Malnutrition in India Essay

Introduction :- Malnutrition is found to be a leading killer through out the world, with under nutrition in the developing world the main nutrition problem. The World Bank Estimate that India is ranked 2nd in the world of the number of children suffering from malnutrition after Bangladesh (1998), where 47% of the Children exhibit a degree of malnutrition. India is one of the fastest growing country in terms of population and economic growth rate , sitting at a population of near about 1200 million (December 2010) and economy growing by 9% GDP growth rate from 2007-2008. Since independence Indian economy considered as low income country with majority of population at or below the poverty line which is lead to problems of malnutrition, hunger etc. the combination of people leaving in poverty and the recent economic growth of India (as well as Maharashtra)has led to the co-emergence of two type of malnutrition: 1) Undernutrition 2) Overnutrition. The National Family Healthy survey 2005-2006 shows that, while Maharashtra is one of the most developed State among the country, It has also problem of Malnutrition exists, but nutrition situation in Maharashtra is slightly better than the national average. National Nutrition Monitoring Bureau (NNMB) study quoted that more than 40 lakh children were affected with grade 2 to 4 malnutrition in Maharashtra. This indicate the seriousness of the problem of malnutrition. Definition of the Term Malnutrition Malnutrition carries different connotations to different people. To some, malnutrition means undernourishment, while to others it means starvation. Some confuse malnutrition with hunger while others consider malnutrition as undernutrition. The writer would like to define the term malnutrition in the following pages and differentiate it from the other similar terms. Malnutrition The word malnutrition might best be reserved to indicate the state of ill-health of a population or of any group of people in so far as that condition is caused either by malnourishment or undernourishment. It is thus, to an extent, a medical term or a term for public health purposes. The students of public health are showing a tendency to use that term in such a sense more consistently. The existence of malnutrition is revealed in various morbid conditions and it is measurable in terms of indices which are medical, anthropological, or biostatistical (such as height, weight, and special diseases, etc. ) Malnutrition is the condition that develops when the body does not get right amount of Vitamins, Minerals and other nutrition’s (Proteins) is needs to maintains healthy tissues and organ function.† Malnutrition occurs in people who are either undernourished or over nourished. Undernutrition is a consequence of consuming too few essential nutrients or excreting them more rapidly than they can be replaced. Infants, teenagers, young children, pregnant and breastfeeding women require additional nutrients. Overnutrition results from eating too much; eating too many of the wrong things, not exercising enough or taking too many vitamins or other dietary replacement Malnourishment Refers to an actual condition of diets in which not the quantity, but the quality of the food stuff is also involved. According to the present knowledge, a diet must supply some 30 or more nutrients in order to provide the proteins of high quality, as well as energy yielding food. A population is malnourished, even if it is able to use and is in the habit of using a quantity of energy yielding food stuffs, but if the people are either unable or unaccustomed to maintain a balanced diet including all the proper nutritive elements in correct proportion, is still suffering from malnourishment Undernourishment â€Å"Expresses a dietary condition largely among the working people in which there is an actual insufficiency both in quantity and in quality of nutritive elements needed for health and well-being.†- Objectives of the study: We have attempted to discuss the crucial issue child malnutrition in Maharashtra State. Therefore we look at the following objectives regarding malnutrition study in the state. 1. To discuss the status of child malnutrition in the state. 2. To find out the major causes of malnutrition. 3. To find out the effects / incidence of malnutrition problem. 4. To address the way to eradicate the malnutrition problems. Methodology: In this research paper we mostly used the secondary kind of data for analysis the issue. Researchers used macro-analysis method for analyze the malnutrition in the country as well as Maharashtra State. Types of Malnutrition: Each form of malnutrition depends on what nutrients are missing in the diet, for how long and what age. A) Proteins Energy Malnutrition (PEM): This is the most basic kind of malnutrition, results from a diet lacking in energy and Protein because of a deficit in all major macro nutrients such as carbohydrates, fats and Proteins. B) Micronutrients deficiencies: Micronutrients deficiencies are also a widespread problem in India. More than 75% of preschool children suffer from iron deficiency anemia (IDA) and 57%  preschool children have subclinical vitamin A deficiency (VAD). Iodine deficiency is endemic in 85% districts (In India) mostly due to the lack of iodized salt. The prevalence of deferent micro nutrients deficiency varies widely across states. Degrees of Malnutrition: Classification of Protein Energy Malnutrition (PEM) is done by Gomez. Degree of PEM % of desired body weight for age and sex. 1. Mild Malnutrition (Grade I ) 90% -100% 2. Moderate Malnutrition (Grade II) 75% – 89% 3. Severe Malnutrition (Grade III) < 60% Status of Malnutrition in Maharashtra :- As far as Maharashtra State is concern, deaths regarding to the malnutrition seems high in tribal dominated districts e.g. Gadchiroli, Amravati, Yewatmal, Chandrapur, Bhandara and Melghat etc. Dr. Abhay Bang committee (2004) reported that between 1.20 lakh and 1.75 lakh children diet every year in the state for medical reasons. The report blamed an Insensitive bureaucracy for the plight of nearly 8 lakh children whose lives were threatened by grade 3 or 4 malnutrition. According to the report during 1988 to 2002 the percentage of affected by grade 3 or 4 malnutrition had fallen by mere 0.6% only which is found little improvements. According to National Nutrition Monitoring Bureau (NNMB) study quoted that more than 40lakh children were affected with grade 2 to 4 malnutrition  in Maharashtra. It estimated that 82000 children died every Year in rural area’s of the state 23, 500 in the tribal area’s and 56000 in urban slums. According to the government statistics in the entire Maharashtra state child death were estimated 45,000 (during July 2004 to June 2005) due to the malnutrition out of these 12,000 fall prey to severe malnutrition and the remaining 33,000 children died due to the mild or moderate malnutrition. The malnutrition is also the underlying cause in about 480 of the 2850 maternal deaths each year in the state. Child Death And Action Group (CDSAG) study found that 10.4% child death are recorded on an account of malnutrition in the state. Tribal Dominated Districts of Amravati, Yewatmal, Gadchiroli, Chandrapur and Bhandara in Vidarbh region as well as Melghat in North Maharashtra region were affected worsely by malnutrition problem. Ø Almost 38% of children under age three are stunted (India – 38.4%) Ø Almost 40% are underweight (India – 45.9%) Ø There is a strong correlation between child malnutrition and the level of maternal education. Ø There are significance differences between rural and urban area’s, where the rural area’s being more affected by malnutrition. Ø The prevalence of overweight and obesity in Maharashtra is higher than the national average for both male and female. Causes of Malnutrition: 1. The economist Amartya Sen observed that poverty is major cause of malnutrition and famine has always a problem of poverty and unbalanced distribution of food. 2. Hike in food prices or food inflation. 3. Insufficient food production (availability) 4. Changes in climate threaten the food security. 5. People with drug or alcohol dependencies are also at increased risk of malnutrition. Effect of Malnutrition: Malnutrition including both protein energy malnutrition and micro nutrient deficiencies not only affect physical appearance and energy level, but also directly affects many aspects of the children mental functions, growth and development. Ø According to the Jean Ziegler UN special report on the right to food (for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006. One in twelve people world wide is malnourished. Ø WHO, also indicate that malnutrition is the biggest contributor to child mortality. Ø Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller. Ø Malnutrition increases the risk of infection and infectious disease. Ø Malnutrition affects adversely physically as well as psychologically. Malnutrition in the form of ioden deficiency is most common preventable cause of mental impairment worldwide. Ø Ioden deficiency specially in pregnant women and infants, lowered intelligence by 10 to 15 I.Q. points. Ø Malnutrition can also be a consequence of other health issues such as  diarrheal disease or chronic illness specially disease of intestinal tract, Kidney’s and liver. Programs to address eradicate the Malnutrition The government of India has launched several programs to converge the growing malnutrition problems in the country. They include ICDS, NCF, National health mission. 1. Integrate child development scheme (ICDS):- Indian government has starter this ICDS program in the year 1975 for improving the health of mothers and children development program is on of largest in the world. It reaches more than 34 million children aged 0-6 years and 7 million pregnant and getting mothers. 2. National Children Fund (NCF):- This Fund was created during the international year of the child in 1979. This Fund provides support to the voluntary organizations that help the welfare of children. 3. United Nations Children Fund (UNCF):- UNISEF has been supporting India from last six decade in a number of sectors like child development, women development support for community based converged services health, education, nutrition, water and sanitation, childhood disability, children in especially difficult circumstances. National Rural Health Mission: This mission was created for the years 2005-2012 and its goal is to â€Å"Improve the availability of and access to quality health care by people, especially for those residing in rural area, the poor women and children.† 1. Objective of the mission are:- Ø Reduce Infant Mortality Rate (IMR). Ø Provide access to integrated compressive primary health care. Ø Revitalize local health tradition and mainstream AYUSH. (This mission has set up strategies and action plan to meet all of its goals.) 