Proposal Presentation - Five Guy's Term Paper Example | Topics and Well Written Essays - 1000 words

Proposal Presentation - Five Guy's - Term Paper Example In this case, researchers are made to go through an array of ethical requirements. There is the need to meet professional and institutional standards as well as those for conducting any research related to human participants. In helping steer clear of any ethical quandaries, this research would consider a number of research ethics. First, the researcher would frankly discuss the intellectual property with the participants (Bernardin & Nairn, 2008). More often than not, academic competitiveness leads to trouble depending on who should be credited for authorship. The best way to avoid disagreements on who is to be credited and which order to use, the researcher should talk about the issues at the beginning of the researcher's working relationships with the participants and should ensure they are put in writing (DiMauro & Grant, 2006). This will act as a tool to help discuss and evaluate the contributions during the research process. Secondly, the researchers would be conscious of multi ple roles of the participants. This could be achieved by avoiding relationships that might tend to impair the researchers’ professional performance or could cause harm to others. However, they will have to take note that many multiple relationships are not ethical especially if they could have some adverse effects (Goree, 2006). When recruiting participants in this study, the researchers would have to think carefully before commencing multiple relationships with students. In this case, the researcher would act as a lab supervisor as well as a mentor and would make sure he or she does not abuse the power to differentiate himself or herself from the participants (Bernardin & Nairn, 2008). The researcher would make sure he/she outlines the nature and structure of mentoring before the mentoring begins. Thirdly, the code of ethics to be upheld during the study would be to make sure the informed consent rules are strictly followed. Doing this properly, the consent process would ens ure that the participants voluntarily participate in the research when fully informed of the relevant benefits and risks. Lastly, the researcher would have to consider respecting the confidentiality and privacy of the participants. Respecting individual rights to confidentiality as well as privacy is a key tenet for every researcher (Bernardin & Nairn, 2008). The researcher will, therefore, have to discus confidentiality limits, giving the participants information concerning how their data will be put into use and for them to know the law of the state, as well as taking practical security measures. Failure of observing ethical stipulations may lead to incidences of taboos – a common element in the incidents of ethical based violations. However, the task of establishing personal ethics is rather demanding. This is with regard to the essence of ethics in an individual’s life. Adoption of appropriate ethical perceptions is a demand that is instilled in the person by his o r her immediate community. This makes ethics seem inclusive of an expectation as well as the desire to protect one’s perception of life (Goree, 2006). Ethical beliefs are regularly challenged, especially during the address of various aggressions in the daily lives. The success in the addressing of these challenges implies a positive or impressive performance of our ethical beliefs and research. The development of successful ethical trends is based

Ancient Indian Mathematics Essay Example for Free

Ancient Indian Mathematics Essay There are opposing views prevalent regarding the prominence of mathematics in ancient India. One, there are those who make excessive claims for the antiquity of Indian mathematics with the motive of emphasizing the uniqueness of Indian mathematical achievements. Whereas, the other conflicting views denies the existence of any ‘real’ Indian mathematics before A. D. 500. This view is the result of deeply entrenched Euro centrism that does not negotiate with the idea of independent developments in early Indian mathematics. Whereas mathematics grew out of philosophy in ancient Greece, it was an outcome of linguistic developments in India. In fact the algebraic character of ancient Indian mathematics is but a byproduct of the well-established linguistic tradition of representing numbers by words. ? Around 800 B. C. Vedic mathematics declined and Jains School of mathematics gradually which was to do notable work in the field. ? From about 200 B. C. was period of instability and fragmentation due to foreign invasions but also of useful cross cultural contacts. Probably the only piece of existing mathematical evidence from this period is the Bakhshali manuscript. ? This period ranges from 3rd to 12th centuries and is referred to as the classical period of Indian civilization. Mathematical activities reached a climax with the appearance of the famous quartet: Brahmagupta, Mahvika and Bhaskracharya. Indian work on astronomy and mathematics spread westward, reaching the Islamic world where it was absorbed, refined and augmented before being transmitted to Europe. This last period described as the medieval period of Indian history, saw the migration of astronomy and mathematics from the north to south. Particularly in present day state of Kerala, this was a period marked by remarkable studies of infinite series and mathematical analysis that predated similar works in Europe by about three hundred years. Harappan society was a highly organized society. There is every possibility that the town dwellers were skilled in mensuration and practical ar ithmetic of a bid similar to what was practiced in Egypt and Mesopotamia. Archaeological findings from that period provide the following indications of the numerate culture of that society: ? It shows uniformity of weights over such a wide area and time which is quite unusual in the history of metrology. Taking 27. 584 grams as a standard, representing 1, the other weights form a series of 0. 05, 0. 1, 0. 2, 0. 5, 2, 5, 10, 20, 50, 100, 200 and 500. Such standardization and durability is a strong indication of a numerate culture with wellestablished, centralized system of weights and measures. Scales and instruments for measuring length have also been discovered with remarkably high accuracy. A notable feature of Harappan culture was its extensive use of kiln-fired bricks and the advanced level of its brick-making technology. These bricks are exceptionally well baked and of excellent quality and may still be used over and over again provided some care is taken in removing them in the first place. Fifteen different sizes of Harappan bricks have been identif ied with standard ratio of the three dimensions as 4:2:1. It was thought until recently that from them evolved first the Bakhshali Number system and then the Gwalior system which is recognizably close to our present day number system. In both Bakshati and Gwalior number systems, ten symbols were used to represent 1 to 9 and zero. With them it became possible to express any number, irrespective of its largeness, by a decimal place value system. Long lists of number- names for powers of 10 are found in various early sources. In the Ramayana, it is reported that Rama had an army of 1010 +1014 +1020 +1024 +1030 +1034 +1040 +1044 +1052 +1057 +1062 +5 men. The very existence of names for powers of ten up to sixty two indicates that the Vedic Indians were quite at home with very large numbers. This is to be compared with ancient Greeks, who had no words for numbers above the myriad (104). The Jains who came after the Vedic Indians were particularly fascinated by even larger numbers which were intimately tied up with their philosophy of time and space. For units of measuring time, the Jains suggested following relationship: 1 purvis = 756 * 1011 days 1 shirsa prahelika = (8,400,000)28 purvis The last number contains 194 digits! The word numeral system was the logical outcome of proceeding by the multiples of 10. Such a system presupposes a scientifically based vocabulary of number names in which the principles of addition, subtraction and multiplication are used. Â  Due to oral mode of preserving and disseminating knowledge, the wordnumeral system persisted in India. As a replacement to this, a new concrete system was devised to help versification and memory, known as bhutasamkhya, wherein numbers were indicated by well-known objects or ideas.

