "Designers" page. There are over a hundred designer companies and businesses linked in their respective names. Customers may alternatively browse the page by category aside from browsing by designers. These links alone offers a collection that is robust enough to be browsed in just a day. The more the choices of collection of available products, the better for the company for it satisfies the freedom of choice among its customers. The website is also well designed in the way that it could only present the most appropriate products available for a given customer, for it considers the profile of an individual based on the records kept by the company in its databases. This factors lead the customer for a better line to choose from with the assurance that the choices they made is suited on their individual needs. 4.2.3.4 Delivery System Net-a-porter delivers to more than 50 countries around the world. Since the price of the products are based on UK/EU, non-EU country customers take advantage of the VAT, and the customer will be clearly informed about this during the transaction. It offers free shipping cost for purchases that cost over 1,000 (www.Net-a-porter.com). Table 3,

Investment projects Essay Example | Topics and Well Written Essays - 1750 words

Investment projects - Essay Example That is why even projects which had a positive net present value where not considered for the purpose of investment. The annual investment process at New Heritage involved personnel from all the three divisions of the company who presented their proposals for projects which can be considered for the purpose of investment. The proposals included projects which can be considered for the purpose of investment. With the growth of the company, initiatives were taken to decentralize some of the project approval process and hence increase spending authority at the division level. However, some projects which were of significantly higher value and required huge source of funds were reviewed at the corporate level by the capital budgeting committee which consists of the CEO, CFO, COO, the controller and the division presidents. As such, this report involves a thorough analysis of the available investment opportunities that the New Heritage Doll Company can undertake. The analysis spans over f ive years (2010 - 2014), evaluating projects which can prove to be a value maximising proposition for the company. The projects were analysed on the basis of key performance measures such as Net Present Value, Internal Rate of Return, Profitability Index, Payback period, riskiness, exposure to debt so on and so forth. The projects which were chosen every year for the purpose of investment were submitted to the budgeting committee. ... ysis has been presented in detail in the following sections and comments have been made regarding the projects which were chosen and the rationale for their choice, the budgeting constraint, the choices among all positive NPV projects, the risk factors which were considered and finally the ethical issues faced by the CEO while taking these decisions. Table of Contents 1. Rationale for choice of investing in a particular project 4 2. Budget Constraint 14 3. Choices among all positive NPV projects 14 4. Riskiness of the projects 14 5. Ethical issues faced by the CEO 15 1. Rationale for choice of investing in a particular project Several factors are considered by analysts while choosing a right project for investment. A project proposal to be presented to the committee includes a brief detail about the project and the strategy behind it. Investment decisions are base upon key financial performance measures such as the net present value of the project (NPV), the internal rate of return ( IRR), payback period and the profitability index (PI) of the project (Harvard Business Publishing 2010a). Accepting or rejecting a project depends to a large extent on the NPV of the project which is the present value of the benefits less the present value of the costs. However, this is not the only factor which is taken into consideration while evaluating a project. The other factors taken into consideration are IRR (the interest rate that sets the NPV equals to zero), Payback Period (the time required by a company to recover the cost of an investment) and Profitability index (the ratio between the NPV to the resource consumed) (Berk and DeMarzo 2011, 54-167). Having analyzed all the investment opportunities available to New Heritage Doll Company in their production, retail and licensing

HEALTHY GRIEF Essay Example | Topics and Well Written Essays - 1000 words

HEALTHY GRIEF - Essay Example Her work was specially linked with the dying as well as diagnosis of life threatening diseases which could put a person in grief and create a sense of loss. (Kurian, 2009) The five stages of grief, according to this model, include denial, anger, bargaining, depression and acceptance. At each stage, an individual experiences grief over the period of time however, it is not necessary that the same stages may occur in sequential manner and every person facing a given situation may pass through this. (Kubler-Ross, 1969) According to this model, persons facing a dying situation may go through five different stages of the grief. However, it is not necessary that everyone must go through the same cycle in same order or experience the same stages of grief at all. According to this model, the five stages of grief are: 1. Denial- this is the first stage where an individual often feels that he is fine and nothing can be done to him. This stage is considered as a temporary defense for an individual and can be replaced with the awareness about the possessions of an individual as well as individuals who will be left behind after the death. 2. Anger is a stage where a person specifically starts to believe as to why he or she is the victim of any illness or grief. This is an stage where an individual actually realizes that denial can no longer work and can often become unmanageable because of misplaced feelings of rage and fury. 3. Bargaining stage is reached when an individual starts to believe that he or she can actually bargain to gain more time to delay the death. It is often argued that it is at this stage where a person fully understands that he cannot avert death but can bargain by altering the life style to negotiate with the higher power. 5. Acceptance is the last stage where individual actually realizes the mortality of his own or the loved ones. It is at this