2. The best wa y to prevent the condition is to eat a healthy balanced diet that contains food from all the major groups like carbohydrates, fruits and vegetable, Protein, dairy and fats. 3. As well as eating healthy, you should aim to drink at least 1.2 liters of fluid a day. 45,000 die of malnutrition every year in MaharashtraDespite being among the wealthiest states in the country, almost half Maharashtra’s children are undernourished and one-third of adults are underweight, says a recent report by the NGO SATHI. Forty-five-thousand children die of malnutrition every year in the state, according to ‘A report on nutritional crisis in Maharashtra’ by the Pune-based SATHI (Support for Advocacy and Training to Health Initiatives). One-third of adults are underweight, and 15% severely underweight.The two major schemes for children meant to prevent such deaths are the midday meal scheme and the Integrated Child Development Scheme (ICDS). But the state government spends just 0.8% of its gross domestic product on these schemes, the report states. More children die of mild or moderate malnutrition (33,000) than of severe malnutrition (12,000). Malnutrition is also the underlying cause of death of 480 of the 2,850 malnutrition deaths in the st ate every year. â€Å"A large number of people in Maharashtra do not get enough to eat and are suffering from serious nutritional deficiencies,† said the coordinator of SATHI, Abhay Shukla, at a press conference to release the report on February 3, 2010. The report takes into account the findings of the National Family Health Survey-3 and the National Sample Survey. The report points out that chronic hunger is not confined to rural areas, as is popularly believed; urban populations in coastal regions, including the city of Mumbai, have the highest prevalence of calorie deficiency (43%) in the state. Calculations made using the per-consumer-unit-calories norm of 2,400 in rural areas and 2,100 in urban areas reveals that the incidence of calories-based poverty is 54% in rural areas and 39.5% in urban areas. The report is critical of government  schemes like the ICDS. Grade 3 and 4 malnutrition is grossly underreported under the scheme as workers lack the skills and equipment to accurately weigh and classify children. Severe malnutrition is often underreported as it points to a failure of the programme. The midday meal scheme too has been underperforming, according to the report. Only 12% of schools surveyed provided midday meals, and many gave only one component of the meal. Moreover, not a single school provided the stipulated 300 calories and 8-12 grams of protein. India’s performance on the nutrition front is poor overall. According to the National Family Health Survey-3 (up to 2005-06), almost half of children under 5 years of age (48%) are stunted, that is, too short for their age, an indicator of chronic malnutrition; 43% are underweight. The proportion of severely undernourished children is also notable — 24% are severely stunted and 16% are severely underweight. The 2009 annual budget earmarked just 4.15% for children when the population under 18 years of age is 447 million. Maharashtra’s poor performance on the health front comes despite it being one of the high GDP states. Though the country as a whole has seen GDP grow by 3.95% per year, between 1980 and 2005, the percentage of underweight children under 3 went down by just 6% , from 52% to 46% between 1992 and 2005. For every 3-4% increase in per capita income, the underweight rate should decline by 1%. This has not happened in India, pointing to the need for more inclusive growth and better delivery and distribution of schemes targeted at malnutrition. Malnutrition among Maharashtra’s tribalsMore than 98 children died in three months of 2005, in Akkalkuwa block of Nandurbar district. Of these, 71 children were found to be severely malnourished.A survey by the Punarvasan Sangharsh Samiti revealed that the government is unaware of the scale of malnutrition in the area. Only 10% of malnourished children figure in the government records. The survey also showed that not only were the children malnourished, their mothers were too. The weight of adult mothers ranged between 40-45 kg.Girls constituted around half the total number of malnourished children, indicating the precarious condition of these ‘future mothers’. The survey also revealed that although generations of malnourished children are born in this region, the government still does not look beyond the singular health aspect of the problem, on the basis of which mitigation measures are designed. Unless the issue of malnutrition is addressed comprehensively, the  tribal community in this part of the country is headed for extinction.These and other startling revelations form part of a report brought out by the Punarvasan Sangharsh Samiti, which has been actively mobilising the tribal population of Nandurbar district for the last decade. The report, titled ‘Maranatach He Jag Jagate’, is based on the survey which was carried out in 22 villages. And information obtained through the Right to Information Act.The tribals of Nandurbar are engaged in a continuous struggle for existence. Malnutrition and child mortality is part of their everyday lives, even as issues related to rights over natural resources and means of livelihood ga in greater urgency with each passing year.Attempts to remedy malnutrition and child mortality by singling it out will not deliver the desired results. ‘Maranatach He Jag Jagate’ attempts to take stock of the situation and get at the root of the problem. The report analyses the situation on the ground and suggests ways to tackle the problem head-on. Obviously there is the need for firm action by the government and the active involvement of society at large.Some basic facts about the survey: * The survey was undertaken in 22 villages of Akkalkuwa block, Nandurbar district. The weights of mothers in seven villages and two rehabilitation and resettlement sites of the Sardar Sarovar Project were recorded. The facts that emerged from the survey were shocking. In April, May and June 2005, 98 children died in Akkalkuwa block alone and of these 71 children were malnourished. Of the malnourished children, 45 were found to be in the second stage of malnutrition. Meanwhile, the government refuses to accept that the children died from malnutrition. * Punarvasan Sangharsh Samiti recorded the weights of children in 22 villages and co mpared this data with that of the government. The comparison showed that the government has only 10% of the facts related to malnutrition. In effect, it is unaware of 90% of malnutrition cases. According to the survey, the number of third-grade malnutrition among children in April was 127, in May 135 and in June 104; the government records showed only 14, 42 and 17 children as malnourished in this grade respectively. The survey figures for fourth-grade malnutrition, during these months, were 61, 50 and 35; the government figures were 6, 6 and 3 respectively. (The figures quoted here were obtained from the government under the Right to Information Act). * Of the 22 villages in the survey, six have been declared ‘hyper-sensitive’ by the government. The  survey showed that the combined number of third and fourth-grade malnutrition among children in April, May and June stood at 100, 104 and 72; the government records showed only six children were malnourished. * Of the total number of malnourished children, half were girls. This raises a serious question about the next generation. * With this question in mind, the Punarvasan Sangharsh Samiti conducted a survey in six villages and two rehabilitation and resettlement sites in which the weights of fully-grown mothers were assessed. The survey showed that the weights ranged between 40-45 kg. This emphasises the need for a comprehensive study of the ages of young mothers, stage of motherhood and its link with malnutrition. It also suggests that the process of malnutrition begins in the womb itself. * The root of the problem is lack of livelihoods. Measures in the areas of health, education, employment and supply do not create sustainable livelihood sources and therefore cannot, in themselves, be decisive remedies to the problem of malnutrition. Let’s take a closer look at the villages covered in the survey.The 22 villages are spread out in the plains as well as in hilly regions of the Satpudas. Of the villages, Khai, Andharbari, Ohwa, Kaulavimal, Toknapimpri, Maliamba, Kondvapada, Thana and Beti have been de clared ‘hyper-sensitive’ villages under the Navsanjivani Scheme, which is touted as the answer to the malnutrition problem. Of the 22 villages, seven villages — Khai, Andharbari, Ohwa, Kaulavimal, Miryabari, Valamba and Pimpalgaon — do not have a yearlong motorable road and are therefore inaccessible. After a point one has to walk to get to the village. Four villages — Thanavihir, Guliamba, Amali and Pimpalgaon — are within a periphery of 12 km from the block headquarters of Akkalkuwa, but they are connected to a remote primary health centre (PHC) in Dab, situated deep in the third range of the Satpudas. One has to pay Rs 15 to get to the PHC by jeep; to reach Akkalkuwa one has to pay Rs 5.Other examples are Ambabri, Andharbari, Bharadipadar and Khai. These villages are connected to the Moramba PHC. To reach Moramba by car one has to travel via Khapar, covering a distance of 17-18 km. Although there is a primary health centre in Khapar, villagers from these four villages have to bypass it and go on to Moramba. The other option to get to Moramba directly is to walk through the h ills of the Satpudas for around 7-8 km. This shows up a serious flaw in the state government’s policy with regard to the location and coverage of primary  health centres. The village of Ohwa is connected to the Horaphali PHC, which is 22 km away. There is no road connecting the village with the centre; people have to walk through the Satpuda hills to get to it. To correct the situation the government sanctioned a health centre for Ohwa in 2004. But, although the tribal development department made provision to build the primary health centre, the health department still has to sanction the plan.Seven villages — Andharbari, Kaulavi, Bari, Pimpalgaon, Valamba, Maliamba and Kondvapada — do not have a public distribution system (PDS) outlet. Tribals from these villages are forced to walk 3-4 km to reach a PDS outlet. Of the 22 surveyed villages, 11 do not have a single job-creation opportunity under the state’s well-known Employment Guarantee Scheme (EGS). The residents of seven villages did receive some form of employment but only for a period of around a month.The survey also covered two rehabilitation and resettlement (R&R) sites of the Sardar Sarovar Project. Although the government claims to have carried out its R&R duties satisfactorily, the situation on the ground is quite the opposite. Of the 634 children surveyed, 378 were found to be malnourished and the number of girls among them was as high as 60%. Of the total number of malnourished children, 119 were in the third and fourth stages. The two sites have separate PHCs, PDS outlets, gram panchayats and four anganwadis each. All the children were in the 0-6 age-group. This shows that they were born after their families were resettled. What conditions are like in the other six sites is a question open for study.What is clearly needed is a debate on the findings of this survey, from the social, economic, political, cultural and medico-anthropological perspective. Especially, vis-ÃÆ' -vis the government’s information on the subject. The report is being made public to facilitate just such a debate.India’s malnutrition problem is a systemic issue | | Girls in India are more malnourished as â€Å"inadequate resources of families are divided preferentially among men†.  