Obesity Essay

Overweight and obesity is on the increase in both adults and children. TheForesight: Tackling Obesities: Future Choices – Project Report(Government Office for Science, 2007) suggests that by 2050, 50% of the UK’s population will be obese. This is a major cause for concern as obesity can lead to coronary heart disease, type 2 diabetes, certain types of cancer and complications in pregnancy as well as many other well documented health complications (Ewles, 2005). Not only is obesity and poor nutrition likely to increase the cost to the NHS from ? 2billion per year to ? 5billion per year in 2025 but the social implications are huge. By reducing premature deaths people, on average would enjoy and extra 1. 3 – 2. 5 million years of life and 2. 8 million years of illness and disability-free life (DoH, 2010). However, in contrast, the Health Survey for England (National Heart Forum, 2009) would suggest that although obesity is still a problem, the prevalence of obese children aged 2-11 years is, in fact, declining: By simply incorporating the recent Health Survey for England (HSE) data into the Heart Forum model, it is shown that for children of both sexes, aged 2 to 11, the predicted prevalence of overweight and obese in 2020 drop from their Foresight predicted values of 28% overweight and 16% obese to 22% overweight and 12% obese. Since the review of obesity predictions in 2005ii, the 2006 data showed a small reduction in obesity levels a nd the 2007 data have tended to confirm this decrease. † This would indicate, that some, if not all of the health promotion strategies are beginning to take effect. This essay will be critically examining the current early interventions, health promotion practices and Government policies aimed at reducing health inequalities with regards to improving nutrition and reducing obesity. All of the interventions discussed in this essay utilise the Public Health ‘Upstream Approach’ whereby the problems caused by disease and disability are addressed through prevention rather than treatment (Bournhonesque and Mosbaek, 2002). I have, therefore, not discussed weight-management clinics which aim to treat overweight and obesity – a ‘Downstream Approach’ which cannot be considered an early intervention. The Black Report (DHSS, 1980), the Acheson Report (DoH, 1998) and the more recent Marmot Review (DoH, 2010) all identify that there are great differences between health behaviours and outcomes across a socio-economic gradient – widely known as health inequalities. In simple terms, the more money you have, the better educated you are and the better your housing and social environment are (including ethnicity) the better decisions regarding your health you will make andthe healthier you and your lifestyle will be. The Determinants of Health and Wellbeing in Human Habitation model (Barton and Grant, 2006) demonstrates clearly the relationship between people and other external factors that contribute to health and wellbeing and, as stated by WHO, 2011: â€Å"The social determinants of health are mostly responsible for health inequities. † For example, with regards to nutrition and obesity, the National Childhood Measurement Programme (2009) shows that in England approx. 23% of people in the most deprived quintile are obese but only approx. 13% of people in the least deprived quintile are obese. It is also shown that whilst different areas of England are more obese than others (London having the highest figures and the South West having the lowest) the general trend remains the same. Despite Government initiatives like ‘Change4Life’ (DoH, 2011) which discusses portion sizes, healthy snack options and makes recommendations such as eating five portions of fruit and vegetables a day statistics suggest that there has been limited success. The House of Commons report, Health Inequalities (2009) showed that 35% of people of professional and managerial occupations will consume five pieces of fruit and vegetables per day but hat only 21% of people who are unemployed or in part-time employment will consume the recommended amount of fruit and vegetables. The Low Income Diet and NutritionSurvey (Nelson et al/Food Standards Agency, 2007) showed that 66% of boys will eat less than two portions of fruit and vegetables per day and in comparison 56% of girls will eat less fruit and vegetables per day. It also showed that the consumption of saturated fat differs between age and gender – men consuming 30. 4g per day, women 59. 4g, boys 27. 5g and girls 24. 7g. There is also evidence of inequalities between race, gender and age and these are not always mutually exclusive. The Government White Paper Healthy Lives, Healthy People: A Call to Action on Obesity in England (DoH, 2011) highlights inequalities within ethnic minorities with women showing a higher prevalence of obesity than men. Healthy Lives, Healthy People (DoH, 2010) describes a partnership between the DoH and Association of Convenience Stores with the aim of making fresh fruit and vegetables more available in deprived areas and also providing chiller cabinets for fresh fruit and vegetables in work areas. Healthy Start (DoH) is an initiative that allows low-income families to purchase free fruit, vegetables, milk and infant formula and vitamins in exchange for vouchers thereby encouraging the uptake of healthy foods. The Healthy Start Quality Impact Assessment (DoH, 2010) has been careful to identify and eliminate potential inequalities that could be connected with the vouchers e. g. Kosher alternatives can be purchased with the vouchers. The same document indicates that the Healthy Start scheme has been largely successful but improvements to healthy nutrition education for families and awareness amongst eligible families of the scheme need to be made. Young children are, of course, reliant on their parents to provide their sources of nutrition. The Scottish Health Survey (2003) showed that children from families of lower socio-economic status consumed more fat, sugar and processed foods and less fibre, less ‘good’ carbohydrates like pasta and rice and less poultry and white fish. A child’s weight can be influenced by many different factors including parental attitudes to food, family eating behaviours (young children model their eating on parental eating habits), food choices and reduced physical activity/increased sedentary lifestyles (DoH, 2009). It is therefore important to address parental nutrition as well as that of the children within the family. This can be a challenge if the family in question do not perceive there to be a problem with their current diet or lifestyle. Sometimes recommending healthy nutrition to parents, handing out leaflets of signposting to websites or support organisations is simply not sufficient. It is important, as professionals, to recognise that some families will need a greater input than others and that the level of engagement with each family is likely to vary. The Educational Approach (Green and Tones, 2010) to Health Promotion aims to provide evidence-based information coupled with developing individual skills that will enable a person to make informed decisions about their health behaviour. This can, however, result in the client making voluntary choices which may not concur with the health promoter’s. Training is available for professionals e. g. HENRY (Health, Exercise and Nutrition for the Really Young) funded by the DoH and Department for Children, Schools and Families. This scheme trains professionals working with families and young children to empower parents to provide an optimally healthy environment for their children. It is soundly based upon the Family Partnership Model and uses solution-focused approaches and reflective practices and, having undergone evaluation, has shown to be a widely successful programme (Rudolf et al, 2009; Davis et al, 2002). For older children and their parents, cookery and nutrition lessons are now being made compulsory within schools (House of Commons, 2009) and ‘Cook It’ classes are available as part of the Healthy Lifestyles Service commissioned in some Primary Care Trusts. There is a drive to improve school meals, children’s awareness and knowledge of healthy food and the general food experience through initiatives such as the Food for Life Partnership which through evaluation has shown to be a success (Orme, 2011). Christensen (2004) describes a Health-Promoting Family Model, whereby internal factors (such as genetics, family health history and values and goals) and external factors at societal level (income and wealth, housing, ethnicity etc. ) and community level (health services, mass media, peer-groups etc. can all shape a child’s health and well-being. It also discusses the idea of a child being an actor for health promotion and that their behaviour, opinions and self-awareness can be influential upon the family within which they are a member. The suggestion, therefore, that parental behaviour change is solely responsible for the health outcomes of family members is, perhaps, inaccurate. This model provides a substantial argument fo r Healthy Eating education within nurseries and pre-schools and also the promotion and implementation of the Food for Life Partnership. It has been widely documented that the gap in health inequalities is widening despite best efforts to close it. The UKPHA (2004) responded to the White Paper Choosing Health – Making Healthy Choices Easier (DoH, 2004) by stating that choices in Public Health at a population level are spurious. The rich are becoming richer, the poor are becoming more likely to be victims and perpetrators of crime, progress in reducing the gender pay gap is slow and deprived communities suffer the worst effects of environmental degradation. The response states that if you have lower socio-economic status, behaviour change and making healthy choices is simply not always an option; whilst Government initiatives and information given to families by health professionals is designed to empower people to make healthy choices, the locus of control is not always endogenous (Rotter, 1966). It should be recognised that the act of empowerment and giving advice to those who cannot act upon it, is, perhaps, an act of disempowerment serving only to feed the concept of a ‘Nanny State’ and creating a disconnection between behaviour and desirable outcomes (Freire, 1985). WHO (1999) states that whilst national health policy should prioritise those most in need, all social groups are affected by unequal distribution of benefits related to socioeconomic growth and societal goods (e. g. access to education) and this needs to be addressed if the gap in health equality is to be closed. The Government has pledged to use evidence-based services to address the problem of inequalities in nutrition aimed at different population groups at National, Community and Local levels (DoH, 2011). Beattie’s Four Paradigms for Health Promotion (1991) clearly shows how health promotion can be a ‘Top Down or Bottom Up’ exercise with the professional being either a leader or a facilitator for change. The Social Change model (Naidoo and Wills, 2009) whereby changes are sought within organisations at Government level to bring about improvements of the physical, social and economic environments thus promoting health can be demonstrated through the use of mass media, advertising and policy-change. The Healthy Food Code of Good Practice (DoH, 2008) sets out seven targets including restrictions on the advertising of unhealthy food to children, information on nutritional content of food in a variety of settings and a single, simple and effective approach to food labelling. The Food Standards Agency has adopted the ‘Traffic Light System’ to visually indicate the nutritional value of foods with ease – this, the DoH (2008) states, has helped to drive behaviour change. The Behaviour Change model (Naidoo and Wills, 2009) is concerned with making improvements to a client’s individual health by encouraging them to change their lifestyle. However, the client has to be ready to make the change – without this component, the act of behaviour change is likely to be ineffective (NICE, 2007). Subsequently, this can lead to ‘victim blaming’ (Ewles, 2005) if the individual is seen to be ‘ignoring’ advice whichis counterproductive when those choices are not really choices and the locus of control is exogenous. However, with the gap in health inequalities no nearer to being closed, can the Government truly conclude that these measures are working towards behaviour change and healthier lifestyle choices? I would suggest that until the cost of healthy food is reduced, thereby making it more accessible to families with lower socio-economic status, surely the visual aids and advertising are futile? Both the Foresight Report (2007) and the Government White Paper Healthy Weight, Healthy Lives (DoH, 2008) recommend that early intervention could be a way oftackling the problem of overweight and obesity. The Health Visitor Implementation Plan: A Call to Action (DoH, 2011) states that early intervention is ‘the most effective way of dealing with health, development and other problems within the family’ and the CPHVA/Unite (2008) recognise that Health Visitors play a key role in reducing childhood obesity through contact with families antenatally, postnatally and throughout the early years of a child’s life. This is discussed further within the schedule of the Child Health Promotion Programme (DoH, 2008) which states that healthy weight and nutrition should be discussed from the days of early pregnancy. The Marmot Review (DoH, 2010) discusses a Life Course Approach which suggests that, even from the antenatal period, there will be certain life events that affect health (for example, in childhood, variation in nutrition affects growth which can then be associated with adult health risks [Wadsworth, 1997]) and wellbeing and that early intervention and prevention is key. A logical early intervention to prevent obesity would be to promote healthy nutrition in families. Singhal et al (2004) state that: â€Å"Early nutrition has a major impact on long-term health including cognitive function, bone health and risk factors for cardiovascular disease. ‘Start4Life’ (DoH, 2011) covers topics such as breastfeeding (which is widely recognised as a protective factor for obesity), weaning (again, widely recognised as a protective factor for obesity if started no earlier than 6 months) and physical activity for babies. EMPOWER (Empowering Mothers to Prevent Obesity at Weaning) is a sp ecialist health visiting programme involving home visits to babies who are at high risk because their mothers were extremely obese prior to pregnancy. The programme has been developed and piloted and is currently undergoing phase 2 of a randomised controlled trial (Barlow et al, 2009). Sure Start Children’s Centres offer support with healthy eating and breastfeeding, in conjunction with Health Visitor clinics, breastfeeding support groups and postnatal groups. However,the NESS (National Evaluation of Sure Start, Birbeck University of London, 2005) review of Sure Start Children’s Centres indicated that whilst the centres had benefit to less deprived families, there was little benefit to those families of greatest need. This could be explained by Tudor Hart’s (1971) Inverse Care Law; those who are most in need of an intervention either do not or cannot access ervices that are available. The setting for health promotion is integral to effective health education and taking into account accessibility, the target group and the premises (or location) is a fundamental role of the health professional (Green and Tones, 2010). Getting this right can help to avoid the risk of increasing the health gap in society by addressing the needs of excluded groups and including unconventional settings (Linnan and Owens Ferguson, 2007). The Ottawa Charter (WHO, 1986) states that: Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities – their ownership and control of their own endeavours and destinies. † TheEuropean Health for All Policy Framework (WHO, 1999) demonstrates that by allowing individuals, groups and communities to influence the context in which they experience health and giving control over the environment in which they live and work, people are encouraged to take responsibility for their own health. Witness accounts of a community successfully working together to prevent the closure of a budget supermarket in an affluent town centre rejuvenation project demonstrate how effective community empowerment can be (Ayre, 2011). As discussed throughout this essay there are a huge number of evidence-based documents that highlight the necessity for healthy nutrition and many more besides. Evidence-based practice and evidence-based health promotion are both becoming increasingly recognised within the public health domain (Nutbeam, 1999). Whilst, as identified by Perkins et al. 1999), evidence-based health promotion is a good thing, the UK Treasury Report (HM Treasury/DoH, 2002) would suggest that there is a high volume of research describing the problem of health inequalities but relatively little intervention research that helps to identify practical responses. Nutbeam (2004) describes the notion of ‘analysis paralysis’ for academics and policy-makers as a result of the compl exities surrounding the differences in opportunity, access and resources and their impact on health status. This leads to continuous examination and debate about the nature of the problem but little effective action to tackle it. Nutbeam carries on to say that a deficit in research surrounding wider social, economic and environmental determinants of health can discourage Government responses until more convincing evidence is obtained or can restrict attention to only good evidence of effect thereby narrowing responses significantly. Public health policies are inevitably guided by political considerations alongside available scientific evidence (Black, 2001) which can lead to restrictions in evidence-based assessments thus resulting in the ‘wrong answer to the right question’ (Davey-Smith et al. 2001). Having discussed healthy nutrition as an early intervention to prevent obesity, I would like to conclude that whilst there are many documents and initiatives concerned with reducing health inequalities across socioeconomic gradients, slow progress is being made. I feel it should be a priority to engage individuals, families and communities in health promoting activities and consultations that will e ncourage ownership in improving their diet and nutritional intake whilst taking into account their social, economic and environmental circumstances. Until the cost of healthy food is driven down and the availability of cheap, unhealthy food is reduced little will change. As stated by the Royal College of Paediatrics and Child Health (2011): â€Å"Suggesting that children in particular can be â€Å"nudged† into making healthy choices especially when faced with a food landscape which is persuading them to do the precise opposite suggests this would be best described as a call to inaction. † I perceive that, when combined, the Behaviour Change model and Educational Approach could be successful – when given the opportunity to make informed decisions, healthy choices may become more likely. I also believe that, if used in isolation, neither model would have the desired outcome. Timely dialogue should occur to encourage the receptivity to behaviour change and evidence-based health promotion should be delivered in a way that is amenable and accessible to all socioeconomic groups. A ‘Bottom Up’ approach, whilst difficult to truly achieve, could be an effective way to tackle to problem of poor nutrition and the resulting overweight and obesity with clients identifying their own needs and gaining skills and confidence to act upon them (Naidoo and Wills, 2009). I would suggest that the majority of interventions regarding healthy nutrition and reducing obesity (and perhaps all health promotion activities) are all top down as they all have a common goal – changing behaviour and improving health by providing evidence-based information with the professional acting as an ‘expert in the field’ (Naidoo and Wills, 2009). The delivery of the intervention, therefore, denotes not only the perceived role of the professional but also the level of success.