The Purpose Of A Business Plan Business Essay

The Purpose Of A Business Plan Business Essay In most cases, a business plan is created to explain and illustrate the vision you have for your business, and to persuade others to help you achieve that vision. To accomplish this, your plan will need to demonstrate on paper that you have a firm visualization of what your business is going to be. It needs to convince others that your business concept can be successful and that you possess the expertise-alone or collectively-to assure that it will be both successful and profitable. Why is it important It is important to use a business plan when starting and running the business as it indentifies the business aims and objectives, also it is important to have one as it will allow the business to go back and see if the business is progressing in the developing business and if the business is on the track to achieve the aim. RANGE OF POSSIBLE IDEAS I had many potential ideas of the businesses that I would like to set up in Lisburn. My most favourite ideas which I was considering to start up are: Restaurant In the current time in Lisburn there are several restaurants and there is no which serves multinational menus which include European, Asian and American foods. I believe that this business could be successful as many of peoples would like to try other nationalities foods. To run this business successfully I will have to create a very warm and welcome premise to which lots of peoples will be able to like it and. Also the service and food will need to be high quality so the customers will love to come back. Advantages Original menu as no restaurants serves the food I would If the business will gain loyal customers the business will survive Disadvantages Risk of not getting into the taste of locals Competition with well established restaurants Unknown local suppliers product quality Inexperienced staff Sandwich bar In modern days more peoples are buying ready to do foods such as chips, crisps, sweets which are bad for health. My idea is to let adults and children to have a healthy break time eating fresh ingredients and healthy sandwiches. To survive I will need to provide my business with the equipment such as Toaster, Micro wave, Panini maker, Serving Unit Hot/Cold, Grills, Till and much more. Advantages Disadvantages Competition with well established businesses Inexperienced staff Unknown local suppliers product quality Coffee shop Many people are in the hurry in these days, where most of them dont have time to consume their breakfast at home. The coffee shop idea will allow to those peoples who have to travel long time to their jobs, to buy tea or coffee and the snack and consume on the way, this could save enormous amount of time if they could decide to do their lunch and coffee themselves. I will have to spend about  ¼ of my budget on the equipment where I will need to buy equipment such as coffee machine, cups (glass and plastics), plates and more. Advantages Disadvantages Competition with well established businesses Inexperienced staff Unknown local suppliers product quality Ice Ring Lisburn does not have many attractions in the city, so it could be a good idea to get everyone enjoy their afternoons on the ice cold ring. It could be a very good place to have fun with the family and friends away from their troubles. The business could survive as the only other attractions could be the swimming pool and cinema which are located in the city centre. Advantages Disadvantages Expensive to run and insure Lots of health and safety issues will need to be complete. After concluding my potential businesses ideas I had rejected some of the ideas as there was the possibility that they wont survive the first year of trading. This is the list in order of the businesses I want to operate. The first one is the business I am currently going for, the last one is the least possible for me to go for. Coffee shop Sandwich bar Restaurant Ice Ring After knowing what business I am going to open I had thought about the name for it. The name that the most attracts my attention is CS. It is short and easy to remember which is excellent name. LEGAL STATUS There are several legal statuses available for my chosen business: Solo trader This is when the business is owned and run by one individual; however this is mainly the local business and will normally not expand on an international level. Main advantages of a solo trader à ¢Ã¢â€š ¬Ã‚ ¢ 100% of control over the business it means that the entire business is controlled by one person only which is mainly owner. à ¢Ã¢â€š ¬Ã‚ ¢ Quicker at decision making it allows to easy and fast make decision as there is only one person whom make the decisions and dont have anyone to make the decisions. à ¢Ã¢â€š ¬Ã‚ ¢ Can keep 100% of profit if the business is well operating it even can make high wage and dont have to share profit with anyone. à ¢Ã¢â€š ¬Ã‚ ¢ Local business, therefore loyal customers from that area loyal customers may result in a consistent flow of money into the business. Main disadvantages of a sole trader à ¢Ã¢â€š ¬Ã‚ ¢ Unlimited liability this may meant that the owner may lose his personal possessions because of the business depth and cannot pay it back. à ¢Ã¢â€š ¬Ã‚ ¢ Heavy stressful workload because it is a solo trader business it means that the one person has to do all of the activities which includes paperwork and more, which could cause stress, about not completing it and of the lack of time. à ¢Ã¢â€š ¬Ã‚ ¢ Finance problems because the business small and is financed by one person and maybe by a bank loan. The solo trader may face finance difficulties if the business will get into the debt. Partnership a partnership is when between two and twenty peoples own a business, as there is large number of co-workers each is investing money in to the business and share the profit or loses of the business. Main advantages of a Partnership à ¢Ã¢â€š ¬Ã‚ ¢ More peoples investing money because there is many partners the large capital and large funds are raised quickly, this means that the business can easily and faster earn stable finance source than a solo trader. à ¢Ã¢â€š ¬Ã‚ ¢ More ideas because there is more than one person who owns the business, each has different ideas how to improve the business. à ¢Ã¢â€š ¬Ã‚ ¢ Shared workload as the business has more than one owners the workload can be easy shared between partners which decrease the possibility of stress. Main disadvantages of a Partnership à ¢Ã¢â€š ¬Ã‚ ¢ Disagreements as each of the partners have different ideas to improve the business the disagreements can appear as other person doesnt like the idea which is currently discussed. à ¢Ã¢â€š ¬Ã‚ ¢ Breakdown in communication this can be cause when one of the partners will decide to go ahead with their own ideas, in which case may cause other departments become confused and may lose the communication between each other. à ¢Ã¢â€š ¬Ã‚ ¢ Unlimited liability if the business will be in the debt there is possibility the owners will lose their personal processions to pay back the debt. Over considering different legal status available, I decided that the most appropriate status for my business is solo trader. Despise of all the disadvantages. I had chosen this legal status for the reason that I can test my self if I can run business on my own. Also I had choose it for the reason the I wont rely on any one with decision making and I will operate the business as I want. I did not choose the partner ship as we may have disagreements which may have effects on business which may lead to close down; this is the risk that I dont want to take, as I may loose lots of my money. RESEARCH COMPREHENSIVE ANALYSIS The primary research that I had carried out was a questionnaire which I had held in the city centre of Lisburn. I choose this destination as this is where I am hoping to set my business. From the questionnaire I will receive the overview and the opinions of my future target market. Primary research The first question I had asked in the questionnaire was What age group would you be in? Form this question I had found the majority of my target market would come from 18-20 age group. The second popular age group was 21-30age group and 31-40 age group as both has the same percentage. The second question I had asked in the questionnaire was How often to you visit coffee shop? The result was very interesting as 40% of people who had fill in this questinoaire had said that they are visiting coffee shops every day. The 28% said that they are visitgin coffee shop weekly. I also asked if they would be interested if I would provide any refreshments suchas sandwitches and fresh salad. For the pie chart I noticed that 72% of people thinks that this is a good idea. As I know thatthey would like to have a sandwitches and salad I had asked them how much they would like to be charged for them. I had allowed them to choose the costs starting form  £1.50 up to  £4+. More than 56% said that they prefeer the price to be  £2.50 as for this price the best igridients can be purchased. As there are many students living in the Lisburn I had asked peoples in their opinion would the discount for students encourage them to go to coffee shop. The 56% of votes said that they would be encouraged to visit the coffee shop. Secondary research The UK branded coffee chain market continues to expand rapidly, exceeding 3,000 outlets for the first time and an estimated  £1.3 billion in turnover as UK consumers taste for coffee bars continues unabated. According to Allegria Strategies, the market is forecast to nearly double over the next decade to reach up to 6,000 outlets and turnover in excess of  £2.5 billion within 7-10 years. Growing at more than 15 per cent for the past eight years, UK coffee bar culture has extended well beyond UKs major urban centres and is penetrating smaller towns and the provincial areas due to phenomenal consumer demand and rapid opening programmes by coffee bar chains Starbucks, Costa Coffee, Caffà ¨ Nero, Pret A Manger and others. Results from more than 6,300 telephone and face-to-face interviews with UK consumers (the largest sample ever conducted in the UK) reveal that consumers are visiting branded coffee chains more frequently than ever before: Coffee shops are now mainstream and form an important part of UK lifestyles with more than 11 million adults visiting coffee shops at least once per week and more than 20 million persons visiting the venues at least once per month AIMS/OBJECTIVES OF A BUSINESS An aim is a long term intention that business wants to achieve. All businesses have different aims and sometimes some businesses have more than one. To achieve the aims an objectives are set. Objectives are the goal outcomes or targets. Many businesses are using SMART method to set their objectives achievable. Smart stands for; Specific they must set out clearly what a business sis aiming to do. Measurable they must be capable of being met Achievable everyone involved in reaching the objective must agree with the objective and understand what is meant by it. Realistic the objectives must be achievable from the source that are available form and for the state of the market conditions Time specific the objective should state over what time of period the objective has to be achieved. Many businesses create a mission statement, which states the purpose of the business and it values. It is meant to stake both the aims of the business and the provide a vision of the business for the stakeholders. The aim for my business is; Achieve the loyal customers by offering an efficient and reliable service at a low cost. The objectives for my business are; Survive when I first start out Get loyal customers and staff To break even within the first year Become market leader within next five years PROMOTION STRATEGIES Marketing mix refers to the primary elements that must be attended to in order to properly market a product or service. Also known as The 4 Ps of Marketing, the marketing mix is a very useful, if a bit general, guideline for understanding the fundamentals of what makes a good marketing campaign Elements of the marketing mix are often referred to as the four Ps: Product A tangible object or an intangible service that is mass produced or manufactured on a large scale with a specific volume of units. Price The price is the amount a customer pays for the product. It is determined by a number of factors including market share, competition, material costs, product identity and the customers perceived value of the product. Place Place represents the location where a product can be purchased. It is often referred to as the distribution channel. Promotion represents all of the communications that a marketer may use in the marketplace. Promotion has four distinct elements advertising, public relations, word of mouth and point of sale This is the marketing mix for my business considering 4ps; Product The product which I am going to provide is a wide range of coffees, teas, snacks, sandwiches and fresh salads and fizzy drinks. Price Because of the recession not many peoples will allow them selves for the take away coffee. There fore I will need to sell my product in the lowest price as possible. All the hot drinks will be sold between  £2  £4, all the soft drinks  £1 and the snacks, sandwiches and salads between  £1,50- £3. Place The premise which I choose for my coffee shop is located in the centre of the city centre. The premise which I found is for the rental purpose and costs  £1,000 per month. This property has 2 floors with reasonable good sizes. The ground floor will be used as a main area of the shop where customers will be served and use the Wi-Fi, where as the first floor will be the office area. Promotion To promote my business I am going to us local news papers to advertise my coffee shop. To support my promoting method I am going to use leaflets which will be delivered by the local postman. The leaflet details will include the prices, available coffees types, and location and contact details. LIKELY COMPETITORS I discovered my likely competitors by doing research on yell.co.uk and from local knowledge. There are four well established businesses which I will compete with for survival. This are; Esquires coffee shop The house of Vic-Ryn Street cafe Coffee Inc Each of those businesses are well established and have regular customers. Because all of them are mainly located in the city centre the competition will be heavy on me as the premise which I will use form my business is also in the city centre. SWOT ANALYSIS SWOT analysis can be defined strategic planning method used to evaluate the Strengths, Weaknesses, Opportunities, and Threats involved in a business venture. It involves specifying the objective of the business venture or project and identifying the internal and external factors that are favourable and unfavourable to achieving that objective. SWOT represents; Strengths: attributes of the person or company those are helpful to achieving the objective(s) Weaknesses: attributes of the person or company those are harmful to achieving the objective(s). Opportunities: external conditions those are helpful to achieving the objective(s). Threats: external conditions which could do damage to the objective(s). Strengths and Weaknesses can be controlled within the business. It is up to the manager to deal with these at the right time and in the appropriate way. Opportunities and Threats are out of control of the manager. Theyre therefore external. This is my swot analyse for my business CAFE LATTE. Strengths Sit in facility Wi-Fi facilities Offering different types of foods and snacks Located in the city centre Weaknesses Not well known Competition with established businesses Opportunities Expand locally Buy more specious premises allowing being more welcome Threats Esquires coffee shop The house of Vic-Ryn Street cafe Coffee Inc SECTION B PHYSICAL RESOURCES Physical resources are defined as resources that are available to business organisations in the form of buildings and other machineries which are needed for the day to day running of the organisation. To smoothly operate my business I need meet physical requirements which will allow me to survive and operate my business. the equipments which I need for my business are listed bellow. The equipment list Item Quantity Unit Price Total Price Timing Buy/Lease Counter 1  £10,000  £10,000 Start Up Buy Seating (chairs and tables) 15  £8,000  £8,000 Start Up Buy Water boiler 1  £464.13  £464.13 Start Up Buy Coffee machine 2  £500  £1,000 Start Up Lease Coffee (12 kg) 4  £60  £240 Start Up Buy Cookery 60  £329.50  £329.50 Start Up Buy Knives, forks and spoons 40  £50  £50 Start Up Buy Refrigerated display units 1  £2,010.  £2,010 Start Up Buy Cleaning fluids 6  £600  £600 Start Up Buy HUMAN RESOURCES Human resources are known as people employed by a business. This means that human resources are the number of people working for the business. The number of human resources is related to the business, for example a small business such as a window cleaning service has small human resources which may include two or five employees. The big international businesses on the other wise, such as Tesco, or Sainsbury are more likely to have thousands or even more workers. Because my business is small and is just starting up I wont need too many human resources. To be able to successfully operate the business I am going to employ 2 full time and 1 part time employees. Each employee will be required to have good communication skills and be able to work in the busy atmosphere. Because I want to encourage my staff to perform on their best abilities I am going to award them by adding additional  £1.00 to theirs minimal wage. There are several policies that I will need to take into consideration if I want my business to operate legally and satisfy my customers and staff. Health and safety issue is the most important regulation which I need to consider. I will be required to make sure that I will create a safe environment for my workers and the customers. If the accident will happen because of not making any health and safety requirements I can be sued which could cost me money and time, including it could reflect my business reputation. Equal Pay Act, 1970 Sex Discrimination Act, 1995 is another important law which I have to make sure I will consider within my business. When I will going to advertise my vacancy I cannot specify what sex I am looking for as this is how the law is broken. I have to make sure that I will give a fair chance for both sexes to try to apply for the job. The National Minimum Wages Act, 1998 this law simply clarified that people cannot be underpaid under the minimum national wage. There are three branches of this legislation; Between 16 and 17 years  £3.57 an hour Between 18 and 21 years  £4.83 an hour 22 and over  £5.80 an hour Data Protection Act, 1984 I need to consider this act in order to keep my staff and my business details save. Because I will need to store the private and financial details I will need to make sure that no on unauthorised will have access to these details. Disability Discrimination Act, 1995 I need to make sure that I wont discriminate any employee because of theirs disability. I am not going to consider the disability in picking appropriate employee for my business. The only fair way is by picking the qualifications and experience. RESOURCES AND QUALITY CONSTRAINTS LEGAL AND ECONOMIC Pestle analysis is one of framework that categorizes environmental influences as political, economic, social and technological forces. Sometimes two additional factors, environmental and legal, will be added to make a PESTEL analysis, but these themes can easily be subsumed in the others. Political influences These refer to government policy such as the degree of intervention in the economy. Economic influences These include interest rates, taxation changes, economic growth, inflation and exchange rates. Social influences Changes in social trends can impact on the demand for a firms products and the availability and willingness of individuals to work. Technological influences new technologies create new products and new processes. Legal influences environmental factors include the weather and climate change. Changes in temperature can impact on many industries including farming, tourism and insurance. Environmental influences these are related to the legal environment in which firms operate. For my business there are several constraints relevant to me are legal, economic, technical, and environmental. Legal constraints The legal constraints that will affect my business are regulations for a contract for example how long is the credit on it. Anther legal constraint would be DPA (Data Protection Act) in the UK gives the right to individual to know which companies hold their personal details and they are allowed to ensure that the information is accurate. This data should be also being protected within the business to ensure no one unauthorised will access the personal details. Economic constraints due to the current economy it will be harder for me to get a bank loan. Also because of the recession not every one will be able to afford the take away or sit in coffee. Technical constraints I will need to make sure that all the Environmental constraints as I will provide a take away service I will provide with recycle cops which will be easily recycle and good for environment. Also I will provide customers with business plastic take away cups with the lids which will allow them to use it to refill. SECTION C SOURCES OF FINANCE There are different sources of finance I can use to finance my business. Those sources are; Money from family or friends because I am a sole trader I may be able to borrow money from family or friends without paying interest, which would be very beneficial for me. Bank loan another way to finance my business I may use a bank loan. Loans from a bank or a building society can be expensive as they will include the interest. An agreed amount is borrowed and repaid over a fixed period of time with interest. To start up my business I am going to use the  £10,000 that I was left by my grandparents. Although my physical resources of total of  £22.694. I decided that I am going to take a bank loan. The loan which I will take will cover both my start up cost and running costs. I am hoping to get a loan that will be for 4-5 years which also will cover the unexpected expenses. The loan which I choose is Platinum Loans. I got a loan for  £30,000 and will be repaid by 5 years. The monthly amount to repay is going to be  £601.63 and the 7.8 APR which I total I will need to repay  £36,098. FORECASTS: CASH FLOW AND BREAKEVEN SUSTAINING IDEA After analysing project figures and the information that I had gathered I can say that the business will make profit within the first year. If I would considering expanding my business locally in the future I will need to consider all the major expenses to pay. Into these expenses I am considering a bank loans which will be repaid within 5 years and capital purchase. After two or more years of trading the external factors will need to be considered, as they may change the impact on the business. Those external factors that would change are due to Political, Legal, Social and Economic influences Political influences Legal influences Social influences Economic influences SECTION D BREAK EVEN ANALYSIS Most of the businesses frequently want to know the amount of the business need to produce or to reach break even. If the business has collect the information about fixed costs and variable cost and what process it is going to charge, it will allows to calculate how many units will be required to sell to cover all of its costs. The stage of sales or outputs where total costs are exactly the same as the total revenue is called a breakeven point. There are several uses of the break even and the most common one which are used by almost most of the businesses are based on: Calculate in advanced the level of sale needed for break even See chow changes on the in cost affect the break-even point and profit See how effect in output affects profit. To calculate a break even point I am going to use following formula; BE= SP-VC/FC. (BE- Break Even, SP Selling Price, VC Variable Cost, FC Fix Costs). I also used this formula to draw up business break even point graph what will show exactly how much units needs to be sold to break even. Selling price Is the price that a unit is sold for. Sales Tax is not included the selling price and a sales tax paid is not included as a cost. The selling price of my products is 2,50 per unit Variable cost Variable costs are costs directly related to production units. Typical variable costs include direct labour and direct materials. Coffee, Cups, Lead and Sugar the total of those materials is 0.40 per unit. Fix costs Cost that do not change when production or sales levels do change, such as, rent, property tax, insurance, or interest expense. The total fix cost is  £55,934 Break even calculation BE= 2.50-0.40/55,934 BE = 26,636 This is the graph which shows the break even unit point. As you can see to break even I need to sell 26,636 units of coffee in a year. To get more specific figures that 2,220 coffees a month, which I think is achievable.  £ 0 RATIO ANALYSIS EXCLUSIVE SUMMARY The business that I had decided to set up is CS which will be located in - in Lisburn. The opening hours will be 8 am to 5 pm form Monday to Friday and 10 am to 3pm in Saturday and Sunday. Products The products that my coffee shop is going to sell is a wide range of coffee, teas, snacks, sandwiches and fresh salads and fizzy drinks. All the foods will be home made which will Employees I am going to employ two full times and one part time employee. Each of the employees will be paid  £1 over their minimal wage, which will allow me to motivate them. Finance Because  £10,000 which I got from my grandparents will be not enough to start the business I will take the loan. The amount I am taking is  £30,000 which will be repaid over 5 year time. Competition Esquires coffee shop The house of Vic-Ryn Street cafe Coffee Inc

The Space Race: USA vs USSR Essay -- The Space Race

The Space Race was a war of firsts between the United States of America and the Union Soviet Socialist Republics. But it was also the culmination of the dreams of man for many millennia and the team who worked on the space programs were able to discover what so many of the people that came before and after them could only dream of. It was an endeavor that all of humanity was invested in at the time. It was a testament to the power of the human spirit and it showed how nothing was impossible if we persevered and strived to be better. The space race did not start as one would expect with the respective American and Soviet space agencies. But rather it began with the German V2 missile launches towards the end of World War 2. The V2 missile was designed by Wernher Von Braun a German scientist who had dreamed of traveling to the moon for many years; however this dream had to be secret as it was considered to be treasonous and not helpful to the German cause. Von Braun and many other amateur rocketeers were drafted into the German war machine in order to help build a super weapon and their base was Peenemà ¼nde. When the war was nearing its end the Third Reich unleashed its secret weapon, the V2 missile. It could hit anywhere within its target range and there would be no warning. When it hit, it caused scenes of mass destruction. The V2 missiles were to be Hitler’s ace in the hole. However by then it was far too late the war had already been lost with Soviets advancing from the East and the other Allies from t he west and when the Allies discovered the German’s V2 missile they knew that they would have to have it as it was decades further than what they had on their own. So when truce was declared it was a race between the Americans and... ...on/timeline/timeline2.html>. "PGM-19 Jupiter." Wikipedia. Wikimedia Foundation, 04 Dec. 2014. Web. 13 Apr. 2014. "Redstone (rocket Family)." Wikipedia. Wikimedia Foundation, 30 Mar. 2014. Web. 13 Apr. 2014. "The Space Race." History.com. A&E Television Networks, n.d. Web. 13 Apr. 2014. . "Space Race." Wikipedia. Wikimedia Foundation, 04 Oct. 2014. Web. 13 Apr. 2014. . "TheSpaceRace.com - Timeline of Space Exploration." TheSpaceRace.com - Timeline of Space Exploration. N.p., n.d. Web. 12 Apr. 2014. . "Voskhod Programme." Wikipedia. Wikimedia Foundation, 04 Nov. 2014. Web. 13 Apr. 2014. . "Waging Peace." : Cold War: The Space Race and Its' Significance. N.p., n.d. Web. 13 Apr. 2014.

