A house Divided: Abortion and Slavery in America

In 1856, Lincoln stood out as he opposed the sovereignty doctrine and freedom for states to choose whether to continue practicing slavery or free all of their slaves. His assertion was that the country had to make a choice either to continue with slavery or make the slaves free in all states. This was based on the understanding that all the states were bound by one constitution.For the country to stand as one, it had to make a single choice. Today the country is being faced by the debate of prolife and pro-choice. To the pro-choice, the decision to keep or terminate the lie of the unborn child is left on the hands of the mother while the prolife believe the unborn child enjoys the same rights just as any other person (Melton, nd). These serious divisions have the potential to split our country along the line of whether to grant the rights to the mother or the unborn child.In both cases, proponents of anti slavery and pro life had and have a moral argument against an evil that deprive s our society of an obligation to protect the life of the unborn just as we protect the living.   It is definite that there cannot be any middle ground in the case relating to abortion. We need either to fully support the pro-choice and continue blatantly killing the helpless young humans who have no power to defend themselves.On the other, hand we can embrace the logic of the pro-lifers and give the unborn children a chance to enjoy the right to life and other rights later when they see the light in their lives. Just as in the case of slavery, the pursuit of our rights should not be allowed to deprive other humans their equal rights. The law should come out straight and define the fact that, ending the life now is no different from ending it later. By then the question of whether we are killing through abortions shall have been answered.ReferencesMelton, B. (nd).A house Divided: Abortion and Slavery in America. Retrieved on   August 3, 2010 from http://capitolhillcoffeehouse.co m/archives/chch_news_435.htm       A House Divided: Abortion and Slavery in America In the article â€Å"A House Divided: Abortion and Slavery in America,† the author draws a parallelism between abortion and slavery. The article notes four premises around which the arguments for both abortion and slavery similarly revolve as advocates of both practices justify their actions.In rejecting the arguments of the pro-slavery and the pro-choice camps on identical grounds, the author admonishes society not to replicate its past mistake.In the first premise, slaves and in utero children are being regarded as properties. Since they are both properties, it is presumed that their owners retain the right to decide what to do about them. Slave owners, therefore, have the right to do whatever they want to do with the slaves that they â€Å"own† and pregnant women should be allowed to decide whether to keep or abort their â€Å"own† fetuses.The second premise involves the economics of the situations, i.e.: slave owners, in particular, and the nation’s ec onomy, in general, profit from the labor of the slaves while women turn to abortion in order to escape the burden of raising a child under conditions of abject poverty especially when the child is unwanted for whatever reason.Third, both the slave owners and the pregnant women argue that their actions are morally acceptable under specific conditions: when the slaves acquiesce to their situation and the pregnancy endangers the life of the mother.Finally, both the slave owners and the pregnant women claim that they are only doing what is best for the slaves and the fetuses. In the former case, owners argue that slaves have better security if they remain slaves because the owners feed and protect them than when they are freed and left by their lonesome to face the harshness of the world. In the case of the fetus of a poor woman, abortion is considered a humanitarian assurance that the child does not experience the evils of life of poverty.The author rejects all of these premises on the ground that they are one-sided. In other words, only the slave owners and the pregnant women are endowed with the rights to â€Å"life, liberty, and the pursuit of happiness.†The author argues that by denying the same rights to the slaves and the fetuses would be to deny them of their humanity as well. Therefore, the author maintains that both slavery and abortion could not be considered morally right since these practices deny the slaves and the fetuses (who are also considered human beings in the eyes of the law) of their human rights to â€Å"life, liberty, and the pursuit of happiness.†ReferenceA House Divided: Abortion and Slavery in America. Attachment to order # 71203674.  

Terrorism Case Study

Caless (2012) defines terrorism as † the threat or use of violence to further a political agenda for change by inducing widespread fear†. However, experts have been debating over a clear definition for terrorism for over 100 years. Although the word was first used over 200 years ago when discussing the Reign of Terror (Whitaker, 2001). Consequently, there have been over 100 definitions offered for terrorism (Laqueur, 1977, cited in Martin, 2013). Alex Schmid's (2004) research also illustrates the lack of clarity surrounding the definition.And most experts believe that an impartial and universal recognised definition will never be agreed upon (Ganor, 2002). With the lack of clarity surrounding the definition, a further question arises; who is classed as a terrorist? This is reflected in the well known phrase â€Å"one man's freedom fighter, is another man's terrorist. † (Gerald Seymour, 1975, cited in Ganor, 2002). Overall, it is agreed, that this depends on the sub jective viewpoint of the individual (Ganor, 2002; Jackson, 2008; Corte, 2007).The Just War doctrine is an â€Å"ideal and moralistic philosophy† (Martin, 2013). It asks questions such as â€Å"what types of force are morally acceptable? † and â€Å"who can morally be defined as an enemy? † This notion is usually used by ideological and religious extremists, in order to justify their own acts of extreme violence. A prime example of religious extremists is the ‘jihadi Islamic fundamentalists', the term jihad means a sacred â€Å"struggle† but is manifested by some radical Muslim clerics as a holy war and therefore perceived that their war is a â€Å"just war† (Martin, 2013).This paper will endeavour to answer the question; Did University College London (UCL) further radicalise Umar Farouk Abdulmutallab? There have been many debates, theories and investigations surrounding this question, many of which will be analysed throughout. Umar Farouk Abd ulmutallab (born 22 December 1986) is a Nigerian Islamist who attempted to detonate plastic explosives in his underwear whilst travelling from Amsterdam to Detroit, on Christmas Day 2009, on the Northwest Airlines Flight 253. In January 2005 Abdulmutallab joined an Islamic forum under the pseudonym â€Å"Farouk1986† (Now Public, 2009).He frequently contributed to the forum. His postings normally gave advice to other forum members, although on occasion he expressed more personal views. These included his â€Å"jihad fantasies†, describing how â€Å"Muslims will win and rule the world† and prays to Allah to â€Å"unite us all Muslims and give us victory over those who do not believe†. The majority of his postings illustrate his loneliness and his struggle to contain his â€Å"sexual drive†, and he goes on to urge fellow forum users to limit their activities to â€Å"Islamically good† and to only â€Å"hang around with good Muslims who enjoy s tudying†.Throughout his postings in the forum he maintains that he is memorising the Quran (Islamic Forum, 2005). These postings illustrate that Abdulmutallab's views on the Islamic religion, are very similar to Salafism or Olivier Roy's neo-fundamentalism (see: Social Science Research Council). This is shown with his fixation on personal faith, and is also portrayed when he praises Shaykhs Saud as-Shuraim and Abdul Rahman as Sudais (Islamic Forum, 2005). Another radical Muslim he mentions is Abdullah el-Faisal, who is currently in prison in the UK for influencing his supporters to murder Jews, Hindus and Americans (Forest, 2012).Some of the media (Gardham, 2009) focused on Abdulmutallab's love for football and this is clearly seen within his postings online. However, by November 15th 2005, he had turned against it stating â€Å"Let’s save our honor and religion and try to stay away from football and do sporting activities that are more Islamically beneficial†¦ ru nning, paintball, archery (or any other sport of the like that teaches [how to] target and aim). † (Islamic Forum, 2005). There are many different theories as to where Abdulmutallab was further radicalised, the one that will be discussed in this paper is the possibility hat University College London (UCL) and it's Islamic Society were the perpetrators. During the investigation of the attempted attack of Flight 253, the University College of London (UCL) had held their own investigation of their Islamic Society and although the evidence holds strongly against them, as will be seen throughout this paper, they came to their own conclusion that   there was â€Å"no evidence to suggest either that Umar Farouk Abdulmutallab was radicalised while a student at UCL, or that conditions at UCL during that time or subsequently were conducive to the radicalisation of students. (UCL, 2010). Umar Farouk Abdulmutallab began university, in September 2005, during a peak of Islamist activity in the UK, there were events organised by Ikhwan (Ikhwan Web, 2005)  and Jamaat-e-Islami inspired groups that were being held weekly and their influence over British Islam was steadily increasing (Hitchens, 2010). This year is an important one, as the emergence of the first Islamic militant groups in Bangladesh (Kabir, 2005) were seen and Islam became the official religion of Iraq (Islamopedia Online).British Islamists were exploiting the wars in Afghanistan and Iraq and implicating the Western governments with the â€Å"war on Islam and Muslims,† (Hitchens, 2010). According to Islamist's, Western Muslims, had a duty to stand up for their religion and fight back using peaceful methods (O'Connor, 2012). The â€Å"Stop Police Terror† lecture was given by Awlaki at the East London Mosque in 2003 (YouTube, 2011). The listed supporters of this group could be found on the Stop Political Terror website, and interestingly UCL was among this list (Stop Political Terror, 2003- 2005).The aims of this campaign was to urge Muslims to fight against the â€Å"anti-terrorist police† and to alert them of â€Å"the deteriorating situation in the UK and the scale of arrests, raids and abuse meted out [against Muslims] by Anti-Terrorist Police. † The campaign statement also included a clear warning: â€Å"Britain's Muslims, as a community, will refuse to cooperate