Ã¢â‚¬Å"The problem of malnourishment in India is a reflection on its deeply entrenched poverty and a lack of functionality of its systems,† says author [EPA]| India’s growing riches have been the subject of many global discussions. In the past few years, India has responded to international emergencies by reaching out with support in cash and kind. However, India  has still not managed to get a grip on the problem of malnutrition its children face, a fact that India’s prime minister this year called a â€Å"national shame†.The facts are daunting – as many as nearly half of India’s children below five years are malnourished. Girls are even more malnourished as inadequate resources of families are divided preferentially among men. India’s nutrition problem shows among women as well – the malnourished girls grow up to be anaemic, deliver underweight babies who face an increased risk of dying and being sick right after their birth. India ranks 76 among 80 middle-income countries rated for the â€Å"best place to be a mother† according to the Save the Children’s Mothers’ Index released in May 2012.’Anganwadi’ centresThe problem of malnourishment in India is a reflection on its deeply entrenched poverty and a lack of functionality of its systems. Policymakers from the comfort of their oversized public-funded accommodation while examining the failure of their policies often argue that a country of India’s size – both in terms of geography as well as population – is difficult to administer. What they admit a little reluctantly is that the government-supported institutions are neither effective nor accountable to the people, and that the budget allocations in sectors critical for people’s well-being are still abysmally low. India’s wealth – no longer so new-found – has so far not filtered down to the areas which would make considerable difference to the lives of its common people.A question often asked in India is about the co-existence of hunger and malnutrition alongside the problem of plenty – of thousands of tonnes of food grains rotting due to poor storage in government stores while the poor go to bed hungry. Clearly, the problem is not of a lack of resources but of systems that ensure that the country’s opportunities and resources are more equitably and equally divided.India’s response to its massive problem of malnutrition has been largely through the Integrated Child Development Services, or ICDS as it is known. The ICDS runs preparatory schools-cum-health institutions called anganwadi centres where pregnant and lactating women and children below five years receive supplementary nutrition while children are also taught to take first steps towards learning letters and numbers. Many states have further equipped their anganwadi centres to enable them to treat the common ailments of  children.Considering the critical role of anganwadi centres in helping children remain healthy, they should have been universalised decades ago but they have not. Anganwadi centres cover only 50 per cent of India’s children. However, data as well as anecdotal evidence appearing in the form of newspaper reports points out that anganwadi centres do not function at their optimum capacity and efficiency. Their staff are not accountable to the people of the village, and being â€Å"influential† (some of them are known to be relatives of village headmen and other important members of the village) are not s usceptible to punitive action when they fail to perform their duty. Poverty and malnourishmentThat is a typical Indian situation – one can get away without being punished for one’s wrongdoings if one has the right connections. This is the bane of most of India’s institutions and facilities which are meant to serve the people but become, instead, means of employment and influence for a few. â€Å"Nearly half of India’s children below five years are malnourished.†| Under the patronage of this protection, doctors in government hospitals may remain absent from work without a note on the attendance register for days, teachers may not teach, clerks in offices may demand a bribe to perform a task which is the right of a citizen. The impact of dysfunctional systems on the lives of the poor and the marginalised is devastating as they have no alternatives. The poor die of common illnesses if they do not get treated at government hospitals, or they go borrow money to access a private hospital and go into debt. In fact, the WHO has said that 3.2 per cent Indians would fall below the poverty line because of high medical bills with about 70 per cent of Indians spending their entire income on healthcare and purchasing drugs. The Planning Commission also accepts that out of pocket expense to pay for healthcare costs is a growing problem in India. It says 39 million Indians are pushed to poverty because of ill health every year. Around 30 per cent in rural India didn’t go for any treatment for financial constraints in 2004. In urban areas, 20 per cent of ailments were untreated for financial problems the same year, said a recent study in the Lancet. The government needs to look at health and education as critically important sectors in the development paradigm. If India is to reap its demographic dividend, it cannot do so with half of its children malnourished and not reaching their full potential| Overview of Malnutrition Situation in Maharashtra Maharashtra: The data below are from the National Family Healthy Survey 2005-2006. Highlights: The nutrition situation in Maharashtra is slightly better than the national average with improvements from 1998-99 and 1992-93 except for an increase of anaemia prevalence among pregnant women. The feeding practice for children aged 6-9 months shows an alarming pattern with only 48% of children aged 6-9 months receiving solid or semisolid food and breast milk. This is significantly lower than the national average of almost 56%. Furthermore, the prevalence drops to 40% for rural areas compared with the national average of 54% and as low as 23.3% for non-educated mothers compared with the national average of 49%. The prevalence of overweight and obesity in Maharashtra is higher than the national average for both female and male with Mumbai reaching almost 35% of obesity among the female population. Within Maharashtra, there are significant differences between rural and urban areas with the ru ral areas being more affected by malnutrition. However, the most outstanding gap in all indicators is between non-educated and well-educated respondents. Malnutrition and Anaemia Rates Are High among Children * Almost 38% of children under age three are stunted (India – 38.4%) and almost 40% are underweight (India 45.9%). Both indicators have slightly improved from 1998-99 and 1992-93. * Wasting affects 14.6% of children under age (India 19%) with a steady improvement from 1998-99 and 1992-93. * Compared with urban areas, under-nutrition is higher in rural areas and in Mumbai. Similar to the national picture, there is a strong correlation between child malnutrition and the level of maternal education showing a two-fold difference between non-educated and well-educated mothers. The stunting and underweight prevalence for children with illiterate mothers is 52.9% and 53.1% respectively contrasted with 22.9% and 25.9% for children with well educated mothers. The stark difference may be linked to access to nutritious diet and complementary feeding at 6-9 months. * Almost 72% of children under age three are anaemic (India 79.2). There is a significant urban-rural divide with Mumbai having the lowest prevalence  with 59.5% compared with 76.8% in rural areas. The non-educated versus educated mothers difference is not as strong with 75% and 71% relatively. This may be linked to a more general poor quality of nutrition and hygiene conditions and limited access to iron supplementation. Improvements Needed in Infant and Child Feeding especially for the age 6-9 months * 53% of children are fed only breast milk for the first 6 months (India 46%). Exclusive breastfeeding is significantly higher among the non-educated mothers, in rural areas and in Mumbai. Work factor and access to breast milk substitutes may have an impact among urban and better educated mothers. The positive deviance in Mumbai may be associated with an increased awareness among the female working class and better baby-friendly employment conditions. * 51.8% of children under three years are breastfed within one hour of birth (India 23.4%) with no significant difference between urban and rural areas and between well-educated and non-educated mothers. * Only 47.8% of children aged 6-9 months receive solid or semisolid food and breast milk. This is significantly lower than the national average of almost 56%. The prevalence drops as low as 40% in rural areas (India rural 54%) and 23.3% among non-educated mothers (India non-educated 49%) showing a high-priority gap. The prevalence in urban areas and in Mumbai is 58% and 56.6% respectively (India urban 62.1%). * 32% of children age 12-35 months received vitamin A supplements in the six months before the survey (India 23%) with the highest prevalence in urban areas (34.2%) followed by rural areas (29.9%) and Mumbai (27%) with a significant difference between non-educated (26.2%) and well-educated mothers (32.2%). A significant percentage of Women and Men Are Either Too Thin or Too Fat * 32.6% of married women (India 33%) and almost 30% of men (India 28%) are too thin, according to the body mass index (BMI). Underweight is strikingly most common among the non-educated and the rural population compared with Mumbai  and urban areas that show a similar prevalence. * Overweight and obesity affects 17% of women (India 14.8%) and almost 16% of men (India 12%). Overweight and obesity are strikingly most common in urban areas and among the well-educated with Mumbai reaching almost 35% of obesity among the female population as compared with the national urban average of 29%. Anaemia is Widespread * 49% of women (India 56.2%) and 16.2% of men (India 24.3) suffer from anaemia. Among pregnant women, anaemia has increased from 52.6% to almost 58%. * Only 30.5% of pregnant women consume Iron and Folic Acid supplementation for 90 days (India 22.3%) with 16.4% among the non-educated women compared to 45.2% among the well-educated ones. Rural and urban areas have the same prevalence of 30.5% with Mumbai reaching only 27.5% (India urban 34.5% respectively) The bleakest numbers* at a glance:*(NOTE: Figures have been rounded to the closest zero for easier understanding of the ratio) 1. For every ten children aged three or less, born to illiterate mothers, five children are stunted – too short for their age. This is a sign of chronic malnutrition. 2. For every ten children aged three or less, born to illiterate mothers, five children are underweight – too thin for their age. This is a sign of acute and chronic malnutrition. 3. For every ten children aged three or less, born to illiterate mothers, two children are wasted – too thin for his/her age. This is a sign of acute malnutrition. Wasted children are at highest risk of dying from malnutrition or from any common child diseases like diarrhoea or respiratory infections. 4. For every ten children aged 6-9 months, born to illiterate mothers, only two receive solid or semi-solid foods in addition to Breast-milk as recommended. This jeopardizes their chances of survival and irreversibly impairs their future growth and development. 5. For every ten children aged one to three years, born to illiterate mothers, only three children received Vitamin A supplementation in the last six months prior the survey. 6. For every ten illiterate women aged 15-49 years, four are too thin. 7. For every ten pregnant illiterate women, six are anaemic but only two  take Iron and Folic Acid supplementation for 90 days as recommended. The higher the education of the mother, the better the nutrition status of themselves and their child.NOTE: In Maharashtra, for every ten women, 2 women are illiterate and 8 are educatedAmong the educated women, 3 are well-educated (10 years complete and above), 2 have 8-9 years complete and 3 have less than 8 years complete.