Forgotten Fire

Forgotten Fire is a fictional book that is based on a true life story of a boy’s life that was destroyed by the Armenian genocide. Adam Bagdasarian the author of Forgotten Fire, uses Vahan Kenderian’s life story to show the disaster that the Armenian Genocide had brought on to this race. Forgotten Fire is about a boy named Vahan Kenderian who grew up in a very affluent family and was very well know. Vahan never expected to have to lose everything he had including his family. His father had always told him that lacked character and that sooner or later he would have to wake up and mature in his ways.He never expected for it to come so soon in the summer of 1950. Vahan had been arrested, malnourished, separated from family, beaten, and had seen his family killed. The Armenian soldiers took his father and then beat up his uncle and shot his older brother. His mother, grandmother, siblings and him were kept in cells without food or water. They were forced to walk miles in a single file line in order to get to the next camp site. They were finally allowed to drink but whoever drank was killed and he witnessed his grandmother die.He ran away from the camp leaving behind his sister and mother only having his brother left. He later lost his brother to malnutrition. He became the slave of an Armenian governor but later ran away only to find a tribe that thought he was deaf and mute. He fell in love with the chief’s daughter and knew that her father was out to kill him. So he ran away to find refuge in a town that was abandon other than a steel worker who helped him into a girls home. The head mistress, Mrs. Fauld, brought him to a doctor’s home who lived on a farm and worked as a slave towards the Germans.He met Seta who was in the house of the German governor. She was later kicked out because she got pregnant, Vahan took Seta in and she had her baby but she died a week after she gave birth. The governor later took the baby boy. Later that ye ar the wife of the doctor died. After she passed Vahan decided to leave so he left to Constantinople. That is where he found peace and place where the war had not touched. In the 1950’s there was a lot of prejudice all over the world. This included turkey although it was to a more extreme extent. The 1950’s was right inthe time of the civil rights movement in America. I was surprised to learn that the Turkish were so brutal with the Armenians they had no respect for them at all they would beat them to a pulp with no regard to them. They considered them as trash they did not look at them as people, they were less than people they had no value what so ever. I learned that many of the genocide happen just because a race does not like a specific race because of what they look like or because of what they have in their cultures or they seem to have the idea that one race is superior to the other.In turkey the Turks ran Armenia they ran the government and the military. Altho ugh most of Armenia had a huge population of Armenians they ran many of the shops in small towns. Up until the Armenian Genocide the people had been somewhat settle about their dislike of each other. They had not brutally beaten one another up just for the fun of it they respected each other until the leader decided to promote the violence against the Armenian nation. I also learned that during the genocide they killed all the boys from the age of sixteen and older because they have the possibility of revolting.They only allowed the women and children to survive because it was easier for the soldiers to overpower them then the men because they were weaker and they tended to cower in fear of them so it was easy to take control once they showed fear. The Armenian culture is very family oriented because of the Armenian Genocide they are very community based they keep themselves within their race like the Hispanic culture they are very family oriented and put family at a very high stake .Armenian enjoy music, dancing, art , and their literature plays a huge role in their race. Over the years many of the stories were passed down this way and are passed down through many generations they have many stories to tell to their families that have been passed from generation to generation. The Armenian culture tries to stay within their race when it comes to marriage they don’t really marry outside of their race The Hispanic culture is loves to dance and to have music playing, hanging out with their whole family.Forgotten Fire is a great book in the way it was written and told. I really liked that they stayed really close to the actual story rather than going on ends trying to make it interesting when they don’t have to because the story is interesting already. It was really cool to see that in real life he was able to reunite with some of his family. He was able to reunite with his uncle I thought it was really cool how they told his end of the story but they also added a twist onto it.The twist really provided hope for the main character allowing you to see that all his trials are over and that all he had gone through is finally done with and he can be at peace where he is at. Although this book was graphic it really helps you understand only slightly what he is going through even though you may never be able to fully comprehend what had happened to him during his life and during that time period they did a really good job on helping you understand how he was feeling. The only thing I didn’t like about the book was how they split it up into sections it made the book to seem to go on for a really long time.

Getting booked into jail Essay Example | Topics and Well Written Essays - 500 words

Getting booked into jail - Essay Example If the suspect is arrested for, let’s say driving under the influence, breath, urine, or blood test has to be conducted. This process may take some hours before the individual is transferred to be booked in a county jail. The jail system does not have any notice of an individual’s arrest until they are forwarded to the jail for bookings. A communication to the jail in a while after an individual’s arrest may find they still are in the pre-booking processing and not in the jail system yet (Cole 227). Many people are concerned by this kind of delay; the pre-booking stage is routine and necessary. When arrested individuals are brought at the jail facility, go through the intake procedure before being contained in the inmate populace. This process can roughly take from 1 to 6 hours and is involved of the booking process, medical screening and the classification interview (Carlson 47). Instantaneously upon appearance at the jail, the convict is tested for any medical conditions which would need immediate treatment. Another medical questionnaire is done later in the booking procedure to ensure all illnesses that an inmate may be having are properly noted and the facility is able to meet the inmate’s medical requirements. During the booking process every inmate is searched to verify that no contraband is brought into the jail facility. They are fingerprinted and photographed. Their charges and personal information are entered into a computer system, their bail calculated, and a law court date is set. There are inmates who may be eligible to be freed on their own recognizance eighteen hours after booking. Majority of inmates are eligible to be bailed out, and to have access to telephones for bail arrangements through family, friends, or bail agents (Frantz 220). When it is confirmed that inmates are not going to be released on

The Body In American Popular Culture Essay Example | Topics and Well Written Essays - 1000 words

The Body In American Popular Culture - Essay Example Even as early as the beginning of the twentieth century, American culture has been concerned with the concept of the ‘body’, and in the need for physical exercise and fitness for both men and women (Winter, 1999, p.33). focusing on the body and the concept of masculinity. One of the important reasons for this development is the increased attention given to the male body by popular culture and the media. With the stress on desirable body images, there is increased premium placed on physical attractiveness for men, with the consequent need for men to invest in their appearance. Visual media in the form of advertising, film, magazines, folk tales, and other fields promote men’s increasing awareness of their bodily condition, encouraging them to pursue ideal conceptualizations of physical beauty. Wienke (1998) adds that vulnerability to the allure of the consumer market is also increased. To â€Å"enhance both the physical and symbolic value of men’s bodiesâ⠂¬  states Wienke (1998, p. 256), there is growing the availability of a range of exercise equipment, dietary supplements, and other products.

