Marketing Management Assignment-Smu Essay Example for Free

Marketing Management Assignment-Smu Essay Q.1 A. Explain the six criteria for effective market segmentation * Identity The marketing manager must have some means of identifying members of the segment i.e., some basis for classifying an individual as being or not being a member of the segment. There must be clear differences between segments. Members of such segments can be readily identified by common characteristics as they display similar behavior. * Accessibility It must be possible to reach the different segments in regard to both promotion and distribution. ln other words, the organisation must be able to focus its marketing efforts on the chosen segment. Segments must be accessible in two senses. First, firms must be able to make segmented customers aware of products or services. Second, they must get products to them through the distribution system at a reasonable cost. * Responsiveness — A clearly defined segment must react to changes in any of the elements of the marketing mix. For example. if a particular segment is defined as being cost-conscious, it should react negatively to price rises. If it does not, this is an indication that the segment needs to be redefined. * Size The segment must be reasonably large to be a profitable target. Lt depends upon the number of people in it and their purchasing power. For example, makers of luxury goods may appeal to small but wealthy target markets whereas makers of cheap consumption goods may sell to a large but relatively poor target markets. * Nature of demand — lt refers to the different quantities demanded by various segments. Segmentation is required only if there are market differentiation in terms of demand. The marketing manager should not only be able to find out the total demand and the differences in demand patterns in each of these segments. * Measurability — The purpose of segmentation is to measure the changing behavioural pattern of consumers. For example, the segment of a market for a car is determined by a number of considerations, such as economy, status, quality, safety, comforts, etc. B. Discuss the types of target marketing strategies. * Undifferentiated marketing strategy or mass marketing strategy In the absence of a proper mechanism to classify the market into a number of markets segments and analyse their potential, many firms decide on the mass marketing strategy. In this case, the marketer goes against the idea of a differentiated market and decides to sell the product to the whole market. Here the marketing manager ignores the idea of segment characteristics and differences, and develops a unified marketing programme for the entire market. This strategy keeps the overall marketing costs low and makes it easier to manage and track the market forces uniformly. The marketer tries to find out commonalities across various segments rather than focusing on the differences between segments. * Concentrated marketing strategy In the second alternative strategy, the marketing manager decides to enter into a selected market segment instead of all the available market segments. When resources and market access are limited and the company has to face intense competition, the marketing manager has to stretch the budget for market coverage. In this case, the company is likely to follow the concentrated marketing strategy. * Differentiated marketing strategy Many marketers choose to target several segments or niches with a differentiated marketing offer to suit each market segment. Maruti is the leading automobile company, which has the distinction of having different products for different market segments. Q.2 Explain the consumer buying decision process. * Problem recognition A buying process starts when a consumer recognizes that there is a substantial discrepancy between his/her current state of satisfaction and expectations in a consumption situation. A need can be activated through internal or external stimuli. The basic needs of common men rise to a particular level and become a drive. From their previous experiences, they know how to satisfy these needs like hunger, thirst, sex, etc. This is a case of internal stimulus. A need can also be aroused by an external stimulus such as sighting a new product in a shop while purchasing other usual products. * Information search After need arousal, the behaviour of the consumer leads towards collection of available information about various stimuli. ln this case, information about products and services are gathered from various sources for further processing and decision-making. The first source of consumer information is the internal source. This means the consumer first search the information regarding the relevant product from his/her inner memory. If the information is not available from internal source for making a purchase decision he or she may collect information from external sources. A External sources for desired information can be grouped into four categories. * Personal sources (family, friends, neighbors, and peer group) * Commercial sources or market dominated sources (advertisements, salesmen, dealers, and company owned sales force) * Public sources (mass media, consumer rating organisations, and trade association publications) * Experiential sources (handling, examining, and using the product) The marketer will find it worthwhile to study the consumers’ information sources when: * A substantial percentage of the target market engages in the search * The target market shows some stable patterns of using the respective information sources. * Alternative evaluation Once interest in a product(s) is aroused, a consumer enters the subsequent stage of evaluation of alternatives. Evaluation leads to formation of buying intention that can be to either purchase or reject the product/brand. The final purchase will however depend on the strength of the positive-intention, which is the intention to buy. * Purchase decision Finally the consumer arrives at a purchase decision. Purchase decisions can be any one of the three no buying, buying later, and buy now. No buying takes the consumers to the problem recognition stage as their consumption problem is not solved and they may again get involved in the process as we have explained. A postponement of buying can be due to a lesser motivation or evolving personal and economic situation that forces the consumer not to buy now or postponement of purchase for future period of time. If positive attitudes are formed towards the decided alternative, the consumer will make a purchase. * Post-purchase behaviour Post-purchase behaviour refers to the behaviour of consumers after their commitment to a product has been made. It originates out of consumers’ experience regarding the use of the product and is indicated in terms of satisfaction. This behaviour is reflected in repeated purchases or abstinence from further purchase. A satisfied product-use experience leads to repeated purchase, referrals from satisfied customers to new customers, higher usage rate, and also brand advocacy. Q.3 A. Discuss the Henry Assael model on buying decision behaviour. Henry Assael has come up with an explanation to analyse why consumers buy the goods they buy. He explained the relationship between the level of involvement by the consumers in the purchase of goods and services and the level at which diverse goods or services differ from one