Building Effective Teams & Managers and leaders

Whether we like it or not, there are always poor performers in any type of team or organization. These are employees or team members who do not meet the standards set by the organization. Commonly, poor performing employees are those who belong to Quartile Four when employees are force-ranked. Most managers and leaders agree that it’s not easy dealing with poor performers. As Levinson (2003) said, â€Å"it’s a wrenching task, but you have to face up to the need to confront poor performers, and either fix their shortcomings or fire them.  Ã¢â‚¬ Poor performers, no matter how small in number they may be, still have a big impact in the performance of the whole team or organization. As the HR Manager of the company, I would advise each member of the team to help one another in their tasks and job responsibilities. If the team members notice that there are poor performers among them, they should take immediate action by working with these people and talking to them. Havi ng a good peer-to-peer conversation may reveal the issues that the employee is facing, thus, affecting his/her performance at work. This can help getting to the root cause of the problem and help the member solve it.Team members who are not performing well tend to share their problems and open up more easily with their peers than with their supervisor or manager. Poor performers can also be identified through feedback from peers and, if applicable, customers. The customers are the people who can see the outputs of the employee or member’s work. If it is unsatisfactory to the customer, then the employee must not be performing well. Peers are good sources of feedback when it comes to how the employee or team member really works when the boss is not around. The employee’s co-workers are the people s/he gets to work with day in and day out.They are the ones who can immediately see where the employee is good at and where he is not. Thus, these people can better provide the data and the tools to determine the poor performers in the team or organization. Though co-workers may contribute to the improvement of a poor performer, still, the best person who could talk to the person and give relevant advices is the immediate superior. The member’s immediate superior would know the areas where s/he needs more improvement. Thus, the superior can give better advice pertaining to these areas and how to better improve on them.The immediate superior can also give suggestions on some actions the member needs to do in order to improve on the areas identified. Coaching and mentoring are the key techniques in handling poor performers. Constant monitoring of the employee’s performance and regular coaching would do a lot of help in the improvement of the employee. People think that coaching is a negative thing when it is actually the opposite. Coaching provides a venue for both the employee and supervisor to talk about each other’s performance (Yes, employees get to speak to! ).However, if several coaching have already been done and all other mentoring techniques and help are also tried but the performance of the employee remains the same, it will be best for both parties for the employee to just say goodbye. The job may just not really be for him/her. References Levinson, M. (2003, November 1). How to Find, Fix or Fire Your Poor Performers. CIO Magazine. Retrieved August 1, 2006 from http://www. cio. com/archive/110103/poor. html Time to Stop Tolerating Poor Performers. (2006, February 26). The Sunday Times. Retrieved August 1, 2006 from http://www. timesonline. co. uk/article/0,,8543-2057887_1,00. html

Bloom Research and Response Paper

Larkin and Burton’s abstract preface the Joint Commission’s directive for effective communication among caregivers during handoff to ensure patient safety (Larkin Burton, 2008, p. 360). The case study reviews the lack of handoff practice and its effect on continuum of care provided to â€Å"Ms. C, a 64-year-old woman, presented to the ambulatory surgery center for an open cholecystectomy† (p. 390), and the subsequent workshop utilizing Bloom’s Taxonomy of Education Objectives to educate and change clinical practice among the staff members. From this reader’s vantage Ms. C’s respiratory de-compensation was a result of the nurses’ failure to communicate patients medical history and critical findings during unit-to-unit transfer and shift report, inadequate nurse to patient ratio along with incomplete charting, failure to recognize early signs and symptoms of respiratory compromise, and lack of critical thinking skills. Evidenced by the case study’s assertions, Ms. C required oxygen in the post anesthesia care unit (PACU) but was transferred without it. Second, the PACU nurse did not communicate to the patient’s need for oxygen to the receiving nurse during handoff report. It is unclear if the surgeon wrote vital sign parameters and pulmonary toilet orders, or if there were standard protocols for this post operative unit. Ms. C’s incomplete graphic record indicate she was placed on four liters of oxygen within two hours of her arrival to the unit at 1630; however, fail to adequately trend abnormal vital signs such as low grade temperature and tachycardia (Larkin Burton, 2008, p. 392). The record does not document any nurse-initiated interventions or call to the doctor requesting a chest x-ray or recommending a respiratory therapy consult for breathing treatment and incentive spirometer. On post-op day two Ms. C’s respiratory status declined requiring a non-rebreather mask, rapid response team consult, and a transfer to the intensive care unit for a diagnosis of respiratory distress (p. 392). There were multiply factors that contributed to the above scenario; Larkin and Burton writes that â€Å"after this near-miss, failure to rescue incident† (p. 94) a task force consisting of management, clinical nurse specialist (CNS) and unit educator convened to discuss the event. The task force concluded that the nursing staff members were ineffectual in critically evaluating the patient’s signs and symptoms. The CNS chose a framework that utilized â€Å"Bloom’s Taxonomy of Educational Objectives†, that provided measurable outcomes to the ed ucational activity and enabled the nursing team to optimize their critical skill levels. A workshop to assist staff to navigate through the case study in a realistic manner was implemented (Larkin Burton, 2008, p. 95). The cognitive domain contains six intellectual skills that measure: knowledge, comprehension, application, analysis, synthesis, and evaluation of information received. The affective domain contains five emotional factors: receiving, responding, valuing, organizing, also conceptualizing and characterizing by value concept. It is during this phase that individual buy-in occurs or not. Finally, the psychomotor domain contains five motor skills functions of imitation, manipulation, precision, articulation, and naturalization. The individual learn to adapt his or her movements intuitively to a given situation (Larkin Burton, 2008, p. 395). The key component of continued nursing education is to advance and apply evidenced based practice at the bedside. The use of Bloom’s Taxonomy of Educational Objectives as the framework promote the transfer of evidence based information, in a setting that allow the nurse educators to evaluate and measure the learner’s: cognitive, affective and psychomotor processes. It allows the learner (nurse) to assess his or her level of application within each domain. Both the educator and the nurse can reinforce successes and target learning opportunities to areas of inefficiency. References Blais, K. K. , Hayes, J. S. (2011). Professional Nursing Practice Concepts and Perspective (6th ed. ). Upper Saddle River, NJ: Pearson. Bouchard, G. J. (2011, November). In Full Bloom: Helping Students Grow Using the Taxonomy of Educational Objectives. The Journal of Physican Assistance Education, 22(4), 44-46. Larkin, B. G. , Burton, K. J. (2008, September). Evaluating a Case Study Using Blooms Taxonomy of Education. AORN, 88(3), 390-402.

Analysing legal text (The case of Mark v. Mark ) Study

Analysing legal text (The of Mark v. Mark ) - Case Study Example Still, the question of whether the divorce should have gone through in Britain or in Nigeria was the initial problem, and the analysis presented below gives an overall summary of the situation. Since the couple was originally from Nigeria, and the wife had been spending the majority of her time in Britain and had decided not to return to her home in Nigeria, she filed for divorce in Britain. Her husband, however, did not agree with this, and moved for a stay, stating that the proceedings should be decided in Nigeria. The following provides an overview of this case, and what and why the British court decided the way it did. The two individuals involved in this case are from Nigeria, born in that country in 1948 and 1950 respectively. They were married by the law of the River State of Nigeria in 1979; the marriage at that time was considered valid and polygamous, since the husband had married at least two other wives prior to this one, and possibly two more after. Between this particular couple, there were four children, all born in the United Kingdom. All four children have been granted British citizenship. The husband in this particular case served in the Nigerian army, and became a General as well as becoming involved in the government following the military coup of 1983. During this time period, he was able to become quite wealthy. He was posted to Washington in 1990. The wife, on the other hand, had been a lawyer that had practiced in Nigeria. When her husband went to Washington, she proceeded to take classes at Queen Mary College in London, spending time either at school, in Nigeria, or with her h usband. She had obtained multiple entry visas and was able to come to Britain for up to six months at a time until March of 1997. Another coup occurred in November 1993, and the husband did not agree with the new ruler, General Abacha. Therefore, he left the army and decided to leave Nigeria for Britain. The couple then proceeded to establish a domestic home here. The husband was able to obtain a four year work permit that would allow him to remain in the country for that time. The wife was also allowed to stay for a longer period of time than her multiple entry visa originally allowed. After this, the husband was given indefinite leave to stay in Britain because of two of the children. The wife was out of the country, in Florida at the time, and was not included in this decision. When she wanted to return, she was allowed to enter for one day, but she stayed longer. This meant that she had become an over-stayer and was violating sections 24(1)(b) and 24A of the Immigration Act 1971. However, she was eventually granted indefinite leave, but only after the case between she and her husband had started. In June 1998, General Abacha died, so the husband came back to Nigeria to once again pursue politics. He eventually became a Senator in the Upper House of the Nigerian Parliament. However, he still made trips to Britain so that he could visit his wife and children. However, as time passed, the wife in this case gave up hope of coming back to her home country as the most important wife to the husband, and therefore decided to stay in Britain. The wife then issued a divorce petition on July 17, 2000. When she did that, she only focused on her current residence in Britain to discover the court jurisdiction; this was later fixed to add a claim

