Malnutrition Effects on Quality Of Life

Malnutrition Effects on Quality Of Life The focus of this assessment is quality of life and specifically this paper considers how malnutrition affects quality of life of community settings patients. According to the Scottish Governments publication Older people living in community Nutrition needs, barrier and interventions: a literature review, malnutrition is an umbrella term for undernutrition, overnutrition and imbalance diet intake (The Scottish Government, 2009). Malnutrition has previously been described in the various ways (The Scottish Government, 2009). However, for purpose of this assessment the following term will be used as defined by World Health Organisation (WHO) the cellular imbalance between the supply of nutrients and energy and the bodys demand for them to ensure growth, maintenance, and specific functions (see European Nutrition for Health Alliance, 2005). According to Saunders, Smith and Stroud (2010) 2 per cent of the UK population is underweight: Body Mass Index (BMI) is lower than 18.5 kg/m. However, they agreed that patients could be still at risk of malnutrition whatever their BMI is (Saunders, Smith and Stroud, 2010). Malnutrition, as well as other factors, has negative effect on the persons quality of life (The Scottish Government, 2009). In the UK, hospitals admission rate and mortality were greatest in patients with BMI below 20 (kg/m2) (Teo and Wynne, 2001). During nutrition screening survey in the UK various settings it was found that malnutrition doubles risk of mortality in the hospital patients and triples morality in elderly patients in hospitals following discharged (RCN and NPSA, 2009). Care Homes nutrition survey shown that 30 per cent of service users recently admitted to care homes were at risk of malnutrition (RCN and NPSA, 2009). According to Hickson (2006), malnutrition may be secondary to certain health conditions which is increasing risks for patients to become malnourished and those risk factors will be discuss later in this assessment (Hickson, 2006 and Teo and Wynne, 2001). However, European Nutrition for Health Alliance (2005) argued that malnutrition should be classified as independent disease (European Nutrition for Health Alliance, 2005), its due to undernutrition has a negative effect on all organs systems such as muscle-skeleton, cardiovascular, respiratory, gastrointestinal, endocrine systems and in addition, malnutrition has a psychosocial effect (Saunders, Smith and Stroud, 2010). It was found that undernutrition could cause following health conditions: in the healthy individuals and has advance exacerbation effects upon existent illnesses or injuries, reduced psychological wellbeing (increase anxiety, depression apathy, and loss of concentration and self-neglect) (Webb and Copeman, 1996 and Saunders, Smith and Stroud, 2010). According to Morley and Kraenzle (1995), balanced diet in general, is improving cognitive and memory performance in elderly (see Vetta et al, 1999). Chandra (1993) found that undernutrition is depressing organism immune function (see Webb and Copeman, 1996). It could be due to impaired cell-mediated immunity and cytokine, complement and phagocyte function this most commonly could lead to developing bacterial and parasitic infections and poor wounds healing (Saunders, Smith and Stroud, 2010). Malnourished patients have reduced muscle function, loss of cardiac muscle and reduce cardiac output, which results in impact on the renal function (Saunders, Smith and Stroud, 2010). The same individuals have reduced respiratory response to oxygen deficit by poor diaphragmatic and respiratory muscle function (Saunders, Smith and Stroud, 2010), increased risk of hypothermia, increase risk of falls and injuries (Webb and Copeman, 1996). In addition, redaction of fat and muscles mass are more obvious signs of malnutrition (Saunders, Smith and Stroud, 2010). According to Clayton (1991), malnourished elderly clients have a poor prognosis for recovery from following fractured femur, hypothermia, pressure ulceration and other conditions (Clayton, 1991). Fracture risk is high then calcium, magnesium and vitamin D intake is insufficient, during the weight loss bone mass is reducing as well (Saunders, Smith and Stroud, 2010). Early stage of malnutrition leads to loss of digestive enzymes that result in intolerance of lactose. The colon loses its ability to absorb liquid, electrolytes, and secretions of small and large bowels, which results in diarrhoea (Saunders, Smith and Stroud, 2010). According to Saunders, Smith and Stroud (2010), endocrine system is affected in malnourished patience. For example, chronic malnutrition will change the pancreatic exocrine function by reducing the insulin secretion (Saunders, Smith and Stroud, 2010). An author is currently working a nursing and residential care home for elderly patients as well as nursing and social recruitment agency, which is covering biggest part of the North West of England. Being allocated in hospitals and nursing homes the author noticed that patiences nutrition needs are being met well but where are still some areas for improvement. During the study carried out in the large the UK hospitals, it was found that 40 per cent patients admitted to hospitals were malnourished and two-thirds subsequently lost weight during their hospital stay (Teo and Wynne, 2001). During the service users meeting in the care home author working in, carried out in January this year, all 14 service users have stated that they are satisfied with food they are getting. However, two patients are still at risk of malnutrition. They have been referred to the GP for dietician support. The author strongly believes that nursing home is providing adequate food to the service users. Catering manager in the UK hospitals compare to chefs in nursing home have a small budge of  £11 to  £15 per patients a week (Teo and Wynne, 2001). The authors care home spends around  £30 per service user a week. However, in March 2007, Royal College of Nursing (RCN) carried out survey questioning nearly 2200 of their member relating nutrition issues. Survey has revealed that 42 per cent said the food provided for patients were below overage expectancy (RCN, 2011). In various reasons government and health profession organisations are now advising for routing screening of all patients admitted to any healthcare facilities (RCN and NPSA, 2009). In authors opinion, the main priority for addressing this issue is promoting patiences health and wellbeing and cutting financial cost. For example, annual financial cost of treatment malnutrition patience and any associated illnesses in the UK was estimated around 7.3 billion pounds. This figure includes treatment malnourished patience in the hospital setting, round 3.8 billion pounds and long-term care facility such as care home, round 2.6 billion (Elia M., et al., 2005). Causes of Malnutrition The author is currently looking after two service users who are scoring on the MUST. All two patients are elderly from 65 to 80 years old, with different background and health conditions. Patient No 1 is 87 years old female, was diagnosed with Alzheimers Disease, history of Transient Ischemic Attack (TIA), high blood pressure, right wrist fracture and Dysphasia. Current BMI is 19, which was stable after referral to dietician and commencing on oral supplements, than BMI was 17 back in the October 2010. Patient No 2 is 72 years old man, diagnosed with alcohol excess, CA oesophagus, Gout, Heart Failure. Current BMI is 23, which was