another. High involvement Low Involvement Signiï ¬ cant differences Complex Variety Seeking between brands Buying Behaviour Buying Behaviour Few differences Dissonance Reducing Habitual Buying between brands Buying Behaviour * Complex buying behaviour — Consumers are highly involved in a purchase and aware of significant differences among brands. This is usually the case when the product is expensive, bought infrequently, risky, and highly self-expressive. Typically the consumers dont know much about the product category and have more to learn. Example: personal computer. * Dissonance-reducing — sometimes, the consumer is highly involved in a purchase but sees little differences in the brands. The high involvement is based on the fact that the purchase is expensive, infrequent, and risky. Example: carpet. After purchasing the carpet, consumers might experience dissonance that stems from noticing certain disquieting features of the carpet or hearing favorable things about other carpets. * Habitual buying behaviour Many products are bought under conditions flow consumer involvement and the absence of significant brand differences. Considering salt, consumers have little involvement in this product category. They go to the store and reach for a brand. If they keep reaching for the same brand, it is out of habit and not strong brand loyalty. * Variety-seeking buying Some buying situations are characterized by low consumer involvement but significant brand differences. Here consumers often do a lot of brand switching. Consumers do the brand switching for the sake of variety rather than dissatisfaction. Example: wafer potato chips. B. Explain the five stages of Adoption Process. * Awareness During the first stage of adoption process, the product innovation is explained to the consumers. This process gives information about the new product or service. * Interest When consumers develop an interest in the product or product category, they search for information about how the innovation can benefit them. * Evaluation The evaluation stage represents a kind of ‘mental trial’ of the product innovation. Only if the consumers’ evaluation of the innovation is satisfactory, they will actually try the product. In case the evaluation is unsatisfactory, the product is automatically rejected. * TriaI- ln this stage- consumers use the product on a limited basis. Their experience with the product provides them with the critical information that they need to adopt or reject it. * Adoption -In this stage, consumers decide to make full and regular use of the product. Q.4 Describe the components of the micro environment of marketing * The company Some company factors that affect the marketing decisions are: Culture and value system — Organizational culture can be viewed as the system of shared values and beliefs that shape a company’s behavioural norms. A value. is an enduring preference as a mode of conduct or an end state. The value system of the founders of the organisation has a lasting impact on it. The value system not only influences the working of the company and the attitude of its people but also the choice of its business. 1. Mission and objectives — The mission and objectives of the company guide the priorities, direction of development, business philosophy, and business policy. 2. Management structure and nature Structure is the manner in which the tasks and sub-tasks of the organisation are related. Structure is concerned with the hierarchical relationship and the relationship between the management of different functional areas like the structure of the top management and the pattern of share holding. 3. Human resource This concerns factors like manpower planning, recruitment and selection, compensation, communication, and appraisal. * Intermediaries intermediaries are independent business units and they carry the company’s products and services to the customers. Prominent intermediaries include wholesalers, retailers, merchants, selling agents, brokers, etc. Their objective of being in business is different than being in a firm, so the intermediaries will be interested in maximizing their profits. Any trade promotion scheme will motivate them to push competitors’ product deeper and faster. * Public Positive and favorable public opinion is crucial to marketing success since the public is the authority that permits the existence and operation of competitive marketing systems. This environmental factor includes the general public, its support, the government, and the set of public who have a direct bearing on business. These public can be classified as welcome public, sought public, and unsought public. As a marketer, one must understand that the general public grants the license for conducting business with an expectation that the company will practice fair play. Lack of this supportive framework as evidenced by declining sales or adverse public opinion can lead to eventual failure of the firm as well as the marketing system. * Competitors Success or failure of an offer largely depends on how competitors react to the company‘s offer. Godrej was a successful refrigerator manufacturer. Once competition intensified, the company started losing market share. Today, though there is a growth in refrigerator industry, Godrej as a brand is not growing as fast as its competitors. Through the years, marketing systems have become increasingly competitive. Traditional economic analysis, views competition as a battle between companies in the same industry or between substitutable products. Marketers, however, tend to accept the argument that all firms are competing for a limited discretionary buying power. Though we can say that Maruti as a car manufacturing-company is facing competition from other car manufacturers, ultimately it is the consumers disposable income for which shampoos, soaps, and scooters are also competing with Maruti. A customer is expected to allocate his disposable income optimally and in the process a category also competes with another category to be in the active consideration set of customers for such an allocation. Industry has found numerous new uses for existing products, with the whole arena of competition being expanded. While this forces business to reassess long-established marketing practices, it also opens new avenues of business opportunity. Emergence of computers with multimedia as a tool of infotainment and knowledge sharing device has challenged traditional products in the entertainment market. * Suppliers Increase in the price of raw materials will have a bang on effect on the marketing mix strategy of an organisation. As a result, the prices may be forced up. This is the impact that the suppliers can have. Closer relationship with suppliers is one way of ensuring competitive and quality products for an organisation. * Customers Organisations exist because of customers. No customer means, no business. Organizations on how they meet the needs and wants of the customers and provide them with maximum benefits. Failure to do so will result in a failed business strategy. Q.5 A. Explain the types of Marketing Information systems MIS supplies three types of information, which are: * Monitoring information Monitoring information is the information obtained from scanning external sources which include newspapers, trade publications, technical journals, magazines, directories, balance sheets of companies, and syndicated and published