with the law enforcement authorities  if  this abuse continues. † (Stop Political Terror, 2003-2005). During this time, the Federation of Student Islamic Societies (FOSIS) ran another campaign alongside â€Å"Stop Political Terror. , issuing further explicit statements -â€Å"previously, it was Muslims themselves under attack, now the agenda [is] to attack Islam, its principles †¦ New laws making it an offence †¦ aim to divide and weaken the Muslim community. † And â€Å"The relative concept of ‘extremism’ is being used to condemn Muslims from very diverse political viewpoints. † (Hitchens, 2010). The perception of a Western â€Å"war on Islam† is one of the key recruitment tools of global jihadist groups like al-Qaeda (Home Office, 2011).Therefore, it is clear that Abdulmutallab was absorbed in an protesting setting, and this appeared to him to give value and objective, to his already pre-existing neo-fundamentalist attitude and personal discontent (loneliness). It is also apparent from his previous online statements, that he was vulnerable to the indoctrination; â€Å"I hope to get over my loneliness when I go to university†¦ where there are usually Islamic groups [and] clubs with good Muslims† (Islamic Forum, 2005).His obsession with Islam is clearly illustrated with the amount of time he devoted to the group, and after a year of starting university he was already president of UCL's Islamic Society (Irvine, 2009). Terrorist groups are also known to use the media to their advantage. As terrorism is à ¢â‚¬Å"not limited to specific locales or regions† and the media has allowed everybody to witness some form of terror. Knowing this terrorist groups can therefore understand the power of the images and manipulate them to their advantage (Martin, 2013).Gus Martin (2013) explains the media frenzy surrounding terrorism, and describes the 21st century as being â€Å"an era of globalized terrorism†. Another key recruitment tool that jihad groups use is the internet (US Department of Defense, 2007). Sites such as Facebook, (Torok, 2011) and the creation of websites that can be regionalised. Although governments monitor the websites and, if necessary shut them down, another website can be made and the process can start again (McNeal, 2008). It is clear that Abdulmutallab was a fan of internet use, with his frequent postings on the Islamic Forum.Awlaki could also be an key element in the â€Å"jihad internet recruitment† process. The media present him as the â€Å"Bin La den of the internet† (Madhani 2010; CNN, 2011). He was  a Muslim lecturer and spiritual leader who had been accused of being a senior al-Qaeda â€Å"effective global recruiter† (Telegraph, 2012) and motivator. He is thought to have given a series of video link lectures at the East London Mosque (Gilligan, 2010). They however, categorically deny this ever took place, and deny that Abdulmutallab even attended the Mosque (East London Mosque, 2010). The University of Westminster Islamic Society are alleged to have ties with Awlaki.Another Islamic Forum announced him as a guest at University of Westminster Islamic Society Annual Dinner in 2006 (Ummah Forum, 2006). Along with these connections Awlaki is also suspected to have had â€Å"recruited† Abdulmutallab before the attack. According to Fox News, an FBI bulletin states that Awlaki showed Abdulmutallab â€Å"how to detonate the bomb† (Catherine Herridge, 2011). Research carried out by the University of Cam bridge suggest that â€Å"the majority of young British Muslims are opposed to political Islam, and are more likely to join Amnesty International† (Cambridge University, 2008).This was criticised, when Anthony Glees accused Cambridge of trying to prove that British universities are not â€Å"hotbeds of Islamic radicalism† and called the research â€Å"flimsy and uncompelling† (Lipsett, 2008). Their research was argued against by the Centre for Social Cohesion (CSC), who stated that â€Å"Umar Farouk Abdulmutallab was radicalised at University College London†, and goes on to describe British universities as the â€Å"breeding grounds of Islamic extremism†(Centre for Social Cohesion, 2010).They describe themselves as the â€Å"Centre [that] has been at the forefront of the debate on what role Universities should play in ensuring that British students do not fall victim to the ideology of violent Islamism. † (Centre for Social Cohesion, 2010). They went on to completely contradict Cambridge Universities report, and suggested within the report that Islamic extremism will â€Å"flourish†. This statement was further supported when Abdulmutallab became the fifth president of a UK Islamic society to face terrorist charges (Weiss, 2011).The vulnerability of Abdulmutallab along with the recruitment tools of jihadist groups illustrate how easily individuals can slip beyond this porous boundary rapidly and very often unnoticed. Since the September 11th attack on the World Trade Center, it has become apparent that Al-Qaeda are focusing on mobilising Western Muslims to commit â€Å"lone-wolf† terror (RUSI, 2012). This evidence is supported by the ICSR (2011) who describe Awlaki's role as â€Å"ideological rather than operational† and explain that the greatest threat he poses is the mobilisation of Western Muslims through his sermons and therefore expanding the jihadi movement.Umar Farouk Abdulmutallab's extremis t views are apparent very early on. Although, as his loneliness grew, so did his radical views. It appears that he was trying to fight his urges to act upon these views time after time. Abdulmutallab was quite clearly an â€Å"extremist† turned â€Å"terrorist†, as it is clearly defined by Martin (2013); â€Å"extremists† who violently act out their extremist beliefs are â€Å"terrorists†. It is clear that his time at UCL and within the Islamic Society unquestionably played a part in Abdulmutallab's further radicalisation when examining the evidence discussed.It is also remarkable to see that UCL was among the list of supporters of the Stop Police Terror campaigns, almost condemning themselves of the radicalisation. They contradicted themselves when they released their findings that â€Å"no evidence to suggest †¦ that conditions at UCL †¦ [are] conducive to the radicalisation of students. † (UCL, 2010). It is noted that Cambridge Univers ity's ‘flimsy' research could support the UCL's outcome, but then could this research, with their ‘bad press', also diminish their findings.Overall, there are many factors that led to the radicalisation of Abdulmutallab, his state of mind, his vulnerability, and the people that he was associated with within the Islamic Society. Therefore, the UCL was not completely at fault, it was also the fundamentalists, that infiltrated the system and took advantage of a vulnerable, young Muslim. References Caless, B (2012) ‘Terrorism and Political Violence: Introduction, Overview and the Problem with Definitions. (Accessed: 5 December 2012). Cambridge University (2008) ‘Campus radicalism fears too extreme? ‘ Available at: http://www. cam. ac. k/research/news/campus-radicalism-fears-too-extreme/ (Accessed: 5 December 2012). CNN Online (2011) ‘ Al-Awlaki: Who was he? ‘, CNN Online, Available at: http://security. blogs. cnn. com/2011/09/30/al-awlaki-who-wa s-he/ (Accessed: 5 December, 2012). De La Corte, L (2007) ‘Explaining Terrorism: A Psychosocial Approach'  Perspectives on Terrorism, North America, Vol. No. 2 [Online] Available at: . (Accessed: 5 Dec. 2012). East London Mosque (2010) ‘ East London Mosque and London Muslim Centre  Ã‚   Statement on Anwar Awlaki' [Online] Available at: http://www. astlondonmosque. org. uk/uploadedImage/pdf/2010_11_07_15_44_46_Awlaki%20Statement%206%20Nov10%20-%20Full%20Statement. pdf (Accessed: 5 December, 2012) East London Mosque (2010) ‘ Sunday Mirror publish ELM letter' [Online] Available at: http://www. eastlondonmosque. org. uk/archive/news/243 (Acccessed: 5 December, 2012). Forest, J (2012) ‘Perception Challenges Faced by Al-Qaeda on the Battlefield of Influence Warfare. ‘  Perspectives on Terrorism, North America, Vol. 6, No. 2. [Online] Available at: . (Accessed: 05 Dec. 2012). Ganor, B. (2002) ‘Defining Terrorism- Is One Man's Terrorist Another Man' s Freedom Fighter? ‘. International Institute for Counter-Terrorism [Online]. Available at: http://www. ict. org. il/ResearchPublications/tabid/64/Articlsid/432/Default. aspx#Defining_Terrorism:_The_Present_Situation (Accessed: 1 December 2012). Gardham, D. (2009) ‘ Detroit bomber: internet forum traces journey from lonely schoolboy to Islamic fundamentalist', The Telegraph, 30 December 2009 [Online]. Available at: http://www. telegraph. o. uk/news/worldnews/northamerica/usa/6910776/Detroit-bo mber-internet-forum-traces-journey-from-lonely-schoolboy-to-Islamic-fundamentalist. html. (Accessed: 5 December 2012). Gilligan, A (2010) â€Å"East London Mosque: the terrorist question and the lies†, The Telegraph, 2 November 2010 [Online]. Available at: http://blogs. telegraph. co. uk/news/andrewgilligan/100061920/east-london-mosque-the-terrorist-connection-and-the-lies/ (Accessed: 5 December 2012). Gregory S. McNeal (2008). â€Å"Cyber Embargo: Countering the Internet J ihad†Ã‚  , Case Western Reserve Journal of International Law, vol. 9, pp. 789-826. [Online] Available at: http://works. bepress. com/gregorymcneal/15 (Accessed 1 December 2012) Herridge, C (2011). ‘ Awlaki Trained Suspected Christmas Jet Bomber How to Detonate Underwear, Document Reveals'. Fox News, 4 October 2011 [Online] Available at:  http://www. foxnews. com/us/2011/10/04/al-awlaki-trained-suspected-christmas-day-jet-bomber-how-to-detonate-underwear/#ixzz2ECpGaSXS (Accessed:5 December 2012). Hitchens, A (2010) ‘The Making of the Christmas Day Bomber', Current Trends in Islamist Ideology, Vol. 10 [Online]. Available at: http://currenttrends. rg/research/detail/the-making-of-the-christmas-day-bomber (Accesed: 29 November 2012). Home Office (2011) Contest: The United Kingdom’s Strategy for Countering terrorism. London: The Stationery Office. (Cm. 8123). [Online] Available at: http://www. homeoffice. gov. uk/publications/counter-terrorism/counter-terrorism -strategy/strategy-contest? view=Binary (Accessed: 2 December 2012). ICSR (The International Centre for the Study of Radicalisation)(2011) ‘ICSR Insight: How Anwar al-Awlaki Became the Face of Western Jihad'. [Online] Available at: http://icsr. nfo/2011/09/icsr-insight-how-anwar-al-awlaki-became-the-face-of-western-jihad/ (Accessed: 5 December, 2012). Irvine, C (2009) ‘ Detroit terror attack: suspect president of university Islamic society', The Telegraph, 29 December 2009 [Online]. Available at: http://www. telegraph. co. uk/news/uknews/terrorism-in-the-uk/6902785/Detroit-terror-attack-suspect-president-of-university-Islamic-society. html (Accessed: 5 December, 2012) Ikhwan Web (2005) International Religious Freedom Report 2005. Available at: http://www. ikhwanweb. com/article. php? id=13543&ref=search. php

