Michael Kors: The Last Word in Luxury Essay

Michael Kors handbags always reflect style and substance. And that’s exactly why everyone wants to own one of them. It helps you to make a style statement. It enables you to stand out among a crowd. To sum it up, it makes you feel special. The brand Michael Kors always evoked feelings of pride and luxury among its innumerable owners. It has class and it projects the indomitable spirit of the modern women. It has a unique charisma and a lazy elegance, which endears it to its aficionados. Rather than being a mundane women’s accessory, MK handbags define the personality of its owner in a delectable manner. It boosts her confidence and allows her to flaunt her persona in front of enchanted connoisseurs. Michael Kors is not just another run-of-the-mill luxury brand, which spawns and inundates the upscale retail stores. MK handbags are exotic and unique pieces of art crafted out of leather. You just can’t fail to fall in love with them. The exquisite designs of MK handbags make you swoon over them. Its stylish and chic appearance makes you drool. And you will find it hard to resist the temptation to make one of them your own. Well, we want you to succumb to this temptation. Surrender to it without even an iota of remorse or guilt and enjoy the comfort and style of Michael Kors handbags. You can select from an amazing range of eclectic MK handbags online and become a proud owner of this valuable possession with ease. Buying MK handbags online from our website is convenient and hassle- free. You don’t need to waste your precious time meandering along the shopping aisles or waiting in never- ending lines. You can possess your sleek and sophisticated Michael Kors handbags online while relaxing at the comfortable and cozy environs of your home. And we assure you that you won’t be disappointed about buying a Michael Kors. If we say that Michael Kors always satisfy you, it will be a huge understatement. It not only satisfies you, it goes one step ahead and delights you in a surreal manner. So be ready to flaunt your confidence unabashedly! Go for MK handbags rather than wasting your hard- earned money on schlock. Always prefer quality to inferiority. It’s your life. Live it large. Make your friends envious by becoming a fashion icon for them. Let the world follow you†¦. So why are you waiting for? Don’t waste time. Go online and browse through the wide variety of exquisite MK handbags we have to offer and choose the one that your heart craves for. And you can own your heart’s desire with the help of a few clicks of the mouse. Well, it do not get much easier than this. And this is the right time to become a proud owner of an MK handbag. This is the right moment for you to bask in the splendor, class and aesthetics of those beautiful creations of fine craftsmanship. And you can possess them online without breaking a sweat. Isn’t it wonderful? So grab your Michael Kors today and fill your life with bliss!

A study into Biodiesel as an alternative fuel

Except for hydroelectricity and nuclear energy, the majority of the present-day world’s energy needs are fulfilled by fossil fuels such as petrochemical fuels, coal and various natural gases. These fossil fuels sources are finite and judging from the current usage rates are in danger of depleting shortly.Also the two renewable sources used currently i.e. hydroelectricity and nuclear energy cannot be used as fuels in transport vehicles majority of which are run using fossil fuels. Because of the large and increasing levels of energy requirement demands in both the industrial and domestic sector, as well as the increased pollution problems because of using fossil fuels have made it necessary to develop renewable energy sources that would last limitlessly and would cause less harm to the environment than the traditional fossil fuels.This requirement has fueled the interest in alternative sources to petroleum-based fuels. One such alternative is to use oils of plant origin which i s known as biodiesel. Biodiesel is a biodegradable and non-toxic fuel and has low emission profiles as compared to petroleum diesel (Meher, Vidyasagar & Naik, 2004:249-250).Using converted vegetable oils and animal fats as an alternative to Petrol-Diesel fuel has been around for decades. In fact the use vegetable oil for diesel engines is almost as old as the diesel engine itself. The original Diesel engine was designed to run on cheap vegetable oils.The engine was commonly demonstrated running on peanut oil. Most of the present day diesel engines can in fact run on biodiesel without using any special equipment. The importance of biodiesel as an attractive fuel is increasing due to the depletion of fossil fuel resources (Knothe, Dunn & Bagby, n.d:1).This dissertation is a study into the use of biodiesel as an alternative to petroleum-based fuels by focusing on the various aspects of biodiesel and its use.The study will focus on understanding the various reasons for going in for alte rnative fuels in detail, study the engine performance using biodiesel fuels, assess the compatibility of biodiesel and fossil fuels, study the production process of biodiesel in detail, analyze the emission levels using biodiesel as fuel, and study the advantages and limitations of using biodiesel.What is Biodiesel? Biofuels can be defined as liquid fuels produced from biomass for either transport or burning purposes. They can be produced from agricultural and forest products, and biodegradable portion of industrial and municipal waste.It is generally held that biofuels offer many benefits, including sustainability, reduction of greenhouse gas emissions, and security of supply. Various scenarios have led to the conclusion that biofuels will be in widespread use in the future energy systems. Biofuels can be converted into liquid and gaseous fuels through thermo-chemical and biological methods.Hence, a variety of fuels can be produced from biomass resources including liquid fuels such as methanol, biodiesel and Fischer-Tropsch diesel, and gaseous fuels such as hydrogen and methane. Biofuels are primarily use din vehicles but can also be used in engines or fuels cells for electricity generation. The figure below shows the types of biofuels.DefinitionsThe term biodiesel is a combination of two terms : the Greek word for life ‘bio’ and ‘diesel’ from the last name of the inventor Rudolf Diesel. The term refers to the diesel equivalent, processed fuel derived from biological sources. It is a cleaner-burning diesel replacement fuel made from natural and renewable sources such as new and used vegetable oils and animal fats. Biodiesel is the name for a variety of ester-based oxygenated fuels from renewable biological sources. It can be made from processed organic oils and fats.Chemically, biodiesel is defined as the monoalkyl esters of long-chain fatty acids derived from renewable biolipids. In general terms, biodiesel may be defined as a domestic, renewable fuel for diesel engines derived from natural oils like soybean oil that meets the specifications of ASTM (American Society for Testing & Materials) D 6751.While in technical terms, biodiesel is a diesel engine fuel comprised of monoalkyl esters of long-chain fatty acids derived from vegetable oils or ani mal fats, designated B100 and meeting the requirements of ASTM D 6751 (Demirbas, 2008:114; Shrivastava & Jain published in Kumar & Nehar 2007:32).Properties of BiodieselBiodiesel is a clear amber-yellow colored liquid with a viscosity similar to that of petrodiesel. Biodiesel is non-inflammable and in contrast to petrodiesel is non-explosive, with a flash point of 423K for biodiesel as compared to 337K for petrodiesel. Unlike, petrodiesel, biodiesel is biodegradable and non-toxic and also significantly reduces toxic and other emissions when burned in a fuel.However, it is more expensive than petrodiesel, which appears to be the primary factor in preventing its more widespread use (Demirbas, 2008:115). The figure below shows the main technical properties of biodiesel.