research reports. Data are captured to monitor changes and trends related to marketing situation. Some of these data can be purchased at a price from commercial sources such as market research agencies or from government sources. * Recurrent information — Recurrent information is the information that is generated at regular intervals like monthly sales reports; the stock statements, the trial balance, etc. ln MlS, recurrent information is the data that MIS supplies at a weekly, monthly, quarterly, or annual interval, which are made available regularly. It can also provide information on customer awareness of company’s brands, advertising campaigns, and similar data on close competitors. * Customized information   Customized information is also called problem-related, which is developed in response to some speciï ¬ c requirements related to a marketing problem or any particular data requested by a manager. B. Discuss the different components of MIS The overall Objective of an Ml IS to provide inputs from marketing environmental factors like target markets, marketing channels, competitors, consumers, and other forces for creating, changing, and modifying marketing decisions in the formulation of relevant and competitive marketing strategies. * Internal record systems — Internal record systems are available within the company across various departments and provide relevant, routine information for making marketing decisions. The most evident internal record system is the purchase and payment cycle systems. It records the timing and size of orders placed by consumers, the payment cycles followed by consumers, and the time taken to fulfill the orders in the shortest possible time. * Marketing intelligence system A marketing intelligence system is the system of collecting and collating data. This system tries to capture relevant data from the external environment. It collects and manages data from the external environment ab out the competitors’ moves, government regulations, and other relevant information having a direct impact on the marketing environment of the firm. *Analytical marketing systems Analytical marketing systems are also known as Marketing Decision Support Systems (MDSS). A MDSS is a coordinated collection of data, systems, tools, and techniques with supporting software and hardware. Using this collection, an organisation gathers and interprets relevant information from business and environment and turns it into a basis for marketing action. lt involves problem-solving technology consisting of people, knowledge, software, and hardware integrated through the information technology platform into the sales management process of the organisation. * Marketing research systems Marketing research systems are based on systems and processes that help marketing managers to design, collect, analyse, and report data and ï ¬ ndings relevant to a specific marketing situation facing the company. It also involves analysis of information, which includes a coordinated collection of data, systems, tools, and techniques with supporting software, and hardware by which an organisation gathers and interprets the relevant data and turns it into a basis for marketing action and tactics. Q.6 Describe the factors to be considered while developing an Effective marketing mix. To develop an effective marketing mix the company should consider the following factors and then choose the most appropriate mix of elements (7Ps) to target the customers: * Company’s resources These are one of the prime factors affecting the company’s marketing mix. The financial, human, and technological resources available with the company affect the composition of the marketing mix. The firm needs to conduct a Strength, Weakness, Opportunity, and Threat (SWOT) analysis for the business unit. * Demographics — It implies to the changes in the composition of the market, the demand of the population, the opportunities in the country, etc. that affect the marketing mix. Current and projected economic conditions It connotes the economic factors like inflation, employment, taxes, and other economic factors that influence marketing mix decisions. * Market potential Analysis of market potential for new products considers market growth, prospects need for your offering, the beneï ¬ ts of the offering the number of barriers to immediate use, the credibility of the offering and the impact on the customers daily operations. * Competitors They are important considerations that affect the marketing mix of a firm as the potential for competitive retaliation is based on the competitor’s resources, commitment to the industry, cash position, predictability, and status of the market. Porter’s Five Forces Model * Supplier power- The power of suppliers to drive up the prices of inputs. * Buyer power- The power of customers to drive ‘down products’ prices. * Competitive rivalry — The strength of competition in the industry. * Threat of substitution The extent to which different products and services can be used in place of a particular product. * Threat of new entry — The ease with which new competitors can enter the market if they see that a product is making good proï ¬ t and then drive your prices down. By thinking about how each force affects a product and by identifying the strength and direction of each force, you can quickly assess the strength of a product’s position and ability to make a sustained proï ¬ t in the industry.

Pathophysiology Underlying Pernicious Anaemia Biology Essay

Pathophysiology Underlying Pernicious Anaemia Biology Essay The following essay explores the pathophysiology underlying pernicious anaemia, with reference to primary sources. In order to fully understand the pathophysiology of pernicious anaemia, normal physiology is also discussed. With this in mind, contemporary treatments and management strategies that are currently in place are then critically appraised using the latest literature. Pernicious anaemia, typically seen in the over 60s, is the most common type of megalobastic anaemia and is usually attributed to the end stage of type A chronic atrophic (autoimmune) gastritis, which in turn leads to Vitamin B12 (cobalamin) deficiency (Toh et al., 1997). Autoimmune gastritis and pernicious anemia are common autoimmune diseases with respective prevalences of 2 and 0.15-1% in the general population (De block et al, 2008). It only manifests once all cobalamin stores (from the liver) have been depleted. Fundamentally, pernicious anaemia results from a lack of intrinsic factor (IF), which is a glycoprotein required for the absorption in the gastrointestinal tract of dietary sources of cobalamin (Toh and Alderuccio, 2004). Pernicious anaemia presents with a vast spectrum of signs and symptoms, including glossitis, generalised weakness, parasthesia, weight loss, infections, nausea, confusion and an unsteady gait. On a long term basis, patients are predisposed to gastric cancer. Haematologically, erythrocytes are normochromic and megalobastic (mean corpuscular volume is increased above 80-95fl in adults (Hoffbrand and Proven, 1997)). The condition is more common in females and is also thought to be more common in people with blood group A. In addition, those with a family history of pernicious anaemia are at an increased risk, along with people suffering from other autoimmune diseases such as Addisons disease (Hoffbrand and Proven, 1997). A more thorough understanding