Factors of production and circular flow of income Coursework

Factors of production and circular flow of income - Coursework Example These factors are divided into four main categories: Land is the first category; land entails all the natural resources. Labor is another factor which simply refers to man power or human resources available for production through the utilization of natural resources and others. The third factor is capital also referred to as the man-made resources. Last but not least is Enterprise; which combines the other three factors or resources for production purpose. The factors are also classified in terms of management, money, materials and machines (Gitman, & McDaniel, 2009, Pg. 5). Where management depicts land resources, machines refer to labor, capital is equated to materials and enterprise to money. They are termed as factors of production since they are scarce resources, which are useful for the creation of services and goods, though, not for immediate and direct satisfaction of human needs. Economists simplify the different sorts of factors of production into broad categories to assist in understanding these factors of production. Land as a factor of production involves anything that comes from it. The most common land resources include water, oil, minerals, forests, gas and others. The land resources form the raw resources or materials in the production process. Natural resources are classified in three kinds such as chemical nature, their availability and abundances and lastly their distribution. Chemical nature resources entail inorganic resources such as air, minerals and water. Organic resources of the chemical nature refer to animals, plants, microorganisms and fossil fuels. The last chemical nature category includes mixed resources like soils. The other category of land resources is abundance and availability which entails in exhaustible or exhaustible resources. Exhaustible resources entails renewable and non-renewable, whereas renewable resources can sustain themselves or be replaced if properly managed. Non-renewable resources are lost forever once has been used. The distribution category involves national, multinational and international resources, which are used to create resources. The revenue that resource proprietors receive in return for land amenities is known as rent. The next factor of production to analyze is labor. Labor as a factor of production is the effort that human beings contribute to the production of services and goods. Labor resources encompass the activities of the people to facilitate service provision and production of goods to assist in day to day activities. Labor resources are almost contributed by people who have attained age of working to earn. This is because economist says that if one has ever been paid for the work he or she did then in that way has contributed labor resources; thus, has enabled production of goods and services. The income obtained from labor resources is referred to as wages and forms the greatest source of income for the majority. The third resource of production is capital. Accor ding to economist, capital as a factor of production refers to tools, machineries or other instruments that humans use to produce goods and services. Capital as a resource of production differs; this is because different services and goods require different resources to produce them. The income that is gained from capital as a fact

Business Plan Essay Example | Topics and Well Written Essays - 1500 words - 1

Business Plan - Essay Example However there have been various gaps in the service standards of online shopping. This paper is about a business plan of Online China Shopping Mall. The first section deals with the business viability of the proposal. Marketing mix is explained in the next section where the product, pricing, place and promotional strategies will be discussed. Entrepreneur skills and leadership styles are the next section which is followed by the human resource strategies. The supply chain management is another important factor of the online retailing that is discussed in the last section followed by conclusion of the paper. There is a good scope within the retail segment for variety of goods and products. These include clothing, fashion and apparel marketing, grocery stores, pharmacy, electronics, fast food and many others. There are number of organization offering these services. These organizations are superstores like Wal-Mart or smaller neighborhood retail outlet. The strategies of these organizations are based on their target customer base, location and company. The average household wealth is higher in the metro areas. In the recent studies inner city areas have indicated a large consumer base and high concentration of wealth and buying power. These areas have low competition, lower operating cost, real estate prices and others which make these areas a good prospect for business. According to a study completed by ICIC and the Boston Consulting Group of the more than $85 billion in retail spending per year that inner cities represent (over 7% of all U.S. retail spending), $21 billion of this demand is going unmet. 1 According to Kalakotas and Robinson (1999) this Internet-based technology, allow the online application to integrate several business functions such as accounting, banking, finance, management and administrative control, supply chain management, selling chain management, data collection system, marketing, and also fund transfer. . E-commerce has become

Your pick for THIS PROJECT Assignment Example | Topics and Well Written Essays - 250 words - 1

Your pick for THIS PROJECT - Assignment Example In 2008, we organized a two-week corporate tour for Barclays Bank employees. Egypt was their target destination and we are proud to announce that the trip was a success. The trip was intended to be an appraisal for outstanding performers and we were able to enable them to fulfill their dream. At Explorer Tours, we believe in offering the best value for money. Thus our cost policies are designed to cater to a wide range of customers who value our services. We enjoy outstanding collaboration with other established business partners such as hotels and airline companies and hence we are able to strike the best deals for our customers. At our company, you can find the best deals for beach holidays, all inclusive cruises, family holidays, corporate holidays and adult holidays. We also have special discounts for cooperates, return and referred customers. Our prices range from  £ 666 -  £200 per person depending on the destination and accommodation requirements. At explorer tours and travel, you will never go wrong with late booking, trip cancellation and occurrence of unfortunate events. Tours and travel is a risky venture and therefore we are concerned with the welfare of our customers. To facilitate smooth operations, we have partnered with Argos Travel Insurance Company. In addition, our contract requires us to assume full responsibility for our customers and their belongings. We value our customers and therefore we provide cover for trip cancellations and other insurable events. For more information on travel packages, offers, holiday destinations and adventure clubs visit our website at explorertours.com. Corporate clients are requested to be on the lookout for our upcoming team-building trip to be held in Sao Paulo, Brazil. The website also has latest information on tours and travel and the trendy holiday destinations. Information on baggage allowance, online bookings, credits cards and advance payments is also available on the website. Testimonies and

Human Rights, Cultural Integrity and Diversity and Protection of Human Essay

Human Rights, Cultural Integrity and Diversity and Protection of Human Rights and Fundamental Freedoms while countering Terrorism - Essay Example Not only the government but the non-governmental organizations are playing a prominent role in this context. According to the Latest Poverty reduction strategy paper about 70% of Zambia’s population live below the poverty line which results in harmful consequences for human rights. There is a lack of awareness in the people of Zambia which poses a negative impact in this regard. Though it is a stable county in many aspects, poverty and unemployment and governmental corruption are the key issues which act as a hindrance to the economic and social development of Zambia. Human rights problems include an unlawful killing; torture, beatings, and abuse of suspects and detainees by security forces; official impunity; life-threatening prison conditions; arbitrary arrests and prolonged pretrial detention; long trial delays; arbitrary interference with privacy; restrictions on freedom of speech, press, assembly, and association; government corruption; violence and discrimination against women; child abuse; trafficking in persons; discrimination based on sexual orientation and against persons with disabilities; restrictions on labor rights; forced labor; and child labor. Zambia is a member of United Nations and the African union and adheres to the commitments made in these universal human rights documents. The inhabitants of Zambia can turn to the UN Human Rights Committee through procedure 1503 to the special representatives in order to combat any kind of violation of specific human rights. ECOSOC is particularly focusing on the women rights violation. Zam bia is also a member of the following organizations including UNESCO, ILO procedure, African Commission on Human and People’s Rights, International Criminal court. Some major roots of human rights violation in Zambia are discussed below: The physical abuse of men, women and children who are in police custody face the worst forms of brutality and torture .The Zambian police

Corporate governance approaches Essay Example | Topics and Well Written Essays - 750 words

Corporate governance approaches - Essay Example Due to the many reported business failures, combined with the low profits generated, the credibility and efficiency of corporate structures has been doubted thus the need to assess the accountability and responsibility of such leadership. This kind of system is based on the assumption that the holders of wealth or those who have exclusively invested capital in the business own it. That means the owners are entitled to the profits accruing from the enterprise since they have put their money at risk. In the case, the shareholders manage and control the activities and values in the organization at sometimes the expense of workers, customers and the public interests for instance, in the case of job outsourcing and the tax evasion experienced by the firms. This system of governance puts together all the parties that contribute to the success of the enterprise by recognizing and empowering such parties. It includes not only the owners but also other players such as the managers, suppliers, customers, distributors, employees and the public (Appleyard, Alfred and Steven 261). The system is actually consumer, suppliers and employees oriented. The stakeholders are included in the board of governors and play an active role in the policy making process The main distinguishing figure between the two systems of capitalism is in the approach to the type of environment in which firms develop including the labor and capital. Under stakeholder capitalism, the total reward system of remuneration is used and support towards productivity through education, training and research is accorded. Labor is secured through promotion of employer relationship thus low turnover rates at work making the labor market to be less flexible. Shareholder capitalism, on the other hand, puts a lot of weight and priority to shareholders interests. This cause labor mismanagement and also reduces the return to labor. There is too much external and internal

