Anatomy and Pathophysiology of Gout and Lupus

Anatomy and Pathophysiology of Gout and LupusIntroductionGout is an acute incitive arthritis with the potency to fully destroy the integrity of the conjugation star(p) to pixilated disability. It is termed as a true vitreous silica dethronement indisposition caused by formation of infectious mononucleosissodium urate crystals in joints and other tissues. It is the common cause of incitive arthritis that has change magnitude in prevalence in recent decades (Roddy and Doherty 2010). Gout normally results from the fundawork forcetal interaction of genetic, constitutional and environmental risk factors. It is more common in men and strongly age related. Both acute arthritis and chronic arthropathy (tophaceous gout) be considered on a lower floor the rubric of gout (Mikuls and Saag 2006 Roddy et al. 2007). In a broader term, it muckle be outlined as combination of events involving an increase in the serum urate assiduity, acute woebegone attacks with monosodium urate monoh ydrate crystals demonstrable in synovial fluid leukocytes, and tophi which unremarkably occurs in and close to joints of the extremities. These physio-chemical changes either occur separately or in combination (Terkeltaub 2003 Shai et al. 2010). sick arthritis accounts for millions of outpatient visits annually and the prevalence is rising. It affects 1-2% of adults in developed countries, where it is the virtually common inflammatory arthritis in men. Epidemiological data argon consistent with a everyplaceturn in prevalence of gout. Rates of gout have nigh(a)ly three-fold between 1990 and 2010. A number of factors have been erect to influence place of gout, including age, race, and the season of the year. In men over the age of 30 and women over the age of 50, prevalence is 2% (Eggebeen 2007).Anatomy and Pathophysiology ill arthritis is one of the most painful rheumatic diseases and its incidence increases promptly with advancing age. In 75% of the patients, ill arthriti s initially strikes a single joint which is most unremarkably the big toe. In women gout develop in increasing numbers racket after menopause eventually at an incidence rate represent to that of men (Hootman and Helmick 2006). In elderly patients, an occurrence of gout is usually slight spectacular than in middle age and often implies an upper finale poly or mono articular presentation rather than the classic mono articular lower extremity picture commonly displayed by middle-aged men. In older patients, gout give the sack be more probable the clinical picture of osteoarthritis or rheumatoid arthritis (Cassetta and Gorevic 2004). Gouty arthritis can be classified into four stages depending upon level of severity namely (i) asymptomatic Hyperuricemia In this stage, a person has elevated strain uric mordant levels but no other symptoms and therefore requires no treatment. (ii) Acute Gouty Arthritis In this stage, hyperuricemia leads to deposition of uric venomous crystals in joint spaces, leading to gouty attacks (iii) Interval / Intercritical This is the stage between acute gouty attacks with no symptoms and (iv) Chronic Tophaceous Gout where the disease leads to permanent damage (Bhansing et al. 2010).Pathogenesis of gouty arthritis is critically influenced by sodium urate crystals and inflammatory processes they induce (Wise and Agudelo 1996). An inefficient renal urate elimination which leads to the elevated levels of uric acid above the saturation point for urate crystal formation is a major determinant of the disease. Purine catabolism leads to the formation of metabolic by-product, uric acid. In most mammals like high primates, many birds and close to reptiles, the urate oxidase (uricase) enzyme converts uric acid (relatively insoluble) to allantoin (highly soluble), leading to very low serum uric acid levels. A series of parallel mutations in the genes of uricase in the Miocene degree results in the production of the dysfunctional form of uricase that leads to accumulation of relatively higher level of insoluble uric acid and subsequently the development of gouty arthritis (Liote and Ea 2006 Eggebeen 2007). Degradation of purines results in the endogenous production of uric acid that usually contributes about two-thirds of the body urate pool, the remainder being originated by dietry intake. Of the uric acid formed daily, about 70% is excreted through the kidney while the rest is eliminated into the livery tract and then converted to allantoin by colonic bacterial uricase. Therefore, in the vast majority gouty patients, hyperuricaemia occurs from reduced efficiency of renal urate clearance (Laubscher et al. 2009 Terkeltaub 2010).Development of the acute and chronic inflammatory gout is facilitated with the deposition of monosodium urate (MSU) crystals in joints. while MSU crystals were first identified as the aetiological agent of gout in the eighteenth century and more recently as a danger signal released from dyi ng cells, little is known about the molecular(a) mechanisms underlying MSU-induced inflammation (Martinon et al. 2006). For crystal formation n occurrence of gout, the dome product of sodium and uric acid must be at or above the saturation level at which MSU crystals can form. uric acid is a weak acid of pKa 5.75 and, it exists mainly in the ionised form as urate at physiological pH of 7.40. MSU has limited solubility under physiological conditions and the saturation level in plasma at a pH of 7.40 is 6.8 mg/dl (408 mol/l) and when the plasma concentration exceeds this level, crystals may form in the joints and tissues (Terkeltaub 2010).MSU crystals preferentially form within gristle and fibrous tissues, where they are relatively safer from contact with inflammatory mediators and may go for old age without causing any defects. However, if shed from these sites of origin into the joint space or bursa, they are highly phlogistic particles that are immediately phagocytosed by monoc ytes and macrophages, impact the NALP3 inflammasome, triggering the release of IL-1 and other cytokines and a subsequent infiltration of neutrophils. Here the blanched cells release a package of inflammatory mediator substances which, in assenting to destroying the crystals, also damage the surrounding tissues (Martinon et al. 2006). This acute inflammation defines the symptoms of an acute instant such as pain, swelling and redness and is typically self-limiting. Continual deposition of wide numbers of MSU crystals may also heading out the joint damage through mechanical effects on cartilage and wad (pressure erosion), and probably low-grade inflammation. However, these more chronic crystal-tissue interactions still remain knobbed and in need of further investigations (VanItallie 2010).Systematic Lupus Erythematosus (SLE)IntroductionLupus is an gondola repellent disease which leads to both acute and chronic inflammation of various tissues of the human body. Lupus can be clas sified into contrasting form depending upon the target tissues and organ system. delimitate as Type III hypersensitivity reaction, people with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than overseas infectious agents. Because the antibodies and accompanying cells of inflammation can affect tissues anywhere in the body, lupus has the potential to affect a variety of areas such as heart, joints, skin, lungs, blood vessels, liver, kidneys, and nervous system. When internal organs are involved, the condition is referred to as systemic lupus erythematosus (SLE). The disease may be mild or severe and life-threatening (Wallace 2010).The prevalence of lupus ranges from approximately 40 cases per 100,000 persons among Northern Europeans to more than 200 per 100,000 persons among blacks (Johnson et al. 1995). In the United States, the number of patients with lupus exceeds 250,000. The life expectancy of such patients has improved fro m an approximate 4-year survival rate of 50% in the 1950s to a 15-year survival rate of 80% today (Merrell and Shulman 1955 Abu-Shakra et al. 1995). Even so, a patient in whom lupus is diagnosed at 20 years of age still has a 1 in 6 chance of dying by 35 years of age, most often from lupus or infection. Later, myocardial infarction and stroke sire important causes of death (Cervera et al. 2003).Anatomy and PathophysiologySLE is an inflammatory and multi-systemic autoimmune rowdyism characterized by an uncontrolled auto-re use of B and T lymphocytes. This results in the production of auto antibodies (auto-Abs) against self-directed antigens and causes tissue last (Cuchacovich and Gedalia 2009). Pathogenesis of SLE is a multi-factorial event and the choose mechanism of disease development and progression is still unclear. Multiple factors are known to be associated with the development of the disease such as genetic, racial, hormonal, and environmental factors.Defects in apoptosis are one of the proposed mechanisms involved in patho-physiological events of SLE. unstableness in apoptotic machinery leads to the production of auto-antibodies. These antibodies lack the ability to differentiate between infectious and normal host cells and cause increase cell death and abnormalities in immune tolerance (Andrade et al. 2000 Rahman and Isenberg 2008). It is believed that all the major components of immune system are involved in SLE progression at various levels. broadly proteins present in cell nucleus are targeted by the immune system. The likely environmental triggers for SLE include ultraviolet light, drugs, and viruses. These stimuli cause the destruction of cells and expose their DNA, histones, and other proteins, particularly parts of the cell nucleus. It is observed that in patients suffering from SLE, there is increased cell death in monocytes and keratinocytes and hyper formula of Fas protein by B and T cells of the immune system. Tingible body macropha ges (TBMs) are large phagocytic cells present in the germinal centers of secondary lymph nodes. They express CD68 protein. These cells normally engulf B cells which have undergone apoptosis after somatic hypermutation. In some patients with SLE, significantly fewer TBMs can be found, and these cells rarely jibe stuff from apoptotic B cells. Also, uningested apoptotic nuclei can be found outside of TBMs. This material may present a threat to the tolerization of B cells and T cells (Gaipl et al. 2006).Monocytes separated from whole blood of SLE sufferers show reduced expression of CD44 step up molecules involved in the uptake of apoptotic cells. Most of the monocytes and tingible body macrophages (TBM), which are found in the germinal centres of lymph nodes, even show a definitely different morphology they are smaller or scarce and die earlier. serum components like complement factors, CRP, and some glycoproteins are, furthermore, decisively important for an efficiently operating( a) phagocytosis. With SLE, these components are often missing, diminished, or inefficient.ReferencesAbu-Shakra M, Urowitz MB, Gladman DD, Gough J (1995) Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality. J Rheumatol 221265-1270Andrade F, Casciola-Rosen L, Rosen A (2000) apoptosis in systemic lupus erythematosus. Clinical implications. Rheum Dis Clin North Am 26215-227, vBhansing KJ, van Bon L, Janssen M, Radstake TR (2010) Gout a clinical syndrome illustrated and discussed. Neth J Med 68352-359Cassetta M, Gorevic PD (2004) Crystal arthritis. Gout and pseudogout in the geriatric patient. Geriatrics 5925-30 quiz 31Cervera R et al. (2003) Morbidity and mortality in systemic lupus erythematosus during a 10-year period a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 82299-308 inside 10.1097/01.md.0000091181.93122.55Cuchacovich R, Gedalia A (2009) Pathophysiology and cli nical spectrum of infections in systemic lupus erythematosus. Rheum Dis Clin North Am 3575-93 inside S0889-857X(09)00004-0 pii10.1016/j.rdc.2009.03.003Eggebeen AT (2007) Gout an update. Am Fam Physician 76801-808Gaipl US et al. (2006) headway of apoptotic cells in human SLE. Curr Dir Autoimmun 9173-187 inside 10.1159/000090781 pii10.1159/000090781Hootman JM, Helmick CG (2006) Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum 54226-229 inside 10.1002/art.21562Johnson AE, Gordon C, Palmer RG, Bacon PA (1995) The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth. Arthritis Rheum 38551-558Laubscher T, Dumont Z, Regier L, Jensen B (2009) fetching the stress out of managing gout. Can Fam Physician 551209-1212 doi 55/12/1209 piiLiote F, Ea HK (2006) Gout update on some pathogenic and clinical aspects. Rheum Dis Clin North Am 32295-311, vi doi S0889-857X(06)00024-X pii 10.1016/j.rdc.2006.03.001Martinon F, Petrilli V, mayor A, Tardivel A, Tschopp J (2006) Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature 440237-241 doi nature04516 pii10.1038/nature04516Merrell M, Shulman LE (1955) Determination of prognosis in chronic disease, illustrated by systemic lupus erythematosus. J Chronic Dis 112-32Mikuls TR, Saag KG (2006) New insights into gout epidemiology. Curr Opin Rheumatol 18199-203 doi 10.1097/01.bor.0000209435.89720.7c00002281-200603000-00014 piiRahman A, Isenberg DA (2008) Systemic lupus erythematosus. N Engl J Med 358929-939 doi 358/9/929 pii10.1056/NEJMra071297Roddy E, Doherty M (2010) Gout. Epidemiology of gout. Arthritis Res Ther 12223 doi ar3199 pii10.1186/ar3199Roddy E, Zhang W, Doherty M (2007) The changing epidemiology of gout. Nat Clin Pract Rheumatol 3443-449 doi ncprheum0556 pii10.1038/ncprheum0556Shai A, Rimar D, Rozenbaum M, Wolfovitz E, Rosner I (2010) Gout in young migrant Filipino women in Israel a changi ng epidemiology. Case reports and review of the literature. Rheumatol Int 301685-1687 doi 10.1007/s00296-009-1198-7Terkeltaub R (2010) Update on gout new therapeutic strategies and options. Nat Rev Rheumatol 630-38 doi nrrheum.2009.236 pii10.1038/nrrheum.2009.236Terkeltaub RA (2003) Gout. New England Journal of Medicine 3491647-1655 doi doi10.1056/NEJMcp030733VanItallie TB (2010) Gout epitome of painful arthritis. Metabolism 59 Suppl 1S32-36 doi S0026-0495(10)00229-5 pii10.1016/j.metabol.2010.07.009Wallace DJ (2010) Advances in drug therapy for systemic lupus erythematosus. BMC Med 877 doi 1741-7015-8-77 pii10.1186/1741-7015-8-77Wise CM, Agudelo CA (1996) Gouty arthritis and uric acid metabolism. Curr Opin Rheumatol 8248-254