into the pathophysiology of the disease will enable contemporary treatment and management of the disease to be critically appraised. Martens et al., (2002) explain that under normal circumstances, cobalamin is vital for nuclear maturation and DNA synthesis in erythrocytes by means of catalysing the action of methionine synthase and R-methylmalonyl-CoA mutase. Vitamin B12 cannot be synthesised by the body therefore dietary intake is essential. It is stored in the liver (2-5mg), and recommended daily amounts are 2-5ÃŽÂ ¼g (Malouf and Areosa, 2003). The pathway for absorption of dietary cobalamin is vital in maintaining hepatic stores. According to Berne et al. (2004), it takes four hours for cobalamin to appear in the blood following ingestion and peak plasma levels occur 6-8 hours after a meal. Andres et al., (2004) describe the metabolic pathway of cobalamin following ingestion. In short, cobalamin ingested in the diet is bound to animal protein which is released upon contact with pepsin and hydrochloric acid. Meanwhile, parietal and salivary cells release R-Protein which binds to the free cobalamin. Intrinsic factor is also released by parietal cells but this has a weaker affinity to cobalamin than R-Protein. The release of intrinsic factor by parietal cells is mediated by histamine, acetylcholine and gastrin which are physiological agonists of hydrochloric acid secretion (Berne et al., 2004). Pancreatic enzymes degrade both biliary and dietary cobalamin-R protein complexes. This releases free cobalamin, allowing it to bind with intrinsic factor. In the brush border of the ileum the intrinsic factor cobalamin complex attaches to mucosal cell receptors (cubilin) (Andres et al., 2004). Free intrinsic factor does not compete for binding, whilst free cobalamin is not recognis ed by cubilin (Berne et al., 2004). This highlights the importance of intrinsic factor. The cobalamin binds to transport proteins (transcobalamin I, II and III). Attached to the transcobalamin, the cobalamin is then transported systemically via the portal system. Absorption into the ileal cells occurs by means of receptor mediated endocytosis of the transcobalamin-cobalamin complex. The cobalamin is then separated from the transport protein and converted into one of two coenzymes, methylcobalamin and adenosylcobalamin. It should also be noted that passive diffusion of cobalamin occurs at a rate of 1.2% of that absorbed, across the small bowel (Nyholm et al., 2003). Once metabolised it then acts as a cofactor and coenzyme for DNA synthesis, methione synthesis from homocysteine and conversion of propionyl into succinyl coenzyme A from methylmalonate (Andres et al., 2004). As discussed above, cobalamin is essential for DNA synthesis. Inhibition of DNA synthesis in red blood cells results in the formation of fragile megaloblastic erythrocytes. In addition to this, symptoms involving the nervous system, such as parasthesia occur as a result of demyelination of neurones (Malouf and Areosa, 2003). In order to analyse treatments in place, the pathophysiology of pernicious anaemia will now be discussed. Much of the evidence surrounding pernicious anaemia connects it to autoimmune chronic gastritis. Later symtoms such as parasthesia are directly as a result of cobalamin deficiency. The lack of intrinsic factor required for the absorption of cobalamin is as a result of loss of parietal cells and antibodies towards both intrinsic factor and the parietal cells (Toh et al., 1997). In order to further understand the development of pernicious anaemia, the early stages of atrophic gastritis must first be understood. Alderuccio and Toh (2000) explain that in its early stages, atrophic gastritis begins with infiltration of the gastric submucosa with inflammatory cells. Over time, this extends into the lamina propria, which ultimately leads to the destruction of parietal and zymogenic cells. These are then replaced by mucus containing cells. Bergman et al., (2003) state that autoimmune gastritis, which underlies pernicious anaemia occurs due to autoantibodies to gastric parietal cells. Specifically, the H+/K+ ATPase part of parietal cells, which is responsible for the secretion of hydrogen by parietal cells, which are recognised by CD4+ T cells. Subsequently, achlorhydria, low serum levels of pepsinogen I and increased gastrin levels also results. In patients with pernicious anaemia, these autoantibodies, along with autoantibodies towards intrinsic factor can usually be detected in patient serum and gastric fluid, with levels being directly proportional to the concentration of parietal cells (Toh and Alderuccio, 2004). Toh and Alderuccio (2004) also explain that two types of intrinsic factor autoantibodies have been identified. Type I bind to the cobalamin binding site of the intrinsic factor, whilst type II bind to a remote site. Berne et al., (2004) state that these autoantibodies act by preventing the binding of cobal amin to the intrinsic factor. Toh and Alderuccio (2004) suggest that parietal cell antibodies are a marker of autoimmune gastritis, whilst intrinsic factor antibodies are actually a marked feature of pernicious anaemia. This is because the presence of only the antibodies to the H+/K+ ATPase of the parietal cell suggests that the gastric lesion is likely to remain at its preliminary stages. In contrast, when intrinsic factor antibodies are present the gastric atrophy is at its end stage, which is associated with pernicious anaemia. In patients with pernicious anaemia, 90% have intrinsic factor autoantibodies. However, as the parietal cell mass reduces, the number of antibodies reduces as a result of the loss of antigenic drive. Therefore the presence of parietal cell antibodies alone are not diagnostic of the progression to pernicious anaemia. Toh and Alderuccio (2004) also explain that as a result of limited research in the field over the past 30 years combined with a 20-30 year developmental timescale of pernici ous anaemia, it is currently unknown whether or not all patients positive for parietal cell antibodies will develop pernicious anaemia. Therefore, more research is required to confirm the developmental process of the antibodies. Genetic factors play a significant role in the development of chronic gastritis and therefore subsequently pernicious anaemia, demonstrated by the presence of autoantibodies and clustering of the disease within families and amongst those with underlying autoimmune diseases. Gorden et al., (2004) state that a lack of intrinsic factor secretion can be attributed to the destruction of parietal cells as a result of adult onset gastric atrophy, or it may be congenital. They claim that the congenital deficiency is thought to be autosomal recessive. Lahner and Annibale (2009) also suggest genetic susceptibility as a result of human leucocyte antigen- DR genotypes. In addition, they also provide a crucial link between pernicious anaemia and the development of intestinal type gastric adenocarcinoma and gastric carcinoid type I. De Block et al., (2008) suggest that in patients with type one diabetes the risk of autoimmune gastritis, in turn leading to pernicious anaemia is increased by three to five times. With this in mind, they suggest that this provides a strong rationale for the implementation of a screening programme with early diagnosis and periodic examination via gastroscopy. Toh and Gleeson (1997) also acknowledge that pernicious anaemia