Economic Issues Simulation Paper

As a representative of Castor Insurance, the job is to maximize profit and minimize risk for the company. Healthcare is a high in demand good that the consumers of any job wants and needs to have. So it is very important to chose the right kind of healthcare for your employees. The two companeys in question Constructit and E-editors need to choose a well balanced health insurance plan that will work for there group of people. I am Jamie Ruth, I am the Vice President, Strategy and Financial Planning at Castor Collins. My duties include pricing plans and setting insurance premiums for our potential clients. Castor Collins was approached by two companies looking for employer insurance and both companies have a set rate their employees are able to pay for premiums since both groups will have to pay for his or her own insurance. The first company is Constructit that consist of 1,000 people and E-Editors that consist of 1,600 people. It is up to my team to come up with a plan the meets Constructit $4,000 max on premium and E-editors max of $4,500 premium. Our task is to keep revenue maximized and risk to a minimum by choosing one of our three plans, which are Castor Standard, Castor Enhanced and our customized plan called Castor Enhanced Minor to suit Constructit the company I have chosen. Demographics of Constructit Constructit consist of 550 men between the ages of 26 to 45 and 450 women between the ages of 26 to 42. At Constructit 32% of the workforce’s duties involve excessive physical activities. This can cause some health risk with these employees. Whereas 25% of the workforce’s duties involve modest physical activities and the remaining 43% of the workforce’s duties involve inactive activities. With the modest activity there is always a chance an injury could happen. The inactive employees mainly desk employee are not immune from injury either. Married employees consist of 60% of the workforce. The employees at Constructit are not all in perfect health. Out of 1000 employees 170 men and 210 women 38% of the workforce has no major health problems. With almost 10% of the workforce 55 men and 36 that are smokers. The majority of the workforce misses work due to injuries, respiratory system diseases, digestive disorders, migraine, and allergic conditions. Health Concerns In our investigation of the health demographics in Constructit we discovered the following health concerns. Almost half of the employees are obese, 198 men and 192 women which adds up to 39% of the workforce which in itself is a major concern. Obesity can cause High Cholesterol the second highest medical condition within this group meaning 19%, 101 men and 95 women. As well as high blood pressure is another cause of health concern with 88 men and 105 women, 19% of the workforce. We also discovered many suffer from an allergy which affects 92 men and 85 women 17% overall. Many of the employees suffer from migraines 16%, 75 men and 93 women. Although only 13% of the employees 78 men and 57 women Respiratory Diseases is still a cause of concern. The Last medical condition we discover was digestive disorders at 8% 52 men and 32 women. Now our task was to develop a plan and stay within our $4000 premium limit. Plans Here at Castor Collins we have two plans that could possibly fit the needs of Constructit. One is Castor Standard which does not cover preexisting medical conditions and the other is Castor Enhanced which does cover preexisting medical conditions. Helen one of my team members suggests we offer Constructit Castor Enhanced and eliminates a few services that have high utilization. Adam says or we could choose not to insure either group if our risk outweighs the profits. In our evaluation the risk, anticipated cost, and cost-effectiveness are different for both plans. We did not choose Castor Standard because for one it did not cover preexisting condition. The premium is within payment range enrollees can pay and our profits would be higher. The cost associated with Castor Collins providing services to Constructit does not include any copayment the enrollee has to pay. For example for inpatient hospital services for Standard the enrollee pays $114 where in Enhance they pay $144. For emergency physician or hospital care Standard is $310 where Enhances is $388. For outpatient services like physician visits the in Standard the enrollee would pay $56 and in the Enhanced he or she would pay $70. If the enrollee was to need outpatient surgery for standard he or she would pay $305 where with enhanced the cost is $381. Here is the expected utilization of services when Castor Standard or Castor Enhanced is provided to Constructit. On average utilization of the services in the population of color scheme are for the age group of 26 through 45. Inpatient hospital services are 3% for standard and 4% for enhanced with the annual average is 6% for standard and 8% for enhanced with the surgical benefits the same. For emergences the expected utilization is 6% and the annual average is the same for standard whereas for enhanced the expected utilization is still 6% however the annual average is 8% for inpatient services. In standard most of the expected utilization is anywhere from 3% to 10% whereas the annual average is 6% for standard. Outpatient services the expected utilization is anywhere from 3% to 10% and the average annually is 6%. For enhanced the expected utilization norm is 4 to 9% and with enhanced the norm is 6% for standard and enhanced is anywhere from 4 to 12%. Plan Choice For Constructit we decided to go with Castor Enhanced so we could modify it so we were able to stay within the $4000 premium prices range. Even though the copay to the enrollee is higher the benefits are revenue for us is higher. We were able to keep the premium below $4,000; the premium is $3,943 making our profit a $3. 94 million and only eliminated obesity treatment. To keep cost and risk low we decided not to include Obesity treatment. To include this service the premium would have exceeded what the enrollees would be able to pay. All other services are intact. Castor Collins earning is high and is adequate to cover the risk insuring Constructit. Services such as substances abuse treatment the expected utilization is low. Even with Castor Enhanced Minor covering preexisting medical conditions, the risk are low and the earnings could be high. Copays for services such as preventative services, diagnostic services, and chiropractic care are at 8% rate. Conclusion Our task was to evaluate the company’s demographics and develop an adequate health care plan that suits Constructit. With Castor Enhanced the premiums are below $4,000 which them enrollee can pay and still have comparable health coverage that cover preexisting medical conditions. Utilization annual average is mostly 8%. Copays are higher but the benefits are higher as well. This was a difficult task but I believe we did what was expected of us in supplying health coverage for Constructit.