Buildings Analysis Project Essay Example | Topics and Well Written Essays - 2000 words

Buildings Analysis Project - Essay Example .....................†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.8 Function†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦....................................................................................................9 Bas-Relief†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..............................................................................................†¦...9 Conclusion....................................................................................................................10 References†¦...............................................................................................................11 Angkor Wat, Cambodia Introduction Angkor Wat is a temple complex at Angkor, Cambodia which was built in the 12th century for king Suryawarman II as a temple dedicated to him and also as the symbol of the capital city. It is the only temple surviving among all other temples dedicated to Hindu deities in the region because it is the best preserved site. It was first dedicated to the Hindu god Vishnu and then it was turned into a Buddhist temple. The temple is at the top of the high classical style of Khmer architecture making it a national symbol for Cambodia; it is also the most important tourist spot of the country. Some of the features are similar to the famous Hindu architecture of the temples. Some of the other salient features are the extensive rectangular galleries each of which is raised above the next level. The three areas of architectural analysis are material and structure, bas relief and function of the building. Material and Structure The temple stands on a terrace raised higher than the city. Three rectangular galleries rise to a central tower, each level higher than the last. One gallery is dedicated to one particular god. Each gallery has a gopura at each point and there are towers at the corners of the inner galleries which forms a quincunx with the central tower. The features are oriented with their back eastwards as the temple faces west. The west facing steps are shallower than the other side. The outer gallery measures 40250 sq m in area with pavilions towers at the corners. The structure is buttressed by columned half-galleries which are extended throughout and are open to the outside temple. The galleries and the towers, all are made according to the Khmer architecture with Khmer inscriptions throughout the gallery walls. There are four ponds for fulfilling the water requirement of the building which are currently dry and look like as if they were courtyards. The second and inner galleries are connected to each other and to two flanking libraries by another cruciform terrace, again a later addition. Devatas abound on the walls are present both singly and in groups of up to four; it starts from the second level. If we trace the history it is revealed that the second level was originally flooded in the past due to the ocean around Mount M eru. The stairways are very deep but it does not represent the architecture, it is related to the religious aspect of the architecture of the building as the stairways are made steep to depict the difficulty for ascending to the gods. The walls feature statues and bas reliefs which will be discussed later. Various materials are used in the buildings, which include Brick, Sandstone and Laterite. These materials signify the Khmer architecture. The earliest Angkorian temples were made mainly of brick, decorations were usually carved into a stucco applied

The Effects of Technology On The Accounting Profession Essay

The Effects of Technology On The Accounting Profession - Essay Example Another useful technology is the automated manufacturing computer. With this form of technology, PCs gather and report data at the same time. The result is an operational data framework that completely incorporates producing with advertising and accounting information, expanding both the quality and timelessness of data (Warren, 1998). This definite data has been of importance in accounting, permitting the accountants to create action based costing frameworks. These new costing frameworks permit accountants to assign overhead more productively. These frameworks can likewise recognize non-value added expenses giving cost accountants a chance to change them to value added expenses (Warren, 1998).Another innovation that is having an incredible impact on the accountant profession is Wi-Fi innovation. Presently, accountants can be on the inverse sides of the nation and deal with the same issues without either being on same location due to the advances of Wi-Fi innovation. Accountants can transfer data and reports from anyplace in the country regardless of the length. Types of Software Used To Improve the Accounting ProcessesEnterprise Resource Planning (ERP) SystemsThis is software that incorporates distinctive divisions in the association into the same framework. This makes information accessible differently and backings exercises between the distinctive divisions. The data is made accessible through a typical focal database and imparted through practical ranges, for example (Laudon & Laudon,   2006).

Customer Satisfaction in Baskin Robbins Research Paper

Customer Satisfaction in Baskin Robbins - Research Paper Example According to the research findings, customer satisfaction was defined as a post-choice judgment made by the customer after making a particular purchase of the product on offer. After the preliminary research and some interview with the employees, it was clear that the three strategies are vital in determining customer satisfaction. This hypothesis was tested through conducting interviews and questionnaires, and from the results, the hypothesis was accepted. Therefore, there is a correlation between customer satisfaction and the three strategies. Baskin-Robbins is situated in Canton, Massachusetts, and it is rated globally as the biggest franchise that sells ice creams. This company is well known as a home of diverse and delicious cakes, shakes, pies, various drinks, frozen yogurt, sherbet, cones and much more ice cream flavors. This company was formed by Burt Baskin and Irv Robbins back in the year 1945. However, these two individuals had the passion for venturing into ice creams bus iness. During the 35th annual franchise ranking, Baskin-Robbins was named by the United States as the leading ice cream and frozen dessert merchandise. The company has more than 1,000 different flavors of ice cream and all are being served in more than 50 countries globally. Their retail outlets are approximately more than 7,300 worldwide. Baskin-Robbins is trying its level best to provide a store environment that is conducive to both the customers and the general public; however, this was part of their long-term plans in their previous budget. Moreover, quite a good number of people have been employed, and they have a favorable service performance hence the relationship with the customers would be good. Lastly, things are being put in place to improve the accessibility of the store or the shops so that each and every customer is attended to.

The Middle Ages and the Renaissance Essay Example | Topics and Well Written Essays - 500 words

The Middle Ages and the Renaissance - Essay Example Religion was a vital cultural feature at the time. Religion influenced the cultural and social values in a society. Furthermore, religion influenced governance since religious leaders advised leaders. As such, religion was a fundamental cultural tenet in the early societies. The role of women in religion safeguarded the position of nuns thereby safeguarding some of the fundamental principles of faith. Additionally, Herrad of Landsberg portrayed the role of women in enhancing the growth of knowledge and safeguarding the position of women in the society. She used arts to show the ability of women to learn and take part in arts. By authoring the Hortus deliciarum, a pictoral encyclopedia she sought to enhance the spread of knowledge besides proving the ability of women to take part in arts. The encyclopedia comprised of paintings and poems that helped grow both arts and the enlightenment of women. Her works were among the earliest forms of feminist movements. Lavinia Fontana was among the earliest female artists in Italy. She was the daughter of a painter a feature that influenced her involvement in the art. Painted in 1576, Christ with the Symbols of the Passion is one of her works. Louise Élisabeth Vigà ©e Le Brun on the other hand was one of the most renowned female painters in Northern Europe in the 18th century. She created several works including Portrait of Princess Alexandra Golitsyna and her son Piotr in 1794. The two women had numerous similarities and differences all of which influenced their works and participation in the various forms of arts. Key among the similarities was the fact that they were both daughters of painters (McGuire 55). They therefore inherited the art from their fathers. Their involvement in the art was in a bid to foster the growth of their respective family business. However, the two women lived in different times and locations thereby creating unique works that

Executive summary Essay Example for Free

Executive summary Essay Donald, you provided a thorough discussion of what an executive summary really is. Your method of presentation of examples that are equivalent to an executive summary such as a business report or a one-verse summary from the Bible serves as a superb way for the reader to totally appreciate what you are talking about (Marydee, 2004). You also provide the technical features of an executive summary, such as the general length and the scope of such documents (Penrose et al. , 2004). However, I would also want to comment on the tone of your discussion. In your fourth and sixth paragraphs, I noticed that there were a couple of sentences that project a negative attitude among the readers of executive summaries. You mentioned in the fourth paragraph that â€Å"†¦executive summaries are designed for audiences that lack time or motivation to read the full report (Bovee et al. , 2003). † I suggest that you modify this sentence because this connotation of this phrase is not very pleasant for the reader. In the sixth paragraph, you stated, â€Å"†¦most executives habitually make quick decisions, well written executive summaries are arguably the most important information in the business report. † This phrase of yours provides an impression that executives either are not interested in reading the full report, making these individuals not as energetic as they are perceived, or that executives are very gullible because their major decisions are all based on the executive summary. The problem here with your description is that if there is a substandard executive summary that has been generated by a fresh writer, any decisions that will be made by the executive will be significantly influenced by the work produced by this immature writer. I suggest that you incorporate my comments and suggestions so that you will have an improved version of your discussion.