Communications & Crisis Essay Example for Free

Communications Crisis Essay The Texas Division of Emergency Management (TDEM) has begun to receive official reports stating that the public water supplies of several towns in the South East Texas (SET) area have become contaminated with life-threatening biological agents. As director of this office, it is my responsibility to address contingency plans within the organization and the public; without creating panic. Areas of focus will include external and internal communication channels, communication advantages and challenges, communication strategies, applicable technology, technology utilization, and media opportunities. Successful management of the situation requires the establishment of teams and communication channels. Organization teams include a state relations team, district relations, media relations, and a crisis communications team (CCT). State, district, and media relations will communicate with CCT acting as coordinator. As the director of TDEM, I will be in charge of the CCT and oversee all organization operations. The state relations team till will be in charge of communications with the Texas Department of Health, the Texas Department of Public Safety, the Texas Emergency Management Council (TEMC), and other government officials. According to Texas law, mayors and county judges serve as emergency management directors, bearing the responsibility for maintaining an emergency management program within their respective jurisdictions (TDEM, 2014). This will help with local emergency coordination’s. The district relations team will engage with local authorities to organize emergency response operations. The media relations team will communicate with local and online media sources and keep them informed of the issue. Our organizations communication channels can instantly connect with multiple organizations at once. This gives our organization a major advantage. We have the ability to spread and collect information quickly and on a grand scale. Information needs to be disseminated as fast and efficiently as  possible. The challenges associated with communications is the coordination of all efforts. According to Athena du Pre, lack of communication can lead to duplicated efforts, costly (and sometimes life-threatening) delays, frustration, and wasted time (Du Pre, A., 2003). During crisis events delays and wasted time can cost lives. This means that our team must keep in constant communication with other organizations to prevent overlapping efforts. Crisis communication is an ongoing process. Having a crisis communication plan is important so that more time can be spent acting and less time be spent making decisions. Examining the communication process of other crisis events can be a useful way to identify successful strategies. In 1979, the Three Mile Island reactor malfunctioned. The major form of communication used to report the event at the time were televisions and radios. Access to information was limited and local television and radio station bore the bulk of public inquiries. Organization communications had to be accomplished via telephones or face-to-face. Public communications were also limited to telephones and face-to-face. In 2005, Hurricane Katrina ravaged the city of New Orleans and left a large portion of it underwater. The major forms of communication during this event included television, radio, and the internet. With this event the internet provided quick connection and communication with multiple entities. Information could also be transferred on faste r and larger scale. However, with this particular event a large portion of the public had to go without electricity for an extended period of time. Without electricity television, radios, and the internet cannot be operated. Smartphones existed at the time, but were not as abundant. Those with smartphones and cell phones had a small window for communications after the loss of electricity. Unfortunately, these devices require recharging and are useless after so many hours. Examination of these scenarios provide proof of the importance of information access during times of crisis. In 1979, their limited resources increased the levels of public concern. In 2005, their lack of resources reduced the number of communication channels. Many people were left clueless and helpless. I believe that a good way of utilizing this knowledge is to prepare for similar situations. Publishing emergency information to the public on a wide variety of channels means more access to information, less confusion, and better coord ination of efforts. Fortunate for us, the current  scenario is not a threat to public electrical systems. However, we should be prepared for interruptions or breakdowns amongst communication channels. Each team should have contingencies in place, in case one or more resources is lost. These contingencies should include backup agencies, officials, and media sources. Teams should also have contingencies in place incase internal communications are interrupted or broken-down. Organization teams should allocate responsibilities between different members. If something happens to a team member, their responsibilities should either be divide up amongst all other team members or given to a single member. This largely depends on the size of responsibility and number of available team members. If an entire team becomes unavailable, then that teams responsibilities will be divided by the CCT and distributed amongst the remaining teams. Public contingency plans must also be addressed. In this scenario there are effectively two distinct immediate dangers. Lack of public knowledge leading to exposure, and difficulties decontaminating the public water supplies. In regards to public knowledge, it’s important that information be disseminated not only through technological communication channels, but through ground communication channels as well. Public and municipal service employees of all types should be called upon to spread the word throughout the public. The more entities that can be informed via employer to employee, the better. In regards to decontamination, the public should be fully aware that government agencies are working around the clock to solve the issue. Government entities should also offer access to alternative water supplies. During times of hurricanes, many agencies and charitable services hand out bottled water from multiple locations in their respective cities. This strategy should be utilized with the current scenario. If necessary, these services should be offered for as long as they are needed. As indicated in the previous scenarios, technology and the spread of the information go hand in hand. With the addition of the internet and digital communications, the communication process has become much more versatile. Social media often provides as a communications network for the public. Social media users can connect with other users and members of the public to share information and coordinate efforts. In today’s world many people have smartphones that are capable of internet access. These devices provide people with the ability to  access information no matter where they are. The downside to this technology is the requirement of data access. Times of crisis can overwhelm internet infrastructure, making communications slow or impossible. Short messaging services (SMS)’s are a good way of combating this effect. The benefit of SMS’s is that they operates on the mobile carrier signal rather than the connection used for mobile voice and data, allowing messages to be delivered and received on mobile devices even when the networks are too congested to make voice calls (Anonymous, 2014). Emergency alerts are also able to be broadcasted this way. Those with smartphones can be sent instant notifications; keeping them updated with current information. These systems can be used to inform a large number of people all at the same time. Compared to previous crisis scenarios, it’s possible that some technologies could be used differently. With the expansion of available communication channels, reliance on some technologies may not be as abundant as it once was. Television and radios no longer bare the sole burden of emergency broadcast communications. This can free up the efforts of local news and radio stations. Fewer public inquires to contend with, increases the overall resources of the stations. People will still call the stations for information, but the number will be significantly lower than it was in previous scenarios. In some cases television and radio may not even be utilized. Advancement in technologies has allowed the home computer to become the central h ub for information in some homes, and amongst many college students. Computers can be used for watching television and listening to radio programming. This technology increases the need for broadcasting emergency information over internet channels. Media opportunities of this management crisis include redundancy broadcast. According to a study from the University of Texas, redundancy is often necessary to overcome the noise in people’s lives because it reveals that people’s urgency perception increased after receiving three messages (Stephens, K., Barrett, A., Mahometa, M., 2013). Having the media broadcast continual information will help increase the urgency perception of the public. The more people that are made aware, the less potential there is for casualties. Social media could also be used as a way to broadcast emergency information to different groups. Sites like Facebook and Twitter, can be used to spread information. Users connected or â€Å"subscribed† to  different groups receive notifications from those groups. This allows for information to be spread quickly across a major network. Often groups will be connected to other groups. When one group learns of the emergency they can then share the information with another group, and so on. Crisis management is an urgent matter that must be handled swiftly and efficiently. Planning and communications are vital for coordinating efforts. To protect the public, organization and communication strategies and contingencies must be in place. Communication channels must be established and their advantages and challenges should be known. Applicable technologies and their utilizations should be identified. Media opportunities should also be known so that appropriate communication channels can be utilized as a means of keeping the public informed. References Anonymous. (2014). Dynmark International: SMS is most effective communication channel during emergency. (2010). Wireless News, Retrieved from http://search.proquest.com/docview/750383013?accountid=458 Du Pre, A. (2003). Communicating About Health (2nd ed.). Boston, MA: McGraw Hill HIPAA compliance. Corrections Forum, 12(1), 15-16. Retrieved from http://search.proquest.com/docview/214412170?accountid=458 Seeger, M. W. (2006). Best Practices in Crisis Communication: An Expert Panel Process. Journal of Applied Communication Research, 34(3), 232-244. doi:10.1080/00909880600769944 Stephens, K., Barrett, A., Mahometa, M. (2013). Organizational Communication in Emergencies: Using Multiple Channels and Sources to Combat Noise and Capture Attention. Human Communication Research, 39(2), 230-251. doi:10.1111/hcre.12002 Texas Department of Emergency Management (TDEM). (2014). Retrieved from http://www.txdps.state.tx.us/dem/ he Fiscal Year of 214.