Analysis of “Dark Shadows” as a Gothic Masterpiece

Analysis of â€Å"Dark Shadows† as a Gothic Masterpiece To most, when asked to define what Gothic is, they will state that it is similar to any other story, just with more â€Å"darkness. † This is because Gothic stories all have a classic story line. First, there is the main character’s back story, if any is then told. Next, there are events that lead up to a horrible incident that is the climax of the story. Lastly, the character finds some way to fix the situation or free him- or herself from it. They might go insane, commit suicide, run away, or watch other characters perish. However, readers would be greatly mistaken if they thought that this was all that there is to a Gothic story; there is much more to the Gothic than meets the eyes. There are Gothic tropes that define this type of Literature from the rest, such as murder, groans, blood, or even an apparition. Even today, there are video games that have these Gothic tropes. According to Kirkland, games such as Silent Hill have â€Å"gloomy settings with a sense of forthcoming violence, spaces such as a haunted house, tombs and prisons, the contaminating influence of family curses, and revenge-driven ghosts† (107). These tropes have endured across time due to their effect on the human mind. And this can be seen no more than in Burton’s film, the 2012 version, Dark Shadows. Humans have a natural fear of the dark that has existed since the beginning of time. Centuries ago, people feared the dark because that was the time when they were most likely to get attacked by robbers. Some people even went so far as to capture starving, wild dogs and have them fenced in to help protect the house. Even today, people are wary of going outside at night due to the fear of getting robbed and/or killed. In Burton’s film Dark Shadows, it was filmed almost entirely at dusk or at night. Although he didn’t update the use of darkness in this Gothic story, he did use it very wisely. For example, in the film he made sure to have candles low to the ground to illuminate people’s faces from the bottom, causing them to appear ghoulish. He also made particular scenes more dark and dreary than others; while it would be sunny at the fishing docks, it was cloudy at the castle. This affected the audience by making them feel that the castle had something sinister hidden within it. Death is a huge fear for countless, as it has been for centuries. Long before embalming, people had no knowledge of what happened during or after death. At one point in history it was so common for people to be accidently buried alive, that next to every grave they put a bell with a string attached that reached down inside the coffin. If the person was alive and woke up, they would pull the string and someone would come to rescue them. Throughout the ages, death and its meaning has slowly changed. In Aikinari’s story, â€Å"The Chrysanthemum Vow,† death is portrayed as a way to free oneself from the confinements of life. When Akana was captured and imprisoned, he committed suicide in order to be able to travel to Samon as a ghost and fulfill his vow with him. In Dark Shadows, death was modernized by the use of the vampire named Barnabas Collins. Vampires have been a part of our society for generations. When someone dies, it is common for the body to bloat and for blood to leak out of the mouth, due to its decomposition. According to Gee, â€Å"a body decomposes in such a way that human teeth protrude like fangs† (8). Not being able to comprehend this, people would tell horror stories of vampires to try and explain what was going on. In Dark Shadows, Barnabas not only updated vampires, but also death. Unlike the original vampires, Barnabas became this monster not by the bite of another vampire but from the curse of a jealous witch, who also killed his fiance. This changed the view of death because death was something that Barnabas could not attain. Unlike his predecessors, he was immortal and couldn’t die. This caused him great pain since he could never be with his beloved again. Death became that which could free him and end his suffering. This also changed the anatomy of vampires. Classic vampires could be harmed with garlic or the light. While the light hurt him, he was able to merely wear a hat and cloak and not be harmed. However, there is still much more to Gothic Literature. According to Baldick, â€Å"For the Gothic effect to be attained, a tale should combine a fearful sense of inheritance in time with a claustrophobic sense of enclosure in space† (xix). A story can have Gothic tropes but not be Gothic. There are loads of books that have murders and ghosts that aren’t considered Gothic at all, like Harry Potter by J. K. Rowling. His parents were killed and there was a ghost trapped in the girl’s bathroom, but it isn’t Gothic at all. What makes a story Gothic is how it is told or portrayed. Sometimes, the scenes that are used are to make the viewers question what is righteous and what is wicked. Burton shows this with how he introduces his characters and their personalities. For the vampire Barnabas, he is portrayed not as monster but as an unfortunate soul who has a curse that he is trying to rid himself of. Instead of wanting to stay a vampire, he joins up with a local physician to try and find a cure to make him human again. However, he still kills humans and drinks their blood. This makes the audience question whether Barnabas is an evil vampire or a poor man with a curse due to this hidden identity. This is also shown with the witch Angelique. For her character, they portrayed her as being jealous that Barnabas chooses to marry someone else, instead of her. She curses him to become a vampire but later on states that she didn’t kill him because he only wanted his love and attention. Before she dies, she rips out her own heart and offers it to Barnabas. Showing this makes the audience debate on whether she is innocent deep down in her actions, or merely empty and insane. Insanity is another classic trope of the Gothic. Traditionally, insanity was shown as a way to become stronger or to become free. In â€Å"If You Touched My Heart† by Allende, Hortensia is caged by her lover. At first, they are in love and can’t be separated. However, Peralta soon forces her into a cage and keeps her there for several decades. In order to deal with the psychological trauma, Hortensia becomes insane to free herself. This is shown when she was â€Å"surrounded by hallucinatory spirits who lead her to other universes†¦ [traveling] through starry space† (523). By creating these illusions in her mind, she was able to free herself from the pain of growing old and hideous in that cage. In Poe’s story â€Å"The Tell-Tale Heart,† the unnamed main character goes insane due to his own thoughts. In the beginning of the story, he states how he is obsessed with this old man, but not insane. He states that, â€Å"it was not the old man that vexed me, but his Evil Eye† (498). This quote shows that the character originally had no aggression towards the old man, only his one pale blue eye. After he kills him and hides the body under the floor, he starts to hear a heartbeat. He concludes that it must be the old man’s heart. This is frightening because the reader is unsure what he is actually hearing. He could simply be hearing his own heartbeat, or imagining it all due to his guilt. In Dark Shadows, insanity is shown in a similar, yet different way. The film actually had two characters that were insane, the witch Angelique and Victoria. Angelique is depicted as going insane after her pure heart was broken by Barnabas. She only turned him into a vampire because she couldn’t stand to see him with another woman. Her insanity allowed her to become strong and have the strength to, in a sense, imprison the man who caused her pain. Victoria, on the other hand, was only considered insane by society. Due to her psychic ability in being able to see spirits, her family feared how others would view them and sent her away to be â€Å"fixed. † This demonstrates how insanity is not simply mental, but also what society deems as insane. However, not everything is clearly stated. Within Gothic Literature, there are hidden messages or symbolisms throughout the entire story. Knowing this allows the reader to think and look more deeply into each action and event that is occurring. For example, in Edgar Allen Poe’s â€Å"The Fall of the House of Usher,† when Roderick dies at the end of the story, the house crumbles to ruins. The house doesn’t crumble because it’s ancient; it symbolizes the end of the Usher’s bloodline. In â€Å"The Yellow Wallpaper† by Stetson, the main female character is moved to a house in the country for â€Å"bed rest. There, she is forbidden to write, think, and sometimes even speak. She starts to see a woman trapped in the wallpaper, shaking it at night and creeping around outside during the day. This symbolizes how the narrator feels trapped and wants to escape. At the end, she â€Å"releases† the woman from the wallpaper and becomes her. The narr ator could only be free by creating an alternate personality. In this story, her insanity helped set her free. Dark Shadows also has some symbolism of its own. When Angelique is dying, they show her breaking as if she is a porcelain doll. This demonstrates how even though she was evil she was also extremely delicate in her true nature. As her face broke, pieces fell and exposed a small hole into oblivion. This signifies how she was truly empty on the inside, nothing more than a doll. Although she was once a human with supernatural powers, her jealousy and obsessive love for Barnabas slowly took over and, over time, left her an empty shell of what she once was. She was unable to truly love Barnabas, because she was literally filled with both darkness and nothingness. At the end of the film, Barnabas finds Victoria standing on the ledge of cliff. She tells him that they are both different, and that she can only be with him if they are the same. He tells her that he can’t turn her into a vampire, so she jumps off the cliff. This symbolizes the difficulty and societal rejection of dating someone who is of a different class or race. For her, she couldn’t see how their relationship could work unless they were both vampires. She also felt that if she couldn’t be with him, then she had no reason to live and must die to free herself from the suffering. Gothic literature is not something that can be defined in a few simple sentences. As Rintoul points out, â€Å"Gothic coincides with an important interrogation of the cannon as a site of power, and with equally important work that links social and political conditions† (701). Gothic literature has tropes that have endured across time and can still be found in modern stories and games. However, these tropes don’t always stay the same; some have been modernized over the centuries. This can easily be seen in Burton’s 2012 film, Dark Shadows. Death was transformed from something terrifying to that which could set one free. The vampire changed from a wicked corpse to a miserable man who was cursed. Insanity also went through some changes. At first, it could set one free from pain. In Dark Shadows, insanity morphed into something that was not only mental, but what society deemed as insane. The symbolism throughout the movie also added depth to seemingly simple scenes. Dark Shadows is a perfect example of how the Gothic has changed through the ages and thrived. Works Cited Allende, Isabel. â€Å"If You Touched My Heart. † The Oxford Book of Gothic Tales. Ed. Chris Baldick. Oxford: Oxford University Press, 2009. 519-526. Print. Baldick, Chris. â€Å"Introduction. The Oxford Book of Gothic Tales. Ed. Chris Baldick. Oxford: Oxford University Press, 2009. xi-xxii. Print. Gee, Joshua. Encyclopedia Horrifica. Hong Kong: Scholastic, 2007. Print. Kirkland, Ewan. â€Å"Gothic Videogames, Survival Horror, and Silent Hill Series. † Gothic Studies14. 2 (2012): 106-122. Print. Rintoul, Suzanna. â€Å"Gothic Anxieties: Struggling With a Definition. † The Journal of Eighte enth-Century Fiction. 17. 4 (2005): 701-709. Print. Sova, Dawn. â€Å"The Tell-Tale Heart. † The Complete Tales and Poems of Edgar Allen Poe. Ed. Dawn Sova. New York: Barns Noble, 2006. 498-501. Print.

Gender Roles in Disney Animation Essay Example | Topics and Well Written Essays - 1000 words

Gender Roles in Disney Animation - Essay Example However, follies of young women can come with great consequences that help build character strength and self-confidence in the long run. This is a message that the company clearly supported through their publicity and marketing campaign for the movie. From Disney’s first full length animated features Snow White and the Seven Dwarfs to their succeeding films, Cinderella, Sleeping Beauty, Beauty and the Beast, Aladdin, Pocahontas, and Mulan, all of these films share something in common with The Little Mermaid. It is a close marketing strategy that ties in closely with the production values promoted by the movie. This campaign has made Disney seem, in the public eye a company that sees gender causes as a commercial issue more than anything else. This, perhaps, has something to do with the unparalleled success of Disney in both the animated film and merchandising sales arena. It was in 2001 when Disney created the Princess line that aggressively targeted and marketed products to l ittle girls and young women. The line was composed of the aforementioned eight traditional Disney Princess films each turning in a huge profit and marketing franchise for each as well. All eight movies are proven to have a strong influence on children in terms of developing concepts of social behavior and norms (Graves 724-5). However, it is The Little Mermaid in particular that struck a chord with the little girls looking for a strong feminine image model that they could identify within our contemporary society. The original Little Mermaid story by Hans Christen Andersen had its main character Ariel suffer a tragic fate as chose to love a man she could never have. In the original, Ariel died carrying an unrequited love to her watery grave with her. As with other fairy tales of its era, the original meant to serve as a warning to young women. It was meant to help control rather than empower them. Disney never believed that fairy tales should have tragic endings which is why their re telling of the fairy tale is a far cry from its original. In the Disney version, we see a playful and oftentimes strong-willed blossoming young lady in Ariel, the little mermaid. She falls in love with a prince whom she saved from drowning. The mere fact that Ariel interacted with human beings and even worse, fell in love with one, was in direct defiance of the edict of King Triton, her father.  

Newcastle College international strategies and beyond with respect to Essay

Newcastle College international strategies and beyond with respect to India - Essay Example the validity of the hypothesis that the marketing strategy that has been most lucrative in the case of New Castle College in India has been one that is distinct from one that New Castle College generally employs and has been tailored for the Indian consumers. Over time, numerous colleges based in the United Kingdom have established their campuses in the Asian region (Cornuel 2005). Most notable of these ventures have been those that have been established in developing counties such as India where ventures such as these are being welcomed by local and federal governments (Aggarwal 1982). However, these colleges have observed that there is a stark difference between the marketing strategy that they use in the United Kingdom and the one that they should use in India (Trade and Industry Committee, Great Britain Parliament and House of Commons 2006). This difference has been attributed to the trends towards education that are found in the Indian populace. It is for the same reason that this paper shall use the case of the Indian campus of New Castle College and shall highlight the marketing strategy that New Castle College adopted in India in order to gain a better understanding of the same fact. The paper shall take advantage of publications such as Imagining Marketing: Art, Aesthetics, and the Avant-garde by Brown and Patterson, Geography of marketing and commercial activities in India: documentation on research information by Dixit, International Marketing Strategy: Analysis, Development and Implementation by Doole and Lowe, Marketing across cultures in Asia by Gestelanda and Seyk, Marketing library and information services: international perspectives by Gupta and other similar publications. A complete list of readings that will be used in the research can be found in the suggested readings list at the end of this research proposal. The research shall initiate by considering literature that pertains to the marketing of academic institutions in foreign regions

The Trusted Traveler Program Essay Example | Topics and Well Written Essays - 1000 words

The Trusted Traveler Program - Essay Example The â€Å"Trusted Traveler" program in essence was made to facilitate the frequent flyers that could include all the business entrepreneurs, government officials and employees as well as other selected individuals who could get their easy way off as regards to airport security checks. The Trusted Traveler program is undoubtedly a good idea when we literally think about it in the first go, but it is also a source of problems on the part of the security people who are present at the airports and are responsible for everything as they are at the helm of affairs when we talk about security and its long checks. This program can have its disadvantages if say for instance a terrorist gets hold of a Trusted Traveler card, would he or she still be unstoppable. The same goes true if he or she is carrying some explosives or weapons on board, would the person be allowed to board the flight? There are serious questions that can be posed with respect to the Trusted Traveler program. The â€Å"Trusted Traveler† program is in the process of being studied thoroughly by the American Senate and would soon, hopefully is put into practice so that American flyers could get extra privileges when they think of security and ease of actions at the airport and within the flights. The reason why this program has not been approved as yet owes to the fact that there are a number of glitches and loopholes through which terrorists and criminals can run off scotch free, thus delaying the whole process. Once these problems are addressed in the broader context of the airline security and with meticulous attention paid to the ease of the passengers, this program would pretty surely be in place for one and all to enjoy and witness at the airports, in the coming times. As regards to passenger authentication, it usually entails the corroboration of passenger ID, which includes from his beginning as a passenger is transited through the airport and

Why Control Development Research Paper Example | Topics and Well Written Essays - 2000 words