stably increasing over past months following admission to nursing home, than his BMI was 17. Both patients have a poor appetite at present. Nursing homes staff cannot establish reasons for anorexia and BMI reduction in one patient. There are number of risk factors, which could cause malnutrition among elderly population. However, the most important factor leading to undernutrition is reducing of oral intake (Saunders, Smith and Stroud, 2010). Inadequate dietary intake is depending on various factors (Saunders, Smith and Stroud, 2010), which could be divided into three main categories: medical, social and psychological (Hickson, 2006). Firstly, age related changes such as changing in appetite or sensory (Teo and Wynne, 2001). Working in the care homes author noticed, an appetite is reducing with advanced age. Some people refused or preferred to omit meals, for example, one patient does not take breakfast, then the author asked her why she is not taken breakfast that patient replied that she is not a breakfast person. In addition, during the study carried out in USA it was discovered that elderly population are consumed less energy intake and follow more traditional eating pattern then younger population (Teo and Wynne, 2001). Poor appetite or anorexia is a most common factor leading to malnutrition in both young and old generation (Hickson, 2006). However, during the study commenced by Roberts et al (1994), it was found that ageing seemed to affect the ability to control food intake and weight lost will take longer to re-gains in elderly men compare to young (see Hickson, 2006). In addition, according to work of De Castro (1993), older people are less responsive to stomach contents than younger people, in term of hunger (see Hickson, 2006). Anorexia may occur as process of aging as well as during underlying illnesses (Teo and Wynne, 2001 and Hickson, 2006). Hetherington (1998) argued that changing in taste and smell could lead to loss of appetite through a perceived decline in the pleasantness of food. Loss of taste and smell could be associated with advance age and medications therapy mechanism of these changes are remains unknown (see Hickson, 2006). In authors care environment patients prefer to eat strong flavour and taste meals such as a roast meat with gravy, bacon, fish which are being served with traditional sauces or salt and vinegar to encourage patients to their food. According to Hickson (2006), a few works have been done to find out that improving the flavour of the food can improve diet intake and follow weight increase in hospitals and community healthcare patients (Hickson, 2006). A few patients do not like vegetables, intake of which have being recommended by NHS 5 a day complain based on the WHO (NHS, 2009). Patient No 1 and Patient No 2 do not have own teeth which is reducing ability to chew tender food. For both patients oral problems have not been reported. However, according to Finch et al (1998), National Diet and Nutrition survey, energy consumption was lower in edentate individuals compare to individuals with own teeth (see Hickson, 2006). Dysphasia or swallowing problem is leading concern in reducing dietary intake (Hickson 2006). The author has experienced that often care and catering staff do not understand the different between soft and liquidised diet and which diet should be given to each patients with dysphasia. Moreover, care staff that is responsible for feeding patients, needed assistant, every often do not understand the sings for swallowing problem. This concern has been addressed in the care home that the author is working in by appointed care staff for appropriate training section provided by Liverpool Primary Care Trust (PCT). According to research carried out by Mowe et al (1994), swallowing problem is showing up in 64 per cent of in-patience elderly (see Hickson, 2006). In addition, Gariballa et al (1998) argued that post Cerebrovascular Accident (CVA) patients with Dysphasia had a worse nutrition status then those patients without swallowing problems (see Hickson, 2006). The author strongly believes that malnutrition caused by various factors combined together such as old age and health or mental health problem (Saunders, Smith and Stroud, 2010). In the UK, it was estimated that around 8 per cent of patients with chronic diseases living in the community are malnourished (Teo and Wynne, 2001). According to Hickson (2006), diseases-related malnutrition is usually associated with cancer, physical disabilities, endocrinology disorder and respiratory disease, gastrointestinal disorders, neurological disorders, sources of infection and other psychological factors such as depression and Dementia (Hickson, 2006 and Teo and Wynne, 2001). Medical factors increase the risk of patient to become malnourish through, for example, nausea or vomiting, diarrhoea or constipation, anorexia and malabsorption (Hickson, 2006). Cultural factors or social (Vetta et. al. 1999) and food habits are also playing an important role in developing malnutrition as independent illness (Hickson, 2006). As example, an individual who had a long-term hospital stay or had no nutrition support while in the community would not used to have full nutritional meals. Moreover, individual who has been admitted to the authors care home used to take fast food or sandwiches at all the time while at home, instead of cooked meals. According to Hickson (2006), there are lifestyles and social risk factors for malnutrition in elderly people are lack of knowledge about food, nutrition and cooking, isolation and loneliness, poverty, inability to shop or prepare food (Hickson, 2006). Dementia has a great effect on individuals relationship with food (Alzheimers Society, 2011). Dementia patients or patients with low mental status appeared to lost weight due to reducing self-feeding ability, acute sense of smell and taste that is depending on severalty and progression of disease (Teo and Wynne, 2001). Berkhout et al (1998) has confirmed that weight lost in demented patients is caused by patients ability to feed them rather than by dementia as illness (Hickson, 2006). According to Incalzi et al (1998), study carried out for in-hospitals patients found out that cognition is causing impairment to ability or desire to eat (see Hickson, 2006). Progressive dementia is usually associated with uncontrolled weight lost and changing eating habits (Claggett, 1989 see Hickson, 2006). Nutrition screening and risk assessment In 2007, RCN commenced Nutrition Now campaign, which has a wide response from members of public as well as members of multidisciplinary teams. The RCN Principles for Nutrition and Hydration were published in 2007. That principals aim to help of all health professionals grades to improve nutrition and hydration of patience. This paper is highlighting three principles of nursing care: accountability, responsibility and management to improve the patience nutrition and hydration (RCN 2011). Nutrition screening pathway, nutrition risk assessment are widely used which assist nursing staff to indentify the risk of malnutrition or/dehydration and appropriate actions to be taken. Risk of malnutrition screening should be a routine process in all healthcare settings (RCN and NPSA, 2009). In the authors care home as required all service users are being screened for malnutrition on the admission and once a month or more often if required, using Malnutrition Universal Screening Tool (MUST) as recommended by government bodies and Care Quality Commission (CQC) as registration body. Part of the