Riordan Manufacturing Supply Chain Design Essay Example for Free

Riordan Manufacturing Supply Chain Design Essay A supply chain is the process of moving information and material to and from the manufacturing and service processes of a firm (Jacobs Chase, 2011). Two components encompass the focus of the supply chain: the production, planning, and inventory control process and the distribution process. The supply chain is part of daily business operations and directly affects productivity, efficiency, and financial profitability. Proper management of the supply chain ensures a business delivers quality, cost-efficient products to customers while remaining competitive in today’s global market. Team B provides a review of Riordan Manufacturing’s (RM) production strategy and describes supplier relationships and how they affect the supply chain. Finally, Team B explores how lean production principles and inventory requirements can be used to determine appropriate supply chain processes. Electric Fan Manufacturing Strategy RM uses the level production planning strategy of maintaining a stable workforce to produce electric fans at a constant output rate (Jacobs Chase, 2011). Shortages and surpluses are absorbed with inventory levels, order backlogs, and potential lost sales (Jacobs Chase, 2011). Employees benefit from stable work hours at the cost of increased inventory levels, increased potential of lost sales, risk of obsolete products, and decreased customer service (Jacobs Chase, 2011). Electric Fan Supply Chain RM’s supply chain process flow in Figure 1 provides raw materials to the manufacturing plant and warehouse at the input end and the supply of  completed plastic fans to the customer on the output end of the supply chain (Jacobs Chase, 2011). The supply chain for the individual manufacturing processes is detailed in Figure 2. Figure 1 Riordan Manufacturing Supply Chain Figure 2 Manufacturing Department Supply Chain Process Supplier Relationships and the Supply Chain RM uses vertical integration as the framework for structuring supplier relationships. A vertically integrated process allows RM to control supply chain activities. Strategic activities are a key source of competitive advantage. Instead of outsourcing non-core activities and maintaining only core competencies under management control, RM evaluates each activity using required coordination (the difficulty of ensuring how well activities integrate with the process), strategic control (degree of loss that would result if supplier relationship were severed), and intellectual property techniques (Jacobs Chase, 2011). Other types of losses important to consider include specialized facilities, knowledge of major customer relationships, and investment in research and development (Jacobs Chase, 2011). RM does not outsource activities requiring frequent information exchange but instead outsource highly standardized, well understood, and easily transferrable activities to specialized business partners. Such strategic planning led to RM offshoring their entire fan operation from Pontiac, Michigan, to Hangzhou, China in 2000. This decision allowed RM to operate in a more feasible location, expand exponentially, and maintain financial stability (Jacobs Chase, 2011). Electric Fan Supply Chain Metrics A performance measurement system is vital for businesses to operate efficiently and effectively. According to Jacobs and Chase (2011), â€Å"process performance metrics give the operations manager a gauge on how productively a process currently is operating and how productivity is changing over time† (p. 116). Two metrics used to evaluate the performance of the RM’s electric  fan supply chain are utilization and productivity. Utilization measures the rate at which resources are used compared to time available for use by calculating time activated divided by time available (Jacobs Chase, 2011). Productivity metrics determine the amount of output per unit of time by calculating output divided by input (Jacobs Chase, 2011). Metrics used by consumers to measure supplier performance are also the strategies suppliers use to improve their services. Examples of metrics include improved quality through lower product defects, cost-efficiency, timely delivery, and shorter order fill time. Globalized businesses must not only have capable supply chain partners that support global market initiatives but also have the capability to lower supply chain costs (Handfield, 2012). Lean Production Principles RM can adopt Toyota’s lean principles by using the just-in-time inventory approach that emphasizes elimination of waste (Jacobs Chase, 2011). The lean process is essential for inventory management to reduce manufacturing cost and increase productivity. Inventory is controlled using the lean principles by eliminating extra processes and ordering supplies just-in-time based on value streaming. Value streaming involves understanding â€Å"the value-adding and non-value-adding activities required to design, order, and provide a product or service from concept to launch, order to delivery, and raw materials to customers† (Jacobs Chase, 2011, p. 421). RM’s electric fan production system uses a push system for input from a number of specialized departments such as receiving, molding, trimming, and assembly. Implementing a pull system for its production process helps master the lean production principles through more efficient inventory management and shorter lead time by focusing on building what customers want, when they want it versus producing too many goods that sit in inventory or become obsolete (Turner, 2013). Sales Forecast Forecasting sales provides necessary information to determine inventory needs, production plans, and resource needs to create customer value. Sophisticated statistical analysis, cyclical and seasonal factors, and historical data are important factors in creating a sales forecast for RM. Forecasting Technique Forecasting techniques can be subdivided into two major groups: qualitative and quantitative. Qualitative techniques use subjective data that is difficult to represent numerically. It is based on the opinion and judgment of key persons, specialists in products and markets. Quantitative techniques involve numerical analysis of past data unbiased by personal opinions or judgment. This technique employs mathematical models to project future demand. Quantitative forecasting is subdivided into two major groups: time series techniques and causal techniques. RM forecasts future sales based on an average of the previous three years production with the idea that history repeats itself. A quantitative forecasting using the time series technique results in the forecast in table 1. This demand forecast provides information management needs to make decisions on production planning, inventory, and marketing activities. Electric Fan Production Planning Aggregate Production Plan RM’s electric fan aggregate production plan in Table 2 specifies the optimal combination of fan production rate, workforce level, and inventory on hand to minimize the total production-related costs over the planning horizon (Jacobs Chase, 2011). Because RM uses the level production planning strategy, inventory is a cost of business that RM accepts. RM will continue to employ a stable workforce at the cost of inventory. This results in level production of 96K units per month. Fluctuations in demand shown in Figure 3 are absorbed by inventory levels, order backlogs, and potentially lost business (Jacobs Chase, 2011). Figure 3 Riordan Manufacturing Electric Fan Demand and Production Master Production Schedule RM’s master production schedule in Table 3 is the time-phased plan specifying how many and when RM plans to build each electric fan model. Materials Requirements Plan Materials requirements planning (MRP) is essential to manufacturing organizations for calculating and maintaining optimum inventory levels to meet production requirements. Material requirements planning (MRP) is a computer-based inventory management system designed to assist production managers in scheduling and placing orders for dependent demand items. Dependent demand items are components of finished goods—such as raw materials, component parts, and subassemblies—for which the amount of inventory needed depends on the level of production of the final product (Reference for Business, 2nd ed., 2013). A proper MRP puts the organization in a proactive position rather than reactive. MRP assists in reducing inventory levels and component shortages and ensures the right materials are in the right place at the right time, which increases productivity. Other benefits include improved plant efficiency, reduced overtime, higher production quality, and less scrap and rework. RM uses MRP to optimize production based on forecasted sales. Table 4 provides a forecast of finished goods inventory based on the forecasted demand. With this data the  organization can forecast and plan for future production requirements and use materials requirement planning to coordinate accurately inventory, shipping, and production. Riordan Manufacturing uses a fixed order system or meeting its materials requirement needs. They procure the assembled motors for the fans from local manufacturers in quantities adequate to meet its order requirements. They also purchase the plants plastic polymer requirements from local suppliers. To assure consistent operations and quality control, Riordan manufacturing has a set of procedures developed for the management of receiving raw materials, tracking products during manufacturing, accounting for the finished goods inv entories. Conclusion The supply chain is an integral part of an organization’s manufacturing process. A successful supply chain is able manage production costs, increase efficiency and effectiveness, and control inventory flow while averting financial impacts from unexpected supply chain disruptions. Last, an effective supply chain is easily integrated into a business’s production planning, scheduling, and forecasting strategies to achieve maximum results. Reference Handfield, R. (2012). Supplier Development Strategies and Outcomes. Retrieved from http://scm.ncsu.edu/scm-articles/article/supplier-development-strategies-and-outcomes Jacobs, F. R., Chase, R. B. (2011). Operations and Supply Chain Management (13th ed.). New York, NY: McGraw-Hill Irwin. Reference for Business, Encyclopedia of Business, 2nd ed. (2013). Materials Requirement Planning. Retrieved from http://www.referenceforbusiness.com/small/Mail-Op/Material-Requirements-Planning-MRP.html Turner, C. (2013). Pull System. Retrieved from http://leanmanufacturingcoach.com/pullsystem.htm