Jing-Mei Woo: The Joy Luck Club Essay

In this chapter we are introduced to the Joy Luck Club which originated all the way back in China when Jing-Mei Woo’s mother Suyuan was in the city of Kweilin. At the Joy Luck Club a group of old Chinese women sit around and eat and after that they sit down in a table to play a friendly game of Mah-Jong. At the Joy Luck Club there are 4 major members, Lindo Jong, Ying-ying St. Clair, An-Mei Hsu, and Suyuan Woo. In the beginning of the chapter we learn that Suyuan has died and Canning Woo, Jing-Mei’s father and Suyuan’s husband has asked Jing-Mei to take her mothers place at the Mah-Jong meeting. In this chapter we learn of how Suyuan had lived in China and during the war as the Japanese were slowly invading China, she had to take her family and leave for the city of Kweilin while her husband, Suyuan’s first husband that is, goes off to Chunking to fight the Japanese. In this chapter we learn about the other Mah Jong players, Lindo Jong, mother of the young girl Waverly, Ying-ying, a woman married to a white man and An-Mei Hsu. In the end of the chapter they old ladies tell Jing-Mei how they have contacted her long lost sisters and they want to send her to China to meet them. The story is quite interesting so far, its interesting to see how the women in this story resemble the way my own Chinese grandmother acts. Its quite funny too actually be able to know what Mah Jong is although I have been so white washed. I was born here in America so all I’ve ever known is American culture and although I look 100% like a Chinese kid would, when I went to visit China for the first time I felt so different from them. An-Mei Hsu: Scar We learn how An-Mei’s father is long gone and that her grandmother who has been a predominant figure in her life is slowly dying. While An-Mei is describing her dying Grandmother (Popo), she talks about her real mother who had dishonored the family by going off to marry a man with many wives thereby getting herself disowned by her own family. As the grandmother is dying, An-Mei’s mother comes back and as a last resort, tries to save grandmother by cutting off a piece of her own flesh and sticks it into a soup that she tries to feed to her mother (the grandmother). I thought it was interesting to see an example of an old Chinese remedy for something. I kind of wonder if that was even a real remedy, rather harsh and repelling if you ask me. Lindo Jong The Red Candle In this story Lindo, the mother of Waverly Jong, the National Chess Champion talks about her own struggles. In China Lindo was forced to marry a man named Tyan-yu whom she didn’t love at all. When she was finally married to him, she would avoid him and the groom’s mother realized this and hired a marriage counselor type of person to help fix things. The marriage counselor lit a candle and said if it was still lit the next day without going out then the marriage will last forever and even if the groom dies, Lindo may never remarry again. Upset, Lindo tries to blow out the candle and succeeds but the next day the servant lies about the candle not going out. Lindo now becomes desperate and tries to devise lies to help her get out of there and finally succeeds and the husband eventually marries one of the pregnant servants and Lindo is sent to America. The odd part of this story was how I was able to empathize with the other  characters in their discussions of their hardships when they were younger while I couldn’t with Lindo. Maybe I’m biased because of how Lindo is so harsh and headstrong towards the other characters in this story. She in my mind seems to be a great description of the family members in my own life, for they are all harsh and headstrong towards each other. Ying-ying St. Clair: The Moon Lady In Chapter 4 we learn about Ying-ying. As a child Ying-ying came from a wealthy family. Unlike she is now Ying-ying was once a very problem child, because she was so spoiled by her family she never thought twice about doing things and because of that she ended up getting lost at what was called â€Å"The Moon Festival†. At the Moon festival she watches a play about the Moon Lady whom she takes as the real person but then realizes her own stupidity and leaves the festival and if finally found by her family. An important part of this chapter is how Ying-ying ends it with the words â€Å"I wished to be found†. Those words to me tell me how she wants to be closer to her daughter and if granted one wish from the Moon Lady that would be it. Ying-ying doesn’t like how her daughter is ashamed of her and has abandoned all of their Chinese traditions In the prelude to The Twenty Six Malignant Gates I found it amusing to see how the little girl like all young children are headstrong and seem to think they are impervious to the dangers of real life and she ignores her mothers advice until it is too late when she falls off the bike like her mother said would happen Waverly Jong- Rules of the Game In this chapter we learn about Waverly’s life and how her mother has taught her â€Å"the art of invisible strength† which has allowed Waverly to do well in life especially in the world of Chess where she became National Chess Champion at a very young age. Waverly however hates her mother for even though she adopted her mother’s quality of â€Å"invisible strength† she dislikes everything about her mother from their culture to the way her mother acts. Waverly unlike her mother doesn’t like to brag about herself and is very upset at her mother who is always comparing her child to everyone else’s and using Waverly’s fame to her own advantage. Lena St. Clair- The Voice from the Wall This is the second story told from eyes of the daughters. Lena in this chapter describes the life of her mother when she was younger. Lena describes Ying-ying as a paranoid and somewhat psychotic person who married her father Clifford St. Clair, and Englishman who spoke very little Chinese and was found unable to understand what her mother was saying half the time they were together. Towards the end of the story Lena describes what is seems like her mother Ying-ying had a miscarriage and Ying-ying who was already mentally unstable blames the death of the unborn child on herself and becomes even more unstable. In this chapter we learn about Lena’s childhood neighbor who was always getting into fights and because in her own Chinese culture when the children would argue with their elders, the argument would ensue a beating from the parents so she always imagined her neighbor to look very beat up since they seemed to argue all the time but to her astonishment when the neighbor sne aked into her house one day, the young girl was unharmed and that same night could be heard laughing with her mother whom she had an argument with a few hours earlier. Jing-Mei Woo â€Å"2 Kinds† I thought it was funny to see how Jing-Mei’s mother wanted her daughter to be like â€Å"Shirley Temple† but then again it makes sense, Shirley Temple was America’s Sweetheart in the early 90’s so it would be fitting since everyone wants the best for their children. It was also interesting to see June’s interest in piano after watching a Chinese girl play the piano on the television but she quickly lost interest in the piano ever since she found out her teacher was deaf and therefore she stopped practicing. Lena St. Clair â€Å"Rice Husband† In this chapter we look into Lena’s life and find out that she is married to a white man named Harold. At first they had a true love and enjoyed their life together and decided to share all their costs but lately the marriage has begun to fall apart and the only thing still concrete in their marriage is their sharing of the costs of things they use and that have become the root of most of their problems. Waverly Jong â€Å"Four Directions† Waverly who is trying to look for a way to tell her mother that she is getting married to her fiancà © Rich, takes her mother out for lunch but ends getting scrutinized by her mother like always. With a certain un-eagerness Waverly invites Rich to meet her mother at her mothers house for dinner and although the dinner was a complete disaster for Rich, Waverly in the end found out that her mother did approve of Rich and that event brings all three of them closer together than before. In the beginning of the chapter we learn that Waverly is a smart young child but her mother has an iron grip on her life and Waverly’s first marriage falls apart completely because of her mother and how she began to see things the way her mother did about her husband. Rose Hsu Jordan â€Å"Without Wood† Rose for once doesn’t believe what her mother says, which was about her husband Ted cheating on her which he really did do. The husband after filing for divorce tries to bully her but Rose stays strong and is able to keep the house and keep her ex-husband in check. Jing-Mei Woo â€Å"Best Quality† In this chapter we learn how Suyuan hurts Jing-Mei, enough that Jing-Mei begins to doubt her mothers love for her but when New Years Eve comes along, Suyuan proves Jing-Mei wrong and then Jing-Mei realizes how much her mother really loves her at dinner. Because of her mothers love for her, Jing-Mei never takes off the pendant Suyuan has given her before she died. An-Mei Hsu â€Å"Magpies† In this chapter An-Mei is taken away to live with her mother. In this chapter both An-Mei and her daughter Rose wonder if their culture has made them weak in the eyes of society. An-Mei was upset at Rose earlier because of Rose’s unwillingness to do anything about her husband request for a divorce. In this chapter we see how Chinese women couldn’t do much with their lives, if they were unhappy all they could do was cry about it so when faced with these types of problems in America, the both of them wouldn’t know what to do although being in America they could do whatever they want. Ying-ying St. Clair â€Å"Waiting Between the Trees† Ying-ying in this chapter reflects on her childhood and from her mistakes she wants her daughter Lena to learn from. Ying-ying wants her daughter to lead a happy life, that her marriage is going to fall apart and she wants her daughter to be strong when this happens. Lindo Jong â€Å"Double Face† In this chapter we see the two cultures, the American culture represented by Waverly and the traditional Chinese culture represented by her mother Lindo Jong. Waverly who was uncertain of herself, thinks she’ll be easily seen as a foreigner but Lindo says she won’t be noticed. Later in the chapter both mother and daughter become closer after Lindo decides to ask Waverly why the year before when Lindo went to visit China, that they knew she was a foreigner despite all of her Chinese styles and traditions still in tact with her. Jing Mei-Woo â€Å"A Pair of Tickets† The last chapter of the book ends with the final daughter and mother couple coming together for Jing is able to finally discover who she really is, for as American she is, she’s also just as much Chinese.

The Long Telegram of George Kennan

The Long Telegram of George Kennan The Long Telegram was sent by George Kennan from the United States Embassy in Moscow to Washington, where it was received on February 22nd, 1946. The telegram was prompted by US inquiries about Soviet behavior, especially with regards to their refusal to join the newly created World Bank and International Monetary Fund. In his text, Kennan outlined Soviet belief and practice and proposed the policy of containment, making the telegram a key document in the history of the Cold War. The name long derives from the telegrams 8000-word length. US and Soviet Division The US and USSR had recently fought as allies, across Europe in the battle to defeat Nazi Germany, and in Asia to defeat Japan. US supplies, including trucks, had helped the Soviets weather the storm of Nazi attacks and then push them right back to Berlin. But this was a marriage from purely one situation, and when the war was over, the two new superpowers regarded each other warily. The US was a democratic nation helping put Western Europe back into economic shape. The USSR was a murderous dictatorship under Stalin, and they occupied a swathe of Eastern Europe and wished to turn it into a series of buffer, vassal states. The US and the USSR seemed very much opposed. The US thus wanted to know what Stalin and his regime were doing, which was why they asked Kennan what he knew. The USSR would join the UN, and would make cynical overtures about joining NATO, but as the Iron Curtain fell on Eastern Europe, the US realized they now shared the world with a huge, powerful and anti-democratic rival. Containment Kennans Long Telegram didnt just reply with insight into the Soviets. It coined the theory of containment, a way of dealing with the Soviets. For Kennan, if one nation became communist, it would apply pressure on its neighbors and they too might become communist. Hadnt Russia now spread to the east of Europe? Werent communists working in China? Werent France and Italy still raw after their wartime experiences and looking towards communism? It was feared that, if Soviet expansionism was left unchecked, it would spread over great areas of the globe. The answer was containment. The US should move to help countries at risk from communism by propping them up with the economic, political, military, and cultural aid they needed to stay out of the Soviet sphere. After the telegram was shared around government, Kennan made it public. President Truman adopted the containment policy in his Truman Doctrine and sent the US to counter Soviet actions. In 1947, the CIA spent considerable sums of money to ensure the Christian Democrats defeated the Communist Party in elections, and, therefore, kept the country away from the Soviets.​ Of course, containment was soon twisted. In order to keep nations away from the communist bloc, the US supported some terrible governments, and engineered the fall of democratically elected socialist ones. Containment remained US policy throughout the Cold War, ending in 1991, but discussed as something to be reborn when it came to US rivals ever since.