admission documentation is to collect and record patiences food likes and dislikes. According to Saunders, Smith and Stroud (2010), MUST is reliable and valid screening tool in diagnostic or prediction of malnutrition (Saunders, Smith and Stroud, 2010). However, nutrition assessment was only done for patients who have been referral to their GPs following scoring, weight loss of 1 to 2 per cen t per week, 5 per cent per month or 10 per cent over period of six months (Mitchell, 2003). According to RCN and NPSA (2009), purpose of nutritional assessment is details identification of nutritional status and for special dietary plan to be formulated and implicated (RCN and NPSA, 2009). In the authors care home, dietician or dieticians assistant based on the information provided by staff nurse on duty normally carries out the nutritional assessment. As far as author concerns, nutrition assessment should be done by care home nurses as they are working in close contact with patients and their families on the daily basis, know better persons food likes and dislikes. However, special nutrition trainings are not always available to the nursing home staff. This could lead to complicated nutrition issues not to be addressed as quickly as they should be due to community dieticians waiting time is usually 6 weeks. In the authors nursing home all necessary equipments are available such as weight scales and height measures. However, weight scales calibration has not been done which could lead to poor nutrition screening assessment (NPSA). After completing the MUST, the author and colleagues will formulate the personalised care plan for each patient in order to meet nutritional requirements. Nutrition care plan could be based on the information or guidance provided by dietician or other health professions. Treatment According to Hark and Morrison (2003), the nutrition needs of healthy older adults are mainly the same as for middle age adults (Hark and Morrison, 2003). The intake of food containing Calcium, Vitamin D, Folate, Vitamin B12 and B6 should be increased for the elderly population (Hark and Morrison, 2003). Protein intake recommendation is variable from 0.8 g/kg per day in the USA (Mitchell, 2003) to 0.75 g/kg in the UK (McKevith, 2009). However, according to Mitchell (2003), one established nutrition needs recommendation cannot be used for all ages population (Mitchell, 2003). In addition, patients lifestyle, height and weight should be taken in account (Mitchell, 2003). There are number of fundamental support of nutrition available at present such as enteral and parenteral nutrition support (Hark and Morrison, 2003). At this assessment only oral nutrition support (ONS) will be discussed. The aim of the nutrition support is to ensure an individual gets enough energy, proteins, macronutrients and micronutrients to meet patients nutrition requirements (Saunders, Smith and Stroud, 2010). Saunders, Smith and Stroud (2010) argued that provision of regular meals with better nutrition content, wide menu choice and assistant with feeding should be enough to meet nutrition requirement and reduce nutrition risk (Saunders, Smith and Stroud, 2010). Numerous studies show that nutrition support could reverse weight loss, only if underlying health conditions under control (Saunders, Smith and Stroud, 2010). However, not all patients react at the same way (Hickson, 2006). At what reasons care and treatment should take an account of individual needs and preferences (RCN and NPSA, 2009). In practice, knowledge of food preferences and past medical history, following personalised nutrition care plan, serving patients with small meals (Teo and Wynne, 2001) or using a small plate could encourage service user to finish all meal. Currently some of the UKs hospitals commenced to use red tray scheme for serving the meals to patients. A purpose of using red trays is to alert hospital staff that patience with red tray is at nutrition risk and need assistance or supervision with diet intake (Bradley and Rees, 2003 see Davis, 2007). Protection of mealtime scheme is also widely spread across the UK. The purpose of this scheme is to create an environment for hospital patients free from hospital activities and unnecessary disturbance during a mealtime. In addition, this scheme is to assist nursing staff with concentration on the meeting nutrition need of hospital patients (NS, 2007). People with Dementia could loss an ability to use cutlery that could lead to weight loss and malnutrition. Providing those patients with available finger food could improve nutrition status (Alzheimers society, 2011). Teo and Wynne (2001) argued that the possible benefits from using energy supplements in elderly patients have received little or no evaluation in clinical practice (Teo and Wynne, 2001). However, during the study carried out by Volkert et al (1996), it was found that patients consuming food supplement while in-patience and 6 months in community have develop positive nutritional status compare to group of patients without food supplements (see Teo and Wynne, 2001). The author has come across the situation then GP has refused to prescribe food supplement to one of the patience and recommended full fat milk instead. In addition, during controlled trial for six months in patients who have been discharged from hospital and prescribed ONS has no economic benefit. To compare, using ONS in community is costing more than using ONS in hospitals (Elia et al., 2005). However, malnourished patients using could be at risk of re-feeding syndrome, which could results in death (Saunders, Smith and Stroud, 2010). Re-feeding syndrome is associated with water retention leading to fluid overload due to decay of potassium, magnesium, phosphorus and sodium in blood plasma (Mallet, 2002). Saunders, Smith and Stroud (2010) recommended that during re-feeding saviour malnourished patients potassium, phosphate and magnesium should be prescribed and thiamine (for patients with history of alcohol excess) (Saunders, Smith and Stroud, 2010). Conclusion The UK elderly population is rising, currently about 16 per cent of the population is above 65 (Hickson, 2006) and by 2050 over 30 per cent European population will be over 60 which will result in prevalence of malnutrition to rise (European Nutrition for Health Alliance, 2005). Many changing associated with aging have been documented, however, how senescence leads to the health conditions, related to aging, is still unknown (Mitchell, 2003). It was found that ageing is leading to slow reduction of weight and modification in body composition. It is due to declines in bone, muscle mass and body cell mass. Bone mass reduced due to inadequate intake of Calcium and inadequate exposure skin to the sunlight to encourage production of Vitamin D (Sahyoun, 2002). In general, people are gaining weight until they 60th birthday and after gradually reducing weight, usually 10 per cent between 70 and 80 (Mitchell, 2003). Weight loss related to aging and malnutrition should be indentified during initial nutrition assessment. In addition, community healthcare is facing many concerns. Firstly, malnutrition remains under-recognized problem facing patients, their families and health professions (Saunders, Smith and Stroud, 2010). Secondly, according to, Hark and Morrison (2003) argued that there are no single physical or biochemical screening tools could accurate predict the nutrition status in elderly (Hark and Morrison, 2003). Food prices are constantly rising and ONS are costing too much to the local PCT. In the authors opinion, providing service users with good quality food, offer choice of menu and snacks between meals are solution to fight malnutrition. The significant role in education medical students and junior doctors in nutrition has widely recommended (Saunders, Smith and Stroud, 2010). However, inadequate knowledge in nutrition of nursing and care staff could increase risk of malnutrition (Saunders, Smith and Stroud, 2010). In the authors care home nutrition in elderly is not mandatory training for the care staff. Following this assessment, the author will provide relevant care staff with information on the nutrition in elderly service users. This could be achieved through supervision sections and face-to-face talks. Moreover, there it is possible, elderly population and their families should be informed about the latest nutrition recommendations related to their age, lifestyle and health conditions and should encouraged to apply those recommendations to individuals lives (Sahyoun, 2002).