Meningitis Vaccine Policy in Saudi Arabia

Meningitis Vaccine Policy in Saudi Arabia Meningitis Vaccine Policy During Hajj Overview of the Essay This essay looks at the meningitis vaccine policy during Hajj in Saudi Arabia, first looking at the healthcare system in Saudi Arabia, in terms of how the health care system is structured and what the policies towards vaccination against meningitis are. The essay then moves on to discuss more general policies towards meningitis vaccination, from the World Health Organisation (WHO), for example, and how the Saudi model of vaccination fits in to this more general framework. The essay then moves on to looking at social theories that have been suggested to explain how organisations work, in terms of understanding how meningitis can be spread through the hajjis attending the Hajj pilgrimage. The essay then moves on to look at what evidence has been gained from research in to meningitis outbreaks during Hajj, and meningitis control through vaccination. This is presented in the form of a literature review of the current, relevant, literature regarding meningitis outbreaks during Hajj, and meningitis control through vaccination. Literature that is specific to Saudi Arabia is focused on, although vaccination programmes that have been successfully attempted further afield will also be discussed. The essay then moves on to looking at how and when the current Saudi Arabian vaccination policy and how this policy differs from previous policies, in terms of why the new policy was introduced and what the positive and negative effects of this policy have been. This section incorporates research reviewed in the previous section, through the literature review of the relevant research, and also looks at how historical trends and international trends in healthcare have contributed to this policy. The impact of globalisation on health care is also discussed. The essay then moves on to discuss any gaps that are present between the stated policy and the implementation of this policy, in terms of the organisational constraints that are present that directly affect policy implementation. The next section of the essay looks at the implications of the policy for nursing practice, in terms of the direct involvement of nurses, the need for counselling and educating parents, in terms of the historical development of nursing and the international trends in nursing. Introduction The Saudi Healthcare System This section looks at how the health care system is structured in Saudi Arabia, and what the policies towards vaccination against meningitis are within the Kingdom of Saudi Arabia. The essay then moves on to discuss more general policies towards meningitis vaccination, from the World Health Organisation (WHO), for example, and how the Saudi model of vaccination fits in to this more general framework. The essay then moves on to looking at social theories that have been suggested to explain how organisations work, in terms of understanding how meningitis can be spread through the hajjis attending the Hajj pilgrimage. The healthcare system in Saudi Arabia is essentially a national health care system, provided by the Government, which is overseen by the Ministry of Health (MOH), which provides primary healthcare services through a series of health care centres scattered throughout the Kingdom. These primary care centres refer applicable cases to advanced specialist curative services based in hospitals. In addition, secondary and tertiary care is provided by a variety of Ministries, and through a variety of private and public organisations: for example, Saudi Arabian universities provide specialist care, through their research hospitals and Saudi Arabian airlines provide health care to it’s employees. Emergency care is provided by the Saudi Red Crescent Society, and is also responsible for providing medical care during the Hajj and Umra pilgrimages. Health care is free, at the point of delivery, to all Saudi citizens and expatriates working in Saudi Arabia, and the Saudi Government spends an estimated ten per cent of its annual budget on health care: this seems to be a good investment as the Saudi’s have one of the highest life expectancy in the region, although obesity is becoming a concern in Saudi Arabia, due to the introduction of the ‘Western’ diet to the region. Whilst a more than adequate health care system is provided by the Saudi Government, as has been seen, there is also a thriving private healthcare system which provides all levels of care, from primary to tertiary and including emergency medical services. The Saudi Government is also interested in reforming the health care system, with a desire to achieve coordination amongst the various sectors and to increase the number of Saudi medical and nursing graduates so that Saudi employees can work in this sector, rather than employing many hundreds of thousands of expatriate nursing and medical staff, as is currently the case. The Saudi Government is also attempting to introduce a cooperative health insurance scheme, which would cover all non-Saudi residents living and working in the country. Infection Control for the Hajj In order to attend the Hajj, vaccination against the A and C meningitis strains was made mandatory, following on from the worldwide outbreak of meningitis A which occurred following the 1987 Hajj (Fonkoua et al., 2002) and a 1992 outbreak of meningitis A which occurred amongst Umra pilgrims (Wilder-Smith et al., 2003). In addition to this requirement for travellers entering Saudi Arabia for the Hajj, all hajjis coming from countries belonging to the African meningitis belt, and those arriving from areas that had recently experienced a meningitis outbreak, were required to take a single dose of ciprofloxacin upon arrival to Saudi Arabia (WHO, 2001). This policy was in place in Saudi Arabia until the recent outbreak of the W-135 serogroup. The current concern of health professionals and health organisations is, however, the W-135 serogroup, due to the recorded outbreak of meningitis amongst Singaporean pilgrims returning from the Hajj in 2001, many of whom had been vaccinated with the quadrivalent vaccine (Wilder-Smith et al., 2003). As stated in Wilder-Smith et al. (2003), there was a massive outbreak of serogroup W-135 meningitis in the 2000 and 2001 pilgrimages, through pharyngeal carriage of the serotype in pilgrims returning from the Hajj. Wilder-Smith et al. (2003) looked at meningitis carriage during the minor pilgrimage (Umra) and found that, whilst the W-135 serotype was carried, it was at a much lower rate of incidence, at 1.3% versus the 17% found in Hajj pilgrims, leading to their conclusion that in order to reduce the potential introduction of N.meningiditis W-135 in to the countries of origin of the pilgrims, then a ttentions would be better focused on those pilgrims attending the Hajj rather than the Umra. Following on from the Hajj-associated outbreak of W-135 serogroup, the Saudi Arabian Ministry of Health changed their policy with regards to meningitis and made it mandatory for hajjis to receive the quadrivalent vaccine (against A, C, Y and W-135) as a visa requirement from 2002 for people entering Saudi Arabia for the purposes of the Hajj (Wilder-Smith et al., 2003). In addition, the Saudi Arabian Ministry of Health administers antibiotics to all local Saudi hajjis in order to eradicate the carriage of the W-135 serogroup and to reduce transmission to local contacts and to the larger community (Wilder-Smith et al., 2003). In terms of more general policies with regards to vaccination programmes against meningitis, the World Health Organisation (WHO) recommended control practices for meningitis involve vaccination with the A/C vaccine in response to epidemics, which requires that epidemics are detected early and that stocks of vaccines be set up in at-risk regions, so that vaccination can be rapid (Fonkoua et al., 2002). Whilst other outbreaks of the W-135 strain of meningitis are becoming increasingly common, such as the outbreaks in Yaounde in Cameroon (Fonkoua et al., 2002) and in Burkina Faso (which killed 1500 people of the 13000 known to have been infected), the WHO is recommends preventative vaccination to protect those individuals at risk (for example, travellers, people in the military and pilgrims) (WHO, 2003) and vaccination for those who have been in close contact with known meningitis cases. In terms of vaccination for epidemic control, the WHO recommends that in the African meningitis belt , the known hotspot for meningitis, stretching from Senegal to Ethopia, epidemics be controlled with enhanced surveillance and the use of oily chloramphenicol, with mass vaccinations for those areas in the epidemic phase and those contiguous areas that are in alert phase: such mass vaccination, promptly administered is estimated to prevent seventy per cent of cases (WHO, 2003). As shown in a 2001 WHO report (WHO, 2001) on the emergence of the W-135 strain of meningitis, infection with this strain can lead to outbreaks of considerable size and because the epidemiology of this strain is not well understood, there is a serious need for travellers to the Hajj to be protected. The 2001 outbreak of W-135 strain of meningitis at the Hajj spread worldwide with a total of 304 cases reported and this outbreak raised serious questions as to whether the W-135 strain of meningitis will become a major public health problem at national and international levels (WHO, 2001). As shown in the NHS leaflet specially designed for UK citizens and residents planning on attending the Hajj, the W-135 strain of meningitis is deadly and vaccination against the A and C strains of meningitis does not protect an individual against this more deadly strain: only the quadrivalent vaccine will protect individuals against the W-135 strain of meningitis (NHS, 2007). In terms of the WHO policy on the W-135 strain of meningitis, the WHO has stated that the currently available vaccine is too expensive to be applicable for mass vaccination programmes that are known to be effective in the prevention of the epidemic outbreak of other meningitis strains, and so the WHO is pressing for an affordable vaccine against the W-135 strain, i.e., a vaccine at a price that would be affordable in an African situation, given that the majority of outbreaks of meningitis occurring worldwide occur in the African meningitis belt (WHO, 2003). Thus, there is no widespread vaccination programme with the quadrivalent vaccine, which protects against the W-135 strain of meningitis, unlike the routine vaccination programmes with the vaccines that are effective against the A and C strains. As the WHO, the Saudi government and various Governments who deal with their citizens who attend the Hajj (for example, the UK) are recommending, it is, at the moment, sufficient that the quadrivalent vaccine is given only to those who are at risk, i.e., those who are planning on entering a region that is known to have the W-135 strain. Widespread vaccination against the W-135 strain of meningitis is not being practiced anywhere in the world, mainly, it seems, due to the high cost of the vaccine but also due to the fact that there is no scientific evidence as to the global direction of the W-135 strain of meningitis i.e., the fact that there is no evidence, as yet, to suggest that the W-135 strain of meningitis will become a global scourge (WH O, 2001) and, as such, that it is not certain, as yet, as to whether a mass vaccination against this strain is necessary. Due to this information, the Saudi Arabian government implemented a mass vaccination with the tetravalent vaccine, active against the A, C and W strains of meningitis (WHO, 2001) and put in place the controls for hajjis as previously outlined: i) making it mandatory for hajjis to receive the quadrivalent vaccine (against A, C, Y and W-135) as a visa requirement from 2002 for people entering Saudi Arabia for the purposes of the Hajj (Wilder-Smith et al., 2003); ii) administering antibiotics to all local Saudi hajjis in order to eradicate the carriage of the W-135 serogroup and to reduce transmission to local contacts and to the larger community (Wilder-Smith et al., 2003); and iii) requiring all hajjis coming from countries belonging to the African meningitis belt, and those arriving from areas that had recently experienced a meningitis outbreak, to take a single dose of ciprofloxacin upon arrival to Saudi Arabia (WHO, 2001). Social theories to explain how organisations work This section looks at some of the social theories that have been suggested to explain how organisations work, in terms of understanding how meningitis can be spread through the hajjis attending the Hajj pilgrimage. In terms of the social theories that have been suggested to explain how organisations work, in terms of understanding how meningitis can be spread through the hajjis attending the Hajj pilgrimage Bourdieu, writing in Hillier and Rooksby (2005) talks about the concept of ‘habitus’ in terms of describing both geographical and social spaces or dispositions, which Bourdieu (2005) describes as permanent manners of being, seeing, acting and thinking, a permanent structure of perception, conception and action. Bourdieu’s (2005) thinking on habitus and dispositions can be applied to participation in the Hajj, as Bourdieu (2005) widens his definition of habitus to include unity of human behaviour, or what he terms lifestyle: that is, a set of acquired characteristics which are the product of prevailing social conditions. Bourdieu (2005) argues that this habitus, this disposition, can lead to entrenched behaviours and responses, especially in religious beliefs, for example, which leads, for example, to people wishing to attend the Hajj pilgrimage as part of their religious beliefs. Other social theories that have been put forward to explain organisational behaviour include social network theory (Barnes, 1954) which explains how social networks are formed, through the formation of nodes (i.e,, individuals) which are bound together through interdependency such as values or visions or disease transmission. The use of this theory can help epidemiologists explain how, for example, meningitis is spread amongst and beyond hajjis, leading to the development of plans and policies to contain the spread of meningitis. This will be looked at in more detail later in the essay. The Evidence from the Research This section looks at what evidence has been gained from research in to meningitis outbreaks during Hajj, and meningitis control through vaccination. This is presented in the form of a literature review of the current, relevant, literature regarding meningitis outbreaks during Hajj, and meningitis control through vaccination. Literature that is specific to Saudi Arabia is focused on, although outbreaks and vaccination programmes that have been successfully attempted further afield will also be discussed. There was a massive outbreak of serogroup W-135 meningitis in the 2000 and 2001 Hajj pilgrimages, through pharyngeal carriage of the serotype in pilgrims returning from the Hajj (Wilder-Smith et al., 2003). Wilder-Smith et al. (2003) looked at meningitis carriage during the minor pilgrimage (Umra) and found that, whilst the W-135 serotype was carried, it was at a much lower rate of incidence, at 1.3% versus the 17% found in Hajj pilgrims, leading to their conclusion that in order to reduce the potential introduction of N.meningiditis W-135 in to the countries of origin of the pilgrims, then attentions would be better focused on those pilgrims attending the Hajj rather than the Umra. Outbreaks of the W-135 strain of meningitis are becoming increasingly common further afield, such as the outbreaks in Yaounde in Cameroon (reported in Fonkoua et al., 2002) and in Burkina Faso (which killed 1500 people of the 13000 known to have been infected) (reported in WHO, 2001). To this