Anthropology ideas Research Paper Example | Topics and Well Written Essays - 250 words

Anthropology ideas - Research Paper Example rge schism was formed between the shared heritage that was formed out of the tragedy and the rights of every American citizen to care for the remains of their family members (Colwell-Chanthaphoh & Greenwald, 2011). From an anthropologist’s point of view, the controversy can bring about two anthropological perspectives. The first is that the actions of the state are working to break the individual right for any American citizen to take care of the remains of the their kin, while the second is that the state’s actions are working to form a new national, shared or common heritage. I believe anthropologists should not take any side on the issue. In my opinion, the actions of the state will affect some part of the national heritage and change the cultural heritage of the nation. Colonialism, in my opinion, was a system that was largely motivated by the acquisition of natural resources where indigenous people were forced into hard labor. I was naturally aware of the era of colonization but did not really recognize the vast effects it had on the colonies as well as the colonizing nations. In the colonizing nations, I believe that one of the lingering effects have to do with the mass transportation of the people in the colonies to the colonizing nation for labor. This greatly affected the demography as well as the cultural heritage of the destination country through the sharing and adoption of different cultural values. Colonization introduced the act of reflexibility in anthropology where anthropologists consider past actions in order to choose the topic to be researched and the method by which they write the

Equity and trusts Essay Example | Topics and Well Written Essays - 3000 words

Equity and trusts - Essay Example If each of these elements can be ascertained by reference to Sadhia’s will and trust instrument, the trustees will be bound by her dispositions. However, the emphasis is on certainty of intention. It was held in Tana & Anor V Tana & Anor, that â€Å"certainty of intention is in many ways the most important† certainty.2 Therefore, in a typical case, once the court is satisfied that the â€Å"declarant had the requisite intention it will strive to validate it.†3 It is against this background that the trustees of Sadhia’s estate should proceed. Bearing in mind that certainty of intention is the most important element for determining whether or not each of Sahdia’s gifts form valid declarations of trusts, the trustees are advised to proceed with this mindset. The gift of the cottage to Sadhia’s husband appears at first glance to be a discretionary trust in that the declaration assumes that her husband will do what is necessary to benefit the children of the marriage. In other words Sadhia has left the question of their children’s benefit up to her husband’s broad discretion. Certainty of subject matter is unambiguously Sadhia’s cottage and that is assuming Sadhia only has one cottage capable of being distinguished from any other realty she leaves behind. The objects of the trust are also unambiguously stated and are the children that Sadhia shares with her husband. The difficulty however, involves certainty of intention. It was held in Wright v Atkyns Turn & R 143 it is possible to descern whether or not there was an intention to create a trust by the words used. However those words must be clear and imperative4 although he failure to use specific words will not render the creation of a trust invalid.5 That said, the use of the words â€Å"in full confidence that he will do what is necessary to benefit our

Research Methods Assignment Example | Topics and Well Written Essays - 1500 words

Research Methods - Assignment Example The oil export business has also allowed the countries to participate in the international trade and thus the countries are developing in order to compete with the developed nations (Narayan and Smyth, 2007). Since oil producing sector is the most important sector in the middle-east and the GCC nations this is considered for carrying out a detailed study. The aim of the research is to carry out an overall analysis of the performance of the oil producing companies of middle-east by focusing mainly on the GCC nations and the revenue generated them. Since crude oil is on high demand in the international market hence it would prove to be an interesting topic of discussion for most of the researchers. The Gulf Cooperation Council (GCC) countries have a number of features in common that is their structural economic features as well as there are significant differences. The common features comprise of high dependency of the other nations on the hydrocarbon as well as the oil production of the middle-east and the GCC nations (Arouri and Rault, 2012). The countries are expected to earn a large portion of their revenue from the oil export business. Oil producing companies face challenges due to the fluctuations in the oil prices where some of the oil importing countries reduce their dependency on the oil and hydrocarbon and set up a separate non-oil sector. There is a possibility of economic diversification that takes place in the international market that would in turn reduce the demand for oil. Study says that, the member nations of GCC are adopting the method of economic diversification with UAE and Bahrain, acting as the most advanced in this field of economic diversification. According to the study, the GDP growth in the non-oil sector has exceeded that of oil producing sectors in the international market, but the non-oil sector are controlled by the government expenditure which is further dependent on

Disputation of Doctor Martin Luther (Luthers 95 Theses at the Internet Essay

Disputation of Doctor Martin Luther (Luthers 95 Theses at the Internet Christian Library) - Essay Example In most of his thesis statements, Luther compared the true Christian beliefs to the Church practices, especially ‘indulgences’ during his time. It can be observed that most practices contradicted the teachings of the Bible. During those times, the church appeared to be in an insurmountable difficulty as it was filled with leaders whose practices were revolving around low moral standards, profanity, and perversion of beliefs; the church exhausted every Germans money through taxes (Biesinger 20). When he went to Rome in 1510, he observed the unlikely personalities of friars and how they used indulgences for their personal consumption (Bratcher). Church leaders of Europe also lived a wealthy life while neglecting their duties. In addition, churches were designed with unnecessary work of arts and instruments called by Protestants an example of "pagan idolatry" ("Roman Catholic Church"). Another problem Luther pointed out in his 95 Theses was the concept of purgatory and indulgences. Luther highlighted in thesis 17 that purgatory should not be treated as a place of horror but of love (â€Å"Disputation of Doctor†). However, friars used the Catholic belief that dead individuals may ascend straight to heaven or may descend directly to hell while others had to repent in purgatory. Since people would be anxious of having to agonize in purgatory, the friars used ‘indulgences’ (Perry et al. 321). Indulgence was described as an absolution of the people’s confessed sins, which can either be bought for one’s self or the dead ("Martin Luther"). Luther indicated in thesis 21 that indulgence was a misconception of Christian belief. Further, he pointed in thesis 10 that there was no way for â€Å"canonical penances for purgatory† to be secured (â€Å"Disputation of Doctor†). Likewise, Pope Leo X declared the "special jubilee indulgence" for the continuance of St. Peters Basilica construction (Spielvogel 381). A Dominican friar named Johann Tetzel went to Germany to

Irrational Consumer Behavior. Why consumer often makes irrational Essay

Irrational Consumer Behavior. Why consumer often makes irrational decision to buy a low quality product because of advertisement or cultures - Essay Example Often a big poster of advertisement or television leads people to make some irrational decision in buying products. The role of television advertisement is significant in irrational consumer behavior (Mafe & Blas, 2007). Consumers often buy a low quality product because they were â€Å"deceived† by the advertisement. This happens because a majority number of individuals just trust tons of beautiful fonts, and words on the advertisement without making any further research about the products. The importance of the sensory receptors (eyes, ears, nose, mouth, and skin) plus peer pressure play an important role in irrational buying. Thus, the marketers often create great teasers to play with the consumer emotion because they know that the coherent pictures and the dynamic graphic on the commercial video are enormous stimuli for getting the consumer attention. Advertisement makes a lot of people ignore the details that are more important than the words that are written on the advert isement. If individuals do more research before they buy the products, they will make the rational choice. However, only a few people are eager to look up additional information on the internet when they are already falling in love with the advertisement on the Television, and Posters. Furthermore peer pressure is also involved in influencing people’s mind when deciding the products that they want to purchase. All of this influential advertisements, that are created by marketers often lead people in choosing some of the bad choices. The marketer has a great way to advertise their product in society with the right timing, and at the right moment. Therefore, people’s perception of being interested at some commercial often lead many people to forget about the health issue because of their subliminal perception. This forces the consumers to purchase more expensive products of low quality because of advertisement Stimulus of the big brand products, and get a poor service by paying a great amount of money after just looking at the descriptive terms of the advertisement. Health is one of the crucial issues in this world. Individuals need health in order to do their jobs. However, there are a lot of health issues in today’s world. But why people often make an irrational decision by buying these unhealthy products with higher price instead of cheaper healthier foods? It is because people frequently consume unhealthy foods. For example, they are willing to spend $1 more for Soda like Coca Cola, and Sprite. This is because of they are attracted by the beautiful soda commercial. Many of soda firms contract a great marketers in their division to market the products. So today, a lot of Soda Corporations are focused on the subliminal perception of people. â€Å"Stimuli that are too weak or to brief to be consciously seen or heard may nevertheless be strong enough† (Schifmann & Kanuk, 2009, Pg. 160). It is about the stimulated awareness of people t hat responds to the advertisement they have watched. By understanding this fact, the marketers use the subliminal commands like DRINK SPRITE, and filming a commercial that tells the audiences that COKE is the best beverage to relieve the feeling of thirst. These types of advertisement have a high effectiveness in becoming a great attention grabber. A big number of people make an irrational decision by buying these drinks as their daily beverages when they can buy cheaper bottle of water that is healthier. Even though Soda brings many health issues like Diabetes, and Obesity, they don’t care about that because they prefer to satisfy their needs after watching the interesting advertisement. Mostly these ads are aired on television, and television advertisement plays a great role in purchase decisions

International Human Resource management Essay Example | Topics and Well Written Essays - 1250 words

International Human Resource management - Essay Example The range of markets served by InterContinental Hotels Group span along the regions of America, Europe, American-European-African Nexus or AMEA and also encompasses Greater China. Total number of hotels encompassed by IHG in the global context range to 4,542 operating based on different brand portfolios (IGH-a, 2012). Current Global Position Pertaining to Global Ranking or Position IHG was found firstly to gain the award of Gifted Ranking in an evaluation made by the Digital IQ Index. The same Index related the hotel company to the Sixth Rank in comparison to around 52 other competing hotel brands (IHG-b, 2012). IHG’S Approach to Human Resource Management HRM in Hospitality IndustryThe recruitment of the people in the hospitality industries undergoes a process of evaluation of the personality traits and attributes of the individual to work in a challenging job atmosphere. Moreover the individual is subjected to different types of psychometric tests to understand the individual ’s problem-solving and team building abilities. Similarly different types of amenities and benefits related to work-time flexibility along with bonuses and increments are rendered to motivate the individual. Opportunities for growth are framed through incorporation of training programs in the work culture along with encouraging the people to intercommunicate amongst each other. Moreover incorporation of a 360 Degree Appraisal Process coupled with Empowering Individuals to take managerial and strategic decisions and rewarding.