Events Provision in Birmingham

This assignment will identify the range of events being promoted in the city of Birmingham, it will also classify whether the events are organised by the public, private or voluntary sector. There will also be an overview of the visitor's perception of the city and event and finally it will analyse the local resident's attitudes towards the event. The six events which will be analysed are the MPH Show '06, which is a motor event hosted by Jeremy Clarkson. Mitchell and Webb Live, which is a comedy sketch show. The BBL Cup Final. The Survivor Series Tour, which is a sports entertainment event. Mela 2006 and the final event is Little Britain Live. Theorists such as Allen 2002 state that an event is defined as a significant gathering or activity that takes place often in a social setting. (J. Allen 2002) The first event, which will be analysed, is the MPH Show '06. The event was in operation between 26-29 October 2006 at the NEC Birmingham. The MPH Show's web page describes the event, as â€Å"a 75 minute theatre show in an explosive combination of car chases, outrageous stunts, incredible driving and world debuts. A personal look at the finest selection of the most stylish, rare and expensive cars in our galleried exhibitions – its motoring heaven!† (www.mphshow.co.uk) This event can be categorised under the mega events typology group. The reason for this is that the event has the potential to attract over one million visitors. A further reason that this event can attract a vast amount of large visitors is that well-known motoring expert Jeremy Clarkson is hosting it. Due to the motor show being taken away from Birmingham, The MPH Show can be its ideal replacement and generate a high level of economic and tourism impact into Birmingham. Theorist such as Getz 1997 states, â€Å"Mega events, by way of their size or significance are those that yield extraordinarily high levels of tourism, media coverage or economic impact for the host community and destinations.† (Getz 1997) There could be arguments suggesting that it can be put under the special events typology. The reason for that being that the event is a one off event and is an event, which comes under persons social activities such as football and music. The second event that will be analysed is Mitchell & Webb Live, which will take place at the Birmingham Hippodrome on 5th November. The event brings comedian duo David Mitchell and Robert Webb to the Hippodrome as part of their live tour. This event can be categorised under the special events typology group. Getz states, â€Å"A special event is a one time or infrequently occurring event outside the normal programme or activities of the sponsoring or organising body.† (Getz 1997- lecture hand out) The third event that will be analysed is the Survivor Series Tour, which is organised by sports entertainment company WWE. The event will be held on 12th November 2006 at the NEC. This event can be categorised into the special events group. The reason for this is that it is part of a person's social interest and it is place where they can go with family and friends to the event. Getz 1997 states, â€Å"To the customer or guest, a special event is an opportunity for leisure, social or cultural experience outside the normal range of choices or beyond everyday experience.† (Getz 1997) The fourth event, which will be analysed, is Little Britain Live, which will be held in The NIA. According to the NEC group website, â€Å"David Walliams and Matt Lucas have extended their phenomenal Little Britain Birmingham tour dates with a 14th night at The NIA on Saturday 9 December.† (www.necgroup.co.uk) This event can be categorised in to the special events typology category, due to this event being a social interest event. The fifth event, which will evaluated is the BBL Cup Final that will be held in The NIA. The BBL Cup Final is the basketball tournament finals that will come to a climax in Birmingham. Also in the event are the women's basketball tournament finals. This type of event can be categorised under the hallmark typology. The reason for this is that it is a one off event. Theorist such as Ritchie 1984 defines a hallmark event as â€Å"A major one-time or recurring event of limited duration, developed primarily to enhance the awareness appeal and profitability of a tourist destination in the short or long term.† (Ritchie 1984) The final event is The Asian Mela 2006, which is to be held between 17-19 November 2006 at the NEC. The Asian Mela is an event targeted at the Asian community by holding an event that has Asian fashion, entertainment and many more experiences. This type of event can categorised in to the special events typology group. A special event recognises a unique moment in time with ceremony and ritual to satisfy specific needs. The reason for this being is that it relates to the cultural aspects of the Asian community and also can be an event that brings together people from different backgrounds to celebrate Asian lifestyles and how it has made an impact in today's British society. The second part of this assignment will identify whether the events have been organised by private, public or voluntary sectors. The Mph Show was organised by the fuel company shell. Shell is considered a global group that produces oil, fuel and other types of energy sources. The company is considered part of the private sector. Theorist such as Fardon state, â€Å"The private sector compromises of businesses which are directly or indirectly in private ownership.† (Fardon 2000) The Mitchell & Webb Live event is being presented at the Birmingham Hippodrome. The Hippodrome is a theatre, which is a charity run theatre. The charity ‘The Friends of The Hippodrome' is an organisation, which counts on donations from corporations such as Lloyds TSB and even donations from the public. The Survivor Series event, which is an event run by the sports entertainment company WWE. The company is a private limited company that runs live events mainly in the United States, but also tours the rest of the world. The Little Britain Live event, which is being shown at the NIA. The event is by the NIA group, which is linked with the city council. This sector can be put in the public sector, as it is part of the district council. The BBL Cup Final is an annual event, which is to be held at the NIA, is being organised by the British Basketball League Association. This is part of the public sector. Websites such as www.whatsis.techtarget.com have given a definition to the public sector, which states, â€Å"The public sector overlaps with the private sector in producing or providing certain goods and services. The extent of this overlap varies from country to country, state to state, province to province, and city to city.