is associated with autoimmune conditions, especially those affecting the endocrine system such as autoimmune thyroiditis, type one diabetes and Addisons disease. However, they also recognise that chronic gastritis can also develop secondary to alcoholism, hot tea and smoking. In addition, partial or total gastrectomy causes intrinsic factor deficiency due to the loss of parietal cells. Helicobacter Pylori infection has been identified as a potential causative factor in the development of cobalamin deficiency (Kaptan et al, 2000). This is consistent with Hersko et al., (2006) who question previous claims that pernicious anaemia is a disease of the elderly. They agree that the autoimmune cascade is triggered by Helicobacter Pylori infection, occurring decades prior to the presentation of cobalamin deficiency. Toh and Alderuccio (2004) also state that Helicobacter Pylori is likely to induce autoreactive T cells, cause epitope spreading and bystander activation, although they do recognise that its involvement remains controversial. This should therefore be considered in the development of novel treatments, focusing on the screening and eradication of Helicobacter Pylori infection. Current recommendations for patients with autoimmune gastritis include testing and treatment (Toh and Alderuccio, 2004). Berne et al., (2004) discuss pernicious anaemia in childhood, which whilst is rare, should not be disregarded since this also challenges the idea of pernicious anaemia being exclusively a disease of the elderly. They claim that there are three forms in childhood which are autoimmune, congenital intrinsic factor deficiency (with normal pepsin and hydrochloric acid) and congenital Vitamin B12 malabsorption syndrome, where there are reduced ileal intrinsic factor cobalamin receptors. Ardill et al., (1998) proposed that in addition to intrinsic factor and parietal cells, there may also be an autoantibody to gastrin. They state that autoantibodies arise when there is a break down in immunological tolerance. In pernicious anaemia, gastrin levels are normally, but not always elevated due to achlorhydria at the end stage of autoimmune gastritis. This leads to failure of the negative feedback mechanism. However the recognition of potential gastrin autoantibodies may obscure plasma gastrin levels, giving lower results than would be the case without the presence of the autoantibodies. This suggests another potential line of treatment where more research is required to determine how effective it may be. Having discussed the pathophysiology of pernicious anaemia, current treatment and management of the disease will now be appraised. As discussed, cobalamin is essential for DNA synthesis. Pernicious anaemia is as a result of a lack of intrinsic factor leading to an inability to absorb cobalamin from the diet. With this in mind, current treatment in the UK involves regular intramuscular injections (monthly to three monthly), which bypass the gastrointestinal system, therefore avoiding any requirement for intrinsic factor (Nyholm et al., 2003). There is currently no long term cure of the disease with more focus on management as opposed to cure (Oh and Brown, 2003). Vidal et al., (2004) studied the effectiveness of oral versus intramuscular injections of Vitamin B12 in the knowledge that regular injections cost the health service time and money. Contrary to the UK, Canada and Sweden already use oral supplementation at doses high enough for passive absorption to take effect. Vidal et al., (2004) state that the passive diffusion of cobalamin across the ileum, without the requirement for intrinsic factor, accounts for 1.2% of the total absorbed. Therefore they propose through their own research, that a dose of 2000ÃŽÂ ¼g of oral vitamin B12 daily, reduced to 1000ÃŽÂ ¼g daily, then weekly, then monthly, is likely to be as successful as intramuscular injections at replacing hepatic stores and reversing short term haematological and neurological effects. Andres et al., (2008) state that in order to manage pernicious anaemia, 1000ÃŽÂ ¼g per day of oral cyanocobalamin is required. With a total storage in the liver of 2-5mg, and 1.2% of absorpti on occurring passively, hepatic stores should be replenished at this dose. Nyholm et al., (2003) also found oral to be equally effective whilst reducing costs of nurse visits and enabling patients to have the choice. They studied 89 patients over 18 months and found no haematological differences to intramuscular administration. Walraven et al., (2001) also agree and found that there would be substantial savings if guidelines were implemented on a national level to change the standard practice to oral versus intramuscular. More recently, Butler et al., (2006) carried out a systematic review comparing oral and intramuscular administration in Vitamin B12 deficient patients. Once again, they agreed with the above evidence. Lederle (1991) initially proposed oral supplementation as medicines best kept secret. Therefore, 19 years on, further research is still required for medics to use oral tablets preferentially with appropriate guidelines in place, or indeed to rule this out as an option. In order to ensure that patients are receiving the best possible treatment, effective tests must be performed to enable accurate diagnosis. Oh and Brown (2003) discuss the use of the measurement of methylmalonic acid and homocysteine levels which are raised in even the early stages of pernicious anaemia. The traditionally used Schilling Test is less sensitive and works by measuring urinary excretion of Vitamin B12, therefore estimating its absorption. Testing for Helicobacter Pylori would also dramatically improve outcomes by means of eradication of the infection (Alderuccio and Toh, 2004). Alderuccio and Toh (2004) also concluded that more research is required into the field of autoantibodies specific to pernicious anaemia. Further research would enable novel treatments to be considered. In addition, genetic testing may prove useful, since there is a confirmed link within families. Also, it has been suggested that regular screening should occur for those with other autoimmune condit ions (De Block et al., 2008). It should be questioned that with so much evidence to suggest that pernicious anaemia is directly associated with autoimmune gastritis, why is there not more screening in place to prevent its effects taking place. In addition, clear associations have been made within families and in individuals with other autoimmune diseases. In terms of the prevention of the autoimmune process, no cures have been found. However, more research should be implemented into the replacement of intrinsic factor. This would perhaps be an option since according to Berne et al., (2004) free intrinsic factor does not compete for binding at the mucosal cell receptors of the ileum. In addition, the eradication and treatment of Helicobacter Pylori should be addressed. In the meantime, the vast research that suggests that oral therapy may be just as effective as parenteral with large enough doses to take advantage of the passive diffusion of cobalamin across the small bowel. However, it is extremely important not to disregard the potential long term effects of pernicious anaemia, such as the predisposition to gastric carcinoma. This highlights the need to treat each patient on an individual basis, taking effective measures to monitor for changes. Word Count: 2533.