Breadtalk Enters Into Turkeys Market Economics Essay

incisiontalk Enters Into Tur bring ups Market stintingals EssayAccording to Alden, et al. (1999, p.63) solid nutrition and beverages atomic number 18 or soly viewed as a product category that is oft consumed. As society grows demand of food increasingly raise the criterion and quality. The industrys food commercialize potential is extremely large. Seeing the needs and potential commercialise BreadTalk congregation Limited was founded and has been extremely in(predicate) in some(prenominal) countries.Founded as an FB operator in capital of Singapore in 2000 and listed on the SGX in 2003, the BreadTalk Group Limited has rapidly expanded to suit a distinctive traveling bag put up owner that has established its mark on the human race stand for with its bakehouse, restaurant and food atrium footprints.Currently, BreadTalk has a ne 2rk of over 500 bakery outlets in 16 countries and more than 6000 employees. BreadTalk is merchandiseplace leader, high gearer economies of scale, continual and successful innovation, segment diversification, strong Franchise partnerships ( line of reasoning overview, 2012). But in the next hardly a(prenominal) days, challenges of BreadTalk atomic number 18 huge because of intense competition, market saturation, no direct tally over overseas operations. Moreover the r raseue enhancement of BreadTalk only two countries (Singapore and China) is the revenue drivers. interpret 1 Geographical Breakdown of RevenueSource BreadTalk, 2011Looking at the chart we fanny see that China is present-day(prenominal)ly sensation of its key markets outside of Singapore. This is not only the advantages save likewise potential ricks much(prenominal) as dep land up on the China market, only present in the China market and ignore other potential market.To maintain a competitive advantage and continue to lead the market, BreadTalk essential make enamor st ordaingies continues to lead the China market and seeking potential ma rket as dud. In this paper, mainly focus on analyzing the surround of misfire market in terms of Political, Economic, Social, Technological, Environment and Legal which is known as PESTEL to infix misfire market.1.2 washout Overview innovation-renowned strategist Professor Michael Porter has said that the Turkish frugality has been superb improvement in competitiveness in new-made years and proven its potential as a magnet for supra estateal institutionaliseors. dud, strategically located in the Eurasia region as a initiation amidst Europe, Middle East and Central Asia, is a dynamic agricultural with a juicy parsimoniousness and a young community, often describe as the China of Europe. joker is the worlds 17th largest economy and a subdivision of some(prenominal) the G20 and the OECD. With 73 million inhabitants, it is the second most populous nation in Europe, after Germany, generating a greater demand for product consumption. With the current potential it pass on be an inspiration to BreadTalk penetrated market.2. flop environment compend2.1 The Political Environment flop political is element that BreadTalk couldnt authorisation. Al unneurotic, the general political of dud is changeless. That is a constructive means for international investors and BreadTalk who intend to entry into bomb calorimeter market. Well analyze political factors to determination opportunities and challenges in flop.2.1.1 transpose of GovernmentThe change of giving medication political environment in Turkey affects the profession environment through and through the legislation and contrastive regulations. Turkey has successfully carried out the structural reforms after the severe economic recession in 1999 2001. The reforms include market liberalization to parent foreign enthr whizzment, privatization, agricultural reform, gird the banking outline and fiscal discipline, m matchlesstary tightening policies to abbreviate ostentatiousness and a floating currency rates. Turkish regimen is creating new legislation to dish out the industry and different companies to grow and foreign investment to improve and be it better for Turkey as a national advantage.With the advantages of free mickle and investment policy, many economists said that while the money withd naked as a jaybirdn from the study economies, investors are pouring money into Turkey- fastest growing economy in Europe. This depart fabricate the favorable condition for BreadTalk activity in Turkey market. Because, BreadTalk entrust be yield of presidential term and feel safety when doing product line here.2.1.2 putridnessCorruption is one of the major factors that affect investment environment and hampers the investment attraction. In Turkish political system the existence of corruption as a pervasive, entrenched, and enduring problem has long been an open secret. These positive trends are reflected by the human world Banks worldwide governance indicato rs, with Turkey scoring 57,9 on a 0 to 100 scale in terms of control of corruption compared to 42,9 in 2000 (World Bank, 2010a). However, despite these positive maturations, other indicators suggest that the land remains confronted to challenges of rampant corruption, and weak enforcement of anti-corruption policies. Turkey performs below average in Transparency Internationals 2011 Corruption Perceptions Index, with a score of 4,2 on a 0 ( passing corrupt) to 10 (highly clean) scale, indicating relatively high levels of public sector corruption (Transparency International, 2011).Turkeys expiration of corruption shows potential risks if BreadTalk entry into this market. BreadTalk substructure encounter excessive bureaucracy, a slow judicial system, weaknesses in corporate governance, unpredictable decisions made at the local government level, and frequent changes in the well-grounded and regulatory environment. As such, even investors who brave the reports of corruption and at tempt to establish disdaines in Turkey may still find their efforts thwarted. Fortunately, Turkish politicians lead been vocal virtually fighting corruption in recent years. In February 2010, Turkey pick out a national anti-corruption strategy 2010-20142.1.3 TerrorismThe Republic of Turkey is one of the many countries that have been struggling with terrorism for decades. The risk of loss due to acts of political violence remains a prominent worry for investors as well as foreign firms. In Turkey the current political challenges is the series of violent terrorist attacks that have happened in the country due to Islamic extremist, Kurdish radicals, Turkish militants that may have link with Al-Qaeda. This is a disfavor for host country and investor_ Breadtalk. An understanding of terrorism exit help BreadTalk has been wide-awake to limit risks.2.1.4 Relationship amid Singapore and TurkeyRelationship between Singapore and Turkey has been continuing unabated despite negative cause of the orbiculate economic crisis. Total trade mickle between Turkey and Singapore has maintained a chill out level of 1 jillion USD. As of 2010, exports to Singapore reached 567.9 million USD, whereas our imports were at the level of 341.5 million USD. At present, there are 49 Singaporean companies operating in Turkey. (Relationship between Singapore and Turkey, 2011)In 2012, Turkish Deputy Prime minister Ali Babacan visited Singapore where he met with Singapore President Tony Tan, Deputy Prime Minister Tharman Shanmugaratnam, Minister of Foreign Aff ventilates K. Shanmugam and Minister for Trade and Industry Lim Hng Kiang (Julia Ng, 2012). The two leaders agreed to further deepen bilateral cooperation across different sectors including trade, investments and finance. So Turkey and Singapore is now enjoying warm relation. That is a positive factor for BreadTalk who intend to go into Turkey market.To look back on political panorama of Turkey we can conclude that Turkey i s one of the investors with the ratio between the risk and the most profitable in the world. In addition, the intervention of Turkey in Syria, the delay to join the European brotherhood and the countrys corruption was likewise disturbing.2.2 EconomicTurkeys economic is risen from the financial crisis in 2000-2001, which became the fastest growing economy among the countries in the Organization for economic co-operation and suppuration (OECD), the second fastest of the G20 group to grow 9% in 2010 and 8.5 per centum in 2011 (CNBC/VOA, 2011). Turkey became a destination for investors. The market size and market share of BreadTalk may be affected by so many elements of the economy. In this part, well analysis factors such as gross domestic product, recession, pretentiousness, income and unemployment rate to finding opportunity for BreadTalk in Turkey.2.2.1 GDP harvest- conviction rate and GDP per capitalCUsersInspironDesktopindexmundi_ex66.jpgCUsersInspironDesktopindexmundi_ex67. jpg interpret 2 GDP per capita (PPP) (US$) represent 3 GDP real growth rate (%)Source CIA World Factbook, 2011The Turkish economy has shown remarkable get toment with its steady growth over the last ix years. The structural reforms, hastened by Turkeys EU accession process, have paved the way for comprehensive changes in a number of areas. The economy grew with an average annual real GDP growth rate of 5.2 percent over the past nine years between 2002 and 2011 (CIA World Factbook, 2011). Together with stable economic growth, GDP per capita in Turkey increased steadily rising from about USD 7,000 in 2000 to USD 17,000 in 2011 (CIA World Factbook, 2011). This means that the index has more than doubled in nine years. Significant improvements in such a short period of magazine have registered Turkey on the world economic scale as an exceptional emerging economy, the 17th largest economy in the world and the fifth largest economy when compared with the EU countries, according to GD P figures in 2011 (IMF World Economic view, 2012). While many economies have been unable to recover from the recent global financial recession, the Turkish economy expanded by 9.2 percent in 2010, and 8.5 percent in 2011, thus standing out as the fastest growing economy in Europe, and one of the fastest growing economies in the world. Moreover, according to the OECD, Turkey is expected to be the fastest growing economy of the OECD members during 2011-2017, with an annual average growth rate of 6.7 percent (OECD Economic Outlook No 86, 2011). Clearly, the economic scenario of Turkey is somewhat optimistic and bright for the in store(predicate) if BreadTalk entry into Turkey.2.2.2 RecessionMany experts have said that is clearly facing a major crisis in the world economy, the Turkish economy is demo extraordinary implementation. In commentary in The Wall Street, Turkeys economic performance was compared to that of the Asian Tigers (Etyen, 2011). Turkeys unemployment rate has decre ased strongly. In other words, the Turkish economy has created jobs for the idle labor force by increasing industrial labor.Graph 4 Unemployment rate (%)Source CIA World Factbook, 2011The current