† By evaluating this statement and relating it to events, the public sector needs sum form of assistance from the private sector such as funds and sponsorship. It can be an advantage for both private and public sectors, as the private sector organisation is getting good recognition by giving a helping hand to the public sector organisation. The Asian Mela event is presented by the Asian television station Zee and events firm Clarion Events. Both companies are part of the private sector. This part of the assignment will explain the impact that the actual events provision of the city has on visitor perceptions. When discussing event impacts there are various elements that need to be considered. These elements are as follows, social/cultural, economics, political and developmental. The social/cultural implications are to bring increased community spirit and bring people from different cultures to unify and enjoy the events. In today's world, there are many negative issues surrounding different cultures. It is vital that there are events that can bring people from different backgrounds and faiths so that they can enjoy them without any fear or scepticism. The economic side of the impact is that it can help with the cities revenue, resulting in the city bringing more events and even construct new buildings to present the events. As Birmingham is one of the United Kingdoms visited places with hot spots such as The Bull Ring and The Mail Box for shopping and leisure and recreational areas like Star City and AMC. Which ever type of event is happening in Birmingham there is high possibility of tourists staying over the local hotels and bed and breakfasts, which also is a plus for the local businesses as well as the city. The political element is that increases the cities national reputation and improves its profile. The developmental and environmental elements of having events in Birmingham are that it can have effects such as urban regeneration. This can have a positive outcome on the less funded areas of the city. With the money generated from these events, by giving the lesser funded area's resources to rejuvenate the area by constructing community centres for young people who have broken backgrounds to learn new skills and make more of their lives. When considering these types of impacts for the events chosen for this assignment. The MPH Show will bring in many visitors who have an interest for exotic and concept cars, these are also known as ‘petrol heads'. The main target market for this event will be 18-30 mainly male. The economic side of the event will be a benefit as it is running for three days, this is a bonus for hotels as there will be visitors from outside of Birmingham who may want to go to the show, whilst site seeing and going to local businesses. The political element will be affected, as Birmingham was once home to the motor show. By having this type of event with a well-known host such as Jeremy Clarkson may not replace the revenue and the publicity that the city used to get from the motor show, but it will be a stepping-stone to bringing in similar types of events to the city. The BBL Cup Final will target mainly basketball fans from different ages. Although basketball is not one of England's favourite sports, a minority can be targeted effectively. The economic element will bring in the minority of basketball fans through as much advertising there can be. This can also be a positive for accommodation businesses. Whether or not the NIA is going to remain being the host of the tournaments finals, it will be a positive for the city council, which can attract other indoor sports events. The Survivor Series event will be targeting mainly young males aged 16 and over. However, there has been an increase in female attendances to the sports entertainment events. Although the company is originated in the United States, the business does have strong relations within the UK. This can bring in tourists from outer Birmingham and even out of England. This resulting in massive revenue for hotels and other local businesses. The Mitchell and Webb Live and Little Britain Live events will both have similar type of element results. The target for these events are going to be varied as the events are based on shows from television, this is a positive because it can attract young and older generations. Economically it will be good for the city as these events are apart of a long tour, generating revenue for local businesses. This will raise the profile of the city by having well known comedy gigs and even make aware of other comedy performances to add the city to their tours in the near future. The Asian Mela event will target mainly the Asian community and even target other cultures, as it is known that different cultures are adapting Asian fashion in to their lifestyles. This will be a good event for local businesses, as the event will attract tourists from other regions. Regarding the political element, this is an event that will be popular as the more it goes grows with the community, there will be more ideas for events for other cultures. By attracting the non Asian community to the event, it can bring a unity to the general public and let the people know that there is room for understanding to the cultures and not the dark cloud that hangs around the Asian community as misinterpreted in today's media. The final part of this assignment will consider local residents attitudes to the events within their city. When events such as the MPH Show come into Birmingham, resident's attitudes are going to be stereotypical. They may assume that the event may attract a group of hooligans and maybe concerned that there will be a riot of some sort. The residents will more likely welcome the sporting events the BBL Cup Final and the Survivor Series Tour, as they are events the whole family can go and watch. The basketball final's tournament is something in which the local residents can be proud that their city is part of. This can result in pride in association with the city. It can also be a positive for locals because it is bringing in tourists and even be welcomed by shops and other business. The comedy events Little Britain Live and Mitchell & Webb Live will be welcomed, as both events are family friendly and are based on television shows that are well known. Birmingham is known for being a cultured city, with evidence being backed up by Birmingham City Councils webpage which provides statistics in the form of charts. One way of showing this is by holding an event targeted for its Asian community, The Asian Mela. As Birmingham has a high percentage of Asians as one of its many ethnic groups, the Asian community will welcome the event. By holding this event, it can even attract other people from different ethnic groups and be welcomed by everyone. A family event for al to enjoy the community will be proud to have it in their city. In conclusion a city such as Birmingham will welcome it. The main factor is that it can hold majority of events within its venues such as the NEC, the NIA and the Symphony Hall. Bringing in more events will increase tourism and revenue for the city. This is a plus as the money generated from the events can go on to bring in more opportunities for people with different interests and backgrounds. Making the city a hotspot for events.