Incidence and Prevalence of Tuberculosis in the UK

Incidence and Prevalence of Tuberculosis in the UK ESSAY TITLE: Using two theoretical perspectives discuss with reference to the prevalence of ONE disease, E.g. Diabetes, Respiratory diseases; how Disease patterns in society vary and the role of public health agencies in reducing disease and promoting health? Chapter 1 Introduction Society is constantly changing, and these changes come with different social and environmental problems, which result to the emergence of new diseases and an increase in the incidence of existing ones, which affect human health and society as a whole. These include diseases such as cancer, respiratory diseases, diabetes, hepatitis, asthma and human immunodeficiency virus (HIV) just to mention a few. In this essay, I will be analysing the incidence and prevalence of Tuberculosis and the pattern of this disease in relation to changes in society. I will also be comparing two theoretical perspectives regarding the nature and causes of Tuberculosis. To conclude, I will be analysing the role and impact of public health agencies in reducing the disease and actively promoting health. Chapter 2 1.1. Incidence and prevalence of Tuberculosis in UK. Definition; Tuberculosis popularly known as TB, is said to be an infectious disease usually caused by a bacterium known as Mycobacterium tuberculosis. TB often affects the lungs but can also spread to any part of the body through the bloodstream. Classic symptoms of TB include; persistent cough, fever, weight loss, loss of appetite and tiredness. TB is contagious and is mostly transmitted from person to person. An infected person can infect about 10 to 15 people over a year if not treated. (NHS choices, 2014). Incidence and prevalence rates; Some decades ago the UK was said to have and increase number of reported TB cases. From 2005 the number of reported cases remained high but stable. In 2009, there was said to be about 9000 cases of TB reported. An incidence rate of 15 case per 100.000 population. This can be said to be the highest since 2005. Then in 2010, the number of cases was 8483, an incidence rate of 13.6/ 100.000 population. This show a decrease in the number of reported cases by about 4.9%. In 2011, there were 8963 cases reported, an incidence of 14.4/100.000 population which again was an increase compared to 2010. Then in 2012, there was 8751 cases, an incidence rate of 13.9 cases per 100.000 population. About 8000 cases of TB was recorded in 2013 in the UK that is a rate of 12.3 cases per 100.000 population. This shows a 10.4% reduction rates in the number of cases reported. (Public Health England, Tuberculosis in UK: Annual reports). The population of UK mostly infected with TB are those born outside the UK. That is those from countries with highest prevalence rate of the disease. For example, India sub-Saharan African, Pakistan, south Asia, Somalia. This group of people usually dwell in urban areas that seem to have the highest number of cases reported. For example London, Luton, Manchester, Coventry Leicester and Birmingham. Chapter 3 1.2. The pattern of Tuberculosis in relation to changes in society Throughout the last 20 years, the UK has been experiencing a steady rise in the number of TB cases. The most affected areas are the urban areas highly populated with immigrants. The rising number of cases in these areas has been related to the pattern of change in how the TB is spread and controlled. For instance, it does not spread through all the segments of the population as it has done previously, but rather affects the population of people in the high risk group. â€Å"†¦those most at risk remain individuals from ethnic minority groups, those with social risk factors such as a history of homelessness, imprisonment or problem with use of drugs or alcohol, and the elderly†. (Public Health England 2013). The small percentage fall in the rates of TB cases in 2012 and 2013 is said to be associated with the fall in the number of cases in the non-UK born population. This may be due to changes in immigration policies and policies to control the disease in the UK and abroad. For instance, around 2007, pre- entry TB test was a requirement for Ghanaians applying for more than six month visa to the UK. â€Å"While this decline is welcome, it is important to recognise that the vast majority of TB cases in the non-UK born population (85%) occur among settled migrants rather than new entrants. Tackling the reactivation of latent TB in such migrants will require systematic implementation of screening and treatment of latent TB infection†. (Public Health England 2014). Chapter 4 2.1. Theoretical perspectives of Tuberculosis. There are so many theoretical perspectives with their individual view about the nature and causes of diseases. There are sociological theories viewing health and diseases in the context of society, and there are psychological theories viewing health and diseases and the context of the mind and so many others. Theories are sometimes useful to public health agencies and the government for the planning of health policies and interventions. In this essay, I will be discussing two theoretical views of tuberculosis, namely the Germ Theory and Biomedical Theory. The Germ theory Around 1850 and 1920, the Germ theory was established, attested and promoted in North America and Europe. This theory stated that every disease is caused by specific invisible tiny organisms (germs). It was a theory that was well matched to the prevailing concepts of health and diseases particularly those connected with the 19th century hygiene and sanitation. Joseph Lister, Robert Koch and Louis Pasteur are some of the well-known persons in connection with the germ theory. This theorist believed that disease can be reduced by means of personal hygiene. They did not pay much attention to other factors such as climate, diet, environmental ventilation etc. Base on this, hygiene and sanitation promoters such as Florence Nightingale and Rudolf Virchow did not accept the theory. To them the germ theory could not be related to the progresses in public health. The theory was established in a social, cultural and economic settings that were highly focused on the principles of mass production, mass consumption, standardisation and efficiency which were harmonious with the discipline of the theory. The high achievement of the theory coupled with the fact that medicine was linked to laboratory resulted in a rise in the social prestige of physicians and medical research and practice. This happened at the time when the general public was uncertain about the significance of traditional medical practice. To rise a new public consciousness of the theory, the general public was made to understand that diseases are not only cause by germs, but also they are passed on from person to person. Germs were related to home hygiene, including cooking, plumbing, and heating. Therefore women were the main targets used to spread the information about germs. (Harvard University Library Open Collections Program, 2015). â€Å"In the case of tuberculosis, which formerly had been considered noncontagious, basic changes in everyday hygiene were required. Mass production, mass communication, and national advertising had developed alongside the germ theory during the same period, and the tools of public relations were put into play to inform the public about TB’s contagiousness, as well as to inform people about the germ theory in general†. (Harvard University Library Open Collections Program, 2015). The biomedical perspective The biomedical perspective on the other hand believe that a sick person is presumed to be an inert receiver of orders from medical professionals (doctors). This theory sees diseases as biomedical problems that are caused by bacteria or viruses, and treatment is targeted on the sick person’s body. A sick person is seen as a broken person who need to be fixed. This does not consider other factors that may be causing the health problems. For instance social, environmental and psychological factors. When a patients does not respond to treatment, it is assumed to be caused by the individual characteristics such as age and gender. Policies and practice of health care services can be said to be based on this theory. Doctors are the authority who give instructions and patients are the receivers of the instruction. Medication Event Monitoring Systems (WHO 2011), used to monitor adherence is embedded in this perspective. In spite of its inherent use by many health professionals, this perspective is uncommonly used openly in interventions. (BMC Public Health, 2007) Chapter 5 3.1. The role of public health agencies in reducing Tuberculosis Tuberculosis is a worldwide health problem which has put government and public health agencies on their toes. Every nation is working hard to control if not eradicate the disease. In the UK, the Local Government Association, Public Health England, the NHS and other public agencies are working together to come out with policies, procedures, practices and measures that will help control the spread of the disease. Some of these include: Pre-entry screening The government has introduced a pre-entry screening programme for TB in countries noted to have high incidence of the disease. Residents of those countries who are applying for more than six month visa to the UK has to undergo TB screening. This screening involve chest x-ray and checking for symptoms. Those found with active TB will have to undergo treatment before they are issue visas. (Local.gov.uk, 2014). Use of Anti-TB drugs A mixture of anti-TB drugs are given to patients to lessen the possibility of the TB bacteria becoming resistant to one or more of them. Patients are usually started on a six months course of anti-TB drugs which is made up of four different drugs. The six month course of anti-TB is said to be the most effective period that will guarantee that the inactive bacteria are killed and cannot reactivate to cause TB in future. (Local.gov.uk, 2014). BCG Vaccination BCG vaccination are being offered to babies, infants and young children who come from countries with high rates of TB. Those born in the UK to parents from the high risk zone are also given the vaccine to protect them from the diseases. Early discovery, diagnosing and treatment is said to be another way of controlling the diseases. Healthcare workers are also advice to take the vaccine because they stand the chance of getting infected at work. Chapter 6 3.2. The impact of public health agencies in reducing Tuberculosis Tuberculosis has been seen to have a huge health and social effect on those infected. The existing inequalities in deprived areas is seen to be rising because of this disease. The Chief Medical Officer has recognised the inequalities, and increasing levels of antimicrobial resistance, as primary concern for England. The Health and Social Care Act 2012 has made it the responsibility of local government, clinical commissioning groups (CCGs), Public Health England (PHE) and NHS England to reduce the inequalities. It is believe that the NHS, CCGs and Public Health will be making savings if TB is eradicated. Because it cost a lot to diagnose and treat drug-sensitive and resistant forms of TB. Some of the task set up to achieve this are; 1. Improve access to services and ensure early diagnosis 2. Provide universal access to high quality diagnostics 4. Ensure comprehensive contact tracing 5. Improve BCG vaccination uptake 6. Reduce drug-resistant TB 7. Tackle TB in under-served populations 8. Systematically implement new entrant latent TB screening 9. Strengthen surveillance and monitoring (gov.uk website, 2015) Chapter 7 3.3. The role and impact of public health agencies in actively promoting health It is the responsibility of every individual in a society to keep themselves healthy. The public health agencies of every society also have the responsibility of helping the members of that society to stay healthy. Some of the responsibilities of health agencies such as the NHS in promoting health as recommended in a report from the NHS Future Forum (gov.uk) are; Healthcare professionals making every contact count; to do so they will need to ensure that every contact they make with a patient should help to improve their mental and physical health and wellbeing. Improving the health and wellbeing of the NHS workforce by designing and implementing strategies to improve the mental and physical health and wellbeing of staff. Refocusing the NHS towards prevention and promotion; all providers of NHSà ¢Ã¢â€š ¬Ã‚ funded care should strive to prevent poor health and promote healthy living by in cooperating it into their daily business, and they should be recognised for achieving excellence. Building partnerships outside the NHS; NHS commissioners and providers of NHSà ¢Ã¢â€š ¬Ã‚ funded care should work together with other local services to promote health and wellbeing in areas where the NHS finds difficult to reach. Sharing learning and best practice; Healthcare professionals, NHS commissioners and providers of NHSà ¢Ã¢â€š ¬Ã‚ funded care should share learning about improving the public’s health and wellbeing and reducing health inequalities, and seek to learn from others. Public Health England should ensure that evidence and best practice are spread across the NHS. 1

With close reference to at least 2 poems explore how the poets create E

With close reference to at least 2 poems explore how the poets create a sense of mood and atmosphere. In "Porphyria's Lover" by Robert Browning and "Mariana" by Alfred Tennyson, the poets use many different literary techniques to create a sense of mood and atmosphere. They choose their language and vocabulary carefully to make the reader use all of their senses, using techniques such as imagery, rhyme and rhythm. "Porphyria's Lover" begins with a description of the rain and the "sullen wind" which makes the mood seem dark and gloomy, though unlike in "Mariana," this changes later in the poem. This is shown when he appears to be sulking when Porphyria calls and he does not respond. However, Porphyria's entrance into the cottage causes the atmosphere to become warmer by lighting the "cheerless grate," which again could mirror her lover's feelings for her in the same way as the setting in "Mariana" reflects the main character's emotions. This change in atmosphere in "Porphyria's Lover" suggests that she is the most important thing in his world and his source of happiness. In "Mariana," the building has fallen into disrepair, as the flowerpots were "thickly crusted" with moss and the shed was falling apart, which is similar to the feelings in her heart. In the same way that there is no one there to look after the garden, there is no one to love Mariana. The writers use rhythm, rhyme and repetition to give the poems movement and structure. For example, in "Mariana," Tennyson returns to a similar pattern of five lines at the end of each verse, which gives the poem phrasing. In "Porphyria's Lover," repetition is not used as much, but, as in "Mariana" there are patterns in the rhyme at the end of each li... ...oftly. The flowing rhythm makes the mood eerily calm, and this feeling continues right to the end of the poem. The opposite effect is created in "Mariana," as Tennyson uses punctuation such as commas and semi-colons to create breaks, which gives the poem a slow pulse and almost shows the passage of time that Mariana has to put up with. The last three to four lines of each poem have many similarities. Both refer to God, showing the religious thoughts of the time, and, more importantly, the both leave the reader wondering what happens next, and leave many questions unanswered. "Porphyria's Lover" and "Mariana" are both examples of how poets can create depressing and eerie moods and atmosphere using clever vocabulary, imagery, rhyme and rhythm. I think that the poems are both quite romantic, but are both examples of how too much love can be a bad thing.

king lear Essay -- essays research papers

Shakespeare's King Lear   Ã‚  Ã‚  Ã‚  Ã‚  William Shakespeare's King Lear had downfalls in character which later on caused him to suffer extreme consequences. if anyone knows the true meaning of suffering it is King Lear.   Ã‚  Ã‚  Ã‚  Ã‚  King Lear's downfalls are his pride, selfishness, and blindness to truth. Pride as one of Lear's first downfalls, in the beginning Lear disowns his lovely daughter Cordelia, because Lear is to blind to realize that cordelia loves her father for who he is and NOT what he has in his possession. Lear sees his daughters for what they have as far as quantity not quality. This is his downfall of selfishness. Lear offers his two greedy and selfish daughters, Coneril, and Regan his entire kingdom, simply because he is so damn conceded and thinks he is so great that he can not possibly see anyone not loving him, and what he owns as far as land and power. His greedy daughters realize this and then decide to kiss a little of their father's butt. Cordelia, and Regan go and kiss their father's butt hoping to get all his power, and his kingdom. On the other hand, his one daughter who loves him for what he is, not what he is or has, realizes that she must play on her fathers side just to receive a little respect from the king.   Ã‚  Ã‚  Ã‚  Ã‚  Lear, by toying with loved one's emotions endues consequences upon himself. Even at his age ,he was still perfectly capable of living up to his duties ...