Why Control Development - Research Paper Example Control development is such a scheme. Emphasis is given on answering the following question: ‘Why control development?’, meaning the reasons for the superiority of control development towards other concepts and mechanisms of similar role. Through the review of the literature published in the particular field it has been proved that control development can significantly help towards the improvement of urban planning; however, it would be necessary for certain terms to be met. In the long term, the effectiveness of control development cannot be guaranteed, being influenced by the social and economic trends that are likely to change overtime. In any case, control development is the most credible process for securing the quality of urban planning and for this reason it should be preferred by urban planners when having to address various social, economic or spatial challenges. 2. Planning Theory Various approaches have been used in the literature for describing the role and the value of planning, as a theoretical concept with important implications on town planning worldwide. In accordance with Lichfield (1998) the theory of communicative planning best reflects the context of planning as the basis for the design of cities and communities worldwide. The above theory is based on realities, as the main element of planning; it is explained that these realities are depended on the life of people within a particular community and the needs of this community. It is implied that planning, as a theory, is a reflection of daily human needs – referring to people as members of a community. From a similar point of view, Sorensen (1999) notes that the first signs of town planning and control development can be identified in the academic movement based on the views of 19th century philanthropists; it is explained that the academic writers who based on these views emphasized on the need for ‘rational public control for urban development’ (Sorensen 1999, p.147). The above theory is characterized as socialist aiming to achieve the following targets: protection of the interests of the working class, of ensuring the expansion of public housing and ‘the increase of the power of citizens to participate in urban management’ (Sorensen 1999, p.147). The above theory was opposed by the revisionists, who emphasized on the value of privatization of public assets and the limitation of public housing – highlighting the importance of private capital for defining the terms of housing and the urban planning in modern cities (Sorensen 1999). This trend is reflected in Cities for Sale of Sandercock; in the above book reference is made to the power of the state to set the rules for urban planning and to prevent the private sector from highly intervening in the town planning process (Sorensen 1999). However, concerns are developed regarding the effects of the limitation of private funding in various public projects. The revisionist approach in town planning has been opposed by the idealism, a theoretical trend that has been partially based on socialist and revisionist theories for explaining the context and the value of town planning. In accordance with the idealism approach on town planning, ‘planning should be based on a ‘

Phase 4 Individual Project 4 Coursework Example | Topics and Well Written Essays - 500 words

Phase 4 Individual Project 4 - Coursework Example The first step would be to develop or at least design various initiatives that might help the local community. This way the company will show the acknowledgment of its role in the setting where it operates and will act accordingly (Mullerat, 2005). Furthermore, it will make connections with other companies in the local scene and this way becomes an integral part of the setting. The next step should focus on the environmental problems that the community experiences. There are several reasons for that. First of all, it is rather difficult to find a community that does not have environmental problems; that is why it often becomes one of the major concerns on the local level. Secondly, by paying its attention to the environmental problems of a community, a company will show its commitment to stay in it for quite a long period of time. The next step that a company should perform to improve its image is to become a role model for other, smaller companies. By doing so, the former will show that it is willing to cooperate and become a valuable contribution to the local scene. Of course, this step requires existence of successful programs that will inspire others. This might be regarded as a motivation for successful completion of the projects. Indeed, it is rather difficult to improve ones image without playing an active role as a leader. The last step should focus on explaining that the environment interest of the local community prevails over corporate interests of the company. This is a sure way to show commitment to sustainable development which is highly praised by the contemporary companies (Pearce & Barbier, 1990). This will be a statement which says that a company does not employ the old ideology of maximizing the return on investment at any cost, but acknowledges its potential impact on the local level, including the environment. Having examined all the points which were mentioned in

The Problems in Human Patterns of Consumption Essay

The Problems in Human Patterns of Consumption - Essay Example All the sub-topics will support the main subject matter, which are the human patterns and quantities of consumption. By the end of the research paper, all points taken will be analyzed into a conclusive synthesis. As for now, this will be a comprehensive summary and exposition of the research at hand. This will explain the rationale behind the choice of the research topic and the relevance it has in the real world. The topic focuses on the issues that human patterns of consumption have affected negatively the status of the natural environment. There are serious and grave problems that produce unrestrained human patterns of consumption. Environmental research has indicated that human consumption of natural resources is outpacing the capacity which the Earth can produce. It does not help that while this fact is being overlooked by most of the world’s population, it seems that human needs and wants are taken as more important than environmental concerns. Historically, the problems in human patterns of consumption were more apparent during the age of human modernization and industrialization. As human technological development started to improve, so did the rate of consumption by human beings on the environment. As human populations started to grow by the thousands and millions per day, the increasing demand for human wants and needs are multiplied exponentially. This is manifested through different negative effects on the natural environment. As human populations grew, so did the necessity to expand for shelter become more apparent. Towns would expand to become cities, and cities would become a sprawling metropolis. The materials needed to pursue this task would require so many natural resources to get this done. Many trees would require being lumbered or cut down to construct buildings, houses and fixtures for shelter and commercial use. At the same time, many natural wilderness areas would have to be cleared out to provide  land for human shelter and consumption.

Napoleon was successful because his enemies were incompetent Essay Example for Free

Napoleon was successful because his enemies were incompetent Essay Napoleon was successful because his enemies were incompetent and divided. How far do you agree? Napoleon was one of the most successful military leaders Europe has ever seen; his leadership of the French army saw him control much of continental Europe. Napoleons enemies did give him a great advantage during his success through their incompetence and divisions. However the weaknesses of Napoleons opposition was not the only reason why he was so successful. One must also look at other reasons to why Napoleon had so much success. Napoleons enemies had old-fashioned, slow and immobile tactics when fighting Napoleon, this made it easier for Napoleon to defeat them, as his army was quick and mobile. This inability to produced new tactics was exposed at the Battle of Ulm in 1805. The Prussians were fighting Napoleon, they were slow and immobile, and as a result lost 45,000 men, Napoleon was able to easily expose their immobility. Napoleons enemies showed were divided and not united together as they failed to join together and forge a successful alliance against Napoleon. The Second Coalition of 1799 is an example of their incompetence to join together against Napoleon. It was between Britain, Russia, Austria and the Ottoman Empire. However it was made up of a series of separate alliances, which meant there was no single aim. Soon there was political fallout between Russia and Britain over Malta, which meant the coalition was effectively disbanded. The fallout allowed Napoleon to interfere and get Russia on side, and then bully Austria into the Peace of Luneville. Although it can be seen that Napoleon was successful in divide and rule as he was able to split the allies and forge a separate alliance, this failed coalition also shows the incompetence of Napoleons enemies to united against him. Napoleons enemies also saw him as infallible and this meant they would enter a battle against him with fear and often gave him too much respect. Evidently Napoleons enemies incompetence and divisions did play a part in his success, they had poor tactics and could not unite against him. However in order to analyse how far his enemies incompetence and divisions led to Napoleons success, one must also look at other factors which led to Napoleons success. Napoleons himself and his leadership of the French army is a key reason for his success. When Napoleon took command of the French army, he reorganised it and took lead of the whole army himself. The army was divided into corps of 25,000 to 30,000 soldiers, which increased the armies mobility. Napoleon controlled the whole army and decided every move on the battlefield. This along with the mobility of the army, allowed him to make fast decisions and his army were able to respond quickly. To increase speed and mobility Napoleon also introduced living off the land which meant his soldiers carried a limited supply of food and clothes and were encouraged to loot as they marched. This meant his men could travel from 12 to 15 miles a day. In another effort to increase mobility Napoleon also used horse artillery. Napoleon had great qualities as a military general; he would formulate a general plan of action before any battle and calculate all the possibilities. He did this at Austerlitz in 1805 to great effect. He engaged the Russians, but kept a large reserve, which allowed him to roll to victory. Napoleon was also a quick thinker and was able to improvise by using his mobile army to take advantage of enemy mistakes. This can be seen at the Battle of Ulm in 1805, where he improvised by making a quick decision to send marshal Murat in pursuit of the Austrians, which reduced their numbers from 70,000 to 27,000. Napoleon possessed great charisma. Wellington said of him his presence in the battlefield is worth an extra 40,000 men. He would fight alongside his men, which inspired his men and gained him respect. He did this at the Battle of Austerlitz in 1805, when times got hard for his soldiers. He also used emotional, theatrical language in his Daily Bulletins, to inspire and arouse the passions of his troops. This ability to inspire his troops meant he got the best out of his men at all times, increasing his chances of victory. Napoleon also understood the importance of paying his men in coin money as appose to paper money, as it did not depreciate in value. He also allowed them to loot as they conquered new lands. This boosted morale as his soldiers were payed well and it also meant they respected him. Napoleon would also play to his strengths, and as he had a weak navy, he never fought naval battles. Another skill of Napoleon was his ability to incorporate other peoples tactics into his own army with great effect. For instance he took military thinker Guiberts tactic of mixed order (a combination of lines and columns of men), and incorporated it into the army. It had a great impact as it increased mobility and meant they were less vulnerable and predictable. Although it was not his idea, Napoleon did incorporate into his army to great effect. Evidently Napoleons military skills and leadership of the French army was another reason for him been so successful. He possessed great skills such controlling the whole army, planning ahead and improving to take advantage of enemy mistakes. He was also brilliant at getting the best out of his troops through his charisma and incorporating other peoples tactics to great effect. Another reason that must be analysed in order to establish why Napoleon was so successful is the strength of the French army he inherited when he came to power. Due to conscription introduced in 1793 before Napoleon was in power, the French army was by far the largest in Europe. By 1805 it consisted of around 600,000 men. This was an obvious a great advantage to Napoleon, it enabled him to change the nature of warfare to levee on masse. The size of the army allowed him to surround enemies as he did at the twin battle of Jena-Auerstadt where by surrounding the Prussians, made them face on the wrong way when battle began, as a result they lost 45,000 men. Napoleon was also able to take huge losses himself, as on average he took on 73,000 new conscripts. Napoleon also inherited the experienced soldiers that had fought in the Grande Armee during the French revolution; these men were of great value. So evidently Napoleon was assisted in his success, as he inherited a huge army, which gave him the edge against the smaller, weaker armies of his enemies. So although Napoleon was assisted by the incompetent and divided nature of his enemies, other factors also had a great contribution in his success, particularly his military skills and leadership. Without possessing great skills he would have not been as successful. It was his skills, which allowed him to take advantage of the weakness of his enemies, and the army he inherited and as a result have so much military success.