Timeline and Definition of the Nazca Civilization

Timeline and Definition of the Nazca Civilization The Nasca (sometimes spelled Nazca outside of archaeological texts) Early Intermediate Period [EIP] civilization was located in the Nazca region as defined by the Ica and Grande river drainages, on the southern coast of Peru between about AD 1-750. Chronology The following dates are from Unkel et al. (2012). All dates are calibrated radiocarbon dates. Late Nasca AD 440-640Middle Nasca AD 300-440Early Nasca AD 80-300Initial Nasca   260 BC-80 ADLate Paracas 300 BC-100 Scholars perceive the Nasca as arising out of the Paracas culture, rather than an in-migration of people from another place. The early Nasca culture arose as a loosely-affiliated group of rural villages with self-sufficient subsistence based on corn agriculture. The villages had a distinctive art style, specific rituals, and burial customs. Cahuachi, an important Nasca ceremonial center, was built and became a focus of feasting and ceremonial activities. The Middle Nasca period saw many changes, perhaps brought about by a long drought. Settlement patterns and subsistence and irrigation practices changed, and Cahuachi became less important. By this time, the Nasca were a loose confederacy of chiefdomsnot with a centralized government, but rather autonomous settlements that regularly convened for rituals. By the Late Nasca period, increasing social complexity and warfare led to the movement of people away from the rural farmsteads and into a few larger sites. Culture The Nasca are known for their elaborate textile and ceramic art, including an elaborate mortuary ritual associated with warfare and the taking of trophy heads. More than 150 trophy heads have been identified at Nazca sites, and there are examples of burials of headless bodies, and burials of grave goods without human remains. Gold metallurgy in early Nasca times is comparable to Paracas culture: consisting of low-tech cold-hammered art objects. Some slag sites from copper smelting and other evidence suggest that by the late phase (Late Intermediate Period) the Nasca increased their technological knowledge. The Nasca region is an arid one, and the Nazca developed a sophisticated irrigation system that aided in their survival for so may centuries. The Nazca Lines The Nasca are probably best known to the public for the Nazca Lines, geometric lines and animal shapes etched into the desert plain by the members of this civilization. The Nazca lines were first intensively studied by the German mathemetician Maria Reiche and have been the focus of many silly theories concerning alien landing places. Recent investigations at Nasca include the Project Nasca/Palpa, a photogrammetric study from the Deutschen Archologischen Instituts and Instituto Andino de Estudios Arqueolà ³gicos, using modern GIS methods to record the geoglyphs digitally.​ More on the Nazca: Nazca Lines, Ica Region pottery vessel Archaeological Sites: Cahuachi, Cauchilla, La Muna, Saramarca, Mollake Grande, Primavera, Montegrande, Marcaya, Sources Conlee, Christina A. 2007 Decapitation and Rebirth: A Headless Burial from Nasca, Peru.  Current Anthropology  48(3):438-453. Eerkens, Jelmer W., et al. 2008  Obsidian hydration dating on the South Coast of Peru.  Journal of Archaeological Science  35(8):2231-2239. Kellner, Corina M. and Margaret J. Schoeninger 2008  Waris imperial influence on local Nasca diet: The stable isotope evidence.  Journal of Anthropological Archaeology  27(2):226-243. Knudson, Kelly J., et al. In press  The geographic origins of Nasca trophy heads using strontium, oxygen, and carbon isotope data.  Journal of Anthropological Archaeology  in press. Lambers, Karsten, et al. 2007  Combining photogrammetry and laser scanning for the recording and modelling of the Late Intermediate Period site of Pinchango Alto, Palpa, Peru.  Journal of Archaeological Science  34:1702-1712. Rink, W. J. and J.  Bartoll  2005  Dating the geometric Nasca lines in the Peruvian desert.  Antiquity  79(304):390-401. Silverman, Helaine and David Browne 1991  New evidence for the date of the Nazca lines.  Antiquity  65:208-220. Van Gijseghem, Hendrik and Kevin J. Vaughn 2008  Regional integration and the built environment in middle-range societies: Paracas and early Nasca houses and communities.  Journal of Anthropological Archaeology  27(1):111-130. Vaughn, Kevin J. 2004  Households, Crafts, and Feasting in the Ancient Andes: The Village Context of Early Nasca Craft Consumption.  Latin  American Antiquity  15(1):61-88. Vaughn, Kevin J., Christina A. Conlee, Hector Neff, and Katharina Schreiber 2006  Ceramic production in ancient Nasca: provenance analysis of pottery from the Early Nasca and  Tiza  cultures through INAA.  Journal of Archaeological Science  33:681-689. Vaughn, Kevin J. and Hendrik Van Gijseghem 2007  A compositional perspective on the origins of the â€Å"Nasca cult† at Cahuachi.  Journal of Archaeological Science  34(5):814-822.

How to Promote Student Growth

How to Promote Student Growth There is a growing need to measure students growth and success in the classroom, especially with all the talk in the media about teacher evaluations. Its standard to measure student growth at the beginning and the end of the school year with standardized testing. But, can these test scores give teachers and parents a good understanding of the students growth? What are some other ways educators can measure students learning throughout the year? Here we will examine a few ways that teachers can promote student understanding and performance. Ways to Promote Student Development According to Wong and Wong, there are some ways professional educators can promote student growth in their classroom: Set high expectations for student achievementMake sure that students perform at or above expectationsSolve problems so students will receive servicesUse up to date research and technologyPlan instructional strategiesApply higher-order learning skillsApply information-processing strategiesApply complex learning tasksUse cooperative learning in the classroomUse invitational learning in the classroomArticulate information clearlyApply classroom management These suggestions that the Wongs gave will indeed help students to achieve and demonstrate their abilities. Promoting this kind of learning can help students prepare for the standardized testing that measures their growth throughout the year. By using the suggestions from the Wongs, teachers will be preparing their students to be successful on these tests while promoting and developing important skills. A Variety of Ways to Measure Student Performance Measuring student growth solely on standardized tests have always been the easiest way for teachers to determine that the students are grasping the information taught. According to an article in the Washington Post, the problem with standardized tests is that they mainly focus on math and reading and do not take into account other subjects and skills students should be developing. These tests can be one part of measuring academic achievement, not the whole part. Students can be evaluated on multiple measures such as: Growth throughout several yearsPortfolio of students work in all subjectsExamsCritical thinking skillsProblem-solving skillsGroup ProjectsWritten and oral presentationsClass projects and experiments Including these measures along with standardized testing would not only encourage teachers to teach a wide range of subjects well but would also accomplish Presidents Obamas goal to make all children college ready. Even the poorest of students would have the opportunity to demonstrate these critical skills. Achieving Student Success To achieve students academic success, it is paramount that teachers and parents work together to help develop and build skills throughout the school year. A combination of motivation, organization, time management, and concentration will help students stay on track and be able to achieve successful test scores. Use the following tips to help students achieve success: Motivation To help motivate students to find out what they are passionate about and use their interests to connect with their school work. Organization For many students, something as simple as staying organized is the key to academic success. To help students stay organized, organize and label all materials and notebooks and keep a checklist of essential tasks. Time Management Learning to prioritize and manage time can be difficult for students. To help them manage their time keep track of assignments and tasks by creating a school calendar. Concentration Students get distracted very easily, to keep their minds on the task at hand enlist parents to designate a quiet zone for homework where there are NO interruptions. Sources: Wong K.H. Wong R.T (2004).How To Be An Effective Teacher The First Days Of School. Mountain View, CA: Harry K. Wong Publications, Inc. TheWashingtonpost.com

Retail Store Marketing Plan Assignment Example | Topics and Well Written Essays - 1250 words

Retail Store Marketing Plan - Assignment Example The report will however specifically focus on the apparel retailing sector. The purpose of this report is to make a promotional plan of an apparel retailing company in UK. The report will shed light on the desired image and store name, the target customers for the new store, and the competitive advantage to be offered by the company. Apart from that, the report will provide several recommendations regarding the layout of the store, its atmosphere, customer service offerings and the promotional techniques to be adopted for the retail outlet. Lastly, the report will also suggest about the most appropriate location strategy. Therefore before getting further deep, the study will provide a brief overview of the global apparel retailing industry. Apparel Retailing Industry: A Brief Overview The apparel retailing industry is one of the fastest growing industries of the world. It consists of ‘childrenswear’, ‘menswear’ and ‘womenswear’. According to the reports, the total revenue of the global apparel retail industry was $1,031.5 billion in the year 2009, which represented a compounded annual growth rate of 3.1%. This report has also emphasized on the fact that majority of the revenue generated was from the sales of womenswear. It nearly constituted $534.4 billion, reflecting a total share of 51.8% of the overall sales. The industry is forecasted to reach a total value of $1,162.8 billion by the end of 2014, reflecting an increase of 12.7% from the year 2009. The major markets of apparel retailing stores are Europe, Asia-pacific and America. Both America and Europe hold 37.3 % of the overall revenue share, while the Asia pacific region embraces 25.5 % revenue share (Datamonitor, 2010). Despite the ongoing financial downturn, the global apparel industry is maintaining a strong growth. The industry is characterized by vast product differentiation, shorter product life cycle, and low switching cost. The bargaining power of consumers of this industry is assessed to be low, while intensity of rivalry among the existing players is moderate. The industry is therefore regarded as fairly attractive (AM Mindpower Solutions, 2010). Moreover, in spite of the consolidation process, the industry is still fragmented and thus provides enough opportunity for the small and new players. The findings also reveal that the retail clothing industry is highly attractive and can provide great opportunities for success to new players. However, for a company to get success, it is also important to design the operation and marketing strategies appropriately. Therefore, prior to getting further deep, the study will describe the business briefly. The study will also shed light on the strategies to be adopted by the company. Description of the Business The company will be involved in the business of manufacturing and marketing of the apparels products. The company will operate through retail outlet, which will be located at the city centr e. The products of the company will be childrenswear, menswear and womenswear. There will be large number of variants in each of the categories. For example, there will be availability of formal clothes, informal clothes, as well as sport clothes. The basic intention of the company is to ensure all the sections of the society are served effectively and it offers wide range of products and service. Another aim of the company is to make sure the prices of the products remain affordable. SECTION II Store Name and Store Image The store name and the image

Poverty Impacts on People's Health and Well-Being in Britain Today Essay

Poverty Impacts on People's Health and Well-Being in Britain Today - Essay Example This paper is aimed at providing a detailed analysis of the impact of poverty on people’s health and well being in Britain and the role of nursing intervention in their treatment. Different effects of poverty on health of Britain: Economic inequality is said to be closely associated with the level of social and healthy inequalities in different countries across the globe. In the developing countries existence of income inequality is expected to form the greatest level of negative effects on the development of health status of people living in the country. However, in the developed countries of the world, such as Britain, income inequalities in the form of poverty are negatively influencing the health conditions of people. Following the prevalence of the global crisis due to early period of 1970s, the process of restoration of class power has been set in the developed part of the world. This restoration has created the existence of significant amount of negative association bet ween the prevalence of poverty and the decline in the health status of people in the country (Smith, 2001, pp. 348-350). ... The purpose of this report has been to persuade monitoring, to allow comparison, and also to encourage the discussion as well as the development of different policies in the process of improving children’s lives. The report has represented the fact that an important progress on previous reports on the topic has revealed the fact that income and poverty are used as proxy in measuring the overall level of well-being of children and young people in the country. Particularly, the paper tries to measure as well as compare the level of well-being of children and young people under the six wide ranges of dimensions. These dimensions include material well-being of these people, the health and safety status, the level of education, â€Å"peer and family relationships, behaviours and risks, and young people’s own subjective sense of well-being†. These aspects are considered as very important ones in the development of the health status of the people living in the country ( Child poverty in perspective: An overview of child well-being in rich countries, 2007, p.43). The level of poverty in the country is negatively affecting the number of people having employment opportunities. This fact is again affecting the purchasing power of these people across the country. One of the most important associations between the level of poverty and the choice and purchasing power of the people in the country suggests, the lower their level of income, the lower is amount of health services they can demand. Those people in the country who are badly suffering from poverty and unemployment are getting mentally affected. This mental effect arises from the fact that these people are not only being deprived of possessing several effective health

Discussion Dissertation Example | Topics and Well Written Essays - 2250 words

Discussion - Dissertation Example In order to find the answer to this question, it is important to consider that whether the Saudis were provided a fair and equal opportunity to evaluate the two sides of the Bahraini conflict through analyzing the themes of the news and the leading stories published in the Saudi print media by drawing the information acquired from the content analysis and interpreting it in the wake of the various press theories. 6.1 The Performance of the Saudi Print Media during the Bahraini conflict In the analysis of the Saudi print media performance, the discussion here take in to account the news content that have been published in Al yaum Newspaper and in Al Riyadh Newspaper during the occurrence of protests and riots at the streets of Bahrain. ... Previously in this study, it has been mentioned that the coverage of the conflict in Bahrain by the Saudi Arabian press would depend extensively on the domestic sources in comparison to the foreign sources, which may be true by looking at each source individually, however, the Saudi print media seemed to be more dependent over the SPA as compared to any other single source. Since the Saudi media is indirectly governed or supervised by the Saudi Arabian government, thus this dependence was anticipated, and it is the duty of the press to carry out the agenda of the government through briefings from the SPA that lies under the supervision of Saudi Arabian Ministry of Information. Nevertheless, if the information sources are conglomerated into external and domestic sources, it get evident that the Saudi Arabian print media relied more on external sources, specifically on AFP, Reuters, UPI, AP, and other such agencies as compared to domestic sources. It is expected that this would impact the geographical perspective of the news coverage by the Saudi media, which suggests that it would emphasize over some areas of the world while neglecting the others. This is specifically significant provided the frequent research findings that the material of the Saudi media was more influential in topics that relate to the Bahraini conflict about which the readers in Saudi Arabia were ill-informed previously In fact, it was clearly found that the Saudi Arabian print media coverage of the Bahraini conflict emphasized more on to stories that emerged from the Middle East, the Western Europe, the USA, and other such foreign locations in comparison to those that emerge in the Saudi Arabia. The findings of the content analysis have been provided below: The first question: What is the

Case Project Assignemnts Assignment Example | Topics and Well Written Essays - 1250 words

Case Project Assignemnts - Assignment Example The project entailed performing the following instructions as stated in the task details. In this particular section, Adobe Acrobat version 8.0 was used given that the version 6.0 and 7.0 has been rendered obsolete for higher versions of windows. The snapshots below showcase the procedure: The procedure requires saving the file in a PDF version that is later opened by the adobe acrobat software. Once this is done the subsequent procedures are showcased below to aid in the creation of a digital certificate key. Experience and Findings: The course of generating a personal digital certificate is relatively simple given the instructive procedure displayed in the coursework assignment. Adobe Acrobat 8.0 pro avails the features for creating a digital certificate quite easily and ensuring its security by storing it on the Windows certificate store. Additionally, managing the certificates has been made easier by the available personal certificate management feature on the acrobat file setting dialogue box. The project entails the exchange of public keys and e-mail messages with your colleagues. The procedure requires the installation of the PGP desktop encryption client which is readily available in the website – pgp.com. Please make sure you have outlook configured and connected to a Microsoft exchange server before implementing the PGP. Experience and Findings: The PGP program provides an easy install and configuration dialogue box that easily connects to the Microsoft outlook program to enable you encrypt your files and informative data alike emails sent within an organization. The assistant console helps one generate keys easily and that can be emails to classmates, recipients or colleagues as can be viewed on the above dialogue box option. Intrusion detection systems provide the needed support for system administrators to efficiently

Best practices for network security Essay Example | Topics and Well Written Essays - 2000 words