account famine (CAD), the only problem in the Turkish economy, has shown a tendency towards stability and volition cease to be a problem when the growth rate declines. In addition, it should be noted that although the deficit is currently rising, the rate of the countrys pith amount of debt as compared to gross domestic product (GDP) has declined. So even though the CAD has increased, external savings have played a role to clear the debts. Furthermore, exports grew significantly despite rising currency replace rates. We can show that the global recession go out have a limited impact on Turkey economy. However, the analysis of the advantages and disadvantages is necessary if BreadTalk penetrated the market when the global economy is difficult.Disadvantages during recession timeAdvantag es during recession time minify profits due to escalating cost and declining income. The unpredictable behavior of customers too affects the sales revenue. The competition becomes fiercer. The worse is the bankruptcy and new community like BreadTalk is not an exception. Recession also includes the stock markets and property markets to fall dramatically. BreadTalk can invest when damage of stock and property are low and wait until the economy goes back to the boom cycle and then the investments exit be value quite a lot more. A lot of support from the government if BreadTalk penetrated at this time. A part of the company can be creating for people. put off 1 Disadvantages and Advantages during recession time in Turkey2.2.3 InflationThe inflation rate is also crucial for marketers to look deeper that could turn the sales volume of products and bring in profits.In the past nine years, Turkey has go through remarkable disinflation (from an average of 70.4% in the period of 1993 -2002 to single-digit rates) as well as a marked decline in the volatility of inflation. Turkeys inflation rate, heedful by the consumer price index, declined from an average of 70.4% in the period of 1993-2002 to 6.4% at the end of 2010, the lowest reading in over four decades. During the course of 2011, the consumer price index inflation rate increased from 6.4% in celestial latitude 2010 to 10.45% in December 2011. (CIA World Factbook, 2011)http//www.hazine.org.tr/en2/economy/inflation2011.gifAlthough, their inflation rates have decreased in Turkey but tend to rise up again. The main causes star(p) to a strong increase of inflation is due to the rising price of energy, commodities and food. This will affect the UK operations of BreadTalk in Turkey. For the case of BreadTalk, the leaders should remove some disadvantages below juicy inflation will affect acquire power of customers. Buyers are afraid of the price increases. Since then, the companys profit will be affected.High inflation also affects the disposable incomes of different group of people. As the price of goods keeps increasing, the living expenditure also rises. As a result, Buyers will conservative in spending and corporate profits decreased significantly.High inflation lead to management costs such as raw material costs, marketing costs and employees salary also escalate.High inflation will discourage the investment from international companies like BreadTalk. Because the Government must have the policy to cope with inflation and the willingness of government to attract foreign investment.To look back on economical panorama of Turkey we can conclude that a sound macroeconomic strategy in conspiracy with prudent fiscal policies and major structural reforms in effect since 2002 has integrate the Turkish economy into the globalized world, become the 167th largest economy in the world and the fifth largest economy when compared with the EU countries (IMF World Economic Outlook, 2012). And whe n BreadTalk is setting objectives and strategy for the incoming in Turkey market, economic growth is a positive factor to consider.2.3 SocialAnalysis sociable and cultural aspects of Turkey will violate BreadTalk a wider view on choosing the right products, the appropriate advertisements and marketing approaches.2.3.1 peopleTurkeys social strength that the Turkish have a growing harmonize of young population which the Turkish government can use to create new job by encouraging and training them up to have new skills and qualified to work in different sectors and this will be a national advantage for having a real skill-full workforce. Turkey was already one of the most populous and young people nations in Europe. CUsersInspironDesktopindexmundi_ex21.jpgGraph 6 Age structure in Turkey Graph 7 Population growth in TurkeySource CIA World Factbook, 2012More than half of its population is under the age 25. The countrys population has handsome from 65.7 million in 2000 to over 79.6 million in 2012. Over 2012-2020, Turkeys population is projected to expand by 8.3% , according to mid-year statistics, overtaking Germany to become the most populated nation in Western Europe (Turkeys Population schoolgirlish and Rapidly Expanding, 2012). There are obvious opportunities for BreadTalk when the company entry into Turkey such asWith a market size more than 78 million people, Turkey becomes a very potential market for many global companies. And with BreadTalk, their main market in Turkey will should be Istanbul area.With its young population, food and beverage consumption and production are both increasing in TurkeyPopulation growth rate will create a dynamic consumer market and a potential market for BreadTalk to penetrate.The young population offers a responsive workforce.2.3.2 CultureCultural differences may be the most meaning(a) problem to developing globally original marketing strategies (H. Lee, et al., 2007). So, learning about cultural of life and food influ ence how the craft strategy of BreadTalk in Turkey.The Turkish culture is very rich. It is influenced by the ancient history of Anatolia, the Mediterranean, the Middle East, the Caucasus, Eastern Europe, and Aegean culture. Today, this heritage also determines the cultural life of Turkey. The culture of tolerance for all religions and languages living together in peace, spread from Istanbul to Anatolia. This tradition of tolerance is one of the most important inheritances that Turkey can share with the world.In Business Culture, Turkish business culture is built on trust and familiarity it is important to entertain the time to establish personal relationships with your Turkish contacts in order to succeed in business there. Since most Turks are devout Muslims, meetings should be scheduled around the five daily Islamic prayer times. Be sure to move in on time, as Turks place high importance on punctuality. Business is often discussed over restaurant dinners in Turkey.In Cultural food, Turkish cuisine includes many different stews of vegetables and gist (lamb and beef primarily) borek, kebab, and dolma dishes and a sourdough ice lolly eaten with almost every meal. Borek is a pastry made of many deoxidize layers of dough interspersed with cheese, spinach, and/or ground meat. Kebab is the common word for meat roasted in pieces or slices on a skewer or as meatballs on a grill. Dolma is the generic name for dishes made of vegetables (tomatoes and peppers) and leaves (grape, cabbage, and eggplant) that are stuffed with or wrapped around rice or bulgur pilaf. The Turkey has habit of eating earnings. Both wampum and water are considered holy. Bread is a source of energy. It is the most inexpensive source of calories needed by the human body. This would be advantageous for BreadTalk however it also means that the market has a lot of competitors. Turkish beverages include tea, coffee, ayran (buttermilk), boza (a fermented bulgur drink taken in the winter), and rak (an aniseed-flavored brandy usually mixed with water). Carbonated drinks have become general with young people, and beer gardens in major cities have become hangouts for men. The major food taboo in Turkey is pork, which is forbidden to Muslims.Cultural analysis gives an overview of social Turkey. Thereby, BreadTalk has to consider this for their marketing plan in TurkeyA highly effective way of expanding a business of BreadTalk in Turkey is through television commercials and newspaper, word of mouthThe company should be aware of Islamic traditions and sensitivitiesWith the turkey, meat and bread make an inseparable combination. Because BreadTalk should make products that fit and stay off combined with pork.If BreadTalk open system restaurants chain in Turkey is a potential because people have a habit of going to a restaurant on the weekends and business is often discussed over restaurant dinners.2.3.3 outgo PatternsThe food industry and beverage of Turkey has received a stea dy growth in recent years, with the Turkish consumers becoming more demanding, dictated by the multitude of choices leaved by the mass grocery retail. Besides, Turkey has become one of the largest markets for its goods baked with bread a key element of the Turkish diet leading to leading to some of the highest rates of per capita consumption in the world. It provides opportunities for profitable investment BreadTalk.Turkey has traditional eating habits that remain stable in the majority of the population. Turkey is one of the largest markets, with rising incomes, packaged bread consumption presents an increase and at the same time, demand for different bread varieties, such as high-fibre and specialty artisan breads offer an opportunity for this high profit market.2.4 TechnologicalTechnological progress has contributed to the economic maturation of the country and has an important factor in their competition. In the future as well, scientific and technological progress is expec ted to follow the destination provided by economic policies and competitive strategies.Turkey has well-developed infrastructure throughout much of the country that is qualified of supporting significant information. Turkey has made many reforms to its infrastructure sector. Besides, the development of the internet is also seen as an effective factor in the business environment of BreadTalk. The number of Internet users has been rising rapidly in Turkey and standing at 15th place around the world, according to CIA, the World Factbook (2011)Graph 8 Internet users in TurkeyCUsersInspironDesktopindexmundi_ex118.jpgSource CIA World Factbook, 2011The development of the Internet in the social life of the Turkey will support BreadTalk greatlyInternet will become a tool to promote the brand, and an introduction to the business. This will help save advertising costs.BreadTalk can take this as a distribution channel in the form of online business with customers buying large quantities2.5 Env ironmentalOne of the environmental strengths in Turkeys is the well-situated biodiversity they have. Turkey has a very affluent natural resource base and has ranked ninth on biodiversity in the European countries. Examples of the lineament of biodiversity they have are not only a range of wild species but important domestic species such as wheat, lentils, chickpeas, pears, apple, chestnut and pistachios. The biodiversity has a very great potential for the development for Turkey and this is an advantage for BreadTalk because it will provide abundant and cheap raw materials. However, challenges of the current environmental in Turkey are the high pollution levels and need nourish.2.5.1 PollutionTurkeys economic development has brought with it fears of increased environmental degradation.Graph 9 2010 Pollution Indexes in TurkeySource http//www.clrsearch.com, 2010The chart shows that the level of pollution of Turkey is alarming. Most of the air pollution is caused by household heating , traffic, industrial sites, the discharge of pollutants by neighbor countries has contaminated the Black Sea So, today government of Turkey has many activities to protect the environment as environmental Pollution Fines. BreadTalk should know the environment situation of Turkey to not be infringed. In addition, the company should also be the same with the government to protect environment to build brand image with the consumers.2.5.2 Environmental protectionEnvironment protection is very hypercritical right now in Turkey. Business has to strictly follow the shape that imposed by host country government. However, there are also some other motives for BreadTalk when entering Turkey to environment protection such asBreadTalk will also carry out some schedule for going green in their Turkey stores such as reduce paper using, switch off the light, limited plastic bags and encourage the mental faculty to use public transportation. This brings beautiful images for BreadTalk in the mi nds of employees, customers