end, as will be seen, whilst there is a vaccine against the W-135 strain of meningitis, this vaccine is extremely expensive and, as such, is not suitable for mass vaccination programmes. The vaccine is currently only in usage for travellers who are expecting to travel in to high risk regions, i.e., hajjis travelling to the Hajj which happens in a known outbreak area. It is hoped, however, that the WHO lobbying of the pharmaceutical companies will produce a more affordable version of the vaccine that would then be utilised in mass vaccination programmes, particularly across the African meningitis region, in order to minimise the spread of the deadly W-135 strain of meningitis. The Saudi Arabian Vaccination Policy This section looks at the current Saudi Arabian vaccination policy and how this policy differs from previous policies, in terms of why the new policy was introduced and what the positive and negative effects of this policy have been. This section incorporates research reviewed in the previous section, through the literature review of the relevant research, and also looks at how historical trends and international trends in healthcare have contributed to this policy. The impact of globalisation on health care is also discussed. Prior to the W-135 meningitis outbreak amongst those who had attended the 2001 Hajj, and following on from the worldwide outbreak of meningitis A which occurred following the 1987 Hajj (Fonkoua et al., 2002) and a 1992 outbreak of meningitis A which occurred amongst Umra pilgrims (Wilder-Smith et al., 2003), the Saudi Arabia vaccine policy was for mandatory vaccination against the A and C meningitis strains for all hajjis, with the necessity to present a certificate of vaccination upon application for a visa to travel to Saudi Arabia for the Hajj. In 2003, similarly to many other countries, such as the UK, who also undertake such a mass vaccination scheme, the Saudi Arabian government implemented a mass vaccination with the tetravalent vaccine, which is active against the A, C and W strains of meningitis (WHO, 2001). Following the 2001 W-135 outbreak, the Saudi Arabian Government put in place several controls for hajjis: i) it became mandatory for hajjis to receive the quadrivalent vaccine (against A, C, Y and W-135) as a visa requirement from 2002 for people entering Saudi Arabia for the purposes of the Hajj (Wilder-Smith et al., 2003); ii) the Saudi Arabian Government administered antibiotics to all local Saudi hajjis in order to eradicate the carriage of the W-135 serogroup and to reduce transmission to local contacts and to the larger community (Wilder-Smith et al., 2003); and iii) it became a requirement for entry to the country that all hajjis coming from countries belonging to the African meningitis belt, and those arriving from areas that had recently experienced a meningitis outbreak, were to take a single dose of ciprofloxacin upon arrival to Saudi Arabia (WHO, 2001). In terms of how international trends in healthcare and globalisation have contributed to these changes in the policy of the Saudi Arabian Government towards controlling meningitis, whilst the Hajj has always attracted pilgrims from all over the world, only recently has the deadly W-135 strain of meningitis reared its head, presenting a potentially disastrous scenario if this disease became epidemic as a consequence of the ideal conditions for disease replication that the Hajj presents. Thus, the Saudi Arabian Government has had to work fast to draw up a policy that minimises, as far as possible, the chances of a W-135 epidemic. The Saudi Arabian response to this threat has been impressive, in terms of drawing up practical, preventative measures so quickly and putting these in to practice so quickly. Globalisation has speeded up international travel and, through globalisation, the world has become, in a very real sense, smaller. One can literally travel wherever one desires, faster than ever before. The fact that there was an outbreak of W-135 in Singapore, amongst Singaporean hajjis, shows that what could once, historically, have been an isolated outbreak of such a deadly disease now has the potential to affect many thousands of individuals, as those infected could, potentially, travel on many different modes of transport, across many thousands of miles, coming in to contact with many different individuals, who could then become carriers of the disease, spreading the disease far afield and leading to different outbreaks of the same disease in places where the disease has never been reported previously. Problems Facing the Policies in Place to Prevent Meningitis Outbreaks During the Hajj This section discusses the gaps that are present between the stated policy and the implementation of this policy, in terms of the organisational constraints that are present that directly affect policy implementation. The actual situation of meningitis control amongst hajjis requires attention, as it is known that many hajjis enter Saudi Arabia illegally and thus are not reached by formal checks or health services whilst entering Saudi Arabia (WHO, 2001). This leads to the situation where diseases could be spread through an individual slipping through the many and varied controls that have been put in place by the Saudi Arabian Government, as it is known that many of these illegal immigrants come from countries that do not have vaccination programmes in place and who, therefore, are highly unlikely to have been vaccined prior to travelling to Saudi Arabia for the Hajj. For this reason, aside from the formal border controls on entry of hajjis, vaccination posts have been established in the last few years around the Holy Mosque (WHO, 2001). In addition, risks are presented by the arrival, at Saudi Arabian border entry ports, of individuals bearing false vaccination certificates. This presents a particular problem as these individuals put at risk the Saudi Arabian control policies that are in place, through the fact that these individuals may be carriers of disease, and may pass disease to the hajjis, but also because the need to vaccinate these individuals, often numbering in to the thousands, costs the Saudi Arabian Government time and money, paying for and administering the vaccine, a vaccine that is in short global supply and which is expensive (WHO, 2001). In terms of minimising the chances of such problems occurring, the Saudi Arabian Government has been in close talks with the Governments of countries of the African meningitis belt to offer direct, on the spot, help with vaccination programmes, donating vaccines to those countries who cannot afford them and opening temporary health centres in those countries that do not have the necessary infrastructure for the administration of said vaccines (WHO, 2001). The Saudi Arabian Government is also involved in research looking at, for example, carriage prevelance of meningitis strains in Mecca and the impact of mass chemoprophylaxis with ciprofloxacin (Who, 2001). Thus, whilst there are gaps that are present between the stated policy and the implementation of this policy, in terms of the organisational constraints that are present that directly affect policy implementation, the Saudi Arabian Government seems, really, as shown through this in-depth study, to be doing literally all it can to attempt to control, as far as possible, the outbreak of various strains of meningitis amongst hajjis during Hajj. Implications of the Saudi Arabian Policy for Nursing Practice The next section of the essay looks at the implications of the policy for nursing practice, in terms of the direct involvement of nurses, the need for counselling and educating parents, in terms of the historical development of nursing and the international trends in nursing. There are many and varied problems presented to UK nurses by the Saudi Arabian policy on vaccination against meningitis, in terms of the fact that UK nursing staff need training to understand the cultural significance of the Hajj to their muslim patients, in order to understand any potential requests for vaccination and to diagnose any potential diseases on their return from the Hajj. Nurses dealing directly with hajjis also require further training in the current vaccination requirements for hajjis, as determined by the Saudi Arabian Government’s vaccination policy, as shown through their visa requirements, in order to administer the correct, required, vaccines. The nursing staff in contact with hajjis should also be fully versed in the symptoms of all types of meningitis (including the deadly W-135) and other diseases that could be contracted whilst undertaking the Hajj, in order for timely diagnoses to be made, and timely treatment to be delivered to the patient. The fact that there was an outbreak of W-135 in Singapore, amongst Singaporean hajjis, shows that what could once, historically, have been an isolated outbreak of such a deadly disease now has the potential to affect many thousands of individuals, as those infected could, potentially, travel on many different modes of transport, across many thousands of miles, coming in to contact with many different individuals, who could then become carriers of the disease, spreading the disease far afield and leading to different outbreaks of the same disease in places where the disease has never been reported previously. Thus, globalisation has led to the situation where nursing staff need to be attuned to the possibility of ‘local’ patients presenting with ‘tropical’ or ‘foreign’ diseases. Whilst there is a system of reporting set up for such diseases, the early diagnosis of such diseases is often mistaken for common ailments, such as flu, for example, and diagnosis and treatment delayed, often leading to the spreading of the disease whilst the patient is ‘at large’ and not contained. This was the case in the 2001 outbreak of W-135 meningitis in the UK, with only 8 of the 51 total cases being actual pilgrims and 22 cases being contacts of the pilgrims, with 21 cases not having any apparent contact with the pilgrims: transmission was maintained for several months prior to diagnosis which is suspected to have led to many of the additional cases (WHO, 2001). Thus, nursing staff in countries that host Hajj attendees, such as the UK, need to be aware not only of current policies which affect the vaccination requirements of hajjis, but also of diseases that could be contracted whilst at the Hajj, in terms of knowing what symptoms to look for in patients returning from the Hajj. Saudi Arabian policies that are aimed at controlling the spread of meningitis during the Hajj thus not only have an effect on Saudi Arabian nursing staff, in terms of requiring them to administer any necessary vaccines and/or other medication, but also have a direct impact on nursing staff in those countries that host hajjis, for example, the UK, requiring special training for nursing staff. Conclusion This essay has looked at the meningitis vaccine policy during Hajj in Saudi Arabia, first looking at the healthcare system in Saudi Arabia, in terms of how the health care system is structured and what the policies towards vaccination against meningitis are. It was seen that the Saudi Arabian policies to vaccination against meningitis have changed somewhat in light of the 2001 outbreak of the W-135 strain of meningitis, which led to a tightening of requirements for entry to the country for the purposes of the Hajj and to a widespread vaccination programme across Saudi Arabia, and a local vaccination and medication programme in the immediate vicinity of the Hajj sites. The essay then moved on to discuss more general policies towards meningitis vaccination, from the World Health Organisation (WHO), for example, and how the Saudi model of vaccination fits in to this more general framework. As seen, the WHO is concerned that a major outbreak of the W-135 strain of meningitis could not be controlled, due to the high cost of the vaccine; the Saudi mondel fits in to this general framework in terms of aiming to prevent an outbreak not through mass vaccination with the quadrivalent vaccine but through the careful control of individuals entering the Hajj zone. The essay then moved on to looking at social theories that have been suggested to explain how organisations work, in terms of understanding how meningitis can be spread through the hajjis attending the Hajj pilgrimage, showing that many social theories are applicable to explain how diseases are transmitted across the Hajj period. The evidence that has been gained from research in to meningitis outbreaks during Hajj was then discussed, as was the historical treatment of meningitis control through vaccination. This was presented in the form of a literature review of the current, relevant, literature regarding meningitis outbreaks during Hajj, and meningitis control through vaccination. Literature that is specific to Saudi Arabia was focused on, although vaccination programmes that have been successfully attempted further afield were also discussed. The essay then moved on to look at how and when the current Saudi Arabian vaccination policy has changed, and how this policy differs from previous policies, in terms of why the new policy was introduced and what the positive and negative effects of this policy have been. It was shown that, prior to the W-135 meningitis outbreak amongst those who had attended the 2001 Hajj, and following on from the worldwide outbreak of meningitis A which occurred following the 1987 Hajj (Fonkoua et al., 2002) and a 1992 outbreak of meningitis A which occurred amongst Umra pilgrims (Wilder-Smith et al., 2003), the Saudi Arabia vaccine policy was for mandatory vaccination against the A and C meningitis strains for all hajjis, with the necessity to present a certificate of vaccination upon application for a visa to travel to Saudi Arabia for the Hajj. In 2003, similarly to many other countries, such as the UK, who also undertake such a mass vaccination scheme, the Saudi Arabian government implemented a mass vaccination with the tetravalent vaccine, which is active against the A, C and W strains of meningitis (WHO, 2001). Following the 2001 W-135 outbreak, the Saudi Arabian Government put in place several controls for hajjis: i) it became mandatory for hajjis to receive the quadrivalent vaccine (against A, C, Y and W-135) as a visa requirement from 2002 for people entering Saudi Arabia for the purposes of the Hajj (Wilder-Smith et al., 2003); ii) the Saudi Arabian Government administered antibiotics to all local Saudi hajjis in order to eradicate the carriage of the W-135 serogroup and to reduce transmission to local contacts and to the larger community (Wilder-Smith et al., 2003); and iii) it became a requirement for entry to the country that all hajjis coming from countries belonging to the African meningitis belt, and those arriving from areas that had recently experienced a meningitis outbreak, were to take a single dose of ciprofloxacin upon arrival to Saudi Arabia (WHO, 2001). In terms of how historical trends and international trends in healthcare have contributed to this policy, and the impact of globalisation on health care, it was shown that globalisation has meant that diseases can spread far more rapidly and widely than ever before, and that this has grave consequences in terms of deadly diseases such as the W-135 strain of meningitis. Various problems for the Saudi Arabian vaccination policy were then discussed, and the relevant solutions were given, and then the essay moved on to discussing the role of nurses involved in the care potential hajjis and of returning, infected, hajjis, in terms of the implications of the Saudi Arabian vaccination policy for nursing practice, in terms of the direct involvement of nurses, the need for counselling and educating parents, and in terms of the historical development of nursing and the international trends in n