Main dynamics driving the development of the modern state Coursework

Main dynamics driving the development of the modern state - Coursework Example In the current context of globalisation, the concept of State autonomy has been subjected to scrutiny, as regards financial and commercial activities (Cudworth, Hall and McGovern, 2008). Owing to these issues, scholars have started analysing the dynamics behind development and origins of the modern state, in order to comprehend the underlying processes and its future shape. This essay review the various dynamics that played a major role during development of the modern state, including the institutionalist, economic and security approaches, and connects these varied approaches to developing an understanding on the concept of modern statehood. Recent studies have emphasised the necessity of analysing the origin and subsequent development of a modern state, primarily owing to the hypothesis that a contemporary State has reached its peak and hence would start declining henceforth. Increasing powers of multinational organisations like World Trade Organization and supranational bodies suc h as European Union indicate an end to the nations-state’s authoritative power (Pierson, 2012). From this viewpoint, state sovereignty is shifting to supranational and multilateral levels of authority (Rosenau and Czempiel, 1992). At the same time, there are reports of states breaking apart into small and fragmented entities. A number of states that appeared as logical territorial bodies, have rapidly fallen apart and the centrifugal forces have not remained restricted only to developing nations, where there might be suppositions that ethnic unrest would arise naturally within the arti?cially imposed borders created by their former colonial rulers and post-independence weak economic conditions. However, developed socialist and capitalist states have also fallen prey to the centrifugal forces and broken apart, such as Soviet Union and Canada (where Quebecois lost a mandate or else territorial integrity of the country would have faced a serious challenges). In the post-Cold War era, there seem to be an uneasy co-existence of centrifugal forces and collective dynamics, and it is essential to examine the methods of historical transitions that help one to draw insights into the modern state and its current form. Development of modern state through warfare: an important dynamics that played a major role in development of modern state is the impact of warfare on the capacity of a state. During the fourteenth century, military technology started changing remarkably, where heavy and mounted cavalry (archetype of feudal warfare) were slowly removed, which led to the decline in the superiority of the mounted knight (Contamine, 1984). The widening scope of war also led to the formation of standing armies and various mercenary contingents, which forced the rulers to raise greater taxes for funding such armies. This transformation greatly helped royal administration to expand while causing a sharp rise in taxes levied on the common people (Ames and Rapp, 1977). The F rench Revolution brought in further changes where the government, instead of depending on large mercenary forces, looked at mobilising an entire national population to rise and revolt against ruling authority. Soon, other states such as, Britain, Russia, Austria and Prussia, after observing transformations in France, changed their army framework and the Ratchet effects swept all over Europe. The scholars that stress on warfare transformation as a major reason for emergence of modern state primarily focus on the dynamics at macro levels that put pressure at systemic levels (Webber and Wildavsky 1986). Recently, scholars have also analysed this cause at a micro-level, where it was derived that military contexts brought forth

Summaries on Chinese Yuan Currency Assignment Example | Topics and Well Written Essays - 2000 words

Summaries on Chinese Yuan Currency - Assignment Example There is also a growing middle class in China that also benefits economic indicators. The article ‘White House Reviewing Proposed U.S. Legislation on the Yuan, Carney Says’ investigates potential policy legislation aimed at the Chinese yuan. White House press secretary Jay Carney has indicated that the Obama’s administrations views on the Chinese yuan currency is that the Chinese government has significantly undervalued this currency as a means of establishing Chinese economic gains. Specific measures in this policy would allow United States companies to seek duties on imports from China as a means of compensating for the unfair advantage Chinese businesses receive from the undervalued yuan currency. In terms of current statistical elements, the article indicates that, â€Å"China’s yuan rose after the central bank set a record daily reference rate, fueling speculation policy makers will favor currency gains as a means to tame inflation and support global exports. The currency gained 0.08 percent to 6.3938 per dollar in Shanghai, according to the China Foreign Exchange Trade System.† It’s also indicated that China’s current economic policies have resulted in the United States losing more than 2.8 million jobs since 2001. It remains to be seen if this legislation will have a bipartisan character. Republican Senator Orrin Hatch has not rejected the potential legislation but has indicated that he will need to learn more about its specific elements. The article ‘Yuan Has Monthly Drop as Europe Debt Crisis Spurs Dollar Demand’ examines volatility related to the Chinese yuan. The article indicates that the Chinese yuan has declined for the first time since January. The currency has declined as Europe’s sovereign-debt crisis will worsen bolstered demand for dollars. The Yuan trading volume greatly decreased in Shanghai as the Chinese government has set its strongest reference rate on record as a means of preventing further investment slide towards the dollar. The pervading notion in these regards is that investors feel the European sovereign debt crisis will slow Chinese economic growth because of strong investment between the nations; the subsequent expansion failure creates an investment environment where the dollar is a more stable investment option. In terms of global outlook in this context of discussion the article notes that, â€Å"European leaders have struggled to contain the region’s worsening debt crisis amid growing concern Greece will default. The International Monetary Fund cut China’s 2012 growth forecast to 9 percent from 9.5 percent on Sept. 20 on credit tightening and faltering demand for its exports.† Still, the Obama administration continues to note that the Chinese yuan remains substantially undervalued even though the currency appreciated 10 percent adjusted for inflation since June 2010. It’s believed that if more volatility and turmoil continue in relation to the yuan the People’s Republic of China will peg the yuan to the dollar. The article ‘Becoming number one’ considers how China’s economy could potentially overtake America’s within the next decade. Within this context of understanding it’s indicated that in 2010 the Chinese economy overtook Japan as the world’s second-largest economy. Analysts indicate that it

Fundamentls of Entrepreneurship Essay Example for Free

Fundamentls of Entrepreneurship Essay Fundamental of entrepreneurship is an individual who takes initiative to bundle resource in innovative ways and is willing to bear the risk or uncertainty to act. The purpose of done this assignment to know and understand that entrepreneurship play role to started new business enterprise. Moreover, entrepreneur for started new enterprise that SPM JATI (cooking oil), need review performance of his business, identify strength and weaknesses, recommend a plan of action that will capitalize on the company’s strengths, and overcome its weaknesses and finally business existing performance could be maintained and strengthened. Without this cannot complete the task to started new business. Before I start my assignment, I had obtained some information from my lecture and I also get information about entrepreneurship from internet. Through internet I know that entrepreneur of review performance to started new enterprise that SPM JATI (cooking oil), strength and weaknesses, recommend a plan of action and business existing performance could be maintained and strengthened. Entrepreneurship must face all kind of problem and know need to solve the problem then only can achieve in business, if the entrepreneur run away from business it show he or she cannot face it the business and don’t know how to solve the problem. Task 1, is mention a bout review the performance of SPM JATI enterprise cooking oil. It’s easy to focus only on the day-to-day running of SPM JATI enterprise. It’s simply include business efficiency, financial position, business goals and conduct a customers and market analysis. Task 2, is indentify about SPM JATI enterprise, strength could be seen in terms of SPM JATI staff extremely polite and helpful and your competitor’s staff has very few customer-friendly attributes, products SPM JATI provides cooking oil, customers loyalty is demand, and location located at. And weakness, an object’s look every aspect of SPM JATI enterprise whether its products and service could be improved. Task 3, is analysis the company strengths and weaknesses. And how to overcome the weaknesses of company. Task 4 is talking about help jerry to investigate ways in which business existing performance could be maintained and strengthened Task 1: 2. 2 How would you review the performance of his business? 2. 1. 1 Introduction task 1 In this task talking about review the performance of business of SPM JATI Company. This task explains about operation management. Product planning, location planning, process planning, supply chain management and quality management. 2. 1. 2 Answer Review the performance of SPM JATI Enterprise cooking oil for financial position, it’s often fail because of poor financial management or a lack of planning. Often the business plan that was used to help raise finance is put on a shelf to gather dust. When it comes to SPM JATI Enterprise cooking oil business success, therefore, developing and implementing sound financial and management systems. . Product planning Product planning and product control work hand in hand to ensure that consumers get the products they want, when they want. Product planning involves evaluating the product and placement, price, package and position. SPM JATI cooking oil using product planning. Price must standard and the package look nice and the customer attract to the package. Location planning Location is also very important for service and manufacturing ventures, which have such costs as advertising, promotion and distribution that are a direct result on where they located. SPM JATI company location is very near customer and other shop also. Location has to be convenient for customers and their employees need adequate parking. That means locating near to key suppliers in areas for pick-up and deliveries. JATI company choosing the best location for business that us the first step to target the customers. Process planning A business plan is used when starting a new business or new product into market. SPM JATI cooking oil develops the products and maintains the products. SPM JATI cooking oil planning buys a new machine that is automotive packing machine to improve the business and supply in big scale. Supply chain management Supply chain management is the oversight materials information and finance as move in a process from supplier to manufacturer to wholesaler to consumer. The product flow includes the movement of goods from a supplier to a customer as well as customer returns or service needs. SPM JATI cooking oil supply to wholesaler and the wholesaler supply to consumer this is supply hain management of SPM JATI cooking oil company. Quality management SPM JATI Company maintains the good name and reputation of the company. To gain a competitive advantage, many companies will implement a quality management system to ensure they produce the best products. 2. 1. 3 Conclusion The conclusion is when I do this question I got a lot of idea about the business and also I can understand very well about what is product planning, location planning, process planning, supply chain management and how much important to business. This steps all SPM JATI company follow and maintain the business Task 2: 2. 2 Help Jerry identify his company’s strength and weaknesses. 2. 2. 1 Introduction task 2 In this task discuss about SPM JATI company strengths and weakness. SPM JATI company strengths and weakness. SPM JATI Company strengths is understand consumer needs and provide high level customer service. Weakness is not enough workers in the company and also the labor costs very high. 2. 2. 2 Answer: The impacts of internal strengths and weaknesses on the success of the ‘subject’ of analysis. The internal strengths and weaknesses of you, your staff, your products, and your business. The internal strength that make’s organization more competitive than its marketplace peers. And the internal weaknesses with organization that will keep it from achieving its objectives; it is what an organization does poorly. Strength This involves looking at the strength and weaknesses of SPM JATIenterprise cooking oil. Internal strength of business SPM JATI enterprise cooking oil, could be seen in terms of SPM JATI enterprise staff, products, customers loyalty, processes, or location. SPM JATI enterprise cooking oil,strengthterms staffextremely polite and helpful, very important to be totally honest and realistic. Next products, cooking oil, customer loyalty is when a supplier received the reward of his efforts in interacting with his customer. Customer loyalty tends the customer to voluntarily choose a particular product against another for his needs. Location for SPM JATI enterprise are very good because very near to customer and wholesaler also. So when very near to customer the supply cost become low and can save money also. The name of company very popular everyone knows about JATI cooking oil and the products quality. JATI Company understands the consumer needs. JATI Companyprovides high level customer service. Have a presence in retail markets. And also the customer like and go for JATI cooking oil. Weakness Company weaknesses are a lack of resources or capabilities. SPM JATI Company has higher labor costs. Competitor who can have similar productivity from lower labor costs. SPM JATI also not enough workers and the management are not very good. 2. 2. 3 Conclusion In this task discuss about the company strengths and weakness. Explain about the SPM JATI company strengths and weakness. Task 3: 2. Following the analysis of the company strengths and weaknesses, recommend a plan of action that will capitalize on the company strengths, and overcome its weaknesses. 2. 3. 1 Introduction In this task discuss about the strengths and weakness of Jerry Company SPM JATI enterprise. So need to find out some step to help Jerry Company to improve. And also discuss the overcome company weakness. 2. 3. 2 Answer Company strengths The first strengths for jerry JATI Company are good name in market everyone know about the company and the brand. JATI Company provides high level customer service. Customer also likes to buy JATI products because customer likes the packing and the good service also. JATI Company supply goods time to time. Overcome company weakness After I discuss about strength and weakness of Jerry Company that is SPM JATI enterprise. Jerry can be try to improve the products and packing. Customer service is very important in business, Jerry Company must focus on customer service. First the weakness of SPM JATI Company is higher labor costs. After that SPM JATI company not enough workers in the company so cannot produce more products because very less worker. SPM JATI must take new worker for company and can produce more products. SPM JATI company have 3 lorry but that is not enough for supply goods because a lot of order from customer and wholesaler. So need to buy new lorry, for more supply goods for customer and the business also can develop if supply more goods for customer the company can make high profit. 2. 3. 3 Conclusion As a conclusion, I help to find the steps or ways to help Jerry Company to improve and do much better then now. Next is, found the ways to solve jerry company weakness Task 4 2. Jerry has bought you a one-week return ticket to his holiday home in Penang. He wants you to helpHim investigate ways in which the business existing performance could be maintained and strengthened. 2. 4. 1 Task 4 introduction In this task discuss about to help jerry investigate ways in which the business existing performance could maintained and strengthened. I help jerry how to improve the performance of SPM JATI Company. So for one-wee k I will take care jerry business and help him also to improve the business. 2. 4. 2 Answer The ways to improve the company performance I have help jerry to promote his company name and product. I do which customers buy a lot of JATI product they all get some gifts from company. Next is, I give some donation under JATI company name then only people know about the company and what they are selling or produce. This also one good type of advertising. If company name popular in market then all customer know about the company and the business sales also increase. And I ask jerry to do some offer or discount. When customer purchase JATI product the price be half price for few month, to promote the product. Another idea is make t-shirt for customer, like which shop sell a lot of JATI products give them t-shirt. 2. 4. 3 Conclusion Conclusion is, this is the ways to improve the company performance and steps. When jerry follow the steps above sure jerry company will be improve and success on his overall business performance and also can increase the business sales or monthly turnover can increase. This steps all are very good to business improve and can increase the production of the company so jerry must follow the ways to improve. But now Jerry Companyimproves ready, so for no problem for Jerry Company. I think Jerry Company does better sales and better business management. Because jerry know ready what is steps and ways to improve the company performance. 3. 0 Conclusion As a conclusion when I finish this whole assignment I can understand what is business strength and weaknesses. And how to take care the business and also how to solve the problem. So when jerry follows all the ways or steps of business, sure the business will successes and can make more profit. Every entrepreneur must know the business strength and weakness.