A Bus Story Essay -- essays research papers

During the entire three years in high school, the bus always was my main transportation. I needed to take it to school and take it home. If you wanted to count how many times I took the bus, it would definitely be plenty. Therefore, I had many different experiences on the bus. As you know, high school bus always has many interesting events that rake place. Among those special experiences, there’s one that happened when I was a junior in high school on my way to school. It was a very interesting one, so that I still remember it until now. One day morning, just like other mornings in my life, I forced myself woke up early, prepared all my stuff, and went to the bus station to wait for my bus. I remembered it was a beautiful Monday morning. The warming sunshine was so comfortable and let me almost forgot the big midterm that I was going to have that day. The bus came early. I got on the bus and sat in the back of the bus. In this early morning, there are already some people on this bus. Some of them hurrying to school, some of them hurrying to their work, but everyone at least could have their seat. I started to read my book and worried about the quiz I would have that day. Suddenly, an invisible power pulled my attention to a couple whom had just gotten on the bus. Maybe because they were the only two that was standing in this bus or maybe because I felt tired of my book, I felt enjoy by watching them. Therefore, I started to observe them. They were around their twen...

New Casts :: essays research papers

News Casts: Is there more than meets the Eye? In today’s world, people rely on different things to inform them of what is happening in society. One of the main ways of receiving the news is by TV. People can tune in at various times during the day and watch a news cast. These news segments vary from a half-hour to a full hour showing. For instance, one might not be interested in the news one day. But before the showing of Channel 31 “Action News'; is to be aired the news shows a little snippet of a very interesting story. This might catch one’s attention and decide to watch just that one story. Now they have you hooked because the very interesting story that you want to watch is going to be shown at the end of the segment. One might have to sit through all the commercials and the other stories just to get to the one story that interests them. These are some of the certain tricks to draw and keep their viewers tuned in. One of the tricks that are use is called “Teasers';. A teaser does exactly what it’s called. The news show’s a snippet of the up coming segment. This snippet is usually of an interesting and exciting story. The snippet is the tease. The news is like fishing. The new anchors are the fishermen or women. The viewers are the fish. The new anchors use these teasers as bait to reel in the viewers. This snippet is showed before the sitcom before the news is over. This way people watching the sitcom might get interested to stay and watch the news cast. Another trick is similar to the teaser. That trick is called the Bumper. The bumpers are used like the teaser, except they are shown during the news and right before commercials. The bumpers are intend to keep you interested enough so the viewer will sit through the commercials to watch the rest of the news. Also there are bumpers at the end of the news program. Those are trying to get you to tune into the next airing of the news. According to Postman and Powers from “How to watch TV news'; if the news programmers had their way people would be watching a steady diet of news programs, one right after the other. The News anchors are the ones that deliver the bumpers.

Hannibal Essay -- essays research papers

Hannibal, a Carthaginian general and one of the greatest generals that ever lived was renown for his strategies and courageousness, such as crossing the Alps and using the "bottleneck strategy" at Lake Trasemene. He used strategies that a lot of generals at this time, especially Roman generals, would never think of and in doing this he almost destroyed the Roman republic. Hannibal's first battle took place when he was only nine. He went on an expedition with his father, Hamilcar Barca, to conquer Spain. From the beginning Carthage’s push into Spain, Hannibal vowed eternal hatred for Rome; Hannibal became Commander in Chief of Carthage’s army when he was 26 after his father was assassinated. His conquest of the Roman town of Sagunto in Spain led to a new declaration of war by Rome; which started the second Punic War and Hannibal’s promise to visit Roman injustice back on Rome a hundred fold. For Carthage to take the town of Sagunto was completely within the rights of the Carthage and the treaty but Rome at the time was getting too big and becoming very imperialistic. All Rome could see was that they had to have all of the Mediterranean and the only thing that stood in their way was a single General and his men. The way in which the Romans were unconsciously straying from "mos maiorum" to manipulate the course of events wa s disturbing. Though these actions were not entirely the "evil" work of Rome. Hannibal from his earliest memories could recall nothing but hatred for Rome. Hannibal’s Father had instilled a horrifically self-destructive desire within Hannibal to see the fall of Rome. This desire manifested itself during The Second Punic War, which was the ultimate fight for supremacy in the Ancient World. The victor would have control over the entire Mediterranean Sea and all of the trade routes bringing land, pride, wealth, and dominance over the victors enemies. Hannibal took a 1,000 mile trek from New Carthage, Spain, through the Alps, Northern Italy, and finally to Carthage. Hannibal won most of his battles with Rome, but never got the reinforcement he needed to over take Rome. The men that he had with him at the time were renowned for their loyalty to Hannibal and unconventional fighting tactics. Their "Gorilla" type war fair or wars of "delaying" almost saw t... ... death and destruction for the Romans that Adolf Hitler would to our Civilization. Hannibal’s name became synonymous with the stereotype that Rome had of the Carthaginian perfidy. And it was this that Rome never wanted to see again; so to be a good Roman, one had to be taught what it was to be a "Hannibal" and how not to be a "Hannibal." In the end Rome was taught many valuable lessons and to the victor go the spoils; so it is a measure of the fear Hannibal’s name instilled, that long after he was dead and gone, parents would scold naughty children with the warning that if they weren't good, Hannibal would come to get them in the night. Italy itself suffered cruelly in the war. Hannibal spent fourteen years there, mostly in southern Italy. As the years went by, the steep hillsides began to lose their topsoil. By war's end, southern Italy was permanently impoverished. In fact, in our own century, in the 1960s, the Italian government began to attempt to recover and reclaim the land from Hannibal, an effort that still goes on intermittently. Hannibal's legacy outlived Rome itself, Cato the Elder would be turning over in his grave if he knew this.