Forming the Pomegranate :: Fruits Foods Papers

Forming the Pomegranate pome ·gran ·ate Punica granatum Punicaceae Derived from Old French pome grenate: pome for apple and grenate, having many seeds. And there is also Latin: grantus, granum, grain, seed. This skin of a pomegranate is like tissue, the inside of the body, like blood clotting. Soft tissue. At least twenty-seven different hues of red. Or any other number, perhaps it is more. Pomegranate red when a lip is bitten, the inside of the mouth--soft tissues of the mouth. The fruit's body is deformed, rough, parched. Gentle dents, the kind found upon a child's skull--the way the cranial bones fuse together. Parched, callused: I think of browning manuscripts in libraries; I think of hands. I have one here I am trying to dry, letting it shrivel, concave upon itself. I am letting the dark, damp seeds inside wither. I place it in the fall of the sun, beneath my window. The pomegranate fits my hand, my palm that agrees to the rises and slopes of the fruit. My fingers curling across the indentations, uneven red ground. When Demeter, the goddess of the earth, lost her daughter Persephone, she made winter. The god of the underworld, pale Hades, saw the beautiful child (one can never help with whom they fall in love) and from his chariot he clasp the girl, descending into his dark land. He would have said I loved her because she was so light. Upon the earth the people were confused by the new cold and still Demeter refused spring until her daughter was returned. The other gods demanded of Hades the release of Persephone. In that dark land, soil as sky and all creatures a languid shade of gray, Persephone ate of a pomegranate. She ate six seeds and those small seeds, Hades' artifice, bound her to him for six months of the year, always. And so she rose to Demeter and still must return again to her melancholy groom, every year the same footsteps, the same chariot of black horses. Pomegranate beneath the soil, a muted shade of gray and seeds also a color she did not recognize. Pomegranate, which is regarded as food for the dead. I learned this fruit's story: pomegranate's origins in Iran, in the Himalayas. Later certain travelers carried its seeds on their journeys across the Mediterranean. It now claims many lands: India, Southeast Asia, the East Indies, tropical Africa.

Fight Club and the Idea of Nonsensical Life Essay

In our dynamic and busy society, every one is prone to suffer some psychological problems from its faintest symptoms to the most severe effect to the human mind. This trouble occurs because our society can not satisfy our mental capabilities. This shows that even if the human mind is regarded as the most important and most reliable machine in the universe, there is still the possibility that it cannot handle every inch of information fed into it, which unfortunately draws back with negative effects in our social and psychological nature. The psychological problems are somewhat manifested in the actions of people in our everyday activities which includes social interaction, eating, walking, sleeping, and others. The body, together with our mind is our ultimate weapon to all problems that attacks us in every minute of every day, thus it is important to take care of our body and mind to ensure a smooth flow of social and psychological functions One of the most common problems that people around the world experience that has something to do with the psychological nature and has an effect in the social realm is the presence of insomnia. This is a physiological and psychological problem that makes a person stay awake for hours in the night and could lead to depression, anxiety, and other psychological and social problems if not being taken cared of. This could be seen in situations of stress and other social factors such as boredom and heavily depressing situations that makes the mind of an individual relatively awake at night, and affects many aspects of its life including his/her career, social life and interaction, leisure, and even the family. This is illustrated in Chuck Palahniuk’s novel â€Å"Fight Club†. Wherein, the main character or the narrator suffers from insomnia and eventually led him to other directions of life that changed the course of his whole nature and realm forever. â€Å"I want to a good night’s sleep. I want to get up without feeling that to waken is to plunge through a trap door†(40). This poem line shows us that many people experience problems of insomnia, which have a different effect on every body based on the interpretation and diagnosis from the persons history and psychological disposition. So why do people suffer from insomnia and psychological problem? One of the main reasons, I think is that, most people who go through is have a feeling that their lives were senseless or vain. This also makes it easier to understand that people who suffer any psychological problem have the tendency to overreact and unfortunately lead themselves to death. Their idea of a good life is being overrun by anxiety and senseless assumptions that makes them think that their actions arte not enough to act ordinarily and make themselves think as if they are the ones responsible for failures and misrecognitions. Chuck wrote about these feelings in his book through the use of a character named Tyler. Tyler shows the people his influence through his illustration of nonsensical lives the people had been which gave him the reason to create the group and the fight club members a new reason to live their lives as they prefer it. The first life that Tyler changed was essentially his own. The main character and Tyler are actually the same person although the narrator did not learn this until near the end of the story. When Tyler and the narrator first met together, they started fight club after Tyler’s uttered his legendary phrase, `I want you to hit me as hard as you can` (Palahniuk 46). This started a totally different period in the narrator’s life. Different from the meaningless but contented life he had been experiencing. This led to an unstructured yet significant life moment he felt in everyday of his life. It is far from his unhappy, monotonous and tedious life at the office, selling cars and dealing with his hated boss. The narrator, having had his life changed by Tyler and fight club, then goes on to say, `You aren’t alive anywhere like your alive at fight club` (51). The narrator would rather be at fight club than anywhere else in the world. Along with this, he also says that `After a night in fight club, everything in the real world gets the volume turned down` (49). The main character cannot compare his experiences at fight club to anything else in his life. His enthusiasm and eager ness is shown in fight club more than anything in the he ever done in the world, and in the course of his life. Tyler Durden tore down the narrator by changing his life and then rebuilt his life by starting fight club with him. For the narrator, his unexpected meeting with Tyler is the most phenomenal yet unbelievable thing that he never thought could change his nonsensical life. Tyler also changed strangers’ lives by establishing Project Mayhem and giving assignments at fight club, to be executed and that would make a change in the social environment as the day goes on. Tyler ordered the members to each make twelve human sacrifices to ensure their existence in the organization and make their commitment as sincere as possible thru these assignments. The best example is the human sacrifice the narrator made of Raymond Hessel. The narrator takes Raymond at gunpoint and makes him explain that he has failed at becoming a veterinarian. After telling Raymond that he will kill him if he won’t be on his way to becoming a veterinarian in three months, the narrator lets him go and remarks, `Raymond K. K. Hessel, your dinner is going to taste better than any meal you’ve ever eaten, and tomorrow will be the most beautiful day of your life` (155). By doing this, the narrator has made Raymond stop taking his life for granted and made him do something productive with his life. Although most people would see this act as being mean or cruel, this is the best and most effective way for the narrator to get Raymond to stop taking his life for granted. In other words, there is a great effect given off by the group not only upon themselves but to other people as well. It did not matter if these people are total strangers, but what is important to them is the huge effect they make in the lives of people, including that of Tyler’s and the narrator’s. By following the rules and compensating the value of their commitment, the members practically make their lives as meaningful to them, especially inside of the fight club circle. Tyler then expands his vision and decides to create Project Mayhem to try to change the world. With all the effect of fight club in the minds of its members and the effect of their actions in the society, they became a large organization that plans to take over the society by way of Tyler Durden’s words and commands. In other words, his words are like God’s commandments that should be followed in order to make some changes in the scenes of problematic worldviews. He says `Like fight club does with clerks and box boys, Project Mayhem will break up civilization so that we can make something better out of the world` (125). He sees that the only way to change the world is to destroy it so it can rebuild into something stronger. Tyler thought of the world as `my world, my world, and those ancient people are dead` (124). He wanted the world to be his generations world and for it to be `free of history. ` Tyler saw that history had done harm to the world, so if they freed the world from its history they were `going to save the world` (125). Project Mayhems main focus is to take the world one step back so they can move three steps forward. It is like an anarchistic thought that, people should not believe in what ever authorities say, what is important is what Tyler says and the members should believe and respect it like no other authorities exist. By putting into every one’s mind that fight club should not be talked about outside of their organizational circle, the group remains as underground as possible to protect their identity and to protect their principle to change the mainstream interpretation of the world. With this, it shows that it reflects the world view of the narrator as a tedious and tiring scenario wherein he should obey every word his boss says. Or he should do every work given to him everyday. Sometimes we are tricked into thinking that the only ways for change to come about is to keep moving forward and in the same direction. In Fight Club, we are shown that this is not true by the character of Tyler and that sometimes it is better to move backwards so we can progress forwards. Not only is this true in the book, but it can also be applied to situations in the real world. In addition, we may take another path to attain progress and growth other than what is given to us by the world. People’s view on the world and life as a whole should be taken on its next level that we should not only think in its linear sense but in a diffusing one. More possibilities and more options. This was also internalized by the narrator through the revelation of Tyler Durden’s identity throughout the story, which gave him other idea of life not just the ordinary life he experienced in the past. But on the otherhand this also led to more serious complications of life as a whole. Works Cited Palahniuk, Chuck. Fight Club. USA: WW Norton, 1996.