Best practices for network security - Essay Example Requiring proper authentication IV. MONITOR THE ENVIRONMENT A. Monitoring security logs 1. Checking for needed attention and applying a security fix B. Reviewing and updating the security policy Network Security Best Practices When it comes to securing your network, reliability and fail proof security are vitally important. With more and more data and sensitive information being conducted and housed on various networks, security has become an important part of the puzzle that must be considered moving forward. To ensure impeccable network security, comprehensive analysis and exploration of the entire network needs to be conducted. One should begin by accessing the environment, as it is through this mechanism that we can make a comprehensive risk assessment. By assessing the environment, we can observe what requirements are needed in order to optimize security. The environment is comprised of two primary elements: infrastructure and staff. A thorough review of infrastructure is requir ed in order to conduct an adequate risk assessment. Once a company knows how much its assets are worth, and what threats could potentially affect those assets, they are able to formulate intelligent decisions regarding how to protect said assets. Network security is a balanced art. It is likely that a company can apply too much security, lagging down the infrastructure, or perhaps too little, exposing the network and making it vulnerable to attack. By assessing the current infrastructure, trained security analysis' can find the balance between the right amount of security required for the particular volume of infrastructure. (Bayrak & Brabowski, 2006). The evaluation of the members of staff and their specific role in the company is important in maintaining a secure network. Each staff and role needs to be assigned a financial value and the cost of comprised or lost data associated with that role needs to be calculated. In this way, financially speaking, administrators can determine the financial repercussions of a threat in relation to the staff, as well as determine the level of security each staff member should have. A risk assessment is a tool for identifying weaknesses and vulnerabilities within a network, and then assessing where to implement security and preventative measures. Risk assessment has four main goals: to indentify the assets and their worth, to identity threats and vulnerabilities, to identify the potential impact of threats, and to provide an economic balance between the impact of the threat and the financial cost of the preventative measures. This is generally the process in which an operation can access whether a risk is at an acceptable level or whether it should be counter measured. (Gerald, 2005). The first step of successful risk assessment is to identify the assets and their appropriate values. The value placed on assets is relative to the work hours required to develop it, the cost to maintain it, the potential damage caused if it we re lost or stolen, and the potential financial gain another company or individual would receive through use of the stolen product. To assess and value the assets, the company must generally consider the following issues. Firstly, the cost of developing an asset should be carefully considered. Secondly, the cost to maintain and protect the asset should rise to the front of any discussion surrounding network security. Third, the estimated value to the asset should be calculated. Fourthly, the value

Social Institutions Assignment Example | Topics and Well Written Essays - 500 words

Social Institutions - Assignment Example For instance, in a family, the father has to work for the needs of the family, the mother takes care of the house, provides love and care to the other members of the family, and children has to do their role to attend school to meet their goal and to abide by their parent’s rules. Functionalist perspective looks at family as having its members with roles to play in order to for the institution to survive. In times of disruption within the family, members have to adjust to go back to its equilibrium. For example, if large families were desired many years ago, today it is considered a threat to the society. To maintain equilibrium, the government provided birth control thus the family has to adjust to the changes. This perspective necessitates the function of each member not only for the family but to contribute to the survival of the society as a whole. However, Functionalist theory is being criticized for its idealistic point of view of the social Institutions. It ignores the fact that conflict or problems may arise as they are inherent part of the society. In addition, this perspective encourages inequalities because it is conservative in nature.

Case Project Assignemnts Assignment Example | Topics and Well Written Essays - 1250 words

Case Project Assignemnts - Assignment Example The project entailed performing the following instructions as stated in the task details. In this particular section, Adobe Acrobat version 8.0 was used given that the version 6.0 and 7.0 has been rendered obsolete for higher versions of windows. The snapshots below showcase the procedure: The procedure requires saving the file in a PDF version that is later opened by the adobe acrobat software. Once this is done the subsequent procedures are showcased below to aid in the creation of a digital certificate key. Experience and Findings: The course of generating a personal digital certificate is relatively simple given the instructive procedure displayed in the coursework assignment. Adobe Acrobat 8.0 pro avails the features for creating a digital certificate quite easily and ensuring its security by storing it on the Windows certificate store. Additionally, managing the certificates has been made easier by the available personal certificate management feature on the acrobat file setting dialogue box. The project entails the exchange of public keys and e-mail messages with your colleagues. The procedure requires the installation of the PGP desktop encryption client which is readily available in the website – pgp.com. Please make sure you have outlook configured and connected to a Microsoft exchange server before implementing the PGP. Experience and Findings: The PGP program provides an easy install and configuration dialogue box that easily connects to the Microsoft outlook program to enable you encrypt your files and informative data alike emails sent within an organization. The assistant console helps one generate keys easily and that can be emails to classmates, recipients or colleagues as can be viewed on the above dialogue box option. Intrusion detection systems provide the needed support for system administrators to efficiently

Social Institutions Assignment Example | Topics and Well Written Essays - 500 words

Social Institutions - Assignment Example For instance, in a family, the father has to work for the needs of the family, the mother takes care of the house, provides love and care to the other members of the family, and children has to do their role to attend school to meet their goal and to abide by their parent’s rules. Functionalist perspective looks at family as having its members with roles to play in order to for the institution to survive. In times of disruption within the family, members have to adjust to go back to its equilibrium. For example, if large families were desired many years ago, today it is considered a threat to the society. To maintain equilibrium, the government provided birth control thus the family has to adjust to the changes. This perspective necessitates the function of each member not only for the family but to contribute to the survival of the society as a whole. However, Functionalist theory is being criticized for its idealistic point of view of the social Institutions. It ignores the fact that conflict or problems may arise as they are inherent part of the society. In addition, this perspective encourages inequalities because it is conservative in nature.

The quality of life for all humans Essay Example for Free

The quality of life for all humans Essay If the governments of the world adopted a socialist philosophy and economy, in recognition of the fact that we are all stuck on this rock together, the quality of life for all humans would greatly improve. First, there would no longer be a need for war. With a sense of global community and the accompanying economy there wouldnt be any motivation to wage wars with each  other. There would be no super-powers, no struggle to attain land or control natural resources. Humans are the only animals in nature that kill each other for reasons of greed and power. How refreshing it would be to finally evolve beyond our current bellicose nature. If we banned together as a world wide society, we could, at long last, live in peace. Next, we could direct our resources and efforts toward fighting the diseases that afflict us. A socialist-based economy would practically eliminate hunger by providing  enough sustenance for everyone, and that would effectively end our battle with malnutrition. Without the political walls put up by governments around scientific and  medical research, we would be able to pool our knowledge and further advance our understanding of medicine. Searching for cures and treatments of diseases would no  longer be a competitive, profitable endeavor. Finally, the only way humans as a race can hope to progress is first by becoming peaceful in nature and, secondly, by joining together and concentrating our efforts on gaining an understanding for where we fit in the universe. We would all benefit from such a focusing of effort. When we shift our attention from the rat-race pursuit of going to work just to maintain what weve acquired, to a more meaningful quest for real understanding, we truly will separate ourselves form the animals. The  exploration of our universe, for example, is in its zygote stage; we know little enough about the community in which we live. How can we be so egocentric as a race to be on a tiny planet in a vast universe and not explore our surroundings with sincerity, as we fight over narrow strips of real estate? Perhaps through the exploration of space we may encounter other forms of life,  possibly even intelligent. Statistically, it is highly unlikely we are the only place in the whole universe where life exists. Seeking out other forms of life and even communicating with them would move us toward being involved in a universal community. But our first step must be taken here on our home planet. Socialism is this first required step in allowing man to reach his potential. It would provide an environment in which a greater understanding would evolve. We could be free of wars, disease and other problems that plague us today. There would be less need for a government and more resources would become available for meaningful purposes.

Impact of the Discretionary Social Fund

Impact of the Discretionary Social Fund The Discretionary Social Fund: Discretion but Little Valour! The introduction of the Social Fund in 1988 was politically driven. Prior to its introduction, there were available a series of grants (â€Å"Single Payments†) which were available as of right. The imperative which drove the measure was the need to constrain the ever-burgeoning Social Security budget. Of course, certain of the stated aims were superficially laudable[1]: â€Å"To concentrate attention and help on those applicants facing greatest difficulties in managing on their income; To enable a more varied response to inescapable individual need than could be achieved under the previous rules; To break new ground in the field of community care† However, it might be argued that in pursuing the aims of containing the Social Security budget without adversely affecting the efficiency of the main Income Support scheme, the three objectives described above have become neglected or even prejudiced. So much so that the Select Committee on Social Security[2] has questioned whether the Fund has succeeded in its stated objective of helping the poorest and most vulnerable in society and has urged the Government radically to reassess (â€Å"urgent overhaul and an injection of funds†) the working of the fund, in particular â€Å"so that it may work to enhance the strategy to reduce child poverty, rather than work against it†. Particular concern has been expressed by charities working in the field of child poverty[3]. The Discretionary Social Fund operates within fiscal policies and weightings and is subject to cash limits for each administrative area. This gives rise to criticism that applications to the Fund are subject to both a â€Å"postcode† and a â€Å"calendar lottery†. The components of the Social Fund are: Community Care Grants (â€Å"CCGsâ€Å"); Budgeting Loans; and Crisis Loans. By contrast with the previous system, the availability of grants as opposed to loans has become severely restricted. The FWA[4] acknowledges that while CCGs are intended to help people remain or re-establish themselves within the community: â€Å"†¦decisions are discretionary and are subject to cash limits, what counts as exceptional pressure can vary and the Social Fund Inspectors regularly see cases that have been refused when qualifying conditions have been met and a payment should have been granted.† More pernicious still is the shift in emphasis to loans. This may be presented politically as an admirable social objective, discouraging continued reliance on â€Å"hand outs† and encouraging a sense of financial self-discipline and responsibility. In reality, the insistence upon repayment militates against the escape from poverty of those of the most limited means. The principle which underlies Budgeting Loans is again admirable: interest free lending to those who are in difficulty budgeting after a period on benefits and usually used for the purchase of essential household items such as beds and cookers. Admittedly they provide invaluable support to those who are unable to access other forms of credit and are directly repayable from benefit thus ensuring repayment discipline. However, they are also subject to the â€Å"postcode lottery† described above and the repayment rates are high and inflexible (78 weeks at between 5%-25% of benefit). Strict rules discourage repeat applications or â€Å"topping up†. The end result is a failure adequately to meet the needs of many poor families giving rise to particular concern for the welfare of the children within such households. This is as a result of what should have been predicted to be an unacceptable imkpact upon weekly income: benefit rates are by definition calculated to meet the su bsistence expenses of the family unit in question. Deductions from such a minimal level of income cannot fail to lead to hardship. However, a more positive evaluation of the Social Fund is supplied by the Department for Work and Pensions[5] which describes it as â€Å"an extremely important and highly valued source of financial support for recipients. It had a positive impact on recipients’ life situation, and made a considerable difference to the housing condition in which people lived.† However, in common with the FWA, the authors of this report acknowledge that â€Å"there was limited knowledge of rules and eligibility criteria among recipients† and â€Å"there may also be scope to providing more training to staff on some of the barriers that recipients face when applying† and to â€Å"offer financial advice to recipients when providing information on the Social Fund†. There are also glaring deficiencies in the procedure by which Social Fund decisions may be reviewed. Dissatisfied claimants may seek internal reviews of initial decisions and further review by the Social Fund Inspectors of the Independent Review Service of the Social Fund. Such decisions are themselves susceptible to judicial review. However, as Pick and Sunkin[6] question: â€Å"Created out of compromise, is the IRS review system to be regarded as an administrative device for deflecting criticism of an unsound system by means of symbolic due process..?† It is not possible in a submission of this length to do more than scratch the surface of the impact of the discretionary social fund. However, as has been demonstrated, the system is fundamentally flawed in principle and defective in operation. There is an appalling parallel with the operation of the much-maligned Child Support Agency. The latter was born of a political desire to reduce the burden imposed on the social security budget by feckless parents but has in many instances signally failed to deliver benefit to the intended recipients. The loan-dominated mechanism of the Social Fund similarly fails to meet the avowed social policy objectives of the government. Bibliography Buck, T. Smith, R., A Critical Literature Review of the Social Fund, (Summary Report) for The National Audit Office (7 April 2004) Department for Work and Pensions, The Discretionary Social Fund and Money Management, Research Report No 241 (2005) Family Welfare Association, ‘Like it or Lump It’, A Role for the Social Fund in Ending Child Poverty, April 2002 Pick, K. Sunkin, M., The Changing Impact of Judicial Review: The Independent Review Service of the Social Fund, (2001) PL 736 Select Committee on Social Security, Third Report, The Social Fund: A Lifeline for the Poor Or the Fund that Likes to Say No? (2001) HC 232 Footnotes [1] Select Committee on Social Security, Third Report, The Social Fund: A Lifeline for the Poor Or the Fund that Likes to Say No? (2001) HC 232, para.1 [2] Op. Cit., paras.117-118 [3] Family Welfare Association, ‘Like it or Lump It’, A Role for the Social Fund in Ending Child Poverty, April 2002 [4] Op. Cit., Chapter 2 [5] Department for Work and Pensions, The Discretionary Social Fund and Money Management, Research Report No 241 (2005), p.5 [6] Pick, K. Sunkin, M., The Changing Impact of Judicial Review: The Independent Review Service of the Social Fund, (2001) PL 736 at p.740

Choosing a Vegan Lifestyle Essay -- Argumentative Animal Rights Vegan

Choosing a Vegan Lifestyle Erica is going out on a date tonight with a boy from her Biology class. She takes a long shower and washes herself with hard animal fat. Next, she neatly spreads grease derived from wool onto her lips. To finish herself off, she spreads liquid from a shark liver onto her face and sprays some oils and liquids derived from the anal sex gland of the beaver and whale excretion. Now she is ready to go as she is sure that she will impress her date with her dolled up appearance. Little does she know that the soap, lipstick, makeup and perfume have all been created from the slaughter of innocent animals. Animal production for agricultural purposes is harmful to humans, the environment, and of course, the animals which are subjected to testing, mistreatment, and distressing conditions. Veganism is an alternate healthy lifestyle in which people choose not to consume or purchase products which harm animals, their personal health, and the environment as a result of animal production. Becoming a vegan may take some initial adjusting, but after acknowledging all the problems that the meat industry creates, it will hopefully seem like the only choice to make. For the sake of animals, personal nutrition and the environment, choosing a vegan lifestyle reflects a beneficial outcome for all. Animals are the unfortunate, innocent test subjects used when creating new products. Every year, except in UK where it is banned, millions of animals are subjected to painful experiments simply so that people can have a new brand of shampoo or a new scent of perfume. There are three main tests which animals are subjected to. First is an eye irritancy test in which a substance is applied to the eye of a rabbit to see if there... ...ome to millions of species, which can become endangered when they lose their habitats. Trees also absorb carbon dioxide, so fewer trees mean more global warming. And it is not just the land that suffers. Every year farmers in the UK spread about 80 million tons of animal manures and other organic farm wastes on to the land as fertilizer. Much of this runs off into nearby rivers or streams. This run-off endangers the health of fish and other animals in the area. This shows how meat and dairy production is an unproductive use of land, food and water. Choosing a vegan lifestyle is beneficial to humans, animals, and the environment. Supporting veganism can make a big difference in the world. Whether it is for animals, personal nutritional reasons, the environment, or all three, there is no reason why anyone should not at least consider or support becoming a vegan.