Psychological Factors of the Issue Essay

Psychological factors include motivation, perception, learning, beliefs and attitudes. These factors are largely unconscious and that a person cannot fully understand his own motivations. People decide based on what h perceives as dictated by his environment that serves as the stimulus and not necessarily that which is real. In marketing, perceptions are more important than reality. Characteristics of Adolescence Adolescence is often a period of stress and conflict, particularly in Western society. The adolescent confronts a host of new, varied and difficult problems of adjustment within a brief period of time. The adolescent attempts to acquire a sense of identity, a sense of who one is and where one is going. Every adolescent wants to be popular. They commonly think, †What can I do to have all the kids at school like me? † â€Å"What can I do to feel I belong to a group? † â€Å"How can I be popular with both girls and boys? † â€Å"What kinds of clothes will make me feel like I am one of them? † Sometimes adolescents go to great lengths to be popular. In some cases, parents go to even greater lengths to try to insulate their adolescents from the rejection and to increase the likelihood that they will be popular. Students show off because it gets attention and makes their peers laugh. Parents set up elaborate parties, buy clothes for their teens and drive adolescents and their friends all over in the hope that their sons and daughters will be popular (Santrock, John). Dr. Riesman in his study of the basic changes taking place in the American characters during the twentieth century (that is, from inner-directed to outer-directed) found that our growing pre-occupation with acts of consumption reflects the change. This pre-occupation, he noted, was particularly intense (and intensively encouraged by product makers). He characterized the children of America as ‘consumer trainees. ’ (Santrock, John). The adolescent confronts a host of new, varied and difficult problems of adjustment within a brief period of time. Physiological changes – rapid body growth, sexual maturity, increases in sex hormones–often precipitate special conflicts and self-doubts. Almost simultaneously, the adolescent is expected to achieve independence from the family, establish satisfying relationships with peers of both sexes, decide on – and prepare for – a set of consistent moral principles to guide decisions and actions. Fashion, therefore, lures the adolescents to try something new and not get stuck with the traditional ways of dressing and doing things. Back then in the 60s, the clothes that the â€Å"old school† hip hop artists donned were expressions of individuality but they even carried a purpose which was a functional one. The Puma branded sneakers that sported fat-laces and sweatsuits were all the rave back then. The colorful clothing which also had resemblance to the beautiful graffitis on the walls were also very popular back then. The dress-code of being loose and comfortable became a style of dressing which identified all those people as exceptional and unpretentious. Because the people in the ghettos had limited resources, they made the most out of what they had. The style and the fashion sense that they sported spoke of a willingness to create a style of their own despite several constraints (Wikipedia 2004). In the hip-hop culture today, fashion has undoubtedly become more stylish, more pronounced and more accessible in this day and age. It has indeed come a long way in the past twenty or so years. Ever since its inception, it has been proven to be a driving force in the fashion scene. From its modest beginnings in the â€Å"ghettos† of the African-American suburbs of New York, the hip hop fashion has transcended race, culture, gender as well as international borders as you will now see different ethnicities and races who have adopted their own hip hop style. The one thing that will immediately identify a person if he listens to hip hop or not is by the way they dress and what they put on themselves. Today, the hip hop clothing and apparel industry grosses over a billion dollars but despite its popularity among people who have the money to spend for the type of look they are sporting, it is still accessible by even the youngest boy in hopes of making it big in the future as an advocate of the hip hop music and fashion (Wikipedia 2004)

Overcoming Prejudices and Self Acceptance-the Color Purple

Overcoming Prejudices for Self Acceptance Throughout Alice Walker’s novel, The Color Purple, the main character, Celie, reveals all of the hardships she has endured during her life. Celie confides in her younger sister, Nettie, and God to express the way she feels in certain situations. As the story progresses, Celie eventually finds her voice and breaks away from all the men who oppressed her during her life. For the duration of the novel, prejudice becomes a reoccurring theme. Not only does Celie struggle with the external prejudices of sexism and racism, but she also struggles with the internal prejudices toward herself.By using Celie’s struggles as an example, Walker teaches the reader that one must overcome prejudices in order to accept themselves. Sexism becomes one of the main external struggles throughout the novel. With the use of the name â€Å"Mr. __† for Celie’s husband, Albert, Walker shows the reader Celie’s growing resentment towards him. The use of this name â€Å"suggests fearful effacement of an identity too dangerous to reveal† (Heglar). She begins to show bitterness when she says, â€Å"I scurry bout, doing this, doing that. Mr. __ sit by the door gazing here and there† (Walker 43). Celie takes the traditional roll of caring for the house while Mr. _ sits by and tends to his own needs and not the needs of the family. Celie’s dislike towards him grows throughout the novel as he becomes more selfish. Sexism occurs again with the use of gender roles in Harpo and Sofia’s relationship. Sofia represents a strong woman who does not let men dominate her. She and Harpo struggle with these roles throughout the novel. Sophia takes on a more masculine roll and Celie describes their arguments as â€Å"fighting like two mens† (Walker 38). Harpo believes that he should beat Sofia because she does not act like Celie in the sense that she does not give in to his every