Ten Alpina Tools

Giulia seems to be excited about the opportunity to own her own business doing something that she loves. There is a high level of uncertainty here in whether or not Giulia would make a profitable business. It seems that there is room for improvement in the current operations since all 6 workers were cross trained and they were currently only busy for about one weeks worth of labor time per month. Giulia does have an MBA and may be able to recognize ways to use the resources more efficiently and keep production costs down. Giulia will need to practice her strategic thinking to determine how to balance the resources on hand to make this situation work. If she can offer the units for $11.70 or higher, she may be able to maintain the business but she will need to drive down the production costs to sustain profits. If any equipment needs repairs or the building needs renovations, those costs are not going to be covered under her current pricing plan. Also, if production increases, variabl e costs may also increase so it will be important for Giulia to pay close attention to this.After reading the case we identified the following risks;1) Graduate School/ MBA: The case takes place as Giulia is returning from summer break after her first year. Given the intense work load of an MBA program and the workload requirements of a startup/expansion, we have to question if she can do both effectively. Quantitative Analysis: LOW†¦. This is more of a time and lifestyle concern.2) Loss of the single customer contract: Anytime a business is relying on a single customer it’s a risk. Giulia is using the cash flow from this customer to support the new venture. There is not a strong history here for her to count on and lack of data increases risk. In addition she also is highly at risk should her customer go out of business or find another supplier; she would be hard pressed to meet her monthly burn rate.In fact there is no evidence in the case that her business could survi ve without that contract. Quantitative Analysis: HIGH†¦.. The key issue here is that the business is running on very thin margins and the cash flow from this customer is critical for Giulia to cover her fixed and variable costs. There is no evidence that she has cash reserves or any access to investors.3) Employee/Operations issues: Giulia has no experience in this industry and we have no evidence that she has ever managed people or managed a manufacturing process. Due to her thin margins any interruption in production would be devastating. Quality is a huge concern here and although her team is â€Å"cross trained† on all the equipment it’s reasonable to assume that there will be employee turnover.She will need to replace them and we don’t know what they training cycle is and how it will impact  production and quality. Qualitative Analysis: HIGH†¦Ã¢â‚¬ ¦ Production ties directly to the ability to fulfill the contract. This contract is key to her cas h flow and the margins are small. Giulia needs to determine the new employee training cycle and factor that into production and cash flow projections.4) Increased Costs: If Giulia experiences an increase in production or fixed costs she is in a very risky situation. Her margins are thin and we have no evidence of cash reserves. Qualitative Analysis: HIGH†¦.. Any increase to costs cuts into margins. Giulia is not in a position to handle such increases.5) Re negotiation or delays on the single contract: The single customer could ask for a lower price point, lower volume or attempt to renegotiate payment terms. Qualitative Analysis: HIGH†¦.. As we have seen a key concern in this case are the margins. Any decrease in price or payment schedule will have a direct impact on Giulias ability to cover her costs

Trumpet Fish Facts

Trumpet Fish Facts Trumpet fish are part of class Actinopterygii, which consists of ray-finned fish, and can be found in coral reefs throughout the Atlantic, Indian, and Pacific oceans. There are three species of trumpet fish under the scientific name Aulostomus: the West Atlantic trumpetfish (A. maculatus), the Atlantic trumpetfish (A. strigosus), and the Chinese trumpetfish (A. chinensis). Their name is derived from the Greek words flute (aulos) and mouth (stoma) for their long mouths. Fast Facts Scientific Name: AulostomusCommon Names: Trumpetfish, Caribbean trumpetfish, stickfishOrder: SyngnathiformesBasic Animal Group: FishDistinguishing Characteristics: Long, slender bodies with a small mouth, varied colors.Size: 24-39 inchesWeight: UnknownLife Span: UnknownDiet: Small fish and crustaceansHabitat: Coral reefs and rocky reefs throughout the Atlantic, Indian, and Pacific oceans.Population: UnknownConservation Status: Least ConcernFun Fact: Male trumpet fish carry fertilized eggs with them until they hatch. Description Trumpet fish have elongated bodies and snouts leading into a small jaw. The lower jaw has small teeth, and their chin has a short barbel for defense. They also have a row of spines on their backs that can be raised to ward off predators, and their body is covered with small scales. Trumpet fish can grow anywhere from 24 to 39 inches depending on the species, with A. chinesis reaching up to 36 inches, A. maculatus averaging 24 inches, and A. strigosus reaching up to 30 inches. Their coloration helps them blend in with their environment, and they can even change their colors for stealth and during their mating ritual. Habitat and Distribution Trumpetfish in Chichiriviche de la Costa,Venezuela,Caribbean Sea. Humberto Ramirez/Moment/Getty Images A. maculatus are found in the Caribbean sea and off the northern coasts of South America, A. chinensis are found throughout the Pacific and Indian oceans, and A. strigosus are found in the Atlantic ocean off the coast of Africa and parts of South America. They live in coral reefs and reef flats in the tropical and subtropical waters in these areas. Diet and Behavior A trumpet fish’s diet consists of small fish and crustaceans, as well as occasionally larger fish. For larger prey, trumpet fish swim near large herbivorous fish to hide and ambush their prey. To catch smaller food, they float in a vertical, head-down position among corals to conceal themselves- a technique that also hides them from predators- and wait for their prey to come across their path. They capture them by suddenly expanding