and government.Environment protection achieve comparative advantage terms of cost saving, offering more benefits to consumers and being friendly with the environment.BreadTalk could take advantage of environment protection campaign and appear some environmental awards of the government to keep in touch with them. This will help company channeling with governmental issues.Environment protection as a way of branding to make BreadTalk familiar and deep in mind of customers2.6 Legal2.6.1 LawThe legal strengths in Turkeys is the comprehensive legal structure they have. The judicial system is made up of general courts which deal with domestic cases, heavy penal courts which deal with more serious case, armed services courts which will deal with the military cases and the Constitutional Court which is the highest level of courts that will deal with many different cases which is essential in the Turkish government such as war crimes. This is an advantage for Br eadTalk as this shows that the Turkish government are strict on the police force and will enforce the law if need be, it will allow the company to have a bazaar trial.Another legal advantage in Turkey would be the robust framework for the business entities, as the company who are looking to invest into Turkey will not need to go through a very long and lengthy business registration process as there is a freedom to start, operate and close a business by the Turkish regulatory environment. so for example in Turkey, it will take on average 6 day to starting up a business compared to 43 days in the other world countries which is a much longer time and could be beneficial for the type of market the company is involved with. This is advantage for BreadTalk when company entry into Turkey because BreadTalk will not lose many time.BreadTalk is food and beverages company because the company pay attention to the Food Safety regulation. The HACCP quality assurance system was introduced in 199 5 in Turkey and since 2008 according to the Regulation on direction and Control of Food Safety and Quality all food manufacturers must apply HACCP as compulsory (Food quality assurance schemes in Turkey, 2011). To protect customers and increase the prestige of the brand, BreadTalk should be combined with organization and obey the law.2.6.2 valuateOne of reasons that BreadTalk should invest in Turkey is low taxes and incentivesCorporate Income tax income reduced from 30 percent to 20 percentIndividual Income value varies from 15 percent to 35 percentTax benefits and incentives in engine room Development Zones, Industrial Zones and Free Zones could include total or fond(p) exemption from Corporate Income Tax, up to 80 percent grant on employers social security share, as well as land allocation. upstart RD and Innovation Support LawRegion and sector-based incentive system3. determinationAnalyzing PESTEL for the business environment of Turkey gives BreadTalk a wider and deeper vie w on Turkey to come up with the decision to enter Turkey market. Turkey can best withstand before the global financial crisis. In addition, Turkey attracts investors by young labor force, capable, modern infrastructure, large domestic market, a number of free trade agreement, investment environment freeBesides, one of the current challenges of BreadTalk is the high rate of inflation, corruption, terrorism.

Risk Of Falls Among Elderly Health And Social Care Essay

Risk Of Falls Among Elderly wellheadness And Social pull off EssayThe loss of qualification, symmetricalness, and mobility atomic number 18 no longer considered inevitable sequel of aging. Physiological impairments related to operable dependency atomic number 18 potentially rechargeable with appropriate cipher interposition (Morgan, 2005 Nelson et al., 2004). Further more(prenominal) dexterity preparation look into architectural planmes adjudge been especially overhaulful in improving proportionateness, fleshly operation and diminution fall (Hoglund, Sadovsky, Classie, 2009 Kruger, Buchner, Prohaska, 2009 Nelson et al., 2004).Several interventional researchers engage been conducted to prevent travel among antiquated lot (Judge, 2003 Kim, Yoshida, Suzuki, 2010 McMurdo, Millar, Daly, 2000). In this adopt we willing leaven a home(a)- ground bringing up intervention to improve skill of muscles which evict directly improve rest and rivet the dan ger of travel among community d considerablyer of age(p) or by dint of increased self-efficacy.Problem statementRisk of locomote collectible to repose impairment among senior(a) multitude is reversely associated with goodish intensiveness (Clemson, Cumming, 2004). Effectiveness of muscle run interventions to improve agreement and reduce the find of falls in hoary great deal with high run a jeopardize for move allow been a matter of controversial in distinct studies (Salminen et al., 2001). patch more or less found wreak educational act schedules successful in reducing the assay of falls (Cheung, Au, Lam, Jones, 2008 Clemson et al., 2010 Gobbi et al., 2009a Nelson et al., 2004), nigh other(prenominal)s have found contrary proves (Au-Yeung et al., 2002 Clemson et al., 2010 Rubenstein et al., 2000).The need for a home-based breeding dress program is felt by some researchers (Kamide, Shiba, Shibata, 2009). vigour intensivenessening purpose interve ntion by home facilities has its own advantages and disadvantages. Home-based recitation program, in comparison to clinic-based interventions which ar very luxurious and seem to be very tempting and promising (Takano et al., 2010), sounds to be more feasible. As a matter of fact, the lack of public availability of high tech facility in civiliseing courtiers, transportation barriers for of age(p), the occupation of cost- emolument and cost dominance of whatever high-tech program are major barriers to use clinical-based exercise programming for patriarchal people (Nelson et al., 2004). merely, it is estimated that about one half of seniors aged 85 days or to a higher place rarely leave their homes and interventional trials targeting on those housebound aged are scarce(Ashworth, Chad, Harrison, Reeder, Marshall, 2005).Nelson et al 2004 summarized that a home-based exercise program in community-dwelling elders with in operation(p) impairment is feasible and effective in impr oving track downal achievement, disrespect limited supervision. They in any case added that home-based exercise programs that focus on intensiveness and equilibrize cooking improve functional performance in hoary people and should be promoted by the allied health community (Nelson et al 2004). economic crisis price and organizational flexibility make it an substitute or a supplement to other forms of forcible exercise and active lifestyle (Hinrichs et al, 2009)On the other hands, compliance, which is a major problem in centered-based exercise among antique people, keep be happen upond by home-based programs. Previous researches emphasis that adhesion to any exercise program is low among antique people especially in long run (Campbell et al., 1997 Dishman, 1991 Gobbi et al., 2009b Sturnieks, St George, Lord, 2008e Sun et al., 2005). Blanchard 2008 stated that less than 15 constituent of immemorial people participate in center-based exercise program. He added that to achieve a grownr fleck of participants, there has been a shift toward implementing home-based replenishment programs. Home-based unchewable lastingness planning can be considered as an alternative to expensive and low compliance clinical-based muscle training (Blanchard, 2008).There have been some problems in previous home-based programs. They still rely on intimately(prenominal) expert soulnel who closely supervise their patients and provide them with high exemplar business organisation at their home (Gardner, Robertson, McGee, Campbell, 2002 Nelson et al., 2004 Luukinen et al., 2007a). The others emphasize on privateized trig programs (Clemson et al., 2010) which raises the cost of intervention program. Moreover, these programs, although were discovered to be effective, lack in large scale randomization was the main limitation of the studies (Nelson et al., 2004). Moreover, because of low health literacy among Persian venerable population, any home-based trai ning intervention without proper supervision and adherence will not be able to achieve its objectives (Carpenter, 2010a). A well cited memorize suggested that elderly people need supervision to improve strength in a home-based setting (Baker et al., 2001). To overcome the problem of health illiteracy among elderly people we plotted to involve participants adult children who have the intimately interaction with the invitee in training program to supervise him/her during training and fill up the log books.Fear of falling, a risk chemical element for falls, is being understood as an emerging public health problem (Denkinger et al., 2010 Hill, Schwarz, Kalogeropoulos, Gibson, 1996 Li, Fisher, Harmer, McAuley, 2005). Evidence suggests that both fallers and non fallers experience psychological problems associated with falls (Honaker, 2001). Previous researches have termed psychological factors as hero-worship, diminished self efficacy and loss of authorization(Topping, 1994 Gai , Gomes, Jansen, 2009 Legters, Verbus, Kitchen, Tomecsko, Urban, 2006 Pednekar, 2007).In community dwelling elderly, a complex interaction has been found among revere of falling, falls self- efficacy, increased physical impairments and diminished functional ability and exertion participation (Legters et al., 2006 Maxwell, 2006 Mihalko, 1997 Tinetti, Richman, Powell, 1990b Pednekar, 2007).This interactive cycle encompasses tending of falling which leads to activity confinement and further decreasing physical capabilities such as functional mobility, oddment and strength which leads to decreased cartel and fear of falling (Pednekar, 2007).A home-based training exercise should be directed toward strengthening weak muscles and dimension. The consequence of intelligent weakness and co- causeion is lack of self-assurance (Tinetti, Richman, Powell, 1990a) which makes elderly people loss their assumption and fear of falls (Hill et al., 1996). Fear of falling deteriorates the rest period reactions and leads to increased risk of falls and increased risk of fault (Okada, Hirakawa, Takada, Kinoshita, 2001). Loss of confidence among elderly people solutions in functional limitations and may cause restriction in activity due to fear of falling, which is very common problem among community-dwelling former(a) adults with or without experience of falls (Hansma, Emmelot-Vonk, Verhaar, 2010). Under a public health perspective, the access to home-exercise programs seems to be easier. Once implemented, a home-exercise program should be undefendable to r some(prenominal)ly a broad audience (Ashworth et al 2005). So, it is logical that ameliorate knock-down(a) strength can result in self-confidence, reduce fear of falls, increase match and decrease risk of falls.A great number of studies have proposed that only additional research with frail elderly individuals will help answer if home-based training would improve balance in former(a) ages (Nelson et al., 2 004 Baker et al., 2001). We, therefore, decided to test the hypothesis that an individual home-based muscle strength training in high risk individuals (60 years old and above elderly people with previous narration of falls in snuff it 12 months) would be feasible with minimal expert supervision and would result in clinically important improvements in balance and functional performance. The voice of distribute givers in this discipline is to fill the log books, because most of the elderly subjects have health illiteracy.Significant of the studyThis dissertation affords to the scientific literary productions in different interrelated shipway. Firstly, the finding of this study can contribute to the personate of knowledge in regard to falls among elderly. Falls have been explored by several researchers from different aspects however it needs more scientific and empirical investigations to find out the ways to prevent the fall or alleviate the relative relative incidence of f alls among frail elderly community-dwellers. To achieve a better understanding of falls, its consequences and legal profession of falls, this area of research needs a richer body of knowledge to illuminate the way for other researchers to explore the ways to reduce risk of falls.Secondly, the findings of this study, practically, can contribute to alleviate the problem of falls among frail elderly people in community. This study looks the problem of falls from both biological (muscular strength) and psychological (self-efficacy) point of view. So, any falls prevention program has to consider the results of this dissertation as evidence to plan a comprehensive program on falls. In addition, finding of this dissertation can be utilize by falls prevention planners. All programs designed to prevent falls can benefit from this study, because it is planned to reduce morbidity and reduces burden of falls for person, family and healthcare services. American Geriatrics Society recommends some activities including exercise and/or physical to prevent falls among elderly people. Health professionals after orienting to the program can deliver and supervise the exercise training program for one-time(a) people. The program has been tested as a single intervention but could be delivered in a complex falls prevention program, too.Thirdly, the findings of this study can be employ by other health practitioners in different disciplines to utilize exercise training to reduce the risk of falls among their elderly lymph nodes. So many other researchers have investigated the benefits of the exercise for other high risk groups such as patients with chronic diseases e.g. Parkinson Disease (PD), Multiple Sclerosis (MS), Stroke, Arthritis and other neuromuscular or articular diseases, depression, anxiety, etc. This study highlights the importance of exercise training among elderly people. Moreover, the current study is one of the low gear studies on the problem of falls in Irania n elderly community. In developing countries where sources are limited, the exercise program can be offered first to those with high risk e.g. history of falls, aged 70 and older. However, other aged people can benefit the advantages of this program.ObjectivesThis study is planned to investigate the relationship amongst muscular strength to risk of fall among community dweller elderly people. To achieve this objective, the following specific goals are followedTo describe the subjects muscular strength, self-efficacy, fear of falls and balance forrader and after interventionTo examine the relationship between subjects backcloth variables, muscular strength, self-efficacy and fear of falls before and after interventionTo examine the relationship between subjects muscular strength and risk of falls before and after interventionHypothesesThe home-based training exercise can improve muscular strengths among elderly people. Strong muscles can directly increase physical balance which is considered as proxy for decreased risk of falls among elderly people. Moreover stronger muscled can increase self-efficacy and reduce fear of falling and decreased risk of falls among elderly people.Definition of key wordsHistory of falls abstract History of falls is previous experience of the event of falls. In this study, fall is an unexpected, involuntary loss of balance by which a person comes to rest at a lower or base train (Kelly Dowling, ). Other researchers have defined falls as An unintentional gunstock that may or may not result in an injury, and in which any motion of descent may not necessarily result in a landing. (Berry et al., 2010). operational In this research, history of falls is defined as any report of falls incidence by which a person comes to rest at a lower or ground take, in subjects of the study. Any incidence of falls in weather 12 months is considered as history of falls. Moreover, the number of falls during intervention is questioned. Data are co llected by a questionnaire. In the questionnaire history of falls during last 12 months and causes of falls are questioned. No history of falls, one incidence of falls and two or more falls are categorized as non-faller, accidental faller and recurrent faller, consecutively.Fear of FallsConceptual fear of falling, first described as ptophobia, by Bhala, ODonnell, Thoppil, 1982, which means a phobic reaction to standing or walking and was subsequently assort by Murphy Isaacs in 1982 as Post fall syndrome (Jung, 2008).Operational In this study Falls Efficacy Scale (FES) is used to prize clients fear of falling. It is a rating scale with 10 items to assess clients confidence in performing periodic activities. Each item is rated from 1, meaning extreme point confidence to 10, meaning no confidence at all. Participants with lower self-efficacy report avoiding most of activities because of fear of falling and get higher FES scores. On the other hands, participants with higher self-ef ficacy report less avoiding most of activities because of fear of falling and represent lower FES scores.BalanceConceptual Benjuya, Melzer, Kaplanski defined balance as the ability to maintain an upright posture during both inactive and dynamic tasks (Bird, Hill, Ball, Williams, 2009).Operational In this study balance is the subjects score in Berg Balance Scale. Total Score is varies between 0 and 56. In interpretation of Berg Balance Scale low, medium and high risk of falls are corresponded to 41-56, 21-40 and 0-20, respectively.Muscular strengthConceptual Muscular strength is defined as the maximal ability of a muscle to contract and generate force (Hanney, Kolber, Schack-Dugre, Negrete, Pabian, 2010).Operational operationally muscular strength in lower extremity and hand grip are assessed. For lower extremity muscular strength the direct stand test commonly used. The chair stand test is a physical performance test used to assess lower-extremity function. A 5 repetition test is a measuring of strength (Ward et al., 2010). Subjects hand grip force score in their left and right hands will be recorded. Individual patients whose grip strength is less than the lower limit of the confidence intervals can be considered to be impaired grip (Bohannon, Peolsson, Massy-Westropp, Desrosiers, Bear-Lehman, 2006).ExerciseConceptual A subset of physical activity. It is planned and repetitive body movement, which improves or maintains one or more components of physical fitness (e.g., cardiovascular endurance, muscular strength, balance, flexibility)(Pate, 1995).Operational operationally exercise is a set of muscular strengthening action used to increase balance in terms of Berg Balance Score (BBS) and reduce the risk of falls among participants of the study.Self efficacyConceptual Bandura (1986) defined self-efficacy as, Peoples judgments of their capabilities to organize and take to the woods courses of action required attaining designated tokens of performances (p. 391). Self efficacy means ones self confidence towards learning. People usually engage in certain behaviors when they believe they are capable of implementing those behaviors successfully, this means that they have high self-efficacy (Bandura, 2007).Operational In this study subjects scores in the Activities-specific Balance Confidence (ABC) Scale are considered as their self-efficacy. The Activities-specific Balance Confidence Scale is a scale with 16 items each item is rated from 0% (no confidence) to 100% (complete confidence). Clients are asked to rate the level of confidence that they will lose their balance in daily activities.Conceptual mouldThis study will be conducted based on a modern biologic conjecture called conduct and tear theory and Orems self-care theory. In this study the gull and tear theory is used to explain why muscular strength and balance deteriorates during old ages. Orems self-care theory is utilized to explain how self-care through and through exe rcise can maintain and improve an old persons ability for balance and reduce the risk of falls. Moreover, Banduras self-efficacy explains the moderating role of self-efficacy between muscular strength, fear of falls and balance to risk of falls among elderly people.Proposed conceptual mannequinBackgroundAgeGenderMarital StatusEducation amiable statusSESChronic DiseasesMedicationHealth literacyADL/IADLSelf-rated Health(IV)Muscular aptitudeFear of FallsSelf-Efficacy(DV)Falls Risk(Balance)Chapter TwoThere has been a lack of investigation on effectiveness of home-based exercise, since there have been few randomized control trials (RCTs) evaluating home-based exercise (Kamide et al 2009). Home-based exercise programs are vox populi to be effective in improving functional performance and balance in functionally impaired elders (Nelson et al 2004). It is demonstrated that participation in a supervised home-based exercise program was associated with significant improvements in exercise b eliefs, including exercise self-efficacy and outcomes expectation (Matsuda, Shumway-Cook, Ciol, 2010). This study is trying to investigate effectiveness of home-based exercise on reducing the risk of falls among elderly people based on theoretical framework and review of related literature.This chapter is devoted to break away two main sections of the dissertation. First, the theoretical framework of the study will be discussed and then the main related literature to this study will be reviewed.Theoretical FrameworkIn this section, theories of wear and tear and self-care are introduced. The wear and tear theory explains the process of biologic changes during old ages which makes gentlemans cells and tissues degenerated. Moreover, self-care theory explains how anyone (self-care agent) can exert some measurements and actions to maintain health and well being. give and Tear TheoryWear and tear theory of ageing was first introduced by Dr. August Weismann in 1982 (Salvi, Akhtar, Curr ie, 2006). The wear and tear theory of aging believes that the effects of aging are caused by damage done to cells and body arrangings over time. Essentially, these systems wear out due to use. Once they wear out, they can no longer function correctly (Giampapa Williamson, 2004). According to the theory, aging occurs through wear and tear that leads to the liberal accumulation of damage(Murphy Partrige, 2008) The theory postulates that the daily roil of life, in particular disuse or overuse, literally wears the body out, leaders to disease states (tears). The degeneration of muscles, cartilage and eventual grinding of bone on bone is pillow slips of the aging process on body joints, as wear and tear exceed the bodys ability to repair (MacWilliam, 2002).The wear and tear compose over the course of time determines such degradations as loss of breeding (genetic and epigenetic mutations during the life course), loss of structural integrity (increases in entropy), and breakdowns in the sudden property of complexity (Juckett, et al. 2009).Based on wear and tear theory, hoary muscular muscles cachexy starts after middle ages, especially when muscles are rare or overused (Giampapa et al., 2004). The process of degeneration is associated with senile changes in body and progressively reduces muscular bulk. There are good evidences to support that type 2 muscles are more prone to degenerated than type 1 muscles (Mannion et al., 2000).Deterioration in muscular size and number in old ages causes muscular atrophy and in combination of other senile changes in other organs (neurons) (Klitgaard et al., 2008) eventually ends up a loss of muscular strength and balance disorder which may predisposes old people to risk of falls (Sturnieks, 2008). overlook of muscular strength and balance affects patients self-efficacy and make them more susceptible to falls (Campbell et al., 1997), because of fear of falls(Denkinger et al., 2010).Self-care theorySelf care theory was given by Dorothea Orem between 1959 and 2001 with a unique philosophy that patients have different level of singly. Orems self-care framework is based on the three components of self-care deficit theory, self-care theory and the treat system theory (Denyes, Orem, Bekel, 2001).Self-care is defined by WHO as activities individuals, families, and communities perform in order to enhance their health, prevent diseases, limit illnesses, and restore health (Klainin Ounnapiruk, 2010). These activities are undertaken by lay people on their own behalf, either independently or in participative collaboration with healthcare professionals. There are several examples for self-care behavior including seeking health-related in coiffureion, exercising and consuming healthy diets (Klainin et al., 2010).Self-Care AgencySelf-care agency, as defined by Orem (2001), refers to the power of individuals to engage in self-care and their capability for self-care. The person who uses this power or self-car e ability is the self-care agent. Self-care agency is acquired and affected by family members and care giver. They specifically may affect the clients adherence to behavioral changes and treatment regimens and boilers suit outcomes (Rutledge et al., 1999). There is a power component to self-care agency, which addresses the importance of knowledge, attitudes, and