Dengue Fever and Malaria in Thrombocytopenic Patients

Dengue Fever and Malaria in Thrombocytopenic Patients Frequency of co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness Dr. Shazia Yasir*, Dr. Muhammad Owais Rashid, Dr. Faisal Moin, Dr. Komal Owais ABSTRACT Introduction: Hepatitis c virus infection affects more than 170 million people worldwide. [1] About 80% of patients with acute infection will afterward develop chronic disease. [15] Interferon (IFN) alpha in combination with ribavirin (RBV) is the current standard care of treatment of chronic hepatitis C virus infection worldwide. Unfortunately, both drugs have significant hematological toxic effects (anemia, neutropenia and thrombocytopenia) Objectives: To determine the frequency of hematological side effects (anemia, neutropenia and thrombocytopenia) during combination therapy with interferon and ribavirin in chronic hepatitis C patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Emergency Medicine, Ziauddin University Hospital, Karachi from Ten months from April 2013 to January 2014. Methodology: A total of 228 patients of chronic HCV, and meeting inclusion criteria were included from OPD of Ziauddin Hospital North Campus Karachi, Sarwar Zuberi Liver Centre and Hepatogastroenterology Section, SIUT. After taking informed consent, patients were given injection IFN 3 MIU subcutaneously thrice weekly and ribavirin 800 – 1200 mg/day, as per body weight, that was, those less than 50 kg will receive 800 mg/day, 50 – 75 kg was received 1000 mg/kg and more than 75 kg was received 1200 mg/day. Result: Overall mean age was 39.6 ( ±9.2) years with Male: Female = 2.2: 1. Hematological abnormalities was seen in 79 (37.3%) cases. Anemia was the most common type of hematological abnormalities developed in 41 (19.3%) cases followed by neutropenia in 33 (15.6%) and thrombocytopenia in 21 (9.9%) cases. Conclusion: Amongst the hematological disorders. Anemia and thrombocytopenia was the most common and least common respectively during the combination therapy of chronic hepatitis C. while neutropenia followed as second common and serious hematological disorder. Key words: HCV, anemia, neutropenia, thrombocytopenia, Interferon, ribavirin. _____________________________________________________________________________________________ INTRODUCTION Hepatitis C Virus (HCV) infection is a global health problem. The virus infects approximately 3% of the world population; placing approximately 170 million people at risk of developing HCV related chronic liver disease. [1] Currently, chronic hepatitis C infection is the most frequent indication for liver transplantation and accounts for estimated 8000 – 10000 deaths each year in the United States. [2] HCV infection is endemic in Pakistan [3] and is a considerable threat to our population. [4] The prevalence of HCV in Pakistan is reported to be 3.29% [3], 3.3% [4] and 3.69% [5] in different studies. Cure of chronic hepatitis C in the natural course is rare, and the rate of progression to cirrhosis and hepatocellular carcinoma is also significantly high. The eradication of hepatitis C virus during the chronic stage is, therefore, extremely important. [6] - Department of Emergency Medicine, Ziauddin University Hospital, North Campus, Karachi * Correspondence Email: [emailprotected] Treatment with pegylated interferon plus ribavirin has become the standard of care for patients infected with chronic hepatitis C. [7] However, standard interferon and ribavirin combination is still widely in use in Pakistan for chronic hepatitis C infection, because of its low cost. Unfortunately, both drugs (interferon and ribavirin) have significant hematological toxic effects (anemia, neutropenia and thrombocytopenia). [8,9,10] Anemia during combination therapy for chronic hepatitis C begins to develop almost immediately after therapy is initiated and becomes most pronounced after 4 to 6 weeks of treatment.8 Hemoglobin levels do not usually change after week 12 to the completion of treatment. [6] The values for incidence and severity of anemia during combination therapy for chronic hepatitis C are higher in Asian studies than in the non-Asian studies. In a study conducted in Taiwan, the mean decrease of hemoglobin was 3.9  ± 1.3 g/dL and 39% of the patients developed severe anemia (hemoglobin levels below 10 g/dL). [9] Treatment with interferon and ribavirin combination therapy is also associated with neutropenia that is more frequent with peg interferon as compared to standard interferon. [11] A study from the National Institutes of Health specifically examined neutropenia associated with combination therapy. The mean neutrophil count decreased by 34% during the 24 to 48 week course of therapy and the frequency of neutropenia was noted to be 63%. [12] Thrombocytopenia is another well known complication of antiviral therapy for chronic hepatitis C but has been infrequently associated with dose reduction or discontinuation. [11] During therapy with at least one dose of standard or pegylated interferon, platelet count decreased by nearly 28%. [13] Few studies have been conducted in Pakistan to assess the side effects of combination therapy in chronic hepatitis C. The frequency of anemia is reported to be 19.6% and of thrombocytopenia to be 13.7% in one study. [14] Another study stated that hematological side effects were noted in 92% of the patients. [10] No local study is available reporting the frequency of neutropenia during treatment for chronic hepatitis C. Hematological abnormalities are the most common indications for dose reduction in chronic hepatitis C therapy. Hematological abnormalities accounts for at least one dose reduction in approximately 25% of patients during therapy. Dose reductions or premature discontinuations results in significantly lower sustained virological response. [11] Because hematological side effects have implications on virological response, therefore, knowledge regarding frequency of these side effects is of utmost importance. As stated earlier, there are very few trials conducted in Pakistan that examined the hematological side effects of combination therapy and most of the data in this regard have come from western population. Pakistani population is different from western population in many ways, for example, the HCV genotype 1 infection is more common in west while genotype 3 infection in Pakistan. Moreover, host factors like different genetic makeup, difference in immune status and lower body mass inde x (resulting in lesser dose of ribavirin required during therapy) for Pakistani population may have implications on frequency of the hematological side effects of combination therapy. In addition, there is an enormous difference in the frequencies of side effects reported in different studies conducted at national level. Therefore, there is a need to add-to and strengthen the national literature. This study was designed to determine the frequency of the hematological side effects of combination therapy (interferon and ribavirin) in patients with chronic hepatitis C. METHODOLOGY The study was planned to be conducted on patients attending the out-patient department of Civil Hospital Karachi, Sarwer Zuberi Liver Centre and Hepatogastroenterology Section, Sindh Institute of Urology and Transplantation. Sample size ( n ) = 182 + 25% of 182 = 228* Proportion of thrombocytopenia ( P ) = 13.7%14 or 0.137 Confidence level (1 – ÃŽ ± ) = 0.05 Margin of error (d ) = 5% * A meta-analysis noted that during treatment for chronic hepatitis C approximately 25% of patients required at least one dose reduction for hematological abnormalities (anemia, neutropenia and thrombocytopenia) [11], therefore the sample size is augmented by 25% to cover the drop-outs because of dose reduction and drug discontinuation. Patients who will require dose reduction and drug discontinuation will be excluded from the study. The criteria for dose reduction and drug discontinuation are stated in data collection. Inclusion Criteria: Patients of either gender with chronic hepatitis C: Between the age of 18 and 50 years, Presence of anti – HCV, HCV – RNA and persistently raised ALT levels for more than 6 months (on at least two occasions). HCV Genotype 2 and 3; and Compensated liver disease (indicated by presence of all of the following: no history of ascites, bleeding esophageal varices or hepatic encephalopathy, serum albumin > 3 g/dL, serum bilirubin ≠¤ 2 mg/dl and prothrombin time Exclusion Criteria: Patients with: Decompensated liver disease HCV Genotype 1 (Infection with HCV Genotype 1 requires combination therapy for 48 weeks. The study is planned to be completed in 6 months.) Co-infection with HBV Pregnancy, Significant systemic illnesses other than liver disease (cardiovascular or renal dysfunction, chronic obstructive pulmonary disease, uncontrolled diabetes) Other contra-indications or precautions to combination therapy (history of epilepsy, depression or other psychiatric disorders, thyroid dysfunction, autoimmune hepatitis) Interferon/ribavirin therapy in the past Pre-treatment hemoglobin level less than 13 g/dL in males and less than 12 g/dL in females, pre-treatment neutrophil count less than 1500 cells/ÃŽ ¼L and platelet count less than 150,000 cells/ÃŽ ¼L Who require dose reduction or drug discontinuation during treatment. Criteria are mentioned in data collection. The source of the sample was the patients attending the out-patient department of Civil Hospital Karachi, Sarwar Zuberi Liver Centre and Hepatogastroenterology Section, Sindh Institute of Urology and Transplantation. Informed consent was taken from the patients who were meet the inclusion and exclusion criteria and the patients were given injection IFN 3 MIU subcutaneously thrice weekly and ribavirin 800 – 1200 mg/day, as per body weight, that was, those less than 50 kg will receive 800 mg/day, 50 – 75 kg was received 1000 mg/kg and more than 75 kg was received 1200 mg/day. The patients were evaluated at week 4, 12 and 24 and blood was drawn for complete blood counts. Dose of the interferon and/or ribavarin was reduced for any patient in whom hemoglobin level falls below 10 g/dL and/or neutrophil count drops below 750 cells/ÃŽ ¼L and/or platelet count falls below 50,000 cells/ÃŽ ¼L during the course of treatment. The therapy was discontinued in the patients in whom hemo globin level drops below 8.5 g/dL and/or neutrophil count falls below 500 cells/ÃŽ ¼L and/or platelet count falls below 30,000 cells/ÃŽ ¼L. These criteria for dose reduction and drug discontinuation were in accordance with the guidelines for treatment of chronic hepatitis C. The patients who were required dose reduction or drug discontinuation during the course of treatment was excluded from the study. The final outcome was measured at week 24, when the values for hemoglobin level, neutrophil count and platelet count was recorded for each patient in the performa given in annex 1. The patient was said to have developed anemia if the hemoglobin level falls below 13 g/dL in males and less than 12 g/dL in females, neutropenia if neutrophil count drops below 1500 cells/ÃŽ ¼L and thrombocytopenia if platelet count falls below 1,50,000 cells/ÃŽ ¼L. Confounding variables like age, gender and body weight were controlled by stratification at the time of analysis. The collected data was analyzed with the help of SPSS program version 19.0. Frequencies and percentages were computed for presentation of qualitative variables like gender and side effects (anemia, neutropenia and thrombocytopenia). Mean  ± Standard Deviation was computed for variables like age and body weight. Confounding variables like age, gender and body weight were controlled by stratification. RESULT A total of 228 patients with chronic hepatitis C were included in this study. Sixteen (7.02%) of the patients were excluded due to dose modification or discontinuation during the follow-up period. Due to anemia dose was reduced in 6 and discontinued in 4 cases, due to neutropenia dose was reduced in 3 and discontinued in 1 case and in thrombocytopenia dose was reduced in 2 cases. Mean ( ±SD) age of patients was 39.6 ( ±9.2) years with range = 18 – 50 years. Majority of cases 113 (53.3%) had age between 20 – 40 years. Figure-1 Gender distribution showed male preponderance (male: female = 2.2: 1), 145 (68.4%) were males and 67 (31.6%) were females. Figure-2 Seventy Nine (37.3%) of the patients developed significant hematological abnormalities during treatment with interferon and ribavirin. Figure-3 Anemia was the most common type of hematological abnormalities developed in 41 (19.3%) cases followed by neutropenia in 33 (15.6%) cases and thrombocytopenia in 21 (9.9%) cases. Figure-4 Proportions of hematological abnormalities were similar in both genders. Fifty five (37.9%) were male and 24 (35.8%) were female. Figure-5 Types of hematological abnormalities were also similar in both males and females, 29 (52.7%), 23 (41.8%) and 15 (27.3%) of males and 12 (50%), 10 (41.7%) and 6 (25%) of females developed anemia, neutropenia, and thrombocytopenia, respectively in male cases. Table-1 Mean ( ±SD) age of those patients who developed hematological side effects was 38.4 ( ±8.6) years with range = 19 – 50 years. Majority of cases 56 (62.2%) had age between 20 – 40 years. Figure-6 FIGURE-1 AGE DISTRIBUTION n = 228 Mean  ±SD = 39.6  ±9.2 years Range = 18 – 50 years FIGURE-2 GENDER DISTRIBUTION n = 228 Male: Female = 2.2: 1 FIGURE-3 OVERALL HEMATOLOGICAL SIDE EFFECTS (SE) n = 212 Keys: hematological side effects were evaluated in this study as: Anemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females. Neutropenia = Neutrophil count between 750 1500 cells/ÃŽ ¼L. Thrombocytopenia = Platelet count of between 50,000 – 1, 50,000 cells/ÃŽ ¼L. SE = Side Effects FIGURE-4 TYPES OF HEMATOLOGICAL SIDE EFFECTS (SE) n = 212 Multiple response exist Keys: Anemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females. Neutropenia = Neutrophil count between 1500 750 cells/ÃŽ ¼L. Thrombocytopenia = Platelet count of between 1,50,000 50000 cells/ÃŽ ¼L. SE = Side Effects FIGURE-5 OVERALL HEMATOLOGICAL SIDE EFFECTS (SE) IN GENDER n = 212 Table-1 TYPES OF HEMATOLOGICAL SIDE EFFECTS (SE) IN GENDER n = 212 Keys: Anemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females. Neutropenia = Neutrophil count between 750 1500 cells/ÃŽ ¼L. Thrombocytopenia = Platelet count of between 50,000 150000 cells/ÃŽ ¼L. FIGURE-6 OVERALL HEMATOLOGICAL SIDE EFFECTS (SE) IN AGE GROUPS n = 212 Mean  ±SD = 38.4  ±8.6 years Range = 19 – 50 years DISCUSSION The treatment of CHC is now well established with conventional interferon or pegylated interferon in combination with ribavirin. [61] However, one of the main drawbacks of this combination therapy is the development of side effects, which can result in suboptimal dosing or discontinuation of therapy. This can limit the likelihood of SVR, since one of the determinants of SVR is adequate dose and duration of therapy, as previously discussed in this supplement. Among the side effects of combination therapy, hematologic abnormalities such as anemia, neutropenia, and thrombocytopenia have been reported to result in dose reduction and discontinuation of therapy in up to 25% and 3% of patients, respectively. [11] The withdrawal rate increases with both the duration of treatment and use of combination therapy. [101] For example, therapy was stopped in 13–14% of patients treated with interferon mono therapy for 48 weeks [102] compared with 19–21% of patients receiving combination therapy for the same duration. The withdrawal rate for combination therapy was lower when therapy was administered for only 24 weeks (8%). [103] Mean ( ±SD) age of patients was 39.6 ( ±9.2) years with range = 18 – 50 years. In this study seventy Nine, 37.3% of the patients developed significant hematological abnormalities during treatment with interferon and ribavirin and Sixteen (7.02%) of the patients were excluded due to drug modification or discontinuation during the follow-up period. A study from USA reported 38.2% of the cases developed hematological side effects during the combination therapy, a figure is similar to what is seen in this study.104 Another study conducted in Pakistan reported 92% mild to moderate hematological side effect during the combination therapy. [10] In this study anemia was the most common type of hematological abnormality seen in 19.3% of cases followed by neutropenia in 15.6% and thrombocytopenia in 9.9% cases. Study from USA reported 20.6%, 22.1%, and 8.1% developed neutropenia, anemia, and thrombocytopenia, respectively. [104] In another study from Pakistan, mild to modest anemia was noted in 70 % of the patients. [10] Anemia is caused both by interferon due to myeloseupression and ribivirin causing hemolysis. [24, 25] In same study mild to moderate neutropenia was reported in 64% of cases and thrombocytopenia in 61% of patients. [10] neutropenia is one of the expected side effects of combination therapy but the risk of the