Anorexia Nervosa and Obsessive Compulsive Disorder Essays -- Essays on

Anorexia Nervosa and Obsessive Compulsive Disorder It has long been recognized that there are similarities between Obsessive Compulsive Disorder (OCD) and Anorexia Nervosa. These similarities lie in the symptoms of the disorder. Many patients of both diseases report intrusive, fearful thoughts, a compulsive need to perform rituals, and an obsession with maintaining these rituals. In the case of anorexia nervosa these behaviors center on food and thinness whereas in OCD they are of a more general type. Past research has indicated that there is a higher prevalence rate for OCD among anorexia nervosa patients then in the normal population. The lifetime prevalence for OCD has been found to be around 3%. Conversely, the comorbidity rate for OCD and anorexia has been reported to be between 6% and 33%! This leads one to hypothesis that there may be a relationship between OCD and anorexia nervosa. It is not clear yet, based on the present research, what this relationship is. But, there are many studies out there that try to examine the relationship as well as its underlying causes. In this literature review some of this research will be examined and some preliminary conclusions will be drawn. Finally, further research to explore this relationship will be proposed. Anorexia Nervosa Anorexia nervosa is a specific disorder defined in DSM IV. Several classifications must be met for a diagnosis of anorexia to be made. There must be a refusal by the patient to maintain a healthy body weight for their age and height. This behavior must eventually lead to a weight loss in which the body weight falls to less then 85% of the persons ideal body weight. Or the patient can refuse to gain any weight during periods of growth. In wome... ...urther studies are conducted that lead to a better connection between the two disorders, sufferers can be treated more efficiently. Reference Gee, Rebecca, Telew, Nicholas. Obsessive Compulsive Disorder and anorexia nervosa in a high school athlete: A case report. Journal of Athletic Training. 1999: 34:375-378 Han L, Nielsen D, Rosenthal N, Jefferson K, Kaye W, Murphy D, Altemus M, Humphries J, Cassano G, Rotondo A, Virkkunen M, Linnoila M, & Goldman D. No coding varient of the tryptophan hydroxylase gene detected in seasonal affective disoder, obsessive-compulsive disorder, anorexia nervosa, and alcoholism. Biological Psychiatry. 1999:45:615-619. Thiel A, Zurger M, Jacoby G, & Shussler G. Thirty month outcome in patients with anorexia or bulimia nervosa and concomitant obsessive-compulsive disorder. The American Journal of Psychiatry. 1998: 155:244-249.

Creating New Enzyme Actions De Novo Essay -- Biology Catalyst

ABSTRACT Enzymes are molecules, specifically proteins that catalyze chemical reactions. Enzymes, like all catalysts, accelerate the rate of a reaction by lowering the activation energy. Nucleic acid RNA molecules called ribozymes can also act as enzymes and catalyze reactions. The development of new enzymes for the synthesis of chemical reactions, pharmaceuticals, and tools for molecular biology is a new and upcoming interest. Work has previously been done in the development for modifying and improving already existing enzymes. There is also much to still learn involving the designs and evolution of enzymes because it is greatly reliant on extensive knowledge of the mechanisms of these reactions. In this paper it is shown that new enzymatic activities can be created de novo, which means from scratch or very differently. There is no need for previous mechanistic information. This is done by selecting from a naive protein library, or one in which it is not designed to do what they are actually doing with it. This library is made up of a trillion different proteins with different amino acid sequences, so there is not much need for a plan. Messenger RNA, RNA used specifically to translate proteins, display is used and the proteins are covalently linked to their encoding mRNA, meaning that they share stable chemical bonds and are tethered to each other. Functional proteins are selected from an in vitro translated protein library. This is not an obvious way to link the genetic information that encodes it together. It is done without constraints imposed by any in vivo step, which simplifies the process when it is in vitro. This specific technique has been used to evolve short or small proteins called peptides as well as specific prote... ...enzymes is much less guided process. Future research will involve continuing to optimize the enzyme’s activity, i.e., seeing if they can get it to catalyze RNA ligation even faster. Sources Cited Denison, R. Ford. "Evolving enzymes in the lab." Weblog entry. 11 Sept. 2007. This Week in Evolution. 15 Nov. 2007 . "Researchers Evolve Artificial Enzymes in the Laboratory." HHMI Research News. 16 Aug. 2007. Howard Hughes Medical Inst. 14 Nov. 2007 . Sadava, David E., et al. Life the Science of Biology. 8th ed. USA: The Courier†¨Companies Inc, 2008 Seelig, Burckhard, and Jack W. Szostak. "Selection and evolution of enzymes from a partially randomized non-catalytic scaffold." Nature 448 (Aug. 2007): 828-833.

Approaches to Film

Auteur theory is the belief that the director is the sole artist of any film, especially if that film is capable of reflecting a style unique to the director. Many directors have a sort of signature that they instill into their films, whether it be based on casting, the soundtrack, camera angles and shots, a continuous prop or character that keeps arising, or any combination of the aforementioned. Part of the auteur theory is that when people see a certain film, they are able to pick out the director of the film based on the aspects of the film itself.However, there is controversy regarding this theory, as many people believe that the film is the creation of the film crew as a whole, that each individual adds their own special touch. A well-known auteur director is Quentin Tarantino, and one of the films that he is most known for is Pulp Fiction, which was released in 1994. Pulp Fiction contains actors and talent that Tarantino tends to use in his films, preferring to work with peopl e he is familiar with rather than with fresh-blooded actors.The film also contains references to old cult songs, which is perhaps one of Tarantino's most obvious signatures within his films. Shots and camera angles are other ways that Tarantino left his mark on Pulp Fiction. One of his signature camera angles involves a person being locked in a trunk, with the camera in the same position as the person in the trunk. When the trunk would open, the camera would be looking up at the two men that put the people into the trunk. This shot has been informally dubbed the trunk shot, thanks to Tarantino.Another memorable shot was the continuous shot of the two men walking down the hallway. Even though they went through doors and turned corners, the entire scene was done in one shot, one camera movement. Though Tarantino's mark and signature shine through everything he does, it is most obvious in Pulp Fiction. It is because of this movie that many people have begun to identify other films of T arantino's, as his style is one that is hard to replicate. Though many people are against the auteur theory, Tarantino, and Pulp Fiction, are what makes the theory plausible for some directors.