skills that enable the individual to engage in self-care (Kumar, 2007)Nursing SystemNursing system are interventions needed when individual is unable to perform the necessary self-care activities and categorized in three distinct levels as followWholly compensatory in which care givers provides entire self-care for the client. An example of this category is an elderly person hospitalized in small care unit who need a care giver for his staple fibre needs to survive.Partial compensatory in which a care giver and client perform care client can perform selected self-care activities, but also accepts care done by the care giv er for needs the client cannot meet independently. An example of this category is an elderly person who needs help for some activities such as ambulating, but is able to perform most activities by his own.Supportive-educative in which training is planned to help the client develop/learn their own self-care abilities through knowledge, education, support and encouragement. A good example of this category is educating the elderly client to perform exercise to strengthen the muscles or to teach how to do insulin self-injection.In this research, the third category of nursing system will be applied among elderly people to strengthen their speeding and lower extremities muscle to improve their balance and reduce the risk of falls critical review of literatureA recent study, by Matsuda et al 2010, proposed that effectiveness of any exercise to improve physical function varies with level of frailty, format and intensity of exercise program, and kind of supervision. A systemic review summa rized the best(p) evidence for effectiveness of interventions designed to reduce the incidence of falls in older people living in the community, concluded that home-based exercises and Tai chi were specific exercise programs that showed benefit (Carpenter, 2010b).Home-based exercise program among relatively healthy older adult are proven to be effective in functional performance than group-based programs. In an Iranian study researchers conducted a 12 weeks home-base exercise training in 40 -65 years old Iranian women to prevent osteoporosis and increase muscular strength and balance (Shirazi et al., 2007). In another study researchers conducted a home base training exercise on Parkinson disease patient. They concluded that individuals with Parkinsons disease can significantly improve functional performance measures utilizing a convenient, cost effective, home-based exercise intervention (Nocera, Gainesville, Horvat, Athens, 2008). Other recent studies on standing exercise and ba lance training program on balance confidence, balance performance, and tempo in debilitated, ambulant community-dwelling older adults back up that exercise can improve balance, However, definitive conclusions need to await organization from more rigorously designed studies before the present training program can be confidently recommended to physical therapists engaged in home care practice(Miller, Magel, Hayes, 2010).In New Zealand, the Otago Exercise Program is designed as a home-based training exercise with combination of strength, balance exercises and walking program to prevent falls. The program is individually designed program three clock a week and progressed over time. Four randomized controlled trials in different setting disclosed the effects of training program among elderly people. In another supervised 6-week, multidimensional home-based exercise program, researchers found that the program was untroubled and associated with improvements in physical and exercise-r elated belief outcome measures(Matsuda et al., 2010).Some researchers have used some technical instrument to improve balance and reduce the risk of falls among elderly people (Runge, Rehfeld, Resnicek, 2000). However, any community home-based program should immix the training into peoples everyday life. It would be feasible, economic and more acceptable for elderly people rather than high technical procedures.A randomized controlled fell study with 12-week physical and/or nutritional intervention program was followed by six months of home-based exercises for the training groups, followed up with training diaries aiming to describe the effects of a physical training and nutritional intervention program on the physical activity level and activities of daily living (ADL) in frail elderly people found moderate correlations between increases in physical activity level and ADL as well as between the amounts of home-based exercises and ADL for the two training groups (Rydwik, Frandin, Akner, 2009). Another study found that a 6-month, home-based exercise program consisting of progressive strength training, balance exercises and general physical activity improves functional performance and balance in functionally impaired elders (Nelson et al., 2004). Finding of another study concluded that an exercise class even once every 2 weeks is very effective in enhancing physical function in ambulatory individuals aged over 73 years, provided that it is supplemented by a home-based exercise program (Suzuki, Kim, Yoshida, Ishizaki, 2004). However they suggested a large scale study to confirm their results and to valuate the most effective exercises for the prevention of falls. Researchers concluded that incorporation of exercises in daily life is important in maintaining an appropriate level of physical function in the elderly.Prevention of falls and injuries is not easy, however, because they are complex events caused by a combination of intrinsic impairments and disabili ties (Kannus, Niemi, Parkkari, Palvanen, Sievznen, 2007) fall prevention in elderly people consists of regular strength and balance training, vitamin D and calcium supplementation, diminution of the number and doses of psychotropic medication, cataract surgery, and professional home-hazard assessment and management in people with a history of falling (Kannus, Sievenen, Palvanen, Jervinen, Parkkari, 2005). On the other hand, a single-factor intervention such as exercise could also reduce many impairments and disabilities and more distant risk factors for falling simultaneously.Muscle big money diminishes considerably between the ages of 20 and 80 years (Sturnieks, St George, Lord, 2008d). Sarcopenia is a common problem among elderly people and is associated with loss of muscle mass and strength (Iannuzzi-Sucich, 2002). Understanding age-related changes in the physiological systems imperative to balance is of importance to prevent falls in older people and reduce the injury-relat ed burden on individuals and society (Sturnieks, St George, Lord, 2008c). It has been estimated that the human beings in their 4th to 8th decade of life lose some half of muscle mass and muscle strength (Spirduso, 2005).Senile muscular atrophy predominantly occurs in type 2 muscle fibers which ends up a degenerated muscular bulk in which remaining muscle mass is not only smaller and weaker but slower as well (Kostka, 2010 Faulkner, 1995).The most primary atrophy occurs in quadriceps, hamstrings and back muscles with the highest concentration of type II fibers (Kostka, 2010). It has also been consistently proven that power-generating capabilities of type II fibers is or so four times more than of type I fibers (Faulkner, 1995 Metter, 1997). Muscular strength is typically maintained at peak levels until the fifth or ordinal decade, after which accelerated losses occur, with strength decreasing approximately 50% by the age of 80 year (Sturnieks, St George, Lord, 2008b).Deficits in skeletal muscle strength, balance, and gait, being major causes of frailty and risk factors for falls, are equivalently and potentially reversible by exercise training (Suzuki et al., 2004). One proposed intervention for preventing falls and fall-related injuries in the elderly is exercise. If falls occur at least in part because of physical deficits in balance, strength, reaction time, and flexibility, then it is plausible to believe that exercise targeted to improve these deficits might result in fewer fall and/or injury events.The role of strength exercise in falls prevention is under investigation. In a recent study, researchers evaluated the balance and weight training to alter gait characteristics of elderly to reduce the likelihood of slip-induced falls. The results indicated decreases in hotdog contact velocities and the friction demand characteristics after 8 weeks of training, although fundamental gait characteristics, such as walking velocity and step length, were not changed (Kim Lockhart, 2010). Latham, et al 2003 in a randomized control trial found that among older people recently discharged from hospital quadriceps strengthening exercises failed to reduce falls rates and was associated with a significant risk of musculoskeletal injury (Sturnieks, St George, Lord, 2008a).A recent study investigating the effects of a multifactorial fall prevention trial on the specified risk factors of falling, incidence of falls and injurious falls did not find significant contravention between control and intervention groups (Sjosten et al., 2007). However there are some evidences to support effectiveness of training program among elderly people (Kruger et al., 2009 Madureira, Bonfb, Takayama, Pereira, 2010)Review of literature reveals that self-confidence deteriorates because of muscular weakness and make old people to fear of falls (Davis, 1999 Evitt, 2003 Gai et al., 2009).Bandura in his book 1997 wrote thatPeople make causative contributions to their own psychosocial functioning through mechanisms of personal agency. Among the mechanisms of agency

Non-pharmacological Pain Relief Intervention in Labour

Non-pharmacological unhinge Relief Intervention in LabourCHAPTER IIREVIEW OF LITERATUREReview of belles-lettres is an important step in the development of any research project. This chapter deals with the information collected with relevant to the present(a) hold by means of the published and unpublished materials. These publications were the foundation to carry unwrap the research work. This helps the investigator to analyze what is already known almost the guinea pig and to describe the modes of inquiry.Research literatures ar look buttocksed under the fol small(a)ing headingsA lit related to non-pharmacological fuss quietus intervention.B writings related to bum abrase as a complementary therapy for infliction management in exertion.A Literature related to non-pharmacological torture stand-in intervention.Davim, Torres Dantas (2009) conducted a field of operations to evaluate the force outiveness of non- pharmacological strategies to mollify hassle in par turient in labour. This is before and afterward therapeutic intervention clinical streak, performed with coke parturients applying breathing exercise, muscle relaxation, lumbosacral rub down and shower. A visual par every(prenominal)el of latitude scale was used for data collection. Oxytocin was administered in 81% of cases, merely 15% did non baffle any medication. A world-shattering contrast was observed in imposition relief after using non- pharmacological strategies, showing reduced smart as cervical dilatation increased. cent April (2004) The control of labour hassle and prevention of suffering are mull concerns of clinicians and their clients. Nonpharmacologic entreees toward these goals are consistent with midwifery management and the cho scratchs of many women. They undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the potential of 13 non-pharmacologic methods used to relie ve injure and reduce suffering in labour.AcupunctureAcupuncture, an important and quaint component of traditional Chinese medicine, is gradually being integrated with effected medicine in the West. Acupuncture is believed to initiate, control, or accelerate physiologic functions, and thus, temper organ malfunctions, heal illnesses, or relieve discomforting symptoms through interjection of pretty needles into the pare down at a combination of specific crowns along meridians (channels of energy, called Qi, enounce chee) in the body, followed by rotation, heating, or electrical stimulation(electro-stylostixis) of the needles.Smith, Collins, Cyna, Crowther (2006)A systematic review of acupuncture for hurting relief in labor reported that acupuncture was associated with a trend toward slight(prenominal) use of pharmacological analgesia (RR 0.70, 95% CI 0.49-1.00) .Compared to controls who had no or sham acupuncture, women who underwent acupuncture were more(prenominal) relax ed and used less pharmacological hurt relief, but did not have pass up pain intensity aim markers. Maternal satisfaction was high among all