Permanent Vascular Access For Hemodialysis Health And Social Care Essay

Permanent Vascular Access For Hemodialysis Health And Social Care Essay Introduction: A progressive rise in the number of patients accepted for renal replacement therapy has been reported world wide . Permanent vascular access (VA) is the life-line for the majority of these patients, when hemodialysis is the treatment of choice. Thus, the successful creation of permanent vascular access and the appropriate management to decrease the complications is mandatory. A well functional access is also vital in order to deliver adequate hemodialysis therapy in end stage renal disease (ESRD) patients. Unfortunately, despite the advances in hemodialysis technology, in the field of vascular access in the last years the introduction of the polytetrafluoroethylene (PTFE) graft and the cuffed double lumen silicone catheter were the only changes. But the cost of vascular access related care was found to be more than fivefold higher for patients with arteriovenous graft (AVG) compared with patients with a functioning arteriovenous fistula (AVF) . It seems that the native arteriovenous fistula that Brescia and Cimino described in 1966 still remains the first choice VA . Thereafter, vascular access still remains the Achilles heel of the procedure and hemodialysis vascular access dysfunction is one of the most important causes of morbidity in this population . It has been estimated that vascular access dysfunction is responsible for 20% of all hospitalizations and the annual cost of placing and looking after dialysis vascular access in the United States exceeds 1 billion dollars per year . Nowadays, three types of permanent vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and cuffed central venous catheters. They all have to be able to provide enough blood flow in order to deliver adequate hemodialysis, have a long use-life and low rate of complications. The native forearm arteriovenous fistulas (AVF) have the longest survival and require the fewest interventions. For this reason the forearm AV, is the first choice, fol lowing by the upper-arm AVF, the arteriovenous graft (AVG) and the cuffed central venous catheter as a final step . History of vascular access Vascular access for hemodialysis is closely associated with the history of dialysis. Glass needles were employed as vascular access when hemodialysis came into view in 1924. The first haemodialysis treatment in humans was carried out by Haas G who used glass cannulae to acquire blood from the radial artery and reverting it to the cubital vein . Venipuncture needles were used as means for blood acquisition from the femoral artery and its reinfusion to patient by vein puncture, in 1943 by Kolff W. . Regular hemodialysis treatments were possible in 1950s through the use of a medical apparatus ( Kolff s twin-coil kidney ), thus projecting the problem of a reliable, capable of repeated use vascular access. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1952, Aubaniac had described the puncture of the subclavian vein . In the 60s, by using Alwalls experience, Quinton, Dillard and Scribner developed arteriovenous Teflon shunt . This procedure involved two thin-walled Teflon cannulas with tapered ends were inserted near the wrist in the forearm, one into the radial artery and the other into the adjacent cephalic vein. The external ends were connected by a curved Teflon bypass tube. Later, the Teflon tube was replaced by flexible silicon rubber tubing. After the advancement of permanent vascular access, the possibility of maintenance hemodialysis was a fact and therefore a groundbreaking procedure. In the subsequent years many variants of the AV shunt were used, with the majority of them concerning temporary vascular access from the onset of chronic dialysis treatment compensating for the time of AV fistulas absence or maturity. In 1961, Shaldon performed hemodialysis procedures by inserting catheters into femoral artery and vein, using the Seldinger-technique . Over time, vessels in different sites were used, including the subclavian vein jugular and femoral. In 1962 Cimino and Brescia described a simple venipuncture for hemodialysis . In 1963 Thomas J. Fogarty invented an intravascular catheter with an inflatable balloon at its distal tip designed for embolectomy and thrombectomy . The first surgically created fistula was placed in 1965, followed by further 14 operations in 1966. In 1966 Brescia, Cimino, Appel and Hurwich published their paper about arteriovenous fistula. Appell had performed a side-to-side-anastomosis between the radial artery and the cephalic antebrachial vein. One year later, in 1967, M. Sperling reported the successful creation of an end-to-end-anastomosis between the radial artery and the cephalic antebrachial vein in the forearm of 15 patients using a stapler . In the next few years this type of AV anastomosis received popular approval. However this procedure was cast aside as first choice AV, due to the increasing numbers of elderly, hypertensive and diabetic patients with demanding vessels and high risk of a stea l syndrome. End-to-end-anastomoses are still a common place technique in revision procedures. In 1968 Rà ¶hl L. published thirty radial-artery-side-to-vein-end anastomoses . After anastomosis was performed, the radial artery was ligated distal to the anastomosis, thus resulting in a functional end-to end-anastomosis. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1970, Girardet R. and Brittinger W.D. described their experience with the femoral vein and artery for chronic hemodialysis. Experimental trials have been done by several authors in order to establish a permanent vascular access using subcutaneous tunnel. Brittinger W. was the first to implant a plastic valve as a vascular access in an animal model but unfortunately his efforts did not proceed to a human one . Moreover during the early 70s, Buselmeier T.J. developed a U-shaped silastic prosthetic AV shunt with either one or two Teflon plugged outlets which communicated to the outside of the body. The U-shaped portion could be totally or partially implanted subcutaneously . Subsequ ently pediatric hemodialysis patients were extremely favored by this procedure. New materials for AV grafts were presented in 1972, one biologic and two synthetic.. In 1976, L.D. Baker Jr. presented the first results with expanded PTFE grafts in 72 haemodialysis patients . In the years to come several publications indicated the benefits and the shortcomings of the prosthetic material in question remaining the primary choice of graft for hemodialysis VA to date. The same year two authors, Mindich B. and Dardik H. had worked with a new graft material: the human umbilical cord vein. . Regrettably so, this material did not succeed in becoming a revolutionary graft material due to its inadequate resistance against the trauma of repeated cannulation and their complication (aneurysm and infection). After the subclavian route for haemodialysis access was firstly introduced by Shaldon in 1961, it was further processed in 1969 by Josef Erben, using the intraclavicular route . In the next 20 y ears or so, the subclavian vein was the preferred access for temporary vascular access by central venous catheterization. Today, due to phlebographic studies revealing a 50% stenosis or occlusion rate at the cannulation site, subclavian route has been discarded. The subclavian stenosis and occlusion predispose to oedema of the arm, especially after creation of an AV fistula . The first angioplasty described by Dotter et al who introduced a type of balloon, was immensely conducive to the resolution of one of the most significant predicaments in vascular surgery and vascular access surgery . In 1977 Gracz K.C. et al created the proximal forearm fistula for maintenance hemodialysis, a variant of an AV anastomosis . An adjustment of this AVF became quite significant in the old, hypertensive and diabetic patients on the grounds that it allows s a proximal anastomosis with a low risk of hypercirculation . In 1979 Golding A.L. et al developed a carbon transcutaneous hemodialysis access device (CATD), commonly known as button, as a blood access not requiring needle puncture . As a procedure of third choice, these devices were expensive and never gained widespread acceptance. Shapiro F.L. described another type of A.L. button, a device similar to that developed by Golding . Angioaccess classification Years after the initial efforts to create the appropriate vascular access in order to perform a safe hemodialysis, modern Nephrologists have now the possibility to select the appropriate access for their patients. So the first distinction is made between temporary and permanent VA . Temporary VA with expected half-life less than 90 days, peripheral arteriovenous shunts and non cuffed double lumen catheters are included . Mid-term VA with expected half life in 3 months to 3 years include veno-venous accesses (tunneled cuffed catheters and port catheter devices) and arteriovenous internal shunts, requiring vascular graft synthetic (PTFE) or biologic (saphenous vein, Procol, etc.) material ,or external shunt. Long-term VA with an expected half-life more than 3 years includes virtually the native arteriovenous fistulas and the new generation of PTFE grafts . Acute hemodialysis vascular access They are used for urgent hemodialysis and should be easy to insert and available for immediate use. Currently there are available two types of such accesses: Non-tunneled dialysis catheters and cuffed, tunnelled dialysis catheters. Double-lumen, non-cuffed, non-tunnelled hemodialysis catheters are the preferred method for immediate hemodialysis when a long term access is not available. They are made of polymers which are rigid at room temperature to facilitate insertion but soften at body temperature to minimize vessel injury and blood vessel laceration. The proximal and distal lumens should be separated by at least 2 cm to minimize recirculation . These catheters can be inserted into the central veins: femoral, jugular, or subclavian veins . The femoral artery can be used as an access central vein when all others central veins have been excluded. A modified Seldinger guide wire technique is used for their insertion. Image guided assistance in placing these catheters is recommended to avoid or minimize some of the immediate insertion complications, but non-cuffed catheters are also suitable for use at the bedside of the patient The 2006 National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines recommend, after internal jugular or subclavian vein insertion, identifying radiographically any potential complications and confirming tip placement prior to either anticoagulation or catheter use . These guidelines also recommend ultrasound vessel identification prior to insertion. In general, now the subclavian catheters should be avoided because of the high incidence of vein stenosis and thrombosis. The maximum blood flow with this class of catheters is usually blood pump speeds of 300 mL/min, with an actual blood flow of 250 mL/min or less . Femoral catheters have to be at least 18 to 25 cm in length in order to have lower recirculation. The routine use-life of these catheters varies by site of insertion. In general, internal jugular catheters are suitable for two to three weeks of use, while femoral catheters are usually used for a single treatment (ambulatory patients) or for three to seven days in bed bound patients . However, the KDOQI guidelines suggest that non-cuffed, non-tunnelled catheters be used for less than one week and that cuffed, tunnelled catheters be placed for those who require dialysis for longer than one week . More recently a non-cuffed, non-tunnelled triple-lumen dialysis catheter has been developed. The purpose for third lumen is for blood drawing and the intravenous administration of drugs and fluid. In a multicenter, prospective study, blood flow rates and infectious complications were similar with double lumen catheter . Infectious complications are the principal reason why the catheter must be removed. Permanent Vascular Access Taking into consideration patient factors such as life expectancy, comorbidities, and status of the venous and arterial vascular system is very important in order to prescribe the appropriate access. Other factors are determined by the type of access itself, as arteriovenous fistula (AVF), arteriovenous graft (AVG), or TC which have a different effect on circulatory system. Also the duration of their functionality and the risk for infection and thrombosis are important factors to consider. Each type of surgical anastomosis has advantages and disadvantages . In 2002 the American Association for Vascular Surgery and the Society for Vascular Surgery published reporting standards according to which three essential components of VA should be mentioned: conduit (autogenous, prosthetic), location and configuration (strait, looped, direct, etc.) . Arteriovenous fistula An AVF is the preferred type of vascular access; it has the lowest complication rates for thrombosis (~ one-sixth of AVGs) and infection (~ one-tenth of AVGs) . There are 3 types of AVF s: à ¢Ã¢â€š ¬Ã‚ ¢ First type when artery and vein are connected in their natural position, either with a side-to-side or a side-artery-to-vein-end anastomosis. à ¢Ã¢â€š ¬Ã‚ ¢ Second type, where a vein is moved to connect to an artery in end-to-side fashion to either bridge a larger anatomical distance, or to bring the vein to the surface where it is accessible for cannulation and requires a tunnel to position the vein in its new location. à ¢Ã¢â€š ¬Ã‚ ¢ Third type where a vein is removed from its anatomical location and, is connected to an artery and vein in end-to-end fashion. Both second and third type requires the formation of a tunnel . End-to-end anastomoses are now rarely performed, since the complete disruption of the artery imposes a risk for peripheral ischemia and thrombosis. The most common surgical technique today is the side-to-end anastomosis. However technical problems as cutting the end of the vein in an oblique angle may create functional problems due to stenosis. An anastomosis more proximal in the arterial system should be smaller to prevent steal and limit maximal fistula flow, with the inherent complication of ischemic steal or heart failure . Arteriovenous fistula creation is often performed under local anaesthesia, with low morbidity and requires time for maturation. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that AVFs should mature at least 14 days before use . Fistula size and flow increase over time, of 8-12 weeks and the initial blood flow rates has a range of 200-300 mL/min. Placement of AVFs should be initiated when the patient reaches CKD stage 4, or within 1 year of the anticipated start of dialysis. A physical examination should document blood pressure differences between the upper extremities and an Allen test should be performed, the lack of a well-developed palmar arch predicts a higher risk for vascular steal symptoms if the dominant artery is used for forearm fistulas creation due to inadequate collateral circulation . Ultrasound must be done before surgical implantation because it can provide information for maximal surgical success by mapping arteries and veins; eg, a preoperative arterial lumen diameter >2 mm is associated with successful fistula maturation, while a diameter of 600 mL/min, a diameter >0.6 cm with discernible margins, and be at a depth of 0.6 cm (between 0.5 and 1.0 cm) from the surface 6 weeks after creation. In fistulas that are maturing successfully, flow increases rapidly post-surgery, from baseline values of 30-50 mL/min to 200-800 mL/min within 1 week, generally reaching flows >480 mL/min at 8 weeks .The AVFs must be evaluated 4-6 weeks after placement, and experienced examiners (eg, dialysis nurses) can identify non-maturing fistulas with 80% accuracy . Arteriovenous graft AVGs were the most commonly used type of dialysis access in the US however, they do not last as long as AVFs and have higher rates of infection and thrombosis . Grafts present a second choice of VA when AVF are not able to be performed because of vascular problems. They can be placed in the forearm, the upper arm, and the thigh, and can have a straight, curved, or loop configuration. They may offer a large surface area for cannulation. AVGs can be cannulated about 2-3 weeks after placement, although there are studies suggesting that immediate assessment after placement for PTFE AVGs is possible . This interval is needed in order to allow the surrounding tissue to adhere to the PTFE conduit, to reduce the postsurgical oedema and the risk for local complications such as perigraft hematoma and seroma . Tunnelled hemodialysis catheter TCs are used when AVFs or AVGs arent possible to be created for several reasons such as multiple vascular surgeries, that lead to vascular thrombosis or when patients have severe peripheral vascular disease or very low cardiac output. Its more often in paediatric and very old patients. Unfortunately they are associated with the highest infection rate and they are not a very long-term access option. Studies have revealed that central venous catheters are colonized within 10 days of placement; however, colonization of the catheter biofilm does not correspond to positive blood cultures or clinical signs of bacteremia . Recently Power A. et al published their experience with 759 TCs. The survival rate at 1,2 and 5 years was 85%, 72% and 48% respectively. The infection rate was 0.34 per 1000 catheter day showing with careful and appropriate use of TCs, they can provide effective and adequate long term hemodialysis and rates of access related infection almost similar to AVGs . Hemodialysis vascular access in children The choice of replacement therapy in children is variable. The registry of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) reports that of patients initiating renal replacement therapy in paediatric centres : one quarter of children underwent preemptive renal transplantation, one half were started on peritoneal dialysis and one quarter were started on hemodialysis. Kidney transplantation remains the preferred therapy for paediatric patients therefore, many paediatric patients receive maintenance HD through an indwelling catheter in perspective of short HD period . In the United States less than 800 paediatric patients receive maintenance HD therapy, therefore surgical experience and clinical data for fistulae or grafts creation in small patients is limited due to rare need for such procedures. Smaller patients, especially those less than 10kg, are very demanding in surgical and nursing skill, this is significant reason the majority of smaller patients re ceive PD for their maintenance dialysis modality . Peritoneal dialysis is much more common in infants and younger children , significantly due to problems of vascular access. However, hemodialysis can be performed successfully in infants and very young children, as well . Children who will join in hemodialysis will need evaluation of their vasculature for placement of an arteriovenous (AV) fistula, arteriovenous graft, or cuffed double lumen catheter. The use of an AV fistula, the recommended type of vascular access in adults, is limited in children due to the size of their vessels. In the 2008 NAPRTCS annual report, vascular access for hemodialysis included external percutaneous catheter in 77.7 percent of patients, internal AV fistula in 12.3 percent, and internal and external AV shunt in 7.3 and 0.7 percent, respectively . K/DOQI has encouraged greater use of AV fistulas in larger children receiving hemodialysis who are not likely to receive a transplant within 12 months, with a goal of achieving more effective dialysis with fewer complications (eg, infection) than occurs with catheters. The choice of catheter size and configuration depends on the size of the patient. It is suggested by studies that in children as small as 4 to 5 kg a dual-lumen 8 Fr catheter can be well tolerated, and as the child becomes larger in size, a larger volume access can be placed . Vascular access should be able to provide sufficient blood flow and adequate dialysis with a Kt/V greater than 1.2. Kt/V is influenced further by the recirculation rate. Because flow rates in paediatrics vary by the size of catheter, which varies by the size of the patient, a recommended flow rate of 3 to 5 mL/kg/min is acceptable in most patients . Vascular access complications and Survival Studies have shown a mortality risk dependent on access type, with the highest risk associated with central venous dialysis catheters, followed by AVGs and then AVFs . The CHOICE study examined mortality based on access type in 616 hemodialysis patients for up to 3 years of follow-up. Central venous catheters and AVGs were associated with approximately 50% and 26% increased mortality, respectively, compared with AVFs with prevalence in men and elderly patients . Despite these findings and the KDOQI recommendations, dialysis access data from 2002-2003 showed that only 33% of prevalent hemodialysis patients in the US were being dialyzed via AVFs. Contrary in Europe and Canada, the majority of the patients (74% and 53% respectively) were being dialyzed via AVFs . Vascular access admissions continue to fall, with more procedures now performed in an outpatient setting, and are 45.1 percent below levels noted in 1993. By two-year time period, the adjusted relative risks of all- cause and cardiovascular hospitalization among hemodialysis patients vary little when compared to the reference period of 1997-1998; the risk of hospitalization for infection, however, is now 18 percent greater than in the reference period, while that of a vascular access hospitalization is 30 percent less. Among African American patients, the relative risk of an all-cause hospitalization or one related to infection is almost equal to that of white patients; the risk of a vascular access hospitalization, however, is 24 percent higher. In our previous work with 149 hemodialysis patients who had undergone 202 vascular access procedures (177 Cimino-Brescia fistulae and 25 PTFE grafts we found that the Cimino-Brescia fistula was used as the first choice of vascular access in all patients except one in the elderly group. PTFE grafts were the second or third choice in 7 patients younger than 65 and 15 in the elderly group (p: NS). The only reason for technique failure was vascular thrombosis in both groups (p: NS). Other complications were: aneurysms (10/48 and 14/101, p: NS), infections (0/48 and 2/101 p: NS) and oedema (0/48 and 6/101, p: NS). (Table à ¢Ã¢â€š ¬Ã‚ ¦.. Five-year technique survival of the first AV fistula in the two groups was 35% and 45% respectively (log-rank test, p: NS). (FIGUREà ¢Ã¢â€š ¬Ã‚ ¦..) Our findings suggested that there was no difference in vascular access complications across age groups and the survival of the first AV fistula is independent of age. Other encouraging results include a 22.9 percent fall in dialysis access admissions since 1999 for peritoneal dialysis patients, among hemodialysis patients, admissions for bacteremia/septicemia continue to rise sharply, reaching 112 per 1,000 patient years similar to the rate of 109 for vascular access infections, and possibly reflecting an increased use of cuffed catheters. In 2010 USRDS Annual Data Report hospitalization in 2008, increased again, to a point 45.8 percent above their 1993 level. In 2007-2008, women treated with hemodialysis were 16 percent more likely to be hospitalized, overall, than male. They also had a greater risk than men of cardiovascular, infectious, and vascular access hospitalizations 11, 14, and 29 percent greater, respectively. Recently unpublished our data are more different than those we published in 1998. We found in 189 patients that female had more possibility to start HD with double lumen catheter than male and also patients with heart failure ind ependent of sex. Female patients had PTEF grafts as first vascular access (p=0,023) and the elderly patients had more complications and more vascular access procedures (p=0.026). Non-tunnelled double lumen catheters complications The non-tunnelled double lumen catheters complications concern the insertion, the infection and thrombosis of the vessel. The severity and likelihood of insertion complications varies with the site of insertion. The complication rate and the severity are lowest in the femoral position. The primary problem is perforation of the femoral artery. Bleeding usually resolves within minutes of direct compression. Large femoral or retroperitoneal hematomas occur occasionally . Subclavian insertion complications are potentially more serious. Over-insertion of guide-wire can occasionally lead to atrial or ventricular arrhythmias. The vast majority of these are transient and hemodynamically insignificant . Penetration or cannulation of the subclavian artery can lead to hemothorax, which in some cases requires a thoracotomy tube. Cases of pericardial rupture and tamponade also have been described . Subclavian insertion from the left has an increased risk of atrial perforation which can present with acute hemopericardium upon initiation of dialysis. The incidence of pneumothorax varies from less than 1 percent to mor e than 10 percent of insertions, depending on the skill and experience of the physician. The risk of pneumothorax is greater from the left than right side, since the pleura and dome of the lung are higher on the left . Due to high rate of catheter-induced subclavian stenosis and subsequent loss of the ipsilateral arm for future hemodialysis access internal jugular vein insertion, particularly the right internal jugular vein is the preferred site of insertion. At internal jugular insertions carry a higher likelihood of carotid artery penetration, but a lower risk of pneumothorax (0.1 percent). Ultrasound guided cannulation of the vessel is recommended to minimize these complications. The location of the catheter tip in subclavian and internal jugular insertion should always be confirmed by fluoroscopy or x-ray prior to the initiation of hemodialysis or the administration of anticoagulants. Ultrasound-guided catheter insertion is lesser likelihood of arterial puncture or pneumothorax . Prevention and treatment of catheter thrombosis are important clinical issues. To prevent formation of thrombus, both lumens of the double lumen catheter are instilled with heparin following hemodialysis. The amount injected should only fill the catheter lumen to minimize systemic heparinization. Anecdotal evidence suggest that chronic anticoagulation with warfarin or low molecular weight heparin may also prevent catheter thrombus, due to either intraluminal clot or fibrin sheath formation . Lytic agents such as urokinase and alteplase are effective in treatment of catheter thrombosis. Alteplase has effectiveness rates in thrombosis treatment comparable to that observed with urokinase . However if non-cuffed catheters cannot have adequate blood flow then they should be exchanged. Ventral vein catheters are associated with the development of central vein stenosis . This complication appear s to occur more often with subclavian (40 to 50 percent of cases in some studies) than with internal jugular insertions (up to 10 percent) . It has been proposed that central venous cannulation creates a nidus of vascular injury and fibrosis. The rapid blood flows associated with the hemodialysis catheter then create turbulence that can accelerate endothelial proliferation, eventually leading to venous stenosis . The K/DOQI guidelines therefore recommend avoiding placement in the subclavian vein, unless no other options are available. If central venous thrombosis is detected early, it responds well to directly applied thrombolytic therapy or to percutaneous transluminal angioplasty when the fibrotic stenosis can be crossed with a guidewire . The infection risks associated with temporary double lumen catheters include local exit site infection and systemic bacteremia, both of which require prompt removal of the catheter and appropriate intravenous antibiotic therapy . Bacteremia gene rally results from either contamination of the catheter lumen or migration of bacteria from the skin through the entry site, down the hemodialysis catheter into the blood stream . Skin flora, Staphylococcus and Streptococcus species, are responsible for the majority of infections. There is conflicting evidence concerning the risk of infection based upon the site of insertion. In the largest prospective randomized study, the risk of infection was not reduced with jugular versus femoral venous catheterization . A prospective nonrandomized studies suggest that the infection risk appears to sequentially increase for hemodialysis catheters inserted into the subclavian, internal jugular, and femoral veins, respectively . Overall, compared with the subclavian vein, the internal jugular vein remains the preferred access site in ambulatory patients because of the high rate of central vein stenosis associated with subclavian vein catheterization (see above). In the Intensive Care Unit, either femoral or internal jugular vein placement is satisfactory, with the use of ultrasound making internal jugular vein placement safer. The best solution is to prevent the infection by proper placement technique, optimal exit site care and management of the catheter within the HD facility . Arteriovenous fistulas complications Complications of AVFs can be divided into early and late causes. Early causes include inflow problems such as small or atherosclerotic arteries, or juxta-anastomotic stenosis so a pre-operative evaluations for suitable access sites has to been performed . The aetiology of this acquired lesion is not entirely clear, but may be related to manipulating the free end of the vein, torsion, poor angulation, or loss of the vasa vasorum during anatomic dissection. This lesion often can be adequately treated with angioplasty or by surgical revision . Outflow problems may include accessory veins that divert blood flow from the intended superficial vessel to deeper conduits, or central venous stenosis in patients with prior central venous catheters. Vessels smaller than one-fourth of the fistula diameter are usually not hemodynamically relevant. Juxta-anastomotic stenosis and accessory veins are the most common causes for early failure AVFs when pre-operative evaluations for suitable access sites have been performed . Late causes for failure of AVFs include venous stenosis, thrombosis, and acquired arterial lesions such as aneurysms or stenosis. Venous stenosis may become apparent as flow decreases over time, worsening weekly Kt/V ([dialyzer clearance _ time]/body volume) or increasing recirculation. Native fistulas typically will not thrombose until flow is severely diminished. Static pressure measurements, which are helpful in graft monitoring, do not appear as helpful in AVFs, since collaterals surrounding the stenosis area often develop, effectively masking the rise in fistula outflow resistance. Stenotic lesions can be treated by angioplasty. Thrombectomy of fistulas, although technically more challenging than in AVGs, is often successful and if flow is re-established, primary patency is longer than in grafts . Aneurysms may form over the course of years as the fistula increases with increased flow and, unless associated with stenotic lesions, are more a cosmetic than functional concern. If the skin overlying the aneurysm is blanching or atrophic, or if there are signs of ulceration