Night World : The Chosen Chapter 13

Rashel knew she had to stop the guard before he could make a sound. The vampires' mansion was on the farther cliffs, overlooking open sea rather than the harbor, and the music ought to help drown outside noises-but the greatest danger was still that they would be heard before the girls could get away. She launched herself at the werewolf, throwing a front snap kick to his chest. She could hear the air whoosh out as he fell backward. Good. No breath for howling. She landed with both knees on top of him. â€Å"This is silver,† she hissed, pressing the blade against his throat. â€Å"Don't make a noise or I'll use it.† He glared at her. He had shaggy hair and eyes that were already half-animal. â€Å"Is there anybody on the boats?† When he didn't answer, she pressed the silver knife harder. â€Å"Is there?† He snarled a breathless â€Å"No.† His teeth were turning, too, spiking and lengthening. â€Å"Don't change-† Rashel began, but at that moment he decided to throw her off. He heaved once, violently. A snap of her wrist would have plunged the silver blade into his throat even as she fell. Instead Rashel rolled backward in a somersault, tucking in her head and ending up on her right knee. Then, as the werewolf jumped at her, she slammed the sheathed knife upward against his jaw. He fell back unconscious. Too bad, I wanted to ask him about the client. Rashel looked shoreward, to see that Daphne, Annelise, and Nyala were on the pier with her. They were each holding a rock or a piece of wood broken from the jagged pilings of the wharf. They were going to help me, Rashel thought. She felt oddly warmed by it. â€Å"Okay,† she said rapidly. â€Å"Annelise and Keiko, with me. Everybody else, stay. Daphne, keep watch.† In a matter of minutes she and the boating girls had checked the boats and found two with features they thought they could handle†¦ and with fuel. Anne-lise had removed a couple of crucial engine pieces out of the others. â€Å"Took out the impellers and the solenoids,† she told Rashel mysteriously, holding out a grimy hand. â€Å"Good. Let's set them adrift. Everybody else, get yourself on a boat. Find a place to sit fast and sit down.† Rashel moved to the back of the group where Fayth had her arms around a couple of the girls who looked scared of setting out on the dark ocean. â€Å"Come on, people.† She meant to herd them in front of her like chickens. That was when it happened. Rashel had an instant's warning-the faint crunch of sand on rock behind her. And then something hit her with incredible force in the middle of the back. It knocked her down and sent her knife flying. Worse, it sent her mind reeling in shock. She hadn't been prepared. That instant's warning hadn't been enough-because she had already lost zanshin. She no longer had the gift of continuing mind. She had lost her single purpose. In the old days she'd been fixed on one thing-to kill the Night People. There had been no hesitation, no confusion. But now†¦ she'd already faltered twice tonight, knocking the werewolves unconscious instead of killing them. She was confused, uncertain. And, as a result, unprepared. And now I'm dead, she thought. Her numbed mind was desperately trying to recover and come up with a strategy. But there was a wild snarling in her ear and a trail of hot pain down her back. Animal claws. There was a wolf on top of her. Rudi had gotten loose. Rashel gathered herself and bucked to throw the wolf off. He slipped and she tried to roll out from under him, arms up to keep her throat protected. The werewolf was too heavy-and too angry. He scrambled over her rolling body like a lumberjack on a log. His snarling muzzle kept darting for her throat in quick lunges. Rashel could see his bushy coat standing on end. She felt fire across her ribs-his claws had torn through her shirt. She ignored it. Her one thought was to keep him away from her throat. Keeping an elbow up, she reached for the knife with her other hand. No good. She hadn't rolled far enough. Her fingertips just missed the hilt. And Rudi the wolf was right in her face. All she could see were sharp wet teeth, black gums, and blazing yellow eyes. Her face was misted with hot canine breath. Every snap of those jaws made a hollow glunk. Rashel only had one option left-to block each lunge as it came. But she couldn't keep that up forever. She was already tiring. It's over, she thought. The girls who might have helped her-Daphne and Nyala and Annelise were at the far end of the wharf or on the boats. The other girls were undoubtedly too scared even to try. Rashel was alone, and she was going to die very soon. My own stupid fault, she thought dimly. Her arms were shaking and bloodied. She was getting weaker fast. And the wolf knew. Even as she thought it, she missed a block. Her arm slipped sideways. Her throat was exposed. In slow motion she saw the jaws of the wolf opening wide, driving toward her. She saw the triumph in those yellow eyes. She knew, with a curious sense of resignation, that the next thing she would feel was teeth ripping through her flesh. The oldest way to die in the world. I'm sorry, Daphne, she thought. I'm sorry, Nyala. Please go and be safe. And then everything seemed to freeze. The wolf stopped in midlunge, head jerking backward. Its eyes were wide and fixed. Its jaws were open but not moving. It looked as if it might howl. But it didn't. It collapsed in a hot quivering heap on top of Rashel, legs stiff. Rashel scrambled out from under it automatically. And saw her knife sticking out of the base of its skull. Quinn was standing above it. â€Å"Are you all right?† He was breathing quickly, but he looked calm. Moonlight shone on his black hair. The entire world was huge and quivering and oddly bright. Rashel still felt as if she were moving in slow motion. She stared at Quinn, then looked toward the wharf. Girls were scattered all over, as if frozen in the middle of running in different directions. Some were on the decks of the two remaining boats. Some were heading toward her. Daphne and Nyala were only fifteen feet away, but they were both staring at Quinn and seemed riveted in place. Nyala's expression was one of horror, hate-and recognition. Waves hissed softly against the dock. Think. Now think, girl, Rashel told herself. She was in a state of the strangest and most expanded consciousness she'd ever felt. Her hands were icy cold and she seemed to be floating-but her mind was clear. Everything depended on how she handled the next few minutes. â€Å"Why did you do that?† she asked Quinn softly. At the same time she shot Daphne the fastest and the most intense look of her life. It meant Go now. She willed Daphne to understand. â€Å"You just lost a guard,† she went on, getting up slowly. Keep his eyes on you. Keep moving. Make him talk. â€Å"Not a very good one,† Quinn said, looking with fastidious disgust at the heap of fur. Go, Daphne, run, Rashel thought. She knew the girls still had a chance. There were no other vampires coming down the path. That meant that Rudi had either been too angry to give a general alarm or too scared. That was one good thing about werewolves-they acted on impulse. Quinn was the danger now. â€Å"Why not a good one?† she asked. â€Å"Because he damaged the merchandise?† She lifted her torn shirt away from her ribs. Quinn threw back his head and laughed. Something jerked in Rashel's chest, but she used the moment to change her position. She was right by the wolf now, with her left hand at the exact level of the knife. â€Å"That's right,† Quinn said. A wild and bitter smile still played around his lips. â€Å"He was presumptuous. You almost surrendered to the wrong darkness there, Shelly. By the way, where'd you get a silver knife?† He doesn't know who I am, Rashel thought. She felt both relief and a strange underlying grief. He still thought she was some girl from the club- maybe a vampire hunter, but not the vampire hunter. The one he'd admitted was good. So he's unprepared. He's off his guard. If I can kill him with one stroke, before he calls to the other vampires, the girls may get away. She glanced at the wharf again, deliberately, hoping to draw his gaze. But he didn't look behind him, and Daphne and the other stupid girls weren't leaving. Refusing to go without her. Idiots! Now or never, Rashel thought. â€Å"Well, anyway,† she said, â€Å"I think you saved my life. Thank you.† Keeping her eyes down, she held out her hand. her right hand. Quinn looked surprised, then reached out automatically. With one smooth motion, like a snake uncoiling, Rashel attacked. Her right hand drove past his hand and clamped on his wrist. Her left hand plunged down to grab the knife. Her fingers closed on the hilt and pulled- and the sheath with its attached silver blade stayed in the werewolf's neck. Just as she'd planned. The knife itself came free, the real knife, the one made of wood. And then Quinn tried to throw her and her body responded automatically. She was moving without conscious direction, anticipating his attacks and blocking them even as he started to make them. It transformed the fight into a dance. Faster than thought, graceful as a lioness, she countered every move he made. Zanshin to the max. She ended up straddling him with her knife at his throat. Now. Fast. End it. She didn't move. You have to, she told herself. Quick, before he calls the others. Before he knocks you out telepathically. He can do it, you know that. Then why isn't he trying? Quinn lay still, with the point of the wooden knife in the hollow of his throat, just where his dark collar parted. His throat was pale in the moonlight and his hair was black against the sand. Footsteps sounded behind Rashel. She heard rapid light breathing. â€Å"Daphne, take the boats and go now. Leave me here. Do you understand?† Rashel spoke every word distinctly. â€Å"But Rashel-â€Å" â€Å"Do it now!† Rashel put a force she hadn't known she had behind the words. She heard the quick intake of Daphne's breath, then footsteps scampering off. All the while, she hadn't taken her eyes off Quinn. Like everything else, the green-black blade of her knife was touched with moonlight. It seemed to shimmer almost liquidly. Lignum vitae, the Wood of Life. It would be death for him. One thrust would put it through his throat. The next would stop his heart. â€Å"I'm sorry,† Rashel whispered. She was. She was truly sorry that this had to be done. But there was no way out. It was for Nyala, for all the girls he'd kidnapped and hunted and lured. It was to keep girls like them safe for the future. â€Å"You're a hunter,† Rashel said softly, trying for steadiness. â€Å"So am I. We both understand. This is the way it goes. It's kill or be killed. It all comes down to that in the end.† She paused to breathe. â€Å"Do you understand?† â€Å"Yes.† â€Å"If I don't stop you, you'll be a danger forever. And I can't let that happen. I can't let you hurt anyone else.† She was aware that she was shaking her head slightly in her attempt to explain to him. Her lungs ached and there were tears in her eyes. â€Å"I can't.† Quinn didn't speak. His eyes were black and bottomless. His hair was slightly mussed on his forehead, but he didn't show any other sign of just having been in a fight. He's not going to struggle, Rashel realized. Then make it quick and merciful. No need for him to feel the pain of wood through his throat. She switched her grip on the knife, raising it over his chest. Holding it with both hands, poised above his heart. One swift downward stroke and it would be over. For the first time since she had killed a Night Person, she didn't say what she always said. She wasn't the Cat right now; this wasn't revenge for her. It was necessity. â€Å"I'm sorry,† she whispered, and shut her eyes. He whispered, â€Å"This kitten has claws.† Rashel's muscles locked. Her eyes opened. â€Å"Go on,† Quinn said. â€Å"Do it. You should have done it the first time.† His gaze was as steady as Fayth's. She could see moonlight in his eyes. He didn't look wild, or bitter, or mocking. He only looked serious and a little tired. â€Å"I should have realized it before-that you were the one in the cellar. I knew there was something about you. I just couldn't figure out what. At least now I've seen your face.† Rashel's arms wouldn't come down. What was wrong with her? Her resolve was draining away. Her whole body was weak. She felt herself begin to tremble, and realized to her horror she couldn't stop it. â€Å"Everything you said was true,† he said. â€Å"This is how it has to end.† â€Å"Yes.† Something had swollen in Rashel's throat and it hurt. â€Å"The only other possibility is that I kill you. Better this way than that.† He looked exhausted suddenly-or sick. He turned his head and shut his eyes. â€Å"Yes,† Rashel said numbly. He believed that? â€Å"Besides, now that I have seen your face, I can't stand the sight of myself in your eyes. I know what you think of me.† Rashel's arms dropped. But limply. The blade pointed upward, between her own wrists. She sat there with her knuckles on his chest and stared at a scraggly wild raspberry bush growing out of the cliff. She had failed Nyala, and Nyala's sister, and countless other people. Other humans. When it really counted, she was letting them all down. â€Å"I can't kill you,† she whispered. â€Å"God help me, I can't.† He shook his head once, eyes still shut. She was open to attack, but he didn't do anything. Then he looked at her. â€Å"I told you before. You're an idiot.† Rashel hit him under the jaw the way she'd hit the guard. The hilt of her dagger caught him squarely. He didn't move to avoid the blow. It knocked him out cold. Rashel wiped her cheeks and got up, looking around for something to tie him with. Her whole life was torn to pieces, falling around her. She didn't understand anything. All she could do was try to finish what she'd come here for. Action, that was what she needed. Thought could wait. It would have to wait. Then she glanced at the wharf. She couldn't believe it. It seemed as if at least a week had passed since she yelled at Daphne, and they were all still here. The boats were here, the girls were here, and Daphne was running toward her. Rashel strode to meet her. She grabbed Daphne by the shoulders and shook hard. â€Å"Get-out-of-here! Do you understand? What do I have to do, throw you in the water?† Daphne's eyes were huge and blue. Her blond hair flew like thistledown with the shaking. When Rashel stopped, she gasped, â€Å"But you can come with us now!† â€Å"No, I can't! I still have things to do.† â€Å"Like what?† Then Daphne's eyes darted to the cliff. She stared at Rashel. â€Å"You're going after them? You're crazy!† Looking frightened, she grabbed Rashel's hands on her shoulders. â€Å"Rashel, there are supposed to be eight of them, right? Plus Lily and Ivan and who knows what else! You really think you can kill them all? What, are they all just going to line up?† â€Å"No. I don't know. But I don't need to kill them all. If I can get the guy who set this up, the client, it will be worth it.† Daphne was shaking her head, in tears. â€Å"It won't be worth it! Not if they kill you-which they will. You're already hurt-â€Å" â€Å"It'll be worth it if I can stop him from doing this again,† Rashel said quietly. She couldn't yell anymore. She didn't have the strength. Her voice was quenched, but she held Daphne's eyes. â€Å"Now get somebody to throw me some rope or something to tie these guys with. And then leave. No, give me five minutes to get to the top of the cliff. Six minutes. That way maybe I can surprise them before they realize you're gone.† Daphne was crying steadily now. Before she could say anything, Rashel went on. â€Å"Daphne, any minute now they could realize that. Someone's bound to check the cellar before midnight. Every second we stand here could make the difference. Please, please, don't fight me anymore.† Daphne opened her mouth, then shut it. Her eyes were desolate. â€Å"Please try to take care of yourself,† she whispered. She let go of Rashel's shoulders and hugged her hard. â€Å"We all know you're doing it for us. I'm proud to be your friend.† Then she turned and ran, herding the others ^^ toward the boats. A moment later she threw Rashel two pieces of line. Rashel tied up Quinn first, then the werewolf. â€Å"Six minutes,† she said to Daphne. Daphne nodded, trying not to cry. Rashel wouldn't say goodbye. She hated that. Even though she knew perfectly well that she was never going to see Daphne again. Without looking back, she loped up the hiking trail.