Protagoras :: Philosophy Papers

Protagoras The passage in question begins with a breakdown in the discussion between Socrates and Protagoras because of disagreement about what its ground rules will be and concludes with the discussion’s restoration. Though formally a mere hiatus from the main line of argument, this passage in fact contains a parable about politics, addressing the question, "How can people of differing abilities and preferences come together to form a community?" Since the passage appears in the middle of a dialogue explicitly concerned with education, the parable extends to education as well. The passage thus provides a springboard for insight into some essential interconnections between and among philosophy, education, and politics. On the one hand, a genuine practitioner of any of the three is ipso facto a engaged in the other two at the same time. And on the other hand, the three share an internal structure which is reflexive and transitive at the same time. In the passage in question, the discussion between Socrates and Protagoras has broken down in disagreement about what its ground rules will be. After some angry saber-rattling from the principals, and some well-meaning intervention from the onlookers, order is restored and the dialogue continues. For all its vivid, memorable banter, the passage is thus apparently no more than a hiatus from the dialogue’s main line of argument.(1) A commentary may skip over it lightly;(2) an anthology may omit it entirely.(3) However, I claim that the passage is more than mere literary entertainment, and has significance beyond the methodology of Socratic dialogue. In this essay I would like to give a reading of the passage which shows it to be not only a dispute about philosophical methodology but also a parable for politics. I will then go on to show that this political parable, placed as it is at the center of a philosophical work in which education is explicitly at issue, suggests some esse ntial interconnections between philosophy, politics, and education. The discussion between Socrates, the dialectician, and Protagoras, the speech-maker, began in a friendly fashion (317e), but by 334d it has broken down entirely. Socrates’s elenchus has exposed some problems in Protagoras’s position, and Protagoras seems to realize that things go better for him when he makes a speech (as at 320d-328d). When he extricates himself from a tight spot into which Socrates has backed him by giving a short speech (334a-c) which brings him applause, Socrates realizes that Protagoras does not wish to engage in dialectic.