their mouth, which generates a suction strong enough to draw in their prey. Additionally, they can also consume fish larger than the diameter of their mouths due to the elasticity of their tissue. Reproduction and Offspring Not much is known about trumpet fish reproduction, but trumpet fish begin courtship via a dancing ritual. Males use their color changing abilities and dance to win over females. This ritual occurs close to the surface. After the ritual, females transfer their eggs to the males to fertilize and care for until they hatch. Like seahorses, the males care for the eggs, carrying them in a special pouch. Species Trumpetfish. Daniela Dirscherl/WaterFrame/Getty Images Plus There are three species of Aulostomus: A. maculatus, A. chinensis, and A. strigosus. The coloration of these fish changes depending on the species. A. maculatus are most commonly reddish-brown but also can be grey-blue and yellow-green with black spots. A. chinensis can be yellow, reddish-brown, or brown with pale bands. The most common colors for A. strigosus are brown or blue, green or orange tones, or intermediate shades. They also have a pattern of pale, vertical/horizontal lines across their body. A. chinensis are seen in shallow reef flats of at least 370 feet. They can be seen swimming close to coral or rocky sea floors or floating motionless under ledges. A. strigosus are a more coastal species and are found over rocky or coral substrates in inshore waters. A. maculatus range in depth from 7-82 feet and are found close to coral reefs. Conservation Status All three species of Aulostomus are currently designated as least concern according to the International Union for Conservation of Nature (IUCN). However, the A. maculatus population has been found to be decreasing, while the populations of A. chinensis and A. strigosus are currently unknown. Sources Aulostomus chinensis. IUCN Red List Of Threatened Species, 2019, https://www.iucnredlist.org/species/ 65134886/82934000.Aulostomus maculatus. IUCN Red List Of Threatened Species, 2019, https://www.iucnredlist.org/species/16421352/16509812.Aulostomus strigosus. IUCN Red List Of Threatened Species, 2019, https://www.iucnredlist.org/species/ 21133172/112656647.Bell, Elanor, and Amanda Vincent. Trumpetfish | Fish. Encyclopedia Britannica, 2019, https://www.britannica.com/ animal/trumpetfish.Bester, Cathleen. Aulostomus Maculatus. Florida Museum, 2019, https://www.floridamuseum.ufl.edu/discover-fish/species-profiles/aulostomus-maculatus/. Eastern Atlantic Trumpetfish (Aulostomus Strigosus). Inaturalist, 2019, https://www.inaturalist.org/taxa/47241-Aulostomus-strigosus. Trumpetfish. Lamar University, 2019, https://www.lamar.edu/arts-sciences/biology/marine-critters/marine-critters-2/trumpetfish.html. Trumpetfish. WaikÄ «kÄ « Aquarium, 2019, https://www.waikikiaquarium.org/experience/anim al-guide/fishes/trumpetfishes/trumpetfish/.

Examples and Definition of Discourse Domain in Speech

Examples and Definition of Discourse Domain in Speech In sociolinguistics, the term discourse domain refers to features or conventions of language use determined by the context in which communication takes place. A discourse domain typically includes a variety of registers. Also known as  cognitive discourse domain, discourse world, and knowledge map. A discourse domain can be understood as a  social construct as well as a cognitive construct. A discourse domain is made up of individuals who exhibit their own distinctive knowledge structures, cognitive styles, and biases. However, within the boundaries of a domain, there is continual interaction between domain structures and individual knowledge, an interaction between the individual and the social level (Hjà ¸rland and Albrechtsen, Toward a New Horizon in Information Science, 1995). See Examples and Observations below. Also, see: Cognitive LinguisticsConversation AnalysisDiscourseLinguistic VariationPragmaticsSpeech Community Examples and Observations Along the lines of what Wittgenstein called (2009) language games and Levinson (1979) labelled activity types,  discourse domains are  frameworks for conduct that organize participants verbal and non-verbal comportment around  recognized modes of activity grounded in shared norms, purposes and goals. Relevant activities include playing tennis, having an academic debate, or going on a walk with a dog- in short, activities that involve interacting with one or more human or non-human others in a particular setting and for specific kinds of reasons. -(Daniel Herman, Building More-Than-Human Worlds.  World Building: Discourse in the Mind, ed. by Joanna Gavins and Ernestine Lahey. Bloomsbury, 2016) These are some domain contextual examples (Based on Hymes, 1974; Gumperz, 1976; Douglas Selinker, 1985a): physical: setting, participants;phonological: voice tone, pitch, tempo, rhythm, volume;semantic: code, topic;rhetorical: register, style, genre;pragmatic: purpose, interactional salience;paralinguistic: posture, gesture, gaze, facial expression. The above list is not intended to be exhaustive and there are no doubt other types of contextualization cues, but it does give the reader a sense of the types of information available to language learners/users in communication situations. -Dan Douglas, Discourse Domains: The Cognitive Context of Speaking. Studying Speaking to Inform Second Language Learning, ed. by Diana Boxer and Andrew D. Cohen. Multilingual Matters, 2004 Contexts and Discourse Domains [A] discourse domain is a cognitive construct created in response to a number of factors, including semantic category, but also to other features of situational and linguistic context. For example, when we enter a room where a conversation is going on, we of course pay attention to the topic of the talk, but we also take note of a number of other features of the situation, including the physical setting, who the participants are, what the purpose of their conversation appears to be, whether the conversation seems to be businesslike, friendly, or angry, what features of language the participants are using, and what relationship they appear to have with each other. Depending upon our analysis of the situation in terms such as these, we might feel that this is a situation we are familiar with and would feel comfortable joining; in other words, as Douglas and Selinker would say, we