command.Finally, the use of gender violence is passed down through the generations. Gerri Bates stated that â€Å"The act of gender violence is almost handed down from father to son† (97). When the conflicts between Sofia and Harpo begin, Mr. __ encourages Harpo to beat Sofia so that she will give in to his ways. He uses Celie as an example because she never fights back and remains very obedient. With the use of sexism throughout the novel, Walker shows the reader all of the struggles Celie faced during this time period and how she overcame them. Racism also becomes a major external struggle during this novel.During this time period, whites embodied the image of higher class citizens. Many of the women in this novel aspire to look like white women in order to become more sophisticated. The white women of this time period wore an array of bright and vibrant colors that stood out from the rest. Celie describes the barrier between the races when she says, â€Å"Us dress Squeak like she a white woma n, only her clothes patch† (Walker 95). This quotation depicts the difference between the races at the time, and how even though they tried to bring Squeak up in society, they couldn’t quite reach that level because of their race.The role of racism occurs again when the mayor’s wife treats Sofia’s children like animals. While walking around town one day, the mayor’s wife approaches Sofia and her children and begins petting them like animals and saying â€Å"and such strong white teef† (Walker 87); she looks down on the family because of their race and treats them like animals. This again builds the wall between the races and shows that the white race believed that they were superior to the black race. The theme of racism contributes to the plot again with the roles of blacks and whites within society.When Sofia begins to work for the mayor and his wife, she is discriminated against solely for her race. This act is seen when she says, â€Å"H ave you even seen a white person and a colored sitting side by side in a car, when one of ’em isn’t showing the other how to drive or clean it? † (Walker 99). This quotation demonstrates the separation between the races during this time period. The mayor’s family â€Å"continually expect her to behave according to their cultural representations of the black mother† (Selzer). Whites and blacks could not create friendships and could not talk unless it was for business purposes.The roles of races play a major role in understanding the attitudes during this time period. With the understanding of the roles that the blacks and whites played in society, one can infer that Celie had to overcome more struggles than what she had originally dealt with in order to blossom and become herself. In ultimately finding herself at the end of the novel, Celie had to overcome the internal prejudices against herself. With the use of Shug Avery in the novel, Walker displa ys the hardships Celie must face with her new found sexuality.Because this relationship uses different and new feelings it â€Å"evokes so profound an erotic awakening that Celie believes she was â€Å"still a virgin† prior to it† (Hankinson). When Celie begins to have feelings for Shug, they start out innocent and then become more serious. She describes a night that they spent together when she says, â€Å"Me and Shug sound asleep. Her back to me, my arms round her waist† (Walker 116). Celie begins to allow her feelings with Shug to become reality and shows that she does not have the shy personality that everyone thinks she does.Celie breaks out of her inner prejudices again when she confides in her sister, Nettie. Celie begins to yell at the dinner table one night when she could no longer take the verbal abuse from Mr. __ and stated â€Å"You took my sister Nettie away from me, I say. And she was the only person love me in the world† (Walker 202). Celie believed that she could only confide in Nettie and God during difficult times, but she began to realize that all of her friendships would help her out in the end to become a strong, independent woman.Lastly, the growth of Celie throughout the novel is shown through all of the women that help her along the journey in becoming herself. Although Celie tries to discover herself, â€Å"Shug Avery and Sophia Butler provide the major alternative influences that allow Celie to grow and develop† (Heglar). All of the female relationships throughout the novel help Celie to realize that women do not need men to control their lives. She also realizes that women can become self-sufficient and brave without the help from other people.With help from all the women in the novel, Celie discovers herself and comes to realize that the support of a man is not necessary in the journey to happiness. By using Celie’s difficulties as a model, Alice Walker teaches the reader that self acceptanc e comes over time and that one must overcome prejudices in order to find themselves. During the course of the novel, Celie struggles with both internal and external prejudices. In the end she conquers them all and becomes the person that she truly wants to be. She realizes this when she says â€Å"I am so happy. I got love, I got work, I got money, friends and time† (Walker 218).Walker teaches the reader that no matter what other people think, what truly matters is the beauty within and being able to handle one’s self in the worst of situations. Works Cited Bates, Gerri. Alice Walker A Critical Companion. Westport, Connecticut: Greenwood Press: 2005. Print. Hankinson, Stacie Lynn. â€Å"From Monotheism to Pantheism: Liberation from Patriarchy in Alice Walker’s The Color Purple. † Midwest Quarterly. 38. 3. Gale, 2003. Literary Resource Center. Web. 1 Feb. 2011. Heglar, Charles J. â€Å"Named and Nameless: Alice Walker's Pattern of Surnames in The Color Pu rple. ANQ 13. 1 (Winter 2000): 38-41. Rpt. in Contemporary Literary Criticism. Ed. Janet Witalec. Vol. 167. Detroit: Gale, 2003. Literature Resource Center. Web. 1 Feb. 2011. inchell, Donna Haisty. Alice Walker. New York: Twayne Publishers, 1992. Print. Selzer, Linda. â€Å"Race and Domesticity in The Color Purple. † African American Review 29. 1 (Spring 1995): 67-82. Rpt. in Contemporary Literary Criticism. Ed. Janet Witalec. Vol. 167. Detroit: Gale, 2003. Literature Resource Center. Web. 1 Feb. 2011. Walker, Alice. The Color Purple. Harcourt, Inc. 2003. Print.