serious infection is very low even with severe neutropenia. [12] Similarly in clinically practice thrombocytopenia does not pose significant problem. [11] In conclusion hematologic abnormalities are common during combination antiviral therapy for chronic hepatitis C. Although dose reduction or discontinuation is tool of overcome these side effects, they can adversely affect the efficacy of combination antiviral therapy. This is especially true in the cases of ribavirin induced anemia. Recent evidence has led to increasing recognition that optimal dosing of ribavirin is a crucial determinant of viral clearance. Preliminary data suggest that hematopoietic growth factors may be useful for managing the hematologic side effects of combination therapy (especially anemia). CONCLUSION The frequency of hematological abnormalities during the treatment of chronic hepatitis C (HCV) in this study was comparable to those seen in certain other studies. Anemia was the most common and thrombocytopenia was the least common hematological side effect noted. The number of patients excluded from the study because of dose modification or drug discontinuation was also greatest due to anemia and least due to thrombocytopenia ACKNOWLEDGEMENT We would like to acknowledge faculty of Ziauddin Hospital, North Campus for helping us during the study, staff for helping in data collection and all others who have given their input. SOURCE OF FUNDINGS We would like to thank HighQ pharma for financially aiding the research and authors for their contribution. CONFLICT OF INTEREST There is no conflict of interest in any term regarding the article from any authors. REFERENCE Dengue Fever and Malaria in Thrombocytopenic Patients Dengue Fever and Malaria in Thrombocytopenic Patients Frequency of co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness Dr. Shazia Yasir (PG Emergency Medicine)*, Dr. Owais , Dr. Faisal Moin ABSTRACT Introduction: Both dengue fever and malaria can present with thrombocytopenia. Thrombocytopenia is a consistent finding in dengue fever and is regarded as a strong predictor of dengue fever. Thrombocytopenia is also considered criterion of disease severity, bad prognostic factor and its presence is associated with increase probability of malaria Objectives: To determine frequency of co-existence of dengue fever and malaria in thrombocytopenic patients presented with acute febrile illness in tertiary care hospital Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Emergency Medicine, Ziauddin University Hospital, Karachi from Ten months from April 2013 to January 2014. Methodology: A total of 159 patients meeting inclusion criteria were included in this study. 5ml of blood by venupuncture in EDTA anti-coagulant for platelet count and preparing thick and thin films and 2 ml of blood in plain bottle for detection of dengue specific IgM was collected from all patients. Thick films are used to identify malarial parasites and thin films to identify specie. Dengue fever was diagnosed on positive dengue IgM. Co-existence was labeled as positive if malarial parasites and dengue IgM found to be present at the same time. This diffusion susceptibility test was use to determine susceptibility of bacterial agents to antibiotics. Data was analyzed by descriptive statistics using SPSS software version 19. Result: Overall mean ( ±SD) age was 38.3 ( ±7.9) years, with Male to female ratio was 1.1: 1. Co-infections (Dengue and Malaria) were diagnosed in 5 (5.6%) of cases. From 5 cases, 3 (60%) were male and 2 (40%) were female. Mean ( ±SD) age of 5 positive cases of co-infection was 37.8 ( ±8.3) years. Conclusion: Concurrent infections were found 5.6% in this study. Although this percentage is slightly low; special attention should be given to the possibility of co-infection with malaria and dengue. Key words: Dengue fever, Malaria, Immunoglobulin-M (IgM), febrile illness, Thrombocytopenia _____________________________________________________________________________________________ INTRODUCTION Dengue Virus is becoming an increasing health problem. Over 99% cases of viral hemorrhagic fever reported worldwide are due to dengue hemorrhagic fever (DHF). [1] Dengue fever is cause by dengue viruses (DENVs) which are members of Flaviviridae family. [2] It has been estimated that 2.5 billion people live in areas which are at risk of epidemic transmission and over 50 million of DENV infections occur globally each year [3,4]. Since we are living in region where malaria is endemic and is considered as the most common cause of fever and in general practice empirical anti-malarial therapy is common, it is important to distinguish the two conditions due to clinical similarities and unexpected progress of dengue fever (DF) to DHF and dengue shock syndrome (DSS). [5] - Department of Emergency Medicine, Ziauddin University Hospital, North Campus, Karachi * Correspondence Email: [emailprotected] Both dengue fever and malaria can present with thrombocytopenia. Thrombocytopenia is a consistent finding in dengue fever and is regarded as a strong predictor of dengue fever. [6] Thrombocytopenia is also considered criterion of disease severity, bad prognostic factor and its presence is associated with increase probability of malaria [7, 8] In a local study Ali et.al showed that Out of 11 patients diagnosed as having dengue fever on serology 9 (81.8%) also had co-existence of malaria and thrombocytopenia was present in 90% of such patients. [5] Out of 11 DENV positive patients three patients died and first DENV positive patients who died was prescribed anti-malarial by general practitioner in outdoor. [5] On autopsy plasmodium falciparum rings were found in blood and DENV IgM was detected in serum samples [5] Due to clinical similarities in two conditions and possibility of extensive mosquito exposure, high co-existence of both conditions cannot be excluded. [5] This study aims to determine frequency of co-existing dengue fever and malaria in thrombocytopenic patients presenting with acute febrile illness so that magnitude of the condition could be assessed. The findings could be used to plan that all patients with acute febrile illness with thrombocytopenia must be screened for dengue fever without delay. METHODOLOGY This study was carried out at the department of emergency medicine, Ziauddin University Hospital, Karachi, Pakistan. Patients of either gender with more than 12 years of age presenting to Ziauddin Hospital Karachi with acute febrile illness and found to have thrombocytopenia were included in the study while patients known to have disease causing thrombocytopenia e.g. systemic lupus erythematous, idiopathic thrombocytopenic purpura and patients with other causes of acute febrile illness such as pneumonia, meningitis, enteric fever etc. diagnosed on blood culture, chest X-ray sputum C/S, urine D/R were excluded from the study. A total of 159 patient’s fulfilling inclusion criteria were included in the study. 5ml of blood by venupuncture in EDTA anti-coagulant for platelet count and preparing thick and thin films and 2 ml of blood in plain bottle for detection of dengue specific IgM was collected from all patients. Thick films are used to identify malarial parasites and thin films to identify specie. Dengue fever was diagnosed on positive dengue IgM. To minimize bias all specimen was sent to single central laboratory of the hospital. A proforma especially designed for the study was used to documents findings such as paients age, gender, name, malaria parasite, dengue IgM by the researcher. Co-existence was labeled as positive if malarial parasites and dengue IgM found to be present at the same time. Data was entered in computer and analyzed by SPSS version 19.0 frequency and percentages were calculated for categorical variables such as gender, co-existing dengue fever and malaria. Mean standard deviation was calculated for numerical variables like age. Stratification was done in terms of age and gender to see the effect of that on outcome. RESULT During the study, a total of 159 cases with thrombocytopenia of age > 12 years were included. From 159 cases, 82 (51.6%) were male and 77 (48.4%) were female. (Figure-1) Mean ( ±SD) age of 159 cases was 38.3 ( ±7.9) years with range = 15 – 53 years. Majority 66 (41.5%) of cases had age between 30 – 44 years. (Figure-2) Out of 159 thrombocytopenic cases presented with acute febrile illness, malaria was diagnosed in 55 (34.6%) cases. (Figure-3) Dengue fever was diagnosed on positive dengue IgM. Out of 159 cases, 34 (21.4%) of cases were diagnosed as dengue. (Figure-4) Co-infections (Dengue and Malaria) were diagnosed in 5 (5.6%) cases. (Figure-5) Out of 5 positive cases of co-infection, 3 (60%) were male and 2 (40%) were female. Mean ( ±SD) age of 5 positive cases of co-infection was 37.8 ( ±8.3) years with range = 15 – 52 years. Majority 3 (60%) of cases had age between 30 – 44 years. (Figure-6) DISCUSSION Despite a wide overlap between malaria and dengue endemic areas, published reports of co-infections are scarce in the literature. Malaria and dengue must be suspected in febrile patients living in or returning from areas endemic for these infections. The confirmation of malaria is rapid, and after malaria is confirmed, dengue is usually ruled out without screening for it. Two methods can confirm dengue: dengue-specific IgM sero-conversion or detection of dengue virus particles during the acute phase (day 0 to day 4 after onset of fever) by RT-PCR, which is faster and more specific. In published case reports, [9 – 12] the diagnosis of dengue infection is usually made based on positive dengue IgM; however, this cannot confirm recent dengue, because IgM can persist for months and cross-react with other arboviruses. [13] If RT-PCR requires a specific laboratory and cannot be performed on site, a new test, the Platelia, is now easily included in any laboratory and is indicated particularly for early-acute phase samples. [14] To investigate the frequency of dengue and malaria co-infection, the Platelia test should be used in all cases of dengue-like or malaria-like syndrome, even when malaria diagnosis was positive, in regions w here both infections may overlap. Both dengue fever and malaria can present with thrombocytopenia. Thrombocytopenia is a consistent finding in dengue fever and is regarded as a strong predictor of dengue fever. [6] Thrombocytopenia is also considered criterion of disease severity, bad prognostic factor and its presence is associated with increase probability of malaria. [7, 8] Mixed infections with many etiologic agents are not uncommon in malaria. [15] Despite scant data, dengue and malaria coinfection should be common in areas where both diseases are co-endemic in many places of the world. [16] In a study regarding diagnostic techniques and management of dengue and malaria co-infection, all patients with dual infection presented prolonged fever for more than seven days, myalgia, bleeding manifestations, rash and anemia. [17] Moreover, according to Vasconcelos et al, the continuous fever caused by arboviral infection can mask the periodic fever associated with malarial parasites. [18] Out of 159 thrombocytopenic cases presented with acute febrile illness, malaria was diagnosed in 55 (34.6%) cases while 34 (21.4%) of cases were diagnosed as dengue. Of the 89 patients of dengue and malaria in this study, 5.6% had concurrent dengue and malaria. This percentage is relatively high as compared with other international studies. A study from France reported that 1% concurrent dengue and malaria. [19] Another study from Brazil reported 1.8% concurrent dengue and malaria. [20] Very high percentage was found in a local study Ali et.al showed that Out of 11 patients diagnosed as having dengue fever on serology 9 (81.8%) also had co-existence of malaria and thrombocytopenia was present in 90% of such patients. [5] In this study from 9 positive cases of co-infection, 3 (60%) were male and 2 (40%) were female. Mean ( ±SD) age of positive cases of co-infection was 37.8 ( ±8.3) years. Although a reduced sample number was assessed in this study, a limitation that we acknowledge, it is important to remember that dengue and malaria co-infection requires special attention because delayed diagnosis and appropriated treatment can result in fatal complications. [16, 21] Both diseases causes similar symptoms and simultaneous infections with two different infectious agents may result in overlapped symptoms, [22] diagnosis of malaria and dengue based purely on clinical grounds may become difficult for physicians [16] and it is possible that either clinical spectrum of the disease or treatment may also be affected. [23] Finally, it is important to remember that both diseases have similar clinical findings, thus the diagnosis could be made concomitantly for dengue and malaria in patients living or returning from areas where both diseases are endemic or during dengue outbreaks. CONCLUSION Concurrent infections were found 5.7% in this study. Although this percentage is slightly low; special attention should be given to the possibility of co-infection with malaria and dengue. The distinction between severe dengue and severe malaria must be made in an emergency department or hospital setting because in both situations, early diagnosis is essential for patient care. Finally, it is important to remember that both diseases have similar clinical findings, thus the diagnosis could be made concomitantly for dengue and malaria in patients living or returning from areas where both diseases are endemic or during dengue outbreaks. Acknowledgement: We would like to acknowledge faculty of Ziauddin Hospital, North Campus for helping us during the study, staff for helping in data collection and all others who have given their input. REFERENCE Rigau-Perez JG, Clark GG, Gulber DJ, Reitee P, Sanders EJ, Vorndam AV. Dengue and dengue hemorrhagic fever. Lancet 1998;352:971-7. Henchal EA, Putnak JR. The dengue viruses. Clin Microbiol Rev 1990;3: 376-96. Pinheiro FP, Corber SJ. Global situation of dengue and dengue hemorrhagic fever and its emergence in Americas. World Health Stat 1997;50:161-9. Guzman MG, Kouri G. Dengue: an update. Lancet infect Dis 2002;2:33-42. Ali N, Nadeem A, Anwar M, Tariq WZ, Chotani RA. Dengue fever in malaria endemic areas. J Coll Physicians Surg Pak 2005;16:340-42. Ahmed S, Ali N, Ashraf S, Ilyas M, Tariq WZ, Chotani RA. Dengue fever outbreak: A clinical management experience. J Coll Physicians Surg Pak 2008;18:8-12. Mahmood A, Yasir M. Thrombocytopenia; a predictor of malaria among febrile patients in Liberia. Infect Dis J Pak 2005;14:41-4. Lathia TB, Joshi R. Can hematological parameters discriminate malaria from nonmalarious acute febrile illness in the tropics? Indian J Med Sci. 2004;58:239-44. Charrel RN, Brouqui P, Foucault C, de Lamballerie X. Concurrent dengue and malaria. Emerg Infect Dis. 2005;11:1153–4. Deresinski S. Concurrent Plasmodium vivax malaria and dengue. Emerg Infect Dis. 2006;12:1802. Thangaratham PS, Jeevan MK, Rajendran R, Samuel PP, Tyagi BK. Dual infection by dengue virus and Plasmodium vivax in Alappuzha District, Kerala, India. Jpn J Infect Dis. 2006;59:211–2. Ward DI. A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg. 2006;75:182–5. Allwinn R. Doerr HW, Emmerich P, Schmitz H, Preiser W. Crossreactivity in fl avivirus serology: new implications of an old fi nding? Med Microbiol Immunol. 2002;190:199–202. Dussart P, Labeau B, Lagathu G, Louis P, Nunes MR, Rodrigues SG, et al. Evaluation of an enzyme immunoassay for detection of dengue virus NS1 antigen in human serum. Clin Vaccine Immunol. 2006;13:1185–9. Singhsilarak T, Phongtananant S, Jenjittikul M, Watt G, Tangpakdee N, Popak N, et al. Possible acute coinfections in Thai malaria patients. Southeast Asian J Trop Med Public Health 2006;37:1-4. Ward DI. A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg 2006;75:182-5. Abbasi A, Butt N, Sheikh QH, Bhutto AR, Munir SM, Ahmed SM. Clinical Features, Diagnostic Techniques and Management of Dual Dengue and Malaria Infection. J Coll Physicians Surg Pak 2009;19:25-9. Vasconcelos PFC, Rosa APAT, Rosa JFST, Dà ©gallier N. Concomitant Infections by Malaria and Arboviruses in the Brazilian Amazon Region. Rev Latinoam Microbiol 1990;32:291-4. Carme B, Matheus S, Donutil G, Raulin O, Nacher M, Morvan J. Concurrent Dengue and Malaria in Cayenne Hospital, French Guiana. Emerg Infect Dis 2009;15:668-71. Santana VD, Lavezzo LC, Mondini A, Terzian AC, Bronzoni RV, Rossit AR et al. Concurrent dengue and malaria in the Amazon region. Rev Soc Bras Med Trop 2010;43:508-11 Charrel RN, Brouqui P, Foucault C, Lamballerie X. Concurrent Dengue and Malaria. Emerg Infect Dis 2007;11:1153-4. Bhalla A, Sharma N, Sharma A, Suri V. Concurrent infection with Dengue and Malaria. Indian J Med Sci 2006;60:330-1. Tangaratham PS, Jeevan MK, Rajendran R, Samuel PP, Tyagi BK. Dual Infection by Dengue Virus and Plasmodium vivax in Alappuzha District, Kerala, India. Jpn J Infect Dis 2006;59:211-2.