possess a discourse domain for dealing with this communication situation... [D]iscourse domains are developed or engaged in response to signals in the situational and linguistic environment which interlocutors attend to in interpreting (indeed, creating) context. -Dan Douglas, Discourse Domains: The Cognitive Context of Speaking. Studying Speaking to Inform Second Language Learning, ed. by Diana Boxer and Andrew D. Cohen. Multilingual Matters, 2004 The Discourse Domain of Higher Education All persons involved in formal education at some point find themselves participating in various sorts of encounters, including less formal interactions in small groups- in laboratories, study groups, or colloquia. It is important to know how to display oneself as intellectually competent, and this is done more often than not through face-to-face interactions...How to utilize powerful speech behaviors without presenting oneself as arrogant involves a careful dance of negotiation. Joking, teasing, challenging, asking questions and commenting, getting and holding the floor- these are all important phenomena of face-to-face discourse in higher education... The discourse domain of education is one that everyone experiences. As an increasing number of citizens seek a higher education, it becomes ever more critical to understand how to negotiate relationships in this domain of interaction. The stakes are high. -Diana Boxer, Applying Sociolinguistics: Domains and Face-to-Face Interaction. John Benjamins, 2002 Story-Telling as a Discourse Domain There are clear reports that have shown that storytelling as a particular discourse domain is an activity that follows a well-delineated line of development within the mainstream culture. From very early on mother and child engage in an interaction format that resembles a book reading activity in the sense that both participants engage in a labeling game of more or less decontextualized units (cf. Ninio Bruner 1978; Ninio 1980). The capacity to label is not only a necessary prerequisite for the joint storytelling activity, it is also an activity that is propagated and embellished with short picture book-like stories that develop into more complicated narrations in the course of the pre-school years. -Michael G. W. Bamberg, The Acquisition of Narratives: Learning to Use Language. Mouton de Gruyter, 1987

Traveling Abroad Essay Example | Topics and Well Written Essays - 500 words

Traveling Abroad - Essay Example Venezuela, Russia, South Korea and China, have also been enlisted to be ranked in the category of projecting unfriendliness towards foreign visitors (Cha, 2013). Nevertheless, as these places present some unique tourism cultures and attractions, tourists can take certain preventive measures when visiting these places. It is worth mentioning in this context that the top priority of every tourist or traveller should be to look forward to his/her own safety first and then, worry about their travelling experiences. An individual should also take into consideration certain essential facts before going for an international trip. Above all, the most important fact is that every foreign visitor, no matter to whichever nation they visit, should go through the past records of every foreign visitor related crime that occurred within that nation and take requisite measures thereto (U. S. Passport & International Travel, 2014). They should also have some formulated backup planning about how to save themselves in case they get into any sort of trouble. Apart from this, the travelers should also book travel packages through registered traveling agencies. Adding to that, they should continuously keep in touch with their family members or some local law authorities who might be helpful in case the travelling individuals get into any sort of trouble (U. S. Passport & International Travel, 2014). Moreover, every international airport is quite likely to maintain a certain degree of safety and an authoritative body who can provide necessary information on the risk rates of various areas within their countries. Apart from these safety measures, the tourists should also keep hold of their necessary identification documents. They should avoid high level of exposure and contact with local inhabitants as well. The visitors should further keep

Constitutional and Administrative Law Essay Example | Topics and Well Written Essays - 1000 words

Constitutional and Administrative Law - Essay Example Out of the three mentioned above the parliamentary sovereignty is the elementary principle which guides the action of the constitution. The root of the doctrine is in the political events of the late seventeenth century and the legal hypothesis propounded by Professor Dicey (Loveland, I, 2006, pp. 21-93.). The Parliament is a sovereign law creator and thus has the power to either make or unmake any law. According to Dicey (1885:39-40), â€Å"Parliamentary sovereignty means Parliament has the right to make or unmake any law whatever; and, further, that no person or body is recognized by the law of England as having a right to override or set aside the legislation of Parliament†(Turpin, C. & Tomkins, A, 2007, p.40). Thus this doctrine entails that there is no law which is higher than the Act of Parliament. The Human Rights Act 1998 contributed the European Rule on Human Rights into UK domestic law. Section 3 of the Act produces an informational responsibility for the courts. It calls for all Acts of Parliament to be understood in a manner which is well-suited with the Convention rights. The informational powers of the courts can change the meaning of legislation when the circumstances demand for it, even though it may be clear that such an intrepretation is against the intention of the legislature. In cases of discrepancy the courts are handed the opening to make a proclamation of repugnance (section 4 of the Act)( http://www.opsi.gov.uk/ACTS/acts1998/19980042.htm accessed on 13th August 2009..) The Human Rights Act 1998 also disputed the querry of whether it is reliable to the principle of Parliamentary sovereignty. Even if it is feasible for the parliament to revoke or alter the Act, it can certainly be said that parliament can not break out from the force which the public opinion o n Human Rights puts on it. According to Elliot "it will become much rarer for legislation to contradict human