Introduction to Epidemiology

Aug 17 2011 Introduction to Epidemiology Epidemiology is considered the basic science of public health, and with good reason. Epidemiology is: †¢ †¢ †¢ A quantitative basic science built on a working knowledge of probability, statistics, and sound research methodology A method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality A tool for public health action to promote and protect the public’s health based on science, causal reasoning, and a dose of practical common sense (2).As a public health discipline, epidemiology is instilled with the spirit that epidemiologic information should be used to promote and protect the public’s health. Hence, epidemiology involves both science and public health practice. The term applied epidemiology is sometimes used to describe the application or practice of epidemiology to address public health issues.Examples of applied epidemiology include the following: †¢ †¢ †¢ †¢ the monitoring of reports of communicable diseases in the community the study of whether a particular dietary component influences your risk of developing cancer evaluation of the effectiveness and impact of a cholesterol awareness program analysis of historical trends and current data to project future public health resource needs ObjectivesAfter studying this document and answering the questions in the exercises, you should be able to do the following: †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ Define epidemiology Summarize the historical evolution of epidemiology Describe the elements of a case definition and state the effect of changing the value of any of the elements List the key features and uses of descriptive epidemiology List the key features and uses of analytic epidemiology List the three components of the epidemiologic triad List and describe Hill’s criteria of causation Understand the natural history of disease and the three types of prevention Understand infectivity, pathogenicity, and virulence List and describe primary applications of epidemiology in public health practice List and describe the different modes of transmission of communicable disease in a population 1 Page 2 Applied Epidemiology I A number of exercises are provided. It is suggested you attempt to answer these questions and then compare your answers with those at the end of this document. Introduction The word epidemiology comes from the Greek words epi, meaning â€Å"on or upon,† demos, meaning â€Å"people,† and logos, meaning â€Å"the study of. Many definitions have been proposed, but the following definition captures the underlying principles and the public health spirit of epidemiology: â€Å"Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the cont rol of health problems. † (17) Key terms in this definition reflect some of the important principles of epidemiology. Study Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data.Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. In fact, epidemiology is often described as the basic science of public health, and for good reason. First, epidemiology is a quantitati ve discipline that relies on a working knowledge of probability, statistics, and sound research methods.Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning. Determinants Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events.Epidemiologists assume that illness does not occur randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual. To search for these determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the â€Å"Why† and â€Å"How† of such events. They assess whether groups with different rates of disease differ in their demographic characteristics, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential risk factors. Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures. Health-related states or eventsEpidemiology was originally focused exclusively on epidemics of communicable diseases3 but was subsequently expanded to address endemic communicable diseases and non-communicable infectious diseases. By the middle of the 20th Century, additional epidemiologic methods had been developed and applied to chronic diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. Then epidemiologists began to look at behaviors related to health and well-being, such as amount o f exercise and seat belt use. Now, with the recent explosion in molecular methods, Introduction to Epidemiology – Epi 592J Page 3 epidemiologists can make important strides in examining genetic markers of disease risk.Indeed, the term health related states or events may be seen as anything that affects the well-being of a population. Nonetheless, many epidemiologists still use the term â€Å"disease† as shorthand for the wide range of healthrelated states and events that are studied. Specified populations Although epidemiologists and direct health-care providers (clinicians) are both concerned with occurrence and control of disease, they differ greatly in how they view â€Å"the patient. † The clinician is concerned about the health of an individual; the epidemiologist is concerned about the collective health of the people in a community or population. In other words, the clinician’s â€Å"patient† is the individual; the epidemiologist’s â⠂¬Å"patient† is the community.Therefore, the clinician and the epidemiologist have different responsibilities when faced with a person with illness. For example, when a patient with diarrheal disease presents, both are interested in establishing the correct diagnosis. However, while the clinician usually focuses on treating and caring for the individual, the epidemiologist focuses on identifying the exposure or source that caused the illness; the number of other persons who may have been similarly exposed; the potential for further spread in the community; and interventions to prevent additional cases or recurrences. Application Epidemiology is not just â€Å"the study of† health in a population; it also involves applying the knowledge gained by the studies to community-based practice.Like the practice of medicine, the practice of epidemiology is both a science and an art. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician comb ines medical (scientific) knowledge with experience, clinical judgment, and understanding of the patient. Similarly, the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience, epidemiologic judgment, and understanding of local conditions in â€Å"diagnosing† the health of a community and proposing appropriate, practical, and acceptable public health interventions to control and prevent disease in the community. SummaryEpidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (patient is community, individuals viewed collectively), and the application of (since epidemiology is a discipline within public health) this study to the control of health problems. Evolution Although epidemiologic thinking has been traced from Hippocrates (circa 400 B. C. ) through Grau nt (1662), Farr, Snow (both mid-1800’s), and others, the discipline did not blossom until the end of the Second World War. The contributions of some of these early and more recent thinkers are described next. Hippocrates (circa 400 B. C. ) attempted to explain disease occurrence from a rational instead of a supernatural viewpoint. In his essay entitled â€Å"On Airs, Waters, and Places,† Hippocrates suggested that environmental and host factors such as behaviors might influence the development of disease.Another early contributor to epidemiology was John Graunt, a London haberdasher who published his landmark analysis of mortality data in 1662. He was the first to quantify patterns of birth, death, and disease occurrence, noting male-female disparities, high infant mortality, urban-rural differences, and seasonal variations. No one built upon Graunt’s work until the mid-1800, when William Farr began to systematically collect and analyze Britain’s mortalit y statistics. Farr, considered the father of modern vital statistics and disease surveillance, developed many of the basic practices used today in vital statistics and disease classification. He extended the epidemiologic analysis of morbidity and mortality data, looking at Page 4 Applied Epidemiology I he effects of marital status, occupation, and altitude. He also developed many epidemiologic concepts and techniques still in use today. Meanwhile, an anesthesiologist named John Snow was conducting a series of investigations in London that later earned him the title â€Å"the father of epidemiology. † Twenty years before the development of the microscope, Snow conducted studies of cholera outbreaks both to discover the cause of the disease and to prevent its recurrence. Because his work classically illustrates the sequence from descriptive epidemiology to hypothesis generation to hypothesis testing (analytic epidemiology) to application, we will consider two of his efforts.It is important to mention that at the time of John Snow’s investigations the most widely accepted cause of diseases, including cholera, was due to miasma, or foul air. Therefore most believed that cholera was transmitted by air, especially foul-smelling air near water. The germ theory, that disease was transmitted by microbes, did not gain acceptance until later in the 1800s. Snow conducted his classic study in 1854 when an epidemic of cholera developed in the Golden Square of London. He began his investigation by determining where in this area persons with cholera lived and worked. He then used this information to map the distribution of cases on what epidemiologists call a spot map. His map is shown in Figure 1. 1.Because Snow believed that water was a source of infection for cholera, he marked the location of water pumps on his spot map, and then looked for a relationship between the distribution of cholera case households and the location of pumps. He noticed that more cas e households clustered around certain pumps, especially the Broad Street pump, and he concluded that the Broad Street pump was the most likely source of infection. Questioning residents who lived near the other pumps, he found that they avoided certain pumps because the water they provided was grossly contaminated, and that other pumps were located too inconveniently for most residents of the Golden Square area.From this information, it appeared to Snow that the Broad Street pump was probably the primary source of water for most persons with cholera in the Golden Square area. He realized, however, that it was too soon to draw that conclusion because the map showed no cholera cases in a two-block area to the east of the Broad Street pump. Perhaps no one lived in that area, or perhaps the residents were somehow protected. Upon investigating, Snow found that a brewery was located there and that it had a deep well on the premises where brewery workers, who also lived in the area, got th eir water. In addition, the brewery allotted workers a daily quota of malt liquor. Access to these uncontaminated rations could explain why none of the brewery’s employees contracted cholera.To provide further evidence that the Broad Street pump was the source of the epidemic, Snow gathered information on where persons with cholera had obtained their water. Consumption of water from the Broad Street pump was the one common factor among the cholera patients. According to legend, Snow removed the handle of the Broad Street pump and aborted the outbreak. Snow’s second major contribution involved another investigation of the same outbreak of cholera that occurred in London in 1854. In a London epidemic in 1849, Snow had noted that districts with the highest mortalities had water supplied by two companies: the Lambeth Company and the Southwark and Vauxhall Company. At that time, both companies obtained water from the Thames River, at intake points downstream of London.In 18 52, the Lambeth Company moved their water works upstream from London, thus obtaining water free of London sewage. When cholera returned to London in 1853, Snow realized the Lambeth Company’s relocation of its intake point would allow him to compare districts that were supplied with water upstream from London with districts that received water downstream from London. Table 1. 1 shows what Snow found when he made that comparison for cholera mortality over a 7-week period during the summer of 1854. Introduction to Epidemiology – Epi 592J Page 5 Figure 1. 1 Distribution of cholera cases in the Golden Square area of London, August-September 1854 Table 1. Mortality from cholera in the districts of London supplied by the Southwark and Vauxhall and the Lambeth Companies, July 9-August 26, 1854 Districts with Water Supplied by Population Deaths from Mortality Risk per (1851 Census) Cholera 1,000 Population 167,654 844 5. 0 Southwark and Vauxhall Co. only Lambeth Co. only Both c ompanies Source: 27 19,133 300,149 18 652 0. 9 2. 2 Page 6 Applied Epidemiology I The data in Table 1. 1 show that the risk of death from cholera was more than 5 times higher in districts served only by the Southwark and Vauxhall Company than in those served only by the Lambeth Company. Interestingly, the mortality risks in districts supplied by both companies fell between the risks for districts served exclusively by either company.These data were consistent with the hypothesis that water obtained from the Thames below London was a source of cholera. Alternatively, the populations supplied by the two companies may have differed on a number of other factors which affected their risk of cholera. To test his water supply hypothesis, Snow focused on the districts served by both companies, because the households within a district were generally comparable except for which company supplied water. In these districts, Snow identified the water supply company for every house in which a deat h from cholera had occurred during the 7-week period. Table 1. 2 shows his findings. Table 1. Mortality from cholera in London related to the water supply of individual houses in districts served by both the Southwark and Vauxhall Company and the Lambeth Company, July 9August 26, 1854 Water Supply of Individual House Population Deaths from Mortality risk per (1851 Census) Cholera 1,000 Population Southwark and Vauxhall Co. 98,862 419 4. 2 Lambeth Co. Source: 27 154,615 80 0. 5 This further study added support to Snow’s hypothesis, and demonstrates the sequence of steps used today to investigate outbreaks of disease. Based on a characterization of the cases and population at risk by time, place, and person, Snow developed a testable hypothesis. He then tested this hypothesis with a more rigorously designed study, ensuring that the groups to be compared were comparable. After this study, efforts to control the epidemic were directed at changing the location of the water intake of the Southwark and Vauxhall Company to reduce sources of contamination.Thus, with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action. More information on John Snow can be found at: www. ph. ucla. edu/epi/snow. html In the mid- and late-1800’s, many others in Europe and the United States began to apply epidemiologic methods to investigate disease occurrence. At that time, most investigators focused on acute infectious diseases. In the 1900’s, epidemiologists extended their methods to noninfectious diseases.The period since the Second World War has seen an explosion in the development of research methods and the theoretical underpinnings of epidemiology, and in the application of epidemiology to the entire range of health-related outcomes, behaviors, and even kno wledge and attitudes. The studies by Doll and Hill (13) linking smoking to lung cancer and the study of cardiovascular disease among residents of Framingham, Massachusetts (12), are two examples of how pioneering researchers have applied epidemiologic methods to chronic disease since World War II. Finally, during the 1960’s and early 1970’s health workers applied epidemiologic methods to eradicate smallpox worldwide.This was an achievement in applied epidemiology of unprecedented proportions. Today, public health workers throughout the world accept and use epidemiology routinely. Epidemiology is often practiced or used by non-epidemiologists to characterize the health of their communities and to solve day-to-day problems. This landmark in the evolution of the discipline is less dramatic than the eradication of smallpox, but it is no less important in improving the health of people everywhere. Introduction to Epidemiology – Epi 592J Page 7 Uses Epidemiology and t he information generated by epidemiologic methods have many uses. These uses are categorized and described below. Population or community health assessment.To set policy and plan programs, public health officials must assess the health of the population or community they serve and determine whether health services are available, accessible, effective, and efficient. To do this, they must find answers to many questions: What are the actual and potential health problems in the community? Where are they? Who is at risk? Which problems are declining over time? Which ones are increasing or have the potential to increase? How do these patterns relate to the level and distribution of services available? The methods of descriptive and analytic epidemiology provide ways to answer these and other questions.With answers provided through the application of epidemiology, the officials can make informed decisions that will lead to improved health for the population they serve. Individual decision s. People may not realize that they use epidemiologic information in their daily decisions. When they decide to stop smoking, take the stairs instead of the elevator, order a salad instead of a cheeseburger with French fries, or choose one method of contraception instead of another, they may be influenced, consciously or unconsciously, by epidemiologists’ assessment of risk. Since World War II, epidemiologists have provided information related to all those decisions.In the 1950’s, epidemiologists documented the increased risk of lung cancer among smokers; in the 1960’s and 1970’s, epidemiologists noted a variety of benefits and risks associated with different methods of birth control; in the mid-1980’s, epidemiologists identified the increased risk of human immunodeficiency virus (HIV) infection associated with certain sexual and drug-related behaviors; and, more positively, epidemiologists continue to document the role of exercise and proper diet in reducing the risk of heart disease. These and hundreds of other epidemiologic findings are directly relevant to the choices that people make every day, choices that affect their health over a lifetime. Completing the clinical picture. When studying a disease outbreak, epidemiologists depend on clinical physicians and laboratory scientists for the proper diagnosis of individual patients.But epidemiologists also contribute to physicians’ understanding of the clinical picture and natural history of disease. For example, in late 1989 three patients in New Mexico were diagnosed as having myalgias (severe muscle pains in chest or abdomen) and unexplained eosinophilia (an increase in the number of one type of white blood cell). Their physicians could not identify the cause of their symptoms, or put a name to the disorder. Epidemiologists began looking for other cases with similar symptoms, and within weeks had found enough additional cases of eosinophilia-myalgia syndrome (EMS) t o describe the illness, its complications, and its risk of mortality.Similarly, epidemiologists have documented the course of HIV infection, from the initial exposure to the development of a wide variety of clinical syndromes that include acquired immunodeficiency syndrome (AIDS). They have also documented the numerous conditions associated with cigarette smoking—from pulmonary and heart disease to lung and cervical cancer. Search for causes. Much of epidemiologic research is devoted to a search for causes, factors which influence one’s risk of disease. Sometimes this is an academic pursuit, but more often the goal is to identify a cause so that appropriate public health action might be taken. It has been said that epidemiology can never prove a causal relationship between an exposure and a disease. Nevertheless, epidemiology often provides enough information to support effective action.Examples include John Snow’s removal of the pump handle and the withdrawal o f a specific brand of tampon that was linked by epidemiologists to toxic shock syndrome. Another example is the recommendation that children not be given aspirin due to its association with Reye syndrome. Just as often, epidemiology and laboratory science converge to provide the evidence needed to establish causation. For example, a team of epidemiologists were able to identify a variety of risk factors during an outbreak of pneumonia among persons attending the American Page 8 Applied Epidemiology I Legion Convention in Philadelphia in 1976, called â€Å"Legionnaire’s disease. However, the outbreak was not â€Å"solved† until the Legionnaires’ bacillus was identified in the laboratory almost 6 months later. Disease control, elimination, and eradication. The ultimate goal of epidemiology is to improve the health of populations and through the reduction in disease. The definitions of disease control, elimination, and eradication as applied to infectious diseases are given below. (Dowdle WR. The principles of disease elimination and eradication. MMWR 48(SU01);23-7, 1999. ): Control: The reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Example: diarrheal diseases.Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Examples: neonatal tetanus. Elimination of infections: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required. Example: measles, poliomyelitis. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate effor ts; intervention measures are no longer needed. Example: smallpox.Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none. The above definitions are specific to infectious disease, but some of the concepts can carry over to other conditions, such as nutritional disorders, inborn errors of metabolism, and chronic diseases. Introduction to Epidemiology – Epi 592J Page 9 Exercise 1. 1 In the early 1980’s, epidemiologists recognized that AIDS occurred most frequently in men who had sex with men and in intravenous drug users. Describe how this information might be used for each of the following: a. Population or community health assessment b. Individual decisions c. Search for causes Page 10 Applied Epidemiology I The Epidemiologic ApproachLike a newspaper reporter, an epidemiologist determines What, When, Where, Who, and Why. However, the epidemiologist is more likely to describe these concepts in slightly different terms: c ase definition, time, place, person, and causes. Case Definition (â€Å"What? †) The identification of disease can be based on symptoms, signs, and diagnostic tests. A symptom is a sensation or change in health experienced by an individual. Examples of symptoms reported by an individual are a cough, fatigue, anxiety, and back pain. Signs, or signs of disease, are an objective evidence of disease observed by someone other than the affected individual, such as a physician or nurse.A case definition is a set of standard criteria for deciding whether a person has a particular disease or other health-related condition. By using a standard case definition we attempt to ensure that every case is diagnosed in the same way, regardless of when or where it occurred, or who identified it. We can then compare the number of cases of the disease that occurred in one time or place with the number that occurred at another time or another place. For example, with a standard case definition, we can compare the number of cases of hepatitis A that occurred in New York City in 1991 with the number that occurred there in 1990. Or we can compare the number of cases that occurred in New York in 1991 with the number that occurred in San Francisco in 1991. With a standard ase definition, when we find a difference in disease occurrence, we know it is likely to be due to a real difference or due to the quality of the disease reporting system rather than the result of differences in how cases were diagnosed. A case definition consists of clinical criteria and, sometimes, limitations on time, place, and person. The clinical criteria usually include confirmatory laboratory tests, if available, or combinations of symptoms (subjective complaints), signs (objective physical findings), and other findings. For example, see the case definition for rabies below; notice that it requires laboratory confirmation. Rabies, Human Clinical description Rabies is an acute encephalomyelitis that almos t always progresses to coma or death within 10 days of the first symptom.Laboratory criteria for diagnosis †¢ Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck), or †¢ Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF), or central nervous system tissue, or †¢ Identification of a rabies-neutralizing antibody titer greater than or equal to 5 (complete neutralization) in the serum or CSF of an unvaccinated person Case classification Confirmed: a clinically compatible illness that is laboratory confirmed Comment Laboratory confirmation by all of the above methods is strongly recommended. Source: 3 Compare this with the case definition for Kawasaki syndrome provided in Exercise 1. 