In The Sri Lankan Freight Forwarding Industry Marketing Essay

In The Sri Lankan Freight Forwarding Industry Marketing Essay After the three decades of the war ended the political situation in the country is stable and the current government enjoys 2/3 of majority of the parliament and president remains the most popular person of the country. But the political turmoil surrounding the Middle East and Iran affecting the local export market since most of the tea products were export to the Middle East market. Also the economic sanctions impose by United States and European Union on Iran affecting the local export market. 2.2 Economical Environment The fluctuating exchange rates are affecting the local produces since most of them imports the raw material from china and India and produce their main products .also the world economic downturn affecting the local economy. On the plus side opening of the new port and expansion of the Colombo port will bring more vessels to the Colombo port. This will definitely increase container volumes to the country. 2.3 Legal Environment The government has introduced a system to regulate the shipping and freight forwarding industry in the country. All shipping and freight forwarding agents must register with Merchant Shipping department. Where they will categorise to two separate groups and issue licences. This is renewable yearly. 2.4 Technological Environment The Sri Lanka customs department has introduced the new EDI (electronic data interchange) system to update shipping manifest through the entering in to customs department website , which will benefit the industry where cost and time of the forwarders will be saved .previously the manifest were submitted by manually and separate person should allocate to do the job. Also this will help the accuracy and duplication of work. 3 ANALYSIS OF THE INDUSTRY THOUGH PORTERS FIVE FORCES The Threat of entry In the Sri Lankan freight forwarding industry the threats of new entry is rather high because there are no legal requirements other than registration as a company with register of companies. Any one or any party can enter in to the industry with only requirements are recognition in the industry, business contact and Agent network with minimum capital can enter in to the industry . When new entry enters in to the market it is a burden for the existing freight forwarders in the market. Since the industry is already overcrowded with so many players with in the industry completing for slow growing export market and everyone have e to share the existing customer base with new entries to the industry. The entry barriers to the market can be arisen due to new entry to the industry unable to get economies of scale at once since they do not have the volume advantage at the start of the business. Another barrier is the new regulation by the government which comes under the Merchant Shipping Department. The forwarders must have the licence to carry out the business with in the local Market. The Treats Of Substitutes The substitutes service can be provided by the carriers and air lines by way of value additions or part of the supply chain to the customers. Ware these carriers can provide additional services like warehousing, transportation, inventory control etc. The Maersk the world leading carrier has started their own arm to provide the additional value added services to the customers by in the name of DAMCO international .this will surely make the adverse effect on the current forwarding market in the country. The Bargaining Power Of The Buyers In the Sri Lankan freight forwarding market the bargaining power of the buyers are very high. when comes to the export market in year 2011 countrys export containers were around 260047 and for a month it is around 21680 .other than forwarders the main carriers are also competing to get the business direct from the customers. The freight forwarder has to convince the buyers and must offer more value for the money. When relating to the concerned company the 10 major customers bring about 26.38% of the total income of the company so there buyer power high and the profit margins from these customers are thin. The Bargaining Power Of Suppliers The suppliers for the freight forwarders either shipping lines, airlines, ware house provider or Logistics Companys provide services to the freight forwarders.in Sri Lanka the shipping lines and air lines are dominating the market .if other than the freight forwarder has large volumes they can bargain with the shipping lines and air lines other than that the bargain power of the suppliers are very high. When come to the concerned company same theory is applied to some destinations not for the all destinations. Competitive Rivalry Among Exciting Firms As per the merchant shipping department there are 296 freight forwarding companies in the local freight forwarding market. But there is other freight forwarders operating in the market without licences also. There is high competition among the forwarders since the export market is only expand around 6% in year 2011and import market did expand by 17% when compared to 2010 as mentioned by the Sri Lanka Freight Forwarders Association (SLFFA).in the industry there are lot of equal size competitors in the market and this will result intense competition with in the market .and there are few major size competitors competing in different sectors of the market .most of these competitors complete in the appeal and tea sector since those are the most exported commodities in the country. When analysing the five force frame work in the freight forwarding industry in Sri Lanka there is little information about the individual performance of the rival organisation. And there is no ranking system to identify who the best company is providing the forwarding services in the industry. Even though there is association in the industry it has only 84 members and where government has issued over 296 licences to practice as freight forwarders. And there is lack of understanding among competitors with in the industry about the growth and there is no growth forecast with in the industry. When analysing the above finding there are lot of competition in the market for sea freight export since the sea freight export growth rate is about 6% but the sea freight import growth rate is high about 17% .most of the freight forwarders concern about the full container cargo (FCL Containers) in market and less about the loose cargo load (LCL) and multi country consolidation (MCC). 4. VALUE CHAIN ANALYSIS To achieve the competitive advantage organisation must deliver the value to the customers below are the value chain analysis for the CWT Globelink Colombo 4.1 Primary Activities 4.1.1 Inbound Logistics When comes to the export of goods organisation provide transport from shippers place of production to the organisations ware house. Fumigation, obtaining relevant certificates for the export purposes is other parts of the job. In the import sea freight communication with relevant shippers in the various destinations, picking up the relevant good, storing in the ware houses in the relevant destinations till it ships to the Colombo or various other ports. 4.1.2 Operations In sea fright exports the operation is stuffing the relevant cargo inside the container according to the stuffing plan.in this case the Cargo must be stuffed to the container without any damages and relevant cargo must be send to the relevant containers accordingly. And should send to the relevant ships accordingly.in import sea cargo must be DE stuffed accordingly. 4.1.3 Outbound Logistics When is come to the import shipments after receiving the goods to the Colombo port the organisation must issue the relevant documents to the relevant consignees to clear the goods from the relevant ware houses operated by the Sri Lanka ports authority. Also must help the consignees to track down the cargo from the ware houses. 4.1.4 Marketing and Sales Promoting sea freight business with relevant rate to the direct and cooperate customers, overseas agents and shippers with value added services are the part of the sales and marketing 4.1.5 Services Tracking the customers cargo till its deliver to relevant parties, issuing Delivery orders, Bill of ladings, surveying for the damage cargo and issuing relevant letters to obtain the insurance claims and sending arrival notices some of the additional services provided by the company. 4.2 support activities 4.2.1 Technology Development The firm provide tracking system to all their customers to track their cargo through new innovative system .using this system customers can see where their cargo are currently lying on or which vessel the shipments are on and time this shipments will be delivered to the destinations. 4.2.2 Firm Infrastructure and Human Resources Management The firm has a good reputation among the customers. The organisation poses a good customer centric culture. The MIS support the innovation and responsiveness to the customer needs. 5. THE SOURCE OF COMPETITIVE ADVANTAGE THROUGH ONION MODEL THE GOOD ONION MODEL 5.1.2 The Agent Network The organisation poses a worldwide agent network .the organisations has 40 associate offices in 13 countries and cargo ships to over 120 countries reaching more than 1200 destinations worldwide which unmatched by the local competitors . 5.1.2 Superior Rate Structure The organisation offers the most competitive rate in the LCL cargo sector in the market and most of the other freight forwarders in the market co-load their shipments with company since they do not have the capabilities match the rate offered by the firm. 5.1.3 Leading Multi Country Consolidator The organisation is the innovator of the large scale of operations of the multi country consolidation among the competitors. Firm is the leading MCC to Indian sub-continent. 5.1.4 Innovative Cargo Tracking System The customers can track their cargo through the system only the have to do is enter the bill of leading numbers to the system and will able to get the full details about their cargo 5.1.5 Customer Centric Culture The organisation is fully focused on customers needs and requirements. Organisation have separate department focusing the customer care and even has customer complaint line which is first for the Sri Lankan freight forwarding industry. 5.1.6 Cost Leadership in LCL market The organisation provide special services for the like packing transport fumigation entry passing as a whole package which includes the freight charges. The organisation always provides the more service for the money charge for the customer. THE BAD ONION MODEL 5.2.1 Parochial Top Management Mind Set Even though the organisation very centric towards the customers and customer need they are not much focused on the developing business to the next level or stepping up for the next level. They poses very narrow set of business vision for the company and does not want step outside the comfort zone their currently in and change the current business dynamics. 5.2.2 Employee Engagement The organisation lacks the motivation to achieve its goals .where employer wants employees to do their best work and drive the organisation towards its goals.to do that employer must engage with the employees and find the ways to get more from the employees other than the primary work set they have been assigned to do . 7. THE SWOT ANALYSIS 7.1 Strengths of the Organisation 7.1.1 Agent Network As mentioned earlier organisation has good agency network around the world. Using this network firm can import and export any cargo according to the customer requirements. 7.1.2 Rate Structure Since the firm operates most parts of the world with various agents organisation can offer the cheapest LCL rate in the market. Most of the agents the firm work are the market leaders in those destinations and the have the lowest tariff with in that particular destination .with the collaboration with them organisation can offer the best rate in the market. 7.1.3 Transhipment Cargo Volume The Colombo port is a strategic transhipment point in the world.so most of the cargo to Europe from Indian sub-continent tranships through the Colombo port and most of the European Cargo to Indian sub-continent tranship through Colombo port. most of the agents send their transhipment cargo to consolidate in Colombo send to the various destinations previously mentioned. 7.2 weaknesses Of the Organisation 7.2.1 Working Capital Inadequacy The firm always works with the thin profit margins with credit to the customers sometimes with low volumes will create a loss situation where it will affect the working capital requirements of the company. The other scenarios is there more imports to firm than exports and the firm has to pay to the agents and should provide credit to the customers this will also create working capital inadequacy. 7.2.2 Human Resource Management The firm not very keen in developing good human resources management process .this will lead to the less employee engagement and will hinder the achievement of organisations goals through performance. 7.3 External Opportunities 7.3.1 Development of Colombo and Hambantota Port The development of Colombo port efficiency and increase of the handling of the containers will affect the industry also opening of the new port in Hambantota will increase the vessel calling specially the car carriers are promoted in the new port. Expansion of the Colombo port to will attract more vessel to the port and will benefit the local industry by more volumes and less cost 7.3.2 Stable political Environment The ending three decades of the war and stable political environment will attract more investors to the country. The more investment comes and starts new business will create more imports and exports from the country. 7.4 External Threats 7.4.1 Weak Economic Development of United States and European Union The European Union and United States economic crisis were affected to the local garment and tea and other sectors badly and this crisis has been effected to the freight forwarding industry also the export market were grown only by 6% in last year. 7.4.2 Turmoil in Middle East and Sanctions to Iran One of the best export market for the country is middle East and Iran .the current turmoil in Syria, Egypt ,Libya has halted the export to those countries also the sanction by the US and EU to Iran also effected the industry . VISION To Be A World-Class Corporation With Global Logistics Capabilities MISSION To Excel As A Leading Logistics Solutions Provider Delivering Best Value To Customers (http://cwt.listedcompany.com/misc/ar2011/ar2011.pdf) 8. THE VISSION, MISSIONS, CORE VALUES OF THE COMPMANY The Colombo office uses the same vision statement as head office in Singapore. This is for a border group with different SBUs and freight forwarding is a one SBU among other business units. Colombo office should have a different vision for its objectives. Modified vision statement for the firm would be TO BE A ONE OF LEADING FREIGHT FORWERDING COMPANY IN SRI LANKA WITH GLOBAL FREIGHT FORWERDING CAPABILITIES. The mission statement by the head office will be the mission to the company since to become the leading freight forwarding company in Sri Lanka the firm must move to the other sectors of the logistics to provide best value to the customer. 8.1 Core Values 8.1.1 Service Reliability Provide the best service to customers and to improve the service levels and consistently upgrade the service levels 8.1.2 Competitiveness To provide competitive freight rates in the market and pass any reductions possible to valued customers so they can keep their cost down to the minimum levels. 8.1.3 Customer Focus To understand the customers requirements and utilise the knowledge of the organisation to deliver quality, committed service to the customer 8.1.4 Teamwork As an reputed organisation it is value the strength of an individuals and combined together to deliver the objective of the firm 8.1.5 Quality The firm to ensure customers receive a standard of service which provides quality and assurance that can be deliver time and time again. 9. GROWTH TARGETS As per the attached Annexure Below the firms average import turnover increase about 28% and export turnover were increase by 41% .but the firms import volume was only increased by 9% and export volume was down by 34% .the export volume decrease is mainly due to the low volume exported during year 2010 recession period .even though year 2011 and 2012 shows an increase of 42% and 22% respectively. These are the growth targets set for the next 3 years 2013 2014 2015 Export tus 3300 3630 3993 Import tus 4,696 5,165 5,682 2013 2014 2015 Export turnover 477,276,792.67 525,004,471.93 577,504,919.13 Import turnover 41,796,722.88 46,394,362.40 51,497,742.26 Export profit 37,495,029.33 41,244,532.27 43,306,758.88 Import profit 30,887,954.40 30,887,954.40 30,887,954.40 After analysing the market trends for the year 2008/2009/2010/2011/2012the growth target was set. The average turnover and profit were nearly about 11% for the export and imports therefore the target was set as 10% increase for income and profit for two sectors. For the volume the fluctuations are very high and it was very difficult to set an accurate target therefore the 10% was taken to the volume target also STRATEGY OPTION TO ACHIVE THE GROWTH 1. The Ansoff Approach 1.1 Market Penetration Increasing the sales volume through new marketing recruitments, encouraging the customers to purchase more services, attracting the customers with price and differentiation and gaining the market through expense of the competitors will help the organisation to penetrate more in to the market 1.2 Market Development Firm can enter in to the new market segments like supply chain management to the garment industry and telecommunication industry. Also can enter in to the market such as Maldives and Afgenistan where there are less competition and high profit margins. 1.3 Product Development Firm can combine their import and export business together and provide services such as imports goods from one country and export the same goods to an another country .bundling the products together and offering as a one product (freight, transport, packing ,entry passing together as one product ) 1.4 Diversification Firm can move in to a commodity markets where they can buy and sell commodities 2. The Porters Approach 2.1 Cost Leadership Currently the firm provides the lowest cost in the market. Where firm cut the costs to the minimum and pass the savings to the customer with lower price .this help to attract more volumes to the organisation. 2.2 Differentiation The firm can differentiate their product and services more attractive than the competitor .this can be create through customer service, image of the organisation, faster services to the one destination to another. STRATEGY FOR THE GROWTH The firm to use hybrid strategy for the growth .the organisation need to penetrate in to the market using differentiation and cost leadership and must move in to the new products to grow in the market . Currently firm offers the best rate in the market. Offering the best rate will help organisation to gain the cost leadership in the market. Gaining the cost leadership will help secure more volumes from the customers and attract the customers from the competitors. With the cost firm can encourage the customers purchase more products and services and these will help the firm to penetrate in to the market with same products catalogue. Currently firm only offers few services such as freight, transport, packing and entry passing. This will limit the growth opportunities. Firm can enter into a new market segment using supply chain management. This will help the firm to tap in to the appeal industry which is one of the largest import and export market in the country. The growth target was set for the next ten years is 10% for the profit and volume. Through new product development firm can attract more customers and volumes to achieve the set target. Combining few product and services as new product and offering to the customers services like imports from one destination to other destination without importing the goods to Colombo will be a new product development to the firm REFERANCE LIST www.slffa.com http://www.dgshipping.gov.lk