Mourning and Melancholia in Hemingway’s For Whom the Bell Tolls Essay

Mourning and Melancholia in Hemingway’s For Whom the Bell Tolls Ernest Hemingway’s For Whom the Bell Tolls (1940) begins with a quotation from John Donne’s â€Å"Meditation XVII.† With this epigraph, Hemingway identifies the source of his title and defines the connections achieved between human beings through mourning.: Donne’s argument begins, â€Å"No man is an island,† and it concludes with an assertion of our bond to the dead: â€Å"never send to know for whom the bell tolls; it tolls for thee.† Proper mourning acknowledges the losses to our self in the death of another. Hemingway’s For Whom the Bell Tolls depicts such connections to the dead and examines the emotional effects of incomplete mourning in terms that parallel Freud’s own comments in â€Å"Mourning and Melancholia†(1917. Hogarth Press edition 1937). Hemingway’s novel about mourning concludes by depicting Robert Jordan, the American volunteer in Spain, as he prepares for his death. Jordan accepts the inevitability of this death and he designs a ritual which expresses his commitment to his lover, Maria, and contributes to the successful retreat of the members the guerrilla band (401-10). He provides a last effort of participation in their struggle against fascism and affirms his 1 Page 2 connection to the future of Spain. In a parallel to the argument of Donne’s â€Å"Meditation,† Jordan’s death while fighting as a volunteer in the Spanish Civil War is presented as a loss to fascism suffered by the people of all the republican nations of the world. In a report published in 1938 Hemingway wrote of the deaths of such volunteers of the International Brigades, and said, â€Å"They die fighting for you† (Hem on War 293). The depiction of Jordan’s life and death parallels the ... ...ocative that Rickman’s edition of Freud’s essay appeared shortly before publication of For Whom the Bell Tolls. Gajdusek, Robert E. (2002). Hemingway In His Own Country. Notre Dame Indiana: University of Notre Dame Press. 11 Page 12 Gellhorn, Martha. (1986). The Face of War. New York: Atlantic Press Ed, 1988. Hemingway, Ernest. A Farewell to Arms. (1940 ) Blakiston: Philadelphia. ________________.By-Line Ernest Hemingway. (1967) New York: Scribners. ________________ Hemingway on War.(2003 ) Ed. with an Introduction, Sean Hemingway. New York: Scribners. Myers, Jeffrey. (2000) Hemingway: Life into Art. New York: Cooper Square Press Nelson, Cary (1994). Remembering Spain: Hemingway’s Civil War Eulogy and the Veterans of the Abraham Lincoln Brigade Urbana: University of Illinois Press. Winnicott, D.W. Playing and Reality. (1971) London: Pelican, 1980. 12

Fragile X Syndrome Essay -- Health, Diseases, Mental Retardation

Background (576 words) The most common cause of inherited mental impairment is Fragile X Syndrome. Fragile X Syndrome is a mental retardation that affects social, learning and intellectual disabilities. It is a result of a change and mutation in a single gene, which can be pasted on to future generations. Symptoms arise when the mutated gene, FMR1, cannot produce enough of the protein, FMRP, that the body’s cells need to function. The symptoms can vary from each affected individual depending on how severe the gene mutation is. Fragile X causes symptoms such as intelligence and learning difficulties. Those who are effect normally have an IQ of 75 or less however this is more variable depending on gender, physical appearance, social and emotional concern, speech and language impairment, sensory problems and many other disorders that are commonly associated with Fragile X, such as autism. Learning and intelligence difficulties affects people who suffer from Fragile X ability to think, reason and learn which can also trigger other disorders for instance attention disorders, hyperactivity and anxiety. Males with Fragile X often show physical indications, which are associated with unique facial features such as wider foreheads and elongated ears, connective tissue problems and enlarged testicles, which is called macro-orchidism, (National Institute of Health, 2006). Graph 1 and graph 2 show the comparison of the symptoms shown by males and females. Graph 1: Males with the full mutation of Fragile X Syndrome (Raspa, 2009) Graph 2: Females with full mutation of Fragile X syndrome (Raspa, 2009) The incidence of fragile X is common among people because there are two classifications of it such as the full mutation and the pre... ...ymptoms associated with Fragile X. The scientists also manufactured mice that had a 50 percent reduction in mGluR5 as well as a deficient of the FMRP protein. It was found that from that group of mice, they presented less symptoms of fragile X, less signs of abnormalities in the brain and fewer signs of abnormal body growth (Bear, 2007). That same group of mice also displayed a considerable decrease in epileptic seizures. Although these discoveries sound promising there is also the issue of ethical controversy. Ethical controversy is the negative feed back from anti science protestors who are arguing that fact that scientists should not have to right to play ‘god’ and should let the course of nature figure it out. Advances in science are normally made before society can conduct meaningful ethical and moral discussions about these advances in medicine and disease.

Essay --

Examine the role of Robert Walton and the role of his letters in Frankenstein. What effect does this character and his letters have on our interpretation of Frankenstein? Dulcinia Martinez once stated that â€Å" without music, life would B flat† , well without Robert Walton and his letters, Frankenstein would be flat. it would be just another typical novel rather than a literary classic that is being carefully examined with detail in IB English courses or university. Robert Walton states in at the beginning of the novel â€Å"You will rejoice to hear that no disaster has accompanied the commencement of an enterprise†(Shelly, 15). Taking a closer look at that sentence, YOU is the first word of the start of the whole novel. Here, Mary Shelly is cleverly using the first person pronoun allowing the reader to sense an interaction with Robert Walton who is introducing the novel, but more importantly trying to communicate the morale purpose of the story. The book commences with a collection of 4 letters written by Robert Walton, who is a ship’s captain writing to his sister over his goal of "trac[ing] a secure way over the pathless sea s"(15) for reaching the North Pole from Russia. He soon, throughout his journey, comes across Victor Frankenstein who lies stranded and frozen on ice. If you look on the bottom page 26 (4th letter), the way Victor is described through Walton’s point of view as being â€Å"nearly frozen, and his body dreadfully emaciated by fatigue and suffering† (26), immediately gives the reader the idea of the struggles that Victor has faced. Walton’s narration not only gives Frankenstein an introduction, but it also sets the scene for Victor’s story to begin. Mary Shelly’s decision of giving Walton the role of narrator in allows for... ...tors story to be dangerous. and although Victor Frankenstein succumbed into his own fate†¦ If you look at the top of pg. 31, Victor warns Robert that if â€Å"You seek for knowledge and wisdom, as I once did; and I ardently hope that the gratification of your wishes may not be a serpent to sting you, as mine has been† (31). He warns Robert; as a result, Robert learns his limitations through his story. Making the outcomes turn out differently. While Victor Frankenstein dies due to his over ambition and lack of responsibility, Robert Walton learns from Victors story and takes responsibility for his crew members while safely returning them back home. And so Walton is the only one who survives in the novel, which is important since he is the one who delivers or signifies the moral purpose of victors story, highlighting the dangers of over-ambition through victor’s story.

Sundial

Another one of the most important technological advancements in history would have to be the sundial. The sundial was invented by ancient Egyptians in 1500 BC. Sundials are the oldest known device for the measurement of time and the most ancient of scientific instruments. The sundial uses the sun to tell the time of the day by casting a shadow on the sundial. The idea of the sundial is based upon the fact that the shadow of an object will move from one side of the object to the other as the sun moves from east to west during each day. The sundial provides the earliest evidence of the division of the day into equal parts. Before the division of day and night into twenty-four equal hours became accepted practice in cultures. The number of hours that was used was the concept that an hour in the summer lasted longer than an hour in the winter because the daylight period itself was longer. One of the reasons why sundials are so important is because it is one of the first known instruments for the measurement of time. It was also used in later cultures as a status symbol, such as ancient Greece and Rome where donors would get their names inscribed on the instruments to show their wealth. The reasons I think that the sundial is one the most important scientific developments is because of the broad usage of it in later cultures after Egypt. The sundial is still used today as an instrument to keep record of time. One of the key reasons that makes the sundial important to me is this was the first known scientific instrument. That to me makes it the most important invention of the time do the fact that it sparked an interest in the keeping of time and is the start to modern day clocks. This also may be the start to the invention of other scientific instruments, which is a huge impact in the field of science and may have led to the invention of many other great devices. I believe that the Egyptians are the leaders of keeping time as well as innovation in the field of science. In conclusion the sundial is a great invention and is one of the few early inventions that is still used today and that shows how great the ingenuity of the Egyptians was.