the women in twain the acupuncture and control companys.Acu pressure levelAcupressure, or Shiatsu, a simpler choice to acupuncture, is pressure with fingers or small beads at acupuncture points.Chung, Hung, Kuo Huang (2003). A study to determine L14 and BL67 acupressure on labour pain during basic typify of labour .A total of 127 parturient were randomly assigned to three pigeonholings. distributively assemblage received only one of the following treatments L14 and BL67 acupressure, light skin stroking or no treatment. There was a significant diversity in labour pain in the source concourse compared with the cardinal others.AromatherapyAromatherapy is the science of using highly concentrated essential oils or essences distilled from plants in order to utilize their therapeutic properties . Abbaspoor and Mohammadkhani (2013) The aim of this study was to investigate the effect of aromatherapy work with Lavender oil. This was a prospective, randomise, controlled trial that was conducted in 2008 Tehran, Iran. The subjects included N=60 primiparous women in 3842 week gestational age, who were expected to have a normal delivery. They were randomly assigned to twain concourses. The first group received only work (n=30) and the second group received aromatherapy massage with Lavender oil (n=30). The intensity of pain was mensurable with the visual parallel of latitude scale ( vessel). Results showed that pain intensity before and after intervention were significantly reduce in the lavender aromatherapy massage group in the latent and active phase, and they had a lower duration of first and second distributor point of labour. Reeja Mariam Joseph Philomena Fernandes(2013) The study was conducted to prise the effectiveness of jasmine oil massage on labour pain during first symbolise of labour among 40 pr imigravida women. The study design adopted was true data-based approach with pre-test berth-test control group design. The demographic Proforma were collected from the women by interview and optic analog scale was used to measure the level of labour pain in both(prenominal) the groups. data obtained in these areas were analysed by descriptive and illative statistics. A significant difference of opinion was found in the data-based group( t 9.869 , p0.05) and the post-test (t 11.75, pBreathing exercises Kamalifard et al.,(2000) A quasi-experimental study was conducted for 42 mothers selected randomly carve up into both groups of massage 2 and breathing 2. The breathing groups employed the techniques during the first or second stage of labour at 4, 6, 8 and 10 centimeter of dilatation for 30 minutes. The intensity of pain was measured by a numerical rating scale (NRS) 30 minutes after determining dilatation. The ERA performed massaging at the same dilatations for M1 and M2 g roups. Massage at 4 and 6 cm dilatations and breathing at most dilatations decreased pain hemorrhoid significantly. The choosing of one or both methods for labour pain relief and decreasing caesarean section rate is suggested.HydrotherapyHydrotherapy is an effective, alternative intervention that can be used by business concern providers as a nonpharmacological pain relief method to help labouring women fuck with labour. A wide variety of pain relief measures are ready(prenominal) to women in labour.Entisar Manal (2012) This study assessed obliges knowledge about the use of hydropathy as a Nonpharmacologic pain-relief techniques during labour and identify the barriers of hydrotherapy to be used in Womens Health Center, Egypt. A descriptive study design was utilized in this study. The 120 nurses who works in obstetrics department. They showed that approximately three reap (73.3%) of the participant nurses knowl-edge were adequate, while (26.7) of nurses had inadequate knowledge about the use of hydrotherapy in labour. Nurses encounter that hospital policy (100%) followed by environ-mental factors (52%) are the major barriers to the use of hydrotherapy in labour. Effort required for hydrotherapy (48%) and military man resources (41%) are indicated to be equivalent barrier of the use of hydrotherapy in labour. Their knowledge represented (26.7%) and not considered to be a major lend barrier to the use of hydrotherapy during labour.HypnosisCyna, McAuliffe Andrew (2004) They examined the evidence regarding the personal effects of hypnosis for pain relief during childbirth. Five RCTs and 14 non-randomized comparisons (NRCs) studying 8395 women were identified where hypnosis was used for labour analgesia. quad RCTs including 224patients examined the primary outcomes of interest. One RCT rated poor on quality assessment. Meta-analyses of the three be RCTs showed that, compared with controls, fewer parturients having hypnosis required analgesia, relative ris k=0.51 (95% confidence interval 0.28, 0.95). Of the two included NRCs, one showed that women using hypnosis rated their labour pain less knockout than controls (PMusic therapy Phumdoung Good (2003) A randomized controlled trial of 110 primiparous women in active phase of labour were assigned to soft unison group for 3hrs (n=55) or a control group (n=55). Dual VAS were used to measure pain before starting the study and all(prenominal) 3 hrs. The results indicate that music group women had significantly less pain sensation(pPositionDeClercq et al., (2006) A national fall over of childbearing experiences in the linked States in 2005 reported that after admission to the hospital, most women (76 per centum) did not laissez passer around. This percentage was slightly high than in a similar survey conducted three years earlier. At that time, the most common reason the women gave for not walking was that they were connected to things (67percent), unable to support self due to pai n medication (32 percent), and told not to walk around (28 percent). However, 58 to 60 percent of the women did report changing positions to relieve pain during labour.Yoga Chuntharapat et al.,(2008) A randomized trial was conducted using 74-primigravid Thai women who were equally divided into two groups (experimental and control). The yoga program tough six, 1-h school terms at prescribed weeks of gestation. The experimental group was found to have higher levels of maternal comfort during labour and 2 h post-labour, and experienced less subject evaluated labour pain than the control group. In each group, pain increased and maternal comfort decreased as labour progressed. The experimental group was found to have a shorter duration of the first stage of labour, as well as the total time of labour.B Literature related to bottom massage as a complementary therapy for pain management in labour. Patricia, Farah Paula (2012) A study conducted to evaluate the effectiveness of massage t herapy in managing labour pain among women in active labour. A randomized controlled trial in Vancouver of 77 healthy nulliparous women presenting in spontaneous labour, upto 5 hours the massage therapy was given. The mean cervical dilataion at the time of epidural insertion was 5.9cm(95% CI 5.2-6.7) compared to 4.9 in the control group. (95% CI 4.2-5.8) scores on the McGrill pain scale were consistently lower in the massage therapy group (13.3 vs 15.8 at 5-6cm 19.4 vs 28.3 at 7.8cm) although these differences were not satisfically significant. Vijayalakshmi S (2011) An experimental was conducted to assess the effectiveness of effleurage over lumbosacral region for reduction of pain perception during first stage of labour among primigravida mothers. The study samples were 60 primigravida mothers (30 in experimental group 30 in control group). The samples were selected using lottery method comes under probability simple random sampling technique. A have numerical categorical scale w as used to assess the level of pain perception among primigravida mothers during first stage of labour. The findings revealed that marked decrease in mean value from 3.43 in pre assessment level to 2.30 in post assessment level and the improvement mean was 2.86 and SD was 0.27 in experimental group.Umarani (2010) conducted a quasi experimental pretest posttest control group design to assess the effectiveness of back massage during the first stage of labour among primigravida mothers. 30 primigravida mothers were taken and assigned for experimental and control group equally. Pain perception was measured by using 0-10 numerical pain intensity scale. 20 minutes back massage was given to the experimental group after the 3cm cervical dilatation, when contractions started. Control group was allowed to follow the conventional method. The results showed that at that place was a significant reduction on pain perception of 2.2 than 3.6 in control group. Dsouza (2010) conducted a study on eff ectiveness of ice massage (acupressure L14) for the reduction of labour pain among intranatal women. A quasi experimental pretest-posttest only design was carried out on 49 intranatal women the pretest was 100mm visual analogue scales (VAS) and McGrill pain Questionaire. In the experimental group the mean posttest pain score (2.1) which is significantly lower than the mean pretest score (5.0) with a mean difference of (2.9).The calculated value(11.588) was more than the table value (2.093,pZahrani (2008). This study has been conducted to determine the effects of massage on intensity of pain during the first stage of labour in primiparous women who have attended Isfahan Shahid Beheshti hospital in 2005. In this randomize clinical trial, a total of 75 primiparous women in 38-42 week of low risk pregnancy were randomly divided in 3 groups. First group received 20 minutes of back effleurage massage at the periods of 4-5 cm, 6-7 cm, 8-10 cm, cervical dilation. An emotional support was of fered for second group in the same duration of time and the same cervical dilation. third group just received routine care during labour. In all groups, pregnant women were asked to evaluate their severity of pain before and after intervention. Data being obtained through the visual analogue scale, check list and reassessment form. Results Study result demonstrated that intensity of pain was significantly lower in massage group (pRefined olive oil is obtained from perfect(a) olive oils by refining methods, which do not lead to alterations in the initial glyceridic structure. It has a free acidity, expressed as oleic acid, of not more than 0.3 grams per 100 grams (0.3%) and its other characteristics correspond to those fixed for this category in this standard.The healthful use of olive oil is a non-selective inhibitor of cyclo-oxygenase similar to classical NSAIDs give care ibuprofen. Fifty grams of extra virgin olive oil is equivalent to about the tenth of a dose of ibuprofen. He alth benefits of olive oil are analgesia, Oil massage, bone growth, decreased aging, and decreased cardiovascular problems.Jeyalakshmi, Latha Venkatesan, Jamuna (2008) conducted a study on effectiveness of olive oil massage therapy upon low back pain of parturient mothers in the first stage of labour at Andhra mahila sabha,Chennai. 60 mothers were randomly selected for experimental and control group. Before and after massage therapy low back pain and feto maternal parameter was assessed in both groups. In experimental group 100% of them experienced moderate level of pain after massage therapy. The mean and standard deviation of low back pain score of the control group were high in comparison with olive oil therapy group (p=0.001). Kuhn (2004) conducted a study to assess the effectiveness of massage therapy on downcast pregnant women. 84 depressed pregnant women were recruited during the second trimester of pregnancy and randomly assigned to a massage therapy group and control group that received standard prenatal care alone. These groups were compared to each other. The massage therapy was for 20 minutes for 2 sessions by their significant other each week for 16 weeks of pregnancy. Immediately after the massage therapy sessions on the first and last days the woman reported lower levels of anxiety and depressed mood and less leg and back pain and also the massage group had higher dopamine and serotonin levels and lower levels of cortisol and norepinephrine.Chang, Wang, Chen,(2002) The third trial randomly assigned 60 women to receive massage or usual care. Massage was performed three times, once during each phase of the first stage of labour (latent, active and transition) and lasted for 30 minutes in each phase. Pain intensity was rated by a nurse observing each womans manifestations of pain using a present behavioural intensity (PBI) scale. Anxiety was measured using a visual analogue scale for anxiety (VASA). Although pain intensity increased steadily throu gh progressing phases of labor, the massage group had significantly lower pain intensity scores at each phase of labor (0.73 versus 1.30 in latent, 1.73 versus 2.17 in active, and 2.17 versus 2.87 in transition phases). Anxiety levels were significantly lower in the massage group only during the latent phase (37.2 versus 53.5 on a 100 point scale). Eighty-seven percent of the women in the massage group reported that the massage was helpful in providing pain relief and psychological support.Field et al., (1999) A study which involved 26 pregnant women were assigned to massage or relaxation therapy group for five weeks. The therapies consisted of 20 minute session in two ways a weeks. MANOVAs and ANOVAs were conducted for repeated measures. A significant group by pre-post session MANOVA, F(4,21) = 2.86p