3 on page 12. Kawasaki syndrome is a childhood illness with fever and rash that has no known cause and no specifically d istinctive laboratory findings.Notice that its case definition is based on the presence of fever, at least four of five specified clinical findings, and the lack of a more reasonable explanation. A case definition may have several sets of criteria, depending on the certainty of the diagnosis. For example, during an outbreak of measles, we might classify a person with a fever and rash as having a Introduction to Epidemiology – Epi 592J Page 11 suspect, probable, or confirmed case of measles, depending on what additional evidence of measles was present. In other situations, we may temporarily classify a case as suspect or probable until laboratory results are available. When we receive the laboratory report, we then reclassify the case as either confirmed or â€Å"not a case,† depending on the lab results.In the midst of a large outbreak of a disease caused by a known agent, we may permanently classify some cases as suspect or probable, because it is unnecessary and wast eful to run laboratory tests on every individual with a consistent clinical picture and a history of exposure (e. g. , chickenpox). Case definitions may also vary according to the purpose for classifying the occurrences of a disease. For example, health officials need to know as soon as possible if anyone has symptoms of plague or foodborne botulism so that they can begin planning what actions to take. For such rare but potentially severe diseases, where it is important to identify every possible case, health officials use a sensitive, or â€Å"loose† case definition.On the other hand, investigators of the causes of a disease outbreak want to be certain that any person included in the investigation really had the disease. The investigator will prefer a specific or â€Å"strict† case definition. For instance, in an outbreak of Salmonella agona, the investigators would be more likely to identify the source of the infection if they included only persons who were confirmed to have been infected with that organism, rather than including anyone with acute diarrhea, because some persons may have had diarrhea from a different cause. In this setting, a disadvantage of a strict case definition is an underestimate of the total number of cases. Exercise 1. 2In the case definition for an apparent outbreak of trichinosis, investigators used the following classifications: Clinical criteria Confirmed case: signs and symptoms plus laboratory confirmation Probable case: acute onset of at least three of the following four features: myalgia, fever, facial edema, or eosinophil count greater than 500/mm3 Possible case: acute onset of two of the above four features plus a physician diagnosis of trichinosis Suspect case: unexplained eosinophilia Not a case: failure to fulfill the criteria for a confirmed, probable, possible, or suspect case Time Onset after October 26, 1991 Place Metropolitan Atlanta Person Any Assign the appropriate classification to each of the person s included in the line listing below. (All were residents of Atlanta with acute onset of symptoms in November. ) Page 12 Applied Epidemiology I ID # 1 2 3 4 5 Last name Abels Baker Corey Dale Ring myalgia yes yes yes yes yes fever yes yes yes no no facial edema no yes no no no eosinophil count 495 pending 1,100 2,050 600 Physician diagnosis trichinosis trichinosis ? trichinosis EMS ? trichinosis Lab confirm yes pending pending pending not done Classification __________ __________ __________ __________ __________Exercise 1. 3 The following is the official case definition for Kawasaki syndrome that is recommended by CDC: Kawasaki Syndrome Clinical case definition A febrile illness of greater than or equal to 5 days’ duration, with at least four of the five following physical findings and no other more reasonable explanation for the observed clinical findings: †¢ Bilateral conjunctival injection †¢ Oral changes (erythema of lips or oropharynx, strawberry tongue, or fis suring of the lips) †¢ Peripheral extremity changes (edema, erythema, or generalized or periungual desquamation) †¢ Rash †¢ Cervical lymphadenopathy (at least one lymph node greater than or equal to 1. cm in diameter) Laboratory criteria for diagnosis None Case classification Confirmed: a case that meets the clinical case definition Comment If fever disappears after intravenous gamma globulin therapy is started, fever may be of less than 5 days’ duration, and the clinical case definition may still be met. Source: 3 Discuss the pros and cons of this case definition for the purposes listed below. (For a brief description of Kawasaki syndrome, see Benenson’s Control of Communicable Diseases in Man). a. Diagnosing and treating individual patients b. Tracking the occurrence of the disease for public health records c. Doing research to identify the cause of the disease Introduction to Epidemiology – Epi 592J Page 13 Numbers and RisksA basic task of a he alth department is counting cases in order to measure and describe morbidity. When physicians diagnose a case of a reportable disease they are suppose to report the case to their local health department. For most reportable conditions, these reports are legally required to contain information on time (when the case occurred), place (where the patient lived), and person (the age, race, and sex of the patient). The health department combines all reports and summarizes the information by time, place, and person. From these summaries, the health department determines the extent and patterns of disease occurrence in the area, and attempts to identify clusters or outbreaks of disease.A simple count of cases, however, does not provide all the information a health department needs. To compare the occurrence of a disease at different locations, during different times, or in different subgroups, a health department converts the case counts into risks, which relates the number of cases to the size of the population. Risks are useful in many ways. With risks, the health department can identify groups in the community with an elevated risk of disease. These so-called high-risk groups can be further assessed and targeted for special intervention; the groups can be studied to identify risk factors that are related to the occurrence of disease.Individuals can use knowledge of these risk factors to guide their decisions about behaviors that influence health. Descriptive Epidemiology In descriptive epidemiology, we organize and summarize data according to time, place, and person. These three characteristics are sometimes called the epidemiologic variables. Compiling and analyzing data by time, place, and person is desirable for several reasons. First, the investigator becomes intimately familiar with the data and with the extent of the public health problem being investigated. Second, this provides a detailed description of the health of a population that is easily communicated . Third, such analysis identifies the populations at greatest risk of acquiring a particular disease.This information provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. Time (â€Å"When? †) Disease risks usually change over time. Some of these changes occur regularly and can be predicted. For example, the seasonal increase of influenza cases with the onset of cold weather is a pattern that is familiar to everyone. By knowing when flu outbreaks will occur, health departments can time their influenza vaccination campaigns effectively. Other diseases may make unpredictable changes in occurrence. By examining events that precede a disease increase or decrease, we may identify causes and appropriate actions to control or prevent further occurrence of the disease.We usually show time data as a graph (Figure 1. 3). We put the number or risk of cases or deaths on the vertical, y-axis; we put the time periods along the horizo ntal, x-axis. We often indicate on a graph when events occurred that we believe are related to the particular health problem described in the graph. For example, we may indicate the period of exposure or the date control measures were implemented. Such a graph provides a simple visual depiction of the relative size of a problem, its past trend and potential future course, as well as how other events may have affected the problem. Studying such a graph often gives us insights into what may have caused the problem.Depending on what event we are describing, we may be interested in a period of years or decades, or we may limit the period to hours, days, weeks, or months when the number of cases reported is greater than normal (an epidemic period). For some conditions—for many chronic diseases, for example—we are interested in long-term changes in the number of cases or risk of the condition. For other conditions, we may find it more revealing to look at the occurrence of t he condition by season, month, day of the Page 14 Applied Epidemiology I week, or even time of day. For a newly recognized problem, we need to assess the occurrence of the problem over time in a variety of ways until we discover the most appropriate and revealing time period to use. Some of the common types of time-related graphs are further described below. Secular (long-term) trends.Graphing the annual cases or risk of a disease over a period of years shows long-term or secular trends in the occurrence of the disease. We commonly use these trends to suggest or predict the future incidence of a disease. We also use them in some instances to evaluate programs or policy decisions, or to suggest what caused an increase or decrease in the occurrence of a disease, particularly if the graph indicates when related events took place, as depicted in Figure 1. 3 (note the scale of the y-axis). Figure 1. 3 Malaria by year, United States, 1930-1990 Works Progress Administration Malaria Control Drainage Program Relapses from Overseas Cases 1000 Reported Cases per 100,000 Population 100Relapses from Korean Veterans Returning Vietnam Veterans 10 Foreign Immigration 1 0. 1 0. 01 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 Source: 9 Year Seasonality. By graphing the occurrence of a disease by week or month over the course of a year or more we can show its seasonal pattern, if any. Some diseases are known to have characteristic seasonal distributions; for example, as mentioned earlier, the number of reported cases of influenza typically increases in winter. Seasonal patterns may suggest hypotheses about how the infection is transmitted, which behavioral factors increase risk, and other possible contributors to the disease or condition.The seasonal pattern of an unknown disease is shown in Figure 1. 4. What factors might contribute to its seasonal pattern? From only the single year’s data in Figure 1. 4, it is difficult to conclude whether the peak i n June represents a characteristic seasonal pattern that would be repeated yearly, or whether it is simply an epidemic that occurred in the spring and summer of that particular year. You would need more than one year’s data before you could conclude that the pattern shown there represents the seasonal variation in this disease. Introduction to Epidemiology – Epi 592J Page 15 Figure 1. 4 Cases of an unknown disease by month of onset 450 400 350 300 Cases 50 200 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: 14 Month of Onset Day of week and time of day. Displaying data by days of the week or time of day may also be informative. Analysis at these shorter time periods is especially important for conditions that are potentially related to occupational or environmental exposures, which may occur at regularly scheduled intervals. In Figure 1. 5, farm tractor fatalities are displayed by days of the week. Does this analysis at shorter time periods suggest any hypothesis? In Figure 1. 5 the number of farm tractor fatalities on Sundays is about half the number on the other days. We can only speculate why this is.One reasonable hypothesis is that farmers spend fewer hours on their tractors on Sundays than on the other days. Figure 1. 5 Fatalities associated with farm tractor injuries by day of death, Georgia, 1971-1981 Source: 15 Page 16 Applied Epidemiology I Examine the pattern of fatalities associated with farm tractor injuries by hour in Figure 1. 6. How might you explain the morning peak at 11:00 AM, the dip at noon, and the afternoon peak at 4:00 PM? Figure 1. 6 Fatalities associated with farm tractor injuries by time of day, Georgia, 1971-1981 Source: 15 Epidemic period. To show the time course of a disease outbreak or epidemic, we use a graph called an epidemic curve.As with the other graphs you have seen in this section, we place the number of cases on the vertical axis and time on the horizontal axis. For time, we use either the time of onset of symptoms or the date of diagnosis. For very acute diseases with short incubation periods (i. e. , time period between exposure and onset of symptoms is short), we may show time as the hour of onset. For diseases with longer incubation periods, we might show time in 1-day, 2-day, 3-day, 1-week, or other appropriate intervals. Figure 1. 7 shows an epidemic curve that uses a 3-day interval for a foodborne disease outbreak. Notice how the cases are stacked in adjoining columns. By convention, we use this format, called a histogram, for epidemic curves.The shape and other features of an epidemic curve can suggest hypotheses about the time and source of exposure, the mode of transmission, and the causative agent. Figure 1. 7 Date of onset of illness in patients with culture-confirmed Yersinia enterocolitica infections, Atlanta, November 1, 1988-January 10, 1989 8 7 6 Thanksgiving Christmas New Year’s Cases 5 4 3 2 1 0 1 4 7 10 13 16 19 22 25 28 1 4 7 10 13 16 1 9 22 25 28 1 4 7 10 November December January Source: 18 Date of Onset Introduction to Epidemiology – Epi 592J Page 17 Place (â€Å"Where? †) We describe a health event by place to gain insight into the geographical extent of the problem. For place, we may use place of residence, birthplace, employment, school district, hospital unit, etc. , epending on which may be related to the occurrence of the health event. Similarly, we may use large or small geographic units: country, state, county, census tract, street address, map coordinates, or some other geographical designation. Sometimes, we may find it useful to analyze data according to place categories such as urban or rural, domestic or foreign, and institutional or noninstitutional. Not all analyses by place will be equally informative. For example, examine the data shown in Table 1. 3. Where were the malaria cases diagnosed? What â€Å"place† does the table break the data down by? Would it have been more or l ess useful to analyze the data according to the â€Å"state of residence† of the cases?We believe that it provides more useful information to show the data in Table 1. 3 by where the infection was acquired than it would have to show where the case-patients lived. By analyzing the malaria cases by place of acquisition, we can see where most of the malaria cases acquired their disease. Table 1. 3 Malaria cases by distribution of Plasmodium species and area of acquisition, United States, 1989 Species Area of Acquisition Vivax Falciparum Other Total Africa 52 382 64 498 Asia 207 44 29 280 Central America & Caribbean 107 14 9 130 North America 131 3 13 147 (United States) (5) (0) (0) (5) South America 10 1 2 13 Oceania 19 2 5 26 Unknown 6 2 0 8 Total 532 448 122 1,102 Source: 6By analyzing data by place, we can also get an idea of where the agent that causes a disease normally lives and multiplies, what may carry or transmit it, and how it spreads. When we find that the occurrence of a disease is associated with a place, we can infer that factors that increase the risk of the disease are present either in the persons living there (host factors) or in the environment, or both. For example, diseases that are passed from one person to another tend to spread more rapidly in urban areas than in rural ones, mainly because the greater crowding in urban areas provides more opportunities for susceptible people to come into contact with someone who is infected.On the other hand, diseases that are passed from animals to humans often occur in greater numbers in rural and suburban areas because people in those areas are more likely to come into contact with disease-carrying animals, ticks, and the like. For example, perhaps Lyme disease has become more common because people have moved to wooded areas where they come into contact with infected deer ticks. Although we can show data by place in a table—as Table 1. 3 does—it is often better to show it pictorial ly in a map. On a map, we can use different shadings, color, or line patterns to indicate how a disease or health event has different numbers or risks of occurrence in different areas, as in Figure 1. 8. Page 18 Applied Epidemiology I Figure 1. 8 AIDS cases per 100,000 population, United States, July 1991-June 1992 Source: 4For a rare disease or outbreak, we often find it useful to prepare a spot map, like Snow’s map of the Golden Square of London (Figure 1. 1), in which we mark with a dot or an X the relation of each case to a place that is potentially relevant to the health event being investigated—such as where each case lived or worked. We may also label other sites on a spot map, such as where we believe cases may have been exposed, to show the orientation of cases within the area mapped. Figure 1. 9 is a spot map for an outbreak of mumps that occurred among employees of the Chicago futures exchanges. Study the location of each case in relation to other cases and to the trading pits. The four numbered areas delineated with heavy lines are the trading pits.Does the location of cases on the spot map lead you to any hypothesis about the source of infection? Figure 1. 9 Mumps cases in trading pits of exchange A, Chicago, Illinois, August 18-December 25, 1987 #1 #3 #2 #4 Key: Pit areas are numbered and delineated by heavy lines. Individual trading pits within pit areas are outlined by light lines. Affected person (N= 43) Desk areas Source: CDC, unpublished data, 1988 Introduction to Epidemiology – Epi 592J Page 19 You probably observed that the cases occurred primarily among those working in trading pits #3 and #4. This clustering of illness within trading pits provides indirect evidence that the mumps was transmitted person-to person. Person (â€Å"Who? ) In descriptive epidemiology, when we organize or analyze data by â€Å"person† there are several person categories available to us. We may use inherent characteristics of people (for example, age, race, sex), their acquired characteristics (immune or marital status), their activities (occupation, leisure activities, use of medications/tobacco/drugs), or the conditions under which they live (socioeconomic status, access to medical care). These categories usually determine, to a large degree, who is at greatest risk of experiencing certain undesirable health conditions, such as becoming infected with a particular disease organism. We may show person-related characteristics in either tables or graphs.In analyzing data by person, we often must try a number of different categories before we find which are the most useful and enlightening. Age and sex are most critical; we almost always analyze data according to these. Depending on the health event we are studying, we may or may not break the data down by other attributes. Often we analyze data by more than one characteristic simultaneously; for example, we may look at age and sex simultaneously to see if the sex es differ in how they develop a condition that increases with age—such as with heart disease. Age. Age is probably the single most important â€Å"person† attribute, because almost every health-related event or state varies with age.A number of factors that also vary with age are behind this association: susceptibility, opportunity for exposure, latency or incubation period of the disease, and physiologic response (which affects, among other things, disease development). When we analyze data by age, we try to use age groups that are narrow enough to detect any agerelated patterns that may be present in the data. In an initial breakdown by age, we commonly use 5-year age intervals: 0 to 4 years, 5 to 9, 10 to 14, and so on. Larger intervals, such as 0 to 19 years, 20 to 39, etc. , may conceal variations related to age which we need to know to identify the true ages at greatest risk.Sometimes, even 5-year age groups can hide important differences, especially in children less than five years of age. Take time to examine Figure 1. 10, for example, before you read ahead. What does the information in this figure suggest health authorities should do to reduce the number of cases of whooping cough? Where should health authorities focus their efforts? You probably said that health authorities should focus on immunizing infants against whooping cough during the first year of life. Now, examine Figure 1. 11. This figure shows the same data but they are presented in the usual 5-year intervals. Based on Figure 1. 11 where would you have suggested that health authorities focus their efforts?Would this recommendation have been as effective and efficient in reducing cases of whooping cough? You probably said that health authorities should immunize infants and children before the age of 5. That recommendation would be effective, but it would not be efficient. You would be immunizing more children than actually necessary and wasting resources. Sex. In general, mal es have higher risks of illness and death than females do for a wide range of diseases. For some diseases, this sex-related difference is because of genetic, hormonal, anatomic, or other inherent differences between the sexes. These inherent differences affect their susceptibility or physiologic responses.For example, premenopausal women have a lower risk of heart disease than men of the same age. This difference is attributed to higher estrogen levels in women. On the other hand, the sex-related differences in the occurrence of many diseases reflect differences in opportunity or levels of exposure. For example, Figure 1. 12 shows that hand/wrist disorders occur almost twice as often in females than in males. What are some sex-related differences that would cause a higher level of this disorder in females? Page 20 Applied Epidemiology I Figure 1. 10 Pertussis (whooping cough) incidence by age group, United States, 1989 Source: 9 Figure 1. 11 Pertussis (whooping cough) incidence by a ge group, United States, 1989 Source: 9 Figure 1. 2 Prevalence of hand/wrist cumulative trauma disorder by sex, Newspaper Company A, 1990 Source: NIOSH, unpublished data, 1991 Introduction to Epidemiology – Epi 592J Page 21 You may have attributed the higher level of disorders in females to their higher level of exposure to occupational activities that require repetitive hand/wrist motion such as typing or keyboard entry. With occupationally-related illness, we usually find that sex differences reflect the number of workers in those occupations. You may also have attributed the higher level of disorders in females to anatomical differences; perhaps women’s wrists are more susceptible to hand/wrist disorders. Ethnic and racial groups.In examining epidemiologic data, we are interested in any group of people who have lived together long enough to acquire common characteristics, either biologically or socially. Several terms are commonly used to identify such groups: race, nationality, religion, or local reproductive or social groups, such as tribes and other geographically or socially isolated groups. Differences that we observe in racial, ethnic, or other groups may reflect differences in their susceptibility or in their exposure, or they may reflect differences in other factors that bear more directly on the risk of disease, such as socioeconomic status and access to health care. In Figure 1. 13, the risks of suicide for five groups of people are displayed. Figure 1. 3 Suicide death rates for persons 15 to 24 years of age according to race/ethnicity, United States, 1988 Source: 22 Clearly this graph displays a range of suicide death rates for the five groups of people. These data provide direction for prevention programs and for future studies to explain the differences. Socioeconomic status. Socioeconomic status is difficult to quantify. It is made up of many variables such as occupation, family income, educational achievement, living conditions, and social standing. The variables that are easiest to measure may not reflect the overall concept. Nevertheless, we commonly use occupation, family income, and educational achievement, while recognizing that these do not measure socioeconomic status precisely.The frequency of many adverse health conditions increases with decreasing socioeconomic status. For example, tuberculosis is more common among persons in lower socioeconomic strata. Infant mortality and time lost from work due to disability are both associated with lower income. These patterns may reflect more harmful exposures, lower resistance, and less access to health care. Or they may in part Page 22 Applied Epidemiology I reflect an interdependent relationship which is impossible to untangle—does low socioeconomic status contribute to disability or does disability contribute to lower socioeconomic status? Some adverse health conditions are more frequent among persons of higher socioeconomic status.These condition s include breast cancer, Kawasaki syndrome, and tennis elbow. Again, differences in exposure account for at least some of the differences in the frequency of these conditions. Exercise 1. 4 The following series of tables (Exercise 1. 4, Tables 1-4) show person information about cases of the unknown disease described in Figure 1. 4 on page 15. Look again at Figure 1. 4, study the information in the four exercise tables and then describe in words how the disease outbreak is distributed by time and person. Exercise 1. 4, Table 1 Incidence of the disease by age and sex in 24 villages surveyed for one year Males Females Age Group Population* # Cases Risk per Population* # Cases Risk per (years) 1,000 1,000