Beauty and the Beast Analysis Essay

In August of 2009, Jaycee Lee Dugard was found alive after she had been abducted in 1991, and she was still with her original captor. Sources have stated that Dugard had developed a case of Stockholm syndrome with the man who kidnapped her eighteen years ago. A psychiatrist named Keith Ablow stated that â€Å"To maintain one’s desperation and grief and rage for many years, would be too damaging to the human mind – so the human mind tells itself a story about safety and contentment to safeguard itself – that’s the essence of Stockholm Syndrome† (Engel). For decades, Stockholm syndrome has made an appearance in dozens of films; sometimes the entire plot focuses around it, sometimes it’s a vague reference. However, one instance of Stockholm syndrome that is incredibly pronounced, yet never addressed occurs in Walt Disney’s Beauty and the Beast (Trousdale 1991). Based on a French novel, Beauty and the Beast was critically acclaimed as being one of the best love stories ever told, as it taught to love what is within, instead of being consumed by vanity; it was considered so successful that it was even the first animated film to be nominated for an Academy Award for best picture. However, even with its critical and box office success, no one has really addressed what kind of love story Disney is promoting. The film Beauty and the Beast does not show a story of true love and admiration of inner beauty, but instead promotes the idea of Stockholm syndrome and falling in love with your kidnapper. When Belle goes on a quest to save her father, she ends up at a secluded castle, where she finds her father locked inside the dungeon at the top of a tower. The Beast, who rules the castle, offers to let her father go if Belle takes his place as prisoner. His reasoning for making her stay as his prisoner is his hope of making her fall in love with him (and him with her) in order to break the curse upon him, his servants, and his castle. Right there we see that the Beast’s entire character motivation is focused around Stockholm Syndrome, as he is attempting to make his prisoner, who he is holding against her will, fall in love with him. He is not kind at first; he roars and yells, effectively scaring the woman of his desires, and demands she follow his orders, much like any captor would. Belle, on the other hand, is at first adamant about keeping her distance from the Beast, even when his enchanted furniture servants attempt to convince her that he’s really a â€Å"good guy†. Belle begins to have a change of heart after the Beast saves her from being eaten by wolves†¦she was almost eaten because she was attempting to escape. Even though the Beast saves her from the mean and scary wolves by bringing her back to her place of captivity, she’s so grateful for his â€Å"rescue† that she begins to think that he has the potential to be good. A montage of cute interactions between the two characters then takes place, showing how the two are beginning to bond and feel something for one another, with barely a whisper of the fact that Belle is still being held against her will. The Beast lavishes upon her with food, music, and clothing; the gracious captor even deems a huge library in the castle to be hers, and she can access it any time she wants. How kind of him to give her full access to books inside a castle that she has no choice but to spend all of her time in. He later creates a fancy date night for the two of them (still inside the castle) that even contains ballroom dancing. He finds out she is homesick, figures out he is in love with her, and let’s her go free. However, she later returns to the castle of her own free will in order to save his life. She professes her love, he turns into a handsome prince, and they live happily ever after at a castle that he now has permission to leave any time she wants. Perhaps by the end of the film Belle really did love the Beast. Even so, her love was shaped and influenced by her self-created tale of â€Å"safety and contentment† altered opinion of him during her captivity in his castle. Disney’s version of this tale of Stockholm syndrome-based love seems to contain a great moral message for young girls: if you’re held captive by a hideous monster who is vying for your affection, just go ahead and fall in love, because he’ll turn beautiful. Belle’s happy ending meant she never had to sue the beast for kidnapping, luckily for him. It’s a shame real life doesn’t follow Disney cartoons as often as it should. Just ask Jaycee. Her beast is still a beast; there was no prince at the end of her story. She got her freedom, yes, but no prince. That’s probably a good thing. It’s definitely better that beastly captors don’t change into rich and handsome men once their imprisoned object of desire returns their feelings; the justice system would never get anything done.

Unit 9 – Assignment 2 Complete the Assignment Specified in Sam.

Judy Vasquez HCMG745-Dr. Szostek March 27, 2013 Week 4-Assignment 4 You will explore these areas in a research based paper with at least four scholarly references. Be sure to summarize the weekly focus area, evaluate its effect on the future of healthcare and your practice, and conclude the aspects of quality and best practice involved. Due Day 7 For Week 4 Operations, develop an overall operations plan. TOPIC SUMMARY EFFECT ON HEALTHCARE FUTURE OVERALL QUALITY & BEST PRACTICE ISSUESWhat will be a typical patient experience? Patients are first seen with either our primary physician or orthopedists, many are experience joint, spinal, or neck issues from motor vehicles accidents or slip and falls, so they are usually in a lot of pain. Patients are prescribed pain medication if needed, and go through a series of tests performed by our physicians at our practice. Imaging is usually needed, so many must have MRI's and X rays performed and bring their CD's with them to be reviewed by our d octors.We always follow-up with each of our patients, and if they have surgery they have ore-surgical and post surgical consultations with our physicians. Describe patient flow from making the appointment to paying the bill. Many of our patients have been in car accidents or slip and falls, they are being referred to our surgeons, neurologists, primary physicians, and orthopedists from attorneys. If the pain is tolerable we do not recommend surgery, however when patients are in excruciating pain we have them see our neurologist to have various neurological tests performed.When we have a new patient referred to our office, we gather all of their demographics and insurance information, if they do not have insurance many times there is a liable party information involved.. First we call the attorney to get more information on the case, next we fax the attorney letters of protection. Some of our cases are funded so we fax the funding company the information on the case with liable party information such as limits. Next we schedule a surgery date for the patient if surgery is needed, and ax the surgery center the case and Letter Of Protection for patient to sign.Lastly, after the surgery we fax the paperwork for coding. How will you address regulatory compliance and risk management? From a medical practice standpoint complying with regulations not only decreases risk but can decrease mortality and costs. http://www. acponline. org/running_practice/practice_management/regulatory_compliance/How will continuous quality improvement and best practices be addressed? How are you going to develop and maintain an ethical, quality, and complaint practice for the long term? What regulatory bodies will you have to be concerned with on an ongoing basis?Medicare and Medicaid Audits are some of the major regulatory bodies our practice is constantly concerned with. Recovery Audit programs aim to decrease the likelihood of overpayment and underpayments of their beneficiaries. This means our practice must stay on top of proper coding and billing to avoid penalties associated with false claims. http://www. cms. gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/recovery-audit-program/index. html? redirect=/rac/ What do you see as possible futuristic operations issues/policies? How will you create the optimal care environment?

Indian Tourism Sector Emmerging Oppurtunities -Emmerging Challenges and Oppurtunities in the Era of Globalisation