The Classic Novel Of The Great Gatsby English Literature Essay

The Classic Novel Of The Great Gatsby face Literature EssayFrancis Scott Fitzgeralds classic novel, The Great Gatsby takes place during the Roaring Twenties. This was a time when nearly any ane with a gambling soul and an intuition for the unratified or immoral could f all told right into fortune. This is a tale of deuce men atomic number 53 who gave all for nonhing, and one who gave nonhing for everything. Although Jay Gatsby and tom turkey Buchanan are stark in contrast, their stories both revolve around deceit, gold, and the love of one woman.The voice of the humbug is Nick Caraway, who is Gatsbys neighbor and the cousin of tom turkey Buchanans married woman, Daisy. Gatsby is a new millionaire who hosts elaborate parties every weekend at his gorgeous theatre, gravid rise to gossip astir(predicate) his enormous wealthiness. Gatsby and Daisy dated once prior to her marriage with tomcat. The latter is a successful line of reasoningman who comes from a breed of money and greed. As the story unfolds, we learn that Gatsbys every action is triggered by love, age Toms wholly by selfishness.The story takes place in extensive Island, where both of the men live. It begins by immediately contrasting the men base upon their respective geographical locations. Gatsby is a resident of the less fashionable western junkie, piece Tom lives in east glob, where residents are believed to be more(prenominal) prestigious and hurt a history of wealth and stance.The areas of easternmost Egg and West Egg in Long Island are non only separated geographically by a courtesy bay, still likewise in spirit. They divide society into two classes of rich people. The vitamin E Egg represents the already established aristocratic society, while the West Egg consists of those, who callable to favorable circumstances require gained their wealth and settled trim in this area. The West Egg stands for the new money and its inhabitants desperately try to be accepted by the old money that are reluctant to assemble them as equals. Those who come from East Egg demonstrate their separateness during one of Gatsbys lavish parties developing an view of superiority. They represent the staid nobility of the countryside East Egg condescending to West Egg, and carefully on guard against its spectroscopic gayety (Fitzgerald, 49). Nevertheless, they visit these parties to mock the festivities and to confirm that they do not want to accord with the self-made riches who, like Gatsby, sprang out of nowhere. The residents of the West Egg, despite all their efforts to lead extravagant and luxurious lifestyle, are no match to the East Egg. The latter adhere to classic understanding of the aristocracy, which can be transmittable only by heredity and upbringing.Both, Tom and Gatsby live a confidential life of deceit. Gatsby found a shortcut to success and to a faultk it when he met a wealthy bootlegger named, Meyer Wolfsheim. Gatsby assured himself that wea lth was the key to winning rear end up Daisy, and he was imparting to do anything necessary to win her back veritable(a) if it had to be unethical. There appears to be no legislature untouchable sufficient to keep him from capturing his American Dream. Gatsby tells everybody that he was in drug store and anoint business, omitting the fact of illegal bootlegging, which became the main source of accumulating vast income. Gatsby keeps his criminal activities in secret, savoring the role of a generous and gracious host. Gatsby to a fault claims to have graduated from Oxford University and ceaselessly uses the phrase old sport throughout the novel. The story he concocts about himself is too trivial and people find it touchy to believe, spreading all sort of gossip around Gatsbys mysterious persona. The verity about his life would most likely undermine his prestige and impatience the rich.Tom is also living a secret life in New York with his mistress, Myrtle Wilson. Although he considers himself to be of aristocratic breed, his brutal way signifies quite the opposite. Tom forbids Myrtle to mention his wifes name and, when she disobeys, Tom reveals his adult male nature. Making a short deft movement Tom Buchanan stony-broke her nose with his open hand (Fitzgerald, 41). More all over, Tom does not try to wait his infidelity and introduces Myrtle to Nick, who becomes an outside observer of their strained relationship. Toms wife Daisy also knows about the amourette, but plays a role of a happy wife in the public.Tom and Gatsby each strive to project a strong image in order to maintain their amicable status and professionalism. Tom drops his guard in New York when he is around Myrtle and in the long onslaught seems complacent. Gatsby loses his composure and acts like a nervous child when he proposes partake with Daisy again. The men appear strong and defiant among their peers, but show a weaker side when around their lovers.Both men act similarly when talk of the town over the phone. Tom sneaks away from everyone to hold phone conversations with his mistress and never reveals who he is talking to. Like Tom, Gatsby also holds short, discreet phone conversations while coordinating his underground bootlegging operation. In substantiveity, Toms secret life is aimed at pleasing himself while Gatsbys is about pleasing Daisy.Each man flaunts his wealth in different ways. Tom flaunts his directly by boasting about his accomplishments. Tom does not like going out as swell up as gather large groups of people in his house. When guest do come to his house, he prefers to be in control and does not knock off any opportunity to boast about his superiority and wealth. For Tom money is the center of his life, it gives his comfort, confidence and power, and there is no need in proving his social status. When things get out of control Tom clouds behind his money in concert with his wife.They were careless people, Tom and Daisy they smashed u p things and creatures and then retreated back into their money or their vast carelessness or whatever unplowed them together and let other people clean up the luck they had made (Fitzgerald, 191).Gatsby flaunts his wealth indirectly by hosting elaborate parties in his mansion. He does not verbally brag about his fortune, but it is visible to anyone who attends his parties. Gatsby sees money as the key into the world of the affluent, the means of existence, but not as the essence of life. The story reveals that Gatsby only hosts parties with the intention of meeting Daisy again. He hopes that Daisy will hear about his success from someone who attends one of the parties and would want to make contact with him.As the story progresses, it becomes evident that Gatsby has strategically picked the location of his mansion so that he may be close to the Buchanans residence, more simply Toms wife, Daisy. Gatsby can see the green light at the end of Daisys sorrel from his home. As long as the light is burning and Daisy lives there, hope is fluent alive that he can win her heart. The green light represents Daisy, who is in the East for the time being. But with big(p) work and determination, he feels that he can capture the light and bring it to the West.The most common denominator in the midst of the two men is Daisy. As the story continues we learn that Daisy has been the chief bonus for Gatsbys mysteriously accumulated income. Gatsby and Daisy dated before he went off to warfare and when he returned, he discovered that she had married Tom. Gatsby feels that he lost her because he was unable to provide the lavish lifestyle that she desires rich girls dont marry lamentable boys. He becomes determined to transform himself into a wealthy man so that she will marry him.Although Tom is married to Daisy, he seems to take her for granted. Tom is used to control everything in his life, his wife is no exception. When he in conclusion discovers the secret affair between Daisy and Gatsby, he feels that he loses control over his wife. However, he soon regains it by telling Daisy about the illegal business Gatsby is involved in. He victoriously concludes He Gatsby wont annoy you. I think he realizes that his presumptuous inadequate flirtation is over (Fitzgerald, 144). Daisy is too preoccupied with her well-being to risk it for the sake of love she does not feel. With Tom she is sure that years later his money will be there, while with Gatsby she does not have any guarantees.Although Gatsby may have obtained his wealth illegally, he was a good-hearted person. He befriended Nick and was more than willing to make for a hand to someone in need. It becomes apparent that Gatsby had a hard life prior to his success, and the reader can relate to Gatsby on a personal level because his actions were motivated by his love for a woman. whatever person that is familiar with that overwhelming feeling of love or want may find themselves supportive and approving of Gatsby.Tom is described as a godly man with chesty eyes, which can be attributed to his attitude in general. He is not only a very arrogant individual, but very confrontational. Tom is bound and determined to present Gatsby in unfavorable light. With that intention he finds out where hes from, where he went to school, and what he very does for a living. When he confronts Gatsby in the hotel room at the height of the story, Gatsby backs down but Tom continues to press forth by attacking what little dignity that Gatsby has left. His ego is in the way so much that he fails to see how hypocritical he really is. Gatsby is not perfect and neither is Tom.Buchanan may have been more law abiding than Gatsby, but his personal characteristics were more deceitful. The one thing that Gatsby wanted Daisy Tom took for granted safe like everything else in his life because he was privileged and respected. His only motives were greed, and his status in the society. Tom stole Gatsbys love of life without any competition. Its not hard to look like an eagle when youre flying with turkeys. At to the lowest degree Gatsby had the courage to fight for what he wanted regardless of any impediment in his path. Tom proved to be a coward on the dark of Myrtles death. He hid cowardly behind the walls of his East Egg palace. He clear displays his true colors in his sanctuary of selfishness.Gatsby was willing to take the point for Myrtles death to keep Daisy out of trouble. He had plenty of time to run away but he chose not to. Instead, he decided to hold back his destiny and accept it. Gatsby decided to go for a swim on the day of his death as if it was the calm before the storm. A real crook would have run cowardly like Tom, but not Gatsby. It seems that he finally accepted the fact that he had lost and surrendered peacefully, not cowardly. Was it because he really wanted to die for Daisy, or could no overnight live a life without her?The truth about Gatsby is discovered b y and by his death. When Gatsbys father arrives to his sons funeral, we learn that Gatsbys birth name is Jay Gatz. His father believes his son to have been an honest hard-worker, who would have helped build up the country. Only Nick knows the truth that Jay Gatz made an illegal fortune under another name but does not have the heart to tell Gatsbys father that his son was a bootlegger. It is obvious that Gatsby knew his father would not approve of the illegal lifestyle. Perhaps he changed his name to keep his family from earning a bad reputation, or to better hide his true identity.Gatsby is killed after having sold his soul in a failed fire to obtain happiness. He gave everything meet to have one more play with Daisy but it was all for naught and cost him his life. Tom quietly escapes from East Egg with his health, fortune, and marriage still intact he sacrificed nothing just as he always had before. I guess the old truism is true nice guys really do finish last.