INDIAN TOURISM INDUSTRY -EMMERGING CHALLENGES AND OPPORTUNITIES IN THE ERA OF GLOBALISATION Dr. GUNDETI RAMESH [email  protected] com FACULTY MEMBER, DEPARTMENET OF ECONOMICS,SATAVAHANA UNIVERSITY, KARIMNAGAR,ANDHRAPRADESH. This paper mainly highlighted the Challenges and Opportunities of the Indian Tourism in the context of globalization. This tourism industry undoubtedly emerged as an instrument of rural employment generation as a labor intensive activity in a labor surplus economy, with its forward and backward linkages with a host sectors like tranport,hospitality and education etc.Finally the paper also makes proper policy suggestion needed communication to promote and boosting tourism in India. Key words: Compound Annual Growth rate (C. A. G. R), Foreign Exchange Earnings (FEE) Foreign Tourist Arrivals (FTA),Forward backward linkages INTRODUCTION: Tourism is not only a growth engine but also an export growth engine and employment generator. According to the Economic Survey 20 11-12 the sector has capacity to create large-scale employment both direct and indirect, for diverse sections in society, from the most specialized to unskilled workforce.It provides 6-7 per cent of the world’s total jobs directly and millions more indirectly through the multiplier effect, as per the UN’s World Tourism Organization. Since tourism does not fall under a single heading in India’s National Accounts Statistics, its contribution has to be estimated. Its contribution to GDP and employment in 2007-08 was 5. 92 per cent respectively as per Tourist Satellite Account Data. FTAs in India during 2010 were 5. 78 million compared to 5. 17 million during 2009, posting a growth of 11. 8 per cent, much higher than the growth of 6. per cent for the world in 2010. FEEs from tourism in rupee terms during 2010 were Rs. 64,889 crore compared to Rs. 54,960 crore during 2009 with a growth rate of 18. 1 per cent. Despite the slowdown and recessionary trends in the econom ies of Europe and America, FTAs during 2011 were 6. 29 million with a growth of 8. 9 per cent over 2010 and FEEs in 2011 were Rs. 77,591 crore with a growth of 19. 6 per cent. In the case of outbound tourism, the number of Indian nationals’ departures from India during 2010 was 12. 99 million with a growth of 17. per cent for the year. Domestic tourism has also emerged as an important contributor to the sector providing much needed resilience. Domestic tourist visits during 2010 are estimated at 740. 2 million, with a growth of 10. 7 per cent. However, Indian tourism industry is not only a growth engine, but also an export growth engine and employment generator. According to the Economic Survey 2011-12 the sector has capacity to create large-scale employment, both direct and indirect, for diverse sections of society, from the most specialized to unskilled workforce.It provides 6-7 per cent of the world’s total jobs directly and millions more indirectly through the mult iplier effect as per the UN’s World Tourism Organization. Its contribution to the GDP and employment in 2007-08 was 5. 92 per cent, respectively as per the Tourist Satellite Account Data. In India, the tourism sector has witnessed significant growth in recent years. During 2006 to 2011, the CAGRs of foreign tourist arrivals and foreign exchange Objectives of the study: 1)To study the emerging challenges and opportunities in the context of globalization. )To examine the trends of foreign exchange earnings growth of foreign tourists arrivals in Indian tourism. 3)To analyze the share of Indian tourism industry when compare to the rest of the world and the Asian and Pacific region. 4)To suggest the policy implications to develop the Indian Tourism Industry. Methodology: The study mainly based on a range of secondary data from various government sources such as ministry of tourism Government of India and other relevant websites etc. For analyzing secondary data simple statistical tools like percentages and averages have been used to interpret the data.A part from these tables, charts, graphs, pictures have been chosen at relevant places to easily understand the data. Observations India has significant potential for becoming a major global tourist destination. According to the World Travel and Tourism Council (WTTC) based on Tourism Satellite According Research (TSAR) in 160 countries has predicted that India has the potential to become the number one tourist destination in the world with the demand growing at not less than 10 percent for annum.The World Tourism Organization has also pointed out that India as the most favored destination among the countries of South Asia receiving more than 50 percent of the total foreign tourist traffic in the area. However India’s share in International tourist arrivals is 0. 59 percent. (Share of India in International receipts is 1. 54%) while its share in the country’s GDP is 12 percent. It has given employ ment to 10. 2 million people directly.Therefore the tourism is undoubtedly has emerged as an instrument of rural employment generation, as a labor- intensive activity in a labor surplus economy, with its forward and backward linkages with a host sectors like transport, hospitality education, health, banking etc,. The interested spending by tourists has generated substantial income earnings both public and private sectors. Therefore the income flow has a multiplier effect on the macro economy. However World Travel and Tourism Council pointed that India is one of the fastest growing tourism industries in the world and expected to grow by a further 6. annually and should create 13,127,000 employment opportunities by 2020. But post globalization and under GATS many changes and challenges are confronted. The table -1 depicts that the foreign exchange earnings through tourists. In terms of rupees tourism receipts have grown from rs. 7. 7 crore in 1951 to 12,150 crore in 1998, to rupees 15 ,626 crore in 2000 to 27,944 in 2004 and US million $ 16564 in 2011. Foreign Exchange Earnings (FEE) from Tourism in Indian Rupee terms and US $ terms FEE from tourism in Rupee terms during 2010 were Rs. 64889 crore as compared to Rs. 54960 crore during 2009 and Rs. 1294 crore during 2008. The growth rate in FEE in Rupees terms during 2010 was 18. 1% as compared to the growth rate of 7. 1% in 2009 over 2008. Therefore, the growth rate observed in 2010 over 2009 was substantially high FEE from tourism during 2010 were US $ 14193 million as compared to US$ 11394 million during 2009 and US $ 11832 million during 2008. The growth rate in FEE in US$ terms during 2010 was 24. 6% as compared to a decline of 3. 7% in 2009 over 2008. Therefore, in US$ terms, also growth rate observed in 2010 was positive and substantially high.Thus tourism recorded a positive and significant compound annual growth rate at 13. 82%, however in terms of US Dollar foreign exchange earnings also increased from US $ 2,889 million in 1997 to US $ 14,193 million in 2010. It is observed that there was a higher fluctuation noticed in the quantum of foreign exchange earnings in both in terms of dollars and in Indian rupee. The study also found the highest growth (Foreign Exchange Earning) rates with 43. 8 are recorded in 2003 and lowest growth rate with 7. 6 is recorded in 2001. Fig-2 gives the details of Foreign Tourists arrivals to India. FTAs in India during 2010 were 5. 8 million with a growth rate of 11. 8% as compared to the FTAs of 5. 17 million and growth rate of (-) 2. 2% during 2009. The 11. 8% growth rate in FTAs for 2010 over 2009 for India is much better than UNWTO’s projected growth rate of 5% to 6% for the world during the same period Foreign tourist arrivals to India rose from 0. 12 million in 1960 to 1. 68 million in 1991 and 3. 46 million in 2011 and6. 29 million in 2010. The study evidently speaks the truth that in terms of foreign tourist arrivals has registered a posit ive significant compound annual growth rate with 7 percent between 2000 and 2010.The study also pointed out that highest tourist arrivals growth rate registered with 26. 8 in 2004 and negative growth rate registered with -2. 2 in 2009. The reason for decrease in foreign arrivals may be due to slow down and recessionary trends in the economics of Europe and America . A top 10 source country for Foreign Tourist Arrivals (FTAS) in India in 2010 was placed in Table-3 It connotes the fact that the majority of the tourist arrivals are from the U. S. A registered with 0. 916 million. The data observed that out of total tourist arrivals 16. 40 percent tourist’s were from U.S. A and followed by U. K with 0. 755 million which contribute 13. 52 percent. The study mainly observed that in terms of foreign tourists arrivals to in India- U. S. A occupied first place (16. 40%) and Malaysia occupied with tenth position. The table-4 reveals the share of India in international tourist arrivals in the world, Asia and the Pacific region during the period of1997-2010. It is observed that foreign tourist arrivals in India have risen from 2. 37 millions in 1997 to 6. 17 million in 2009. In terms of share and rank of India in the world rose to 0. 40 in 1997 to 0. 59 in 2009.As the rank of India when compare to the world has come down from 47th rank in 1998 to 41 rank in 2009.. The study also pointed out that compare to share and rank of India Asia and the Pacific nearly increased with 2. 67 in 1997 to 2. 86 in 2009. However the study reveals the fact that the share of India in international tourist arrivals in the world, Asia and Pacific region 1997-2011 was not increased significantly but merely increased. The table 5 gives the fact that the share of top 10 states / UTs of India in number of foreign tourist visits in 2010. The study observed that 28. percent tourists are visiting Maharastra followed by Tamilnadu which comprising 15. 7 percent and followed by Delhi with 10. 6 p ercent. Finally the study explores the fact that 28. 5 percent foreign tourist visiting Maharastra and 2. 5 percent foreign tourist visiting to Goa state. Hotels and restaurants is an important component of the tourism sector. As on 31 December 2011, there were 2,895 classified hotel having a capacity of 1, 29,606 rooms in the country. Availability of good quality and affordable hotel rooms play an important role in boosting the growth of tourism in the country.The share of the hotel and restaurant sector in overall economy increased from 1. 46 per cent in 2004-05 to 1. 53 per cent in 2008-09 and then decreased to 1. 46 per cent in 2010-11. However, if the contribution of this sector only in the service sector is considered, its share decreased from 2. 75 per cent in 2004-05 to 2. 64 per cent in 2010-11 as other service sectors grew faster than this sector. It CAGR was 8. 44 per cent during 2004-05 to 2009-10 and the growth rate in 2010-11 was 7. 7 per cent. Health tourism, the new entrant in the sector is a niche area where India has good potential.Findings The study mainly pointed out that India has significant potential for becoming a major global tourist destination. The Tourism Industry has grown significantly during the study period and registered a compound annual growth rate of 7 percent in foreign tourist arrivals in to India. The study also found that highest growth rate (foreign exchange earnings) with 43. 8 are recorded in 2003 and lowest growth rate with -7. 6 in 2001. The study also explores the fact that the highest tourist arrivals growth rate registered with 26. in 2004 and negative growth rate registered with -2. 2 in 2009. The study observed that in terms of foreign tourist arrivals to India ,U. S. A. occupied first place (16. 40 percent) and Malaysia occupied tenth position. From the share of India and the Pacific region 1997-2011 was not significantly performed but substantially increased. India achieved 5,717 of international tourism rece ipts in the world and Asia, Pacific regions, and has jumped in leaps and bounds from a ranking of 36 to 16th position in the world and from 10th position to 6th position in the Pacific region.Coming up to the other findings the share of India in international tourist arrivals is only 0. 59 percent and tourism receipts are only 1. 54 percent and ranks 16 only. The major shortcoming of the tourism is inadequate capacity (e. g. 85,481 hotel rooms as against 8, 97,206 in China) and costly travel (e. g. soaring fuel, surcharges, poor blight management etc,. ). Inadequate infrastructure and trained manpower, lapses in security and safety (e. g. Terrorist attacks and harassment of tourists) and poor organization (e. g. fragment market, poor advertising and un trained tourist guides.Moreover there is need of well equipped infrastructure and management to meet the high international standards and need of skilled management to benefiting from the opportunities thrown open by (GATS, WTO) to to urism. There is need to develop the alternative tourism like health tourism village tourism and sports tourism and it is needed to take more initiation by the involving government and private agencies for more investments to develop tourism sector. Conclusions Tourism undoubtedly has emerged as an instrument of employment generation.However to take the emerging challenges and opportunities of globalization, India needs a long term plan for this industry with periodic evaluation and revision. Therefore there is a need future vision to identify the potentials of tourism industry. Finally the success of tourism depends to a large extent on better access to infrastructure, with a consumer centric approach. Appendix Tables Table-1 FEE from Tourism in India (in Rs. Crore) (1997-2011) YearFEE from Tourism inPercentage (%) change over the previous years India (in US$ MILLONS) 199728892. 0 199829482. 0 199930092. 1 2000346015. 20013198-7. 6 20023103-3. 0 2003446343. 8 2004617038. 2 200574932 1. 4 2006863415. 2 20071072924. 3 20081183210. 3 200911136-5. 9 2010 #1419327. 5 2011 #1656416. 7 2012(#Jan – June) 84558. 2 # Advance Estimates, @ Growth rate over Jan-June 2011 Source: i) Reserve Bank of India, for 1997 to 2008 2)MTM1997-2011 figure-1 FEE from Tourism in India (in Rs. Crore) (1997-2012) TABLE 2 Foreing Tourist Arrivals (FTAs) in India, 1997-2012 YearFTAs in India (in Million)Percentae (%) change over the previous year 19972. 373. 8 19982. 36-0. 7 19992. 485. 2 20002. 656. 7 20012. 4-4. 2 20022. 38-6 20032. 7314. 3 20043. 4626. 8 20053. 9213. 3 20064. 4513. 5 20075. 0814. 3 20085. 284 20095. 17-2. 2 20105. 788. 1 2011 (P)6. 298. 9 2012(jan-Jun)3. 247. 4 (P) Provisional, @ Growth rate ove Jan-June, 2011 Source: (i) Bureau of Immigration, Govt of India, for 1997-2009 (ii) Ministry of Tourism, Govt. of India, for 2010 & 2012 TABLE 3 Foreing Tourist Arrivals (FTAs) in India, 1997-2011 S. NoSource CountryFTAs (in Million) (P)Percentge (%) Share 1USA0. 91616. 4 2U K0. 75513. 52 3Bangladesh0. 3816. 82 4Canada0. 2404. 3 5Germany0. 2244. 01 6Sri Lanka0. 2193. 2 7France0. 2183. 9 8Japan0. 1652. 95 9Australia0. 1642. 94 10Malaysia0. 1602. 87 Total of top 10 countries3. 44261. 64 Others2. 14238. 36 All countries5. 584100. 00 (P) Provisional, @ Growth rate ove Jan-June, 2010 Source: (i) Bureau of Immigration, Govt of India, for 1997-2009 (ii) Ministry of Tourism, Govt. of India, for 2010 & 2011 Table-4 Share of India in International Tourist Arrivals in World, and Aisa & the Pacific Region, 1997-2010 YearInternational Tourist Arrivals (in million)FTAs in India (in million)Percentge (%) shre and rank of India in worldPercentage (%) hare and rank of India in Asia and the Pacific WorldAsia and the Pacific%ShareRank%ShareRank 1997593. 089. 02. 370. 40-2. 67- 1998611. 088. 32. 360. 3947th2. 67- 1999633. 097. 62. 480. 3946th2. 54- 2000683. 3109. 32. 650. 3950th2. 4211th 2001683. 4114. 52. 540. 3751st2. 2212th 2002703. 2123. 42. 380. 3454th1. 9312th 200369 1. 0111. 92. 730. 3951st2. 4411th 2004762. 0143. 43. 460. 4544th2. 4111th 2005803. 4154. 63. 920. 4943rd2. 5311th 2006846. 0166. 04. 450. 5344th2. 6811th 2007894. 0182. 05. 080. 5741st2. 7911th 2008917. 0184. 15. 280. 5841st2. 8711th 2009882. 0180. 95. 170. 5941st2. 611th 2010(P)940. 0203. 85. 580. 5940th2. 7411th P: Provisional Source: i) UNWTO Tourism Market Trends 2007 edition, for the years upto 2005 ii) UNWTO Barometer June 2010 for 2006 and January 2011 for 2007 and UNTO TABLE 5 Share of Top 10 States/Uts of India in Number of Foreign Tourist Visits in 2010 RankState/UTForeign Tourist Visits in 2010 (P) NuberPercentae share (%) 1Maharashtra508312628. 5 2Tamil Nadu280468715. 7 3Delhi189365010. 6 4Uttar Pradesh16751239. 4 5Rajasthan12785237. 2 6West Bengal11921876. 7 7Kerala6592653. 7 8Bihar6357223. 6 9Himachal Pradesh4536162. 5 10Goa4410532. 5Total of top 10 countries1611695290. 3 Others17358259. 7 Total 17852777100. 00 P: P Source: State/UT Tourism Departments Note: i) Figures for Chhattisgarh has been estimated ii) For some states data adjusted using the information available with Ministry of Tourism References 1 Reserve Bank of India, for 1997 to 2008 2 MTM1997-2011 3 Bureau of Immigration, Govt of India, for 1997-2009 4 Bound, John and Timothy Waidmann, (2000), Accounting for Recent Declines in Employment Rates among the Working – Aged Disabled, NBER Working Papers 5 Ministry of Tourism, Govt. of India, for 2010 & 2011 UNWTO Tourism Market Trends 2007 edition, for the years upto 2005 7 UNWTO Barometer June 2010 for 2006 and January 2011 for 2007 and UNTO 8 Driedger, D, (1987), Disabled People and International Air Travel, Journal of Leisurability, 14, pp. 13–19. 9 Miller, G. A. , & Kirk, E, (2002), The Disability Discrimination Act: Time for the stick? Journal of Sustainable Tourism, 10(1), pp. 82–88. 10 McKercher, B. , T. Packer, M. Yau, and P. Lam, (2003), Travel Agents: Facilitators or Inhibitors of Travel for People with Disab ilities, Tourism Management, 24, pp. 465–74. 11. Economoc survey 2011-12