SAP ERP systems Essay Example | Topics and Well Written Essays - 1000 words

SAP ERP systems - Essay Example SAP product design and development deals with business expansion and advancements. The system reduces marketing time while increasing productivity from the developed products. As the product design cycles are reduced, collaboration also improves under the integrated SAP software dealing with product development. It connects development and design, manufacturing, procurement and services seamlessly via flexible collaborations’ environment. Its other tasks are to raise the innovation speed, lower marketing duration through aligning products developments and designs with manufacturing and procurement. It allows for flawless environments collaboration to avoid time wastage and minimizes the cost of the designed products through streamlining design and optimizing components. The system ensures regulatory compliance under transparency during the phases in product definition. Decision-making becomes speedy to maximize quality in 3D visualization embedding. Production and inventory co ntrol offers a suite full of features essential for the success of supply chain management and inventory controls. The objective is to a kitty, track objects, industry specified customization to ultimately assist in boosting the bottom line. It has several benefits in that it increases revenue, accelerates decision making and identifies non-moving and discounted products in real-time. The I.T infrastructure is simplified whilst optimizing inventory levels by ensuring production of the right products at the right time.

Market Demand Essay Example for Free

Market Demand Essay The calculation above shows that Bonia Group practice elastic demand for the previous 10 years. This is mainly due to strong competition among competitors. Bonia Group, which target the mid-high price range market encounter a few international branding competitor like Calvin Klein, DKNY, Paris Hilton, Armani Exchange and Lacoste in the market and were highly competitive for years. Bonia Group was advised to avoid price increase for the coming years as sales figures for the past 10 years show that Bonia Group were in elastic demand. In order to increase yearly sales amount, the Group could actually remain or decrease price as in elasticity demand, sales growth is oppositely proportional to price. They are always encourage to remain or decrease the price, and at the same time remain the quality and material of goods to boost up the sales quickly and to show immediate results. Besides that, the mid-high price range in Bonia Group show that their products are actually inferior goods. In order to overcome the coming economic crisis and recession, lower down the price range to normal goods is another way to avoid for profit losing. Economists predict that beginning from this year, it would be another recession coming ahead. During recession, the average salary for population will decrease and unemployment increase. People will try to find out substitute for expensive goods. Thus, Bonia as an inferior goods brand will encounter sales decrease during recession. It is good to change from inferior goods to normal goods so that they can still gaining profit during recession.

Child With Failure To Thrive Health And Social Care Essay

Child With Failure To Thrive Health And Social Care Essay In this review article, the definition, aetiology, evaluation, differential diagnoses, management, prevention and prognosis of failure to thrive are discussed. Failure to thrive (FTT) is a common problem in paediatric practice, affecting 5-10% of under-fives in developed countries with a higher incidence in developing countries. Majority of cases of FTT are due to a combination of nutritional and environmental deprivation secondary to parental poverty and/or ignorance. Many infants with FTT are not identified. The key to diagnosing FTT is finding the time in busy clinical practice to accurately measure and plot a childs weight, height and head circumference, and then assess the trend. In the evaluation of the child who has failed to thrive, three initial steps required to develop an economical treatment-centred approach are: (i) A thorough history including itemized psychosocial review, (ii) Careful physical examination and (iii) Direct observation of the childs behaviour and of parent-child interaction. Laboratory evaluation should be guided by history and physical examination findings only. Once FTT is identified in a particular child, th e management should begin with a careful search for its aetiology. Two principles that hold true irrespective of aetiology are that all children with FTT need a high-calorie diet for catch-up growth (typically 150 percent of their caloric requirement for their expected, not actual weight) and all children with FTT need a careful follow up. Social issues of the family must also be addressed. A multidisplinary approach is recommended when FTT persists despite intervention or when it is severe. Overall, only a third of children with FTT are ultimately judged to be normal. Keywords: Failure to thrive, growth deficiency, undernutrition. INTRODUCTION Although the term failure to thrive (FTT) has been in use in the medical parlance for quite some time now, its precise definition has remained debatable1. consequently, other terms such as undernutrition1 and growth deficiency2 have been proposed as preferable. FTT is a descriptive term applied to young children physical growth is less than that of his or her peers.3 The growth failure may begin either in the neonatal period or after a period of normal physical development.4 The term FTT is not, in itself, a disease but a symptom or sign common to a wide variety of disorders which may have little in common except for their negative effect on growth.5 In this regard, a cause must always be sought. Often, the evaluation of children who fail to thrive pose a difficult diagnostic problem. Some of the difficulties result from the numerous differential diagnoses, the definition used or misdirected tendency to search aggressively for underlying organic diseases while neglecting aetiologies based on environmental deprivation.6 In addition, early accusations and alienation of the childs parents by the health-care provider will make the evaluation and management of the child who has failed to thrive more difficult.7 In general, factors that influence a childs growth include: (i) A childs nutritional status; (ii) A childs health; (iii) Family issues; and (iv) The parent-child interactions.3,8,9 All these factors must be considered in evaluation and management of child who has failed to thrive. This paper presents a simplified but detailed approach to the evaluation and management of the child with FTT. DEFINITION The best definition for FTT is the one that refers to it as inadequate physical growth diagnosed by observation of growth over time using a standard growth chart, such as the National Center for Health Statistics (NCHS) growth chart.10 All authorities agree that only by comparing height and weight on a growth chart over time can FTT be assessed accurately.11 So far, no consensus has been reached concerning the specific anthropometric criteria to define FTT.11 Consequently, where serial anthropometric records is not available, FTT has been variously defined statistically. For instance, some authors defined FTT as weight below the third percentile for age on the growth chart or more than two standard deviations below the mean for children of the same age and sex1-3 or a weight-for-age (weight-for-hieght) Z-score less than minus two.1 Others cite a downward change in growth that has crossed two major growth percentiles in a short time.3 Still others, for diagnostic purposes, defined FTT as a disproportionate failure to gain weight in comparison to height without an apparent aetiology.6 Brayden et al.,2 suggested that FTT should be considered if a child less than 6 months old has not grown for two consecutive months or a child older than 6 months has not grown for three consecutive months. Recent research has validated that the weight-for-age approach is the simplest and most reasonable marker of FTT.12 Pitfalls of these definitions: One limitation of using the third percentile for defining FTT is that some children whose weight fall below this arbitrary statistical standard of normal are not failing to thrive but represent the three percent of normal population whose weight is less than the third percentile.5,6 In the first 2 years of life, the childs weight changes to follow the genetic predisposition of the parents height and weight.13,14 During this time of transition, children with familial short stature may cross percentiles downward and still be considered normal.14 Most children in this category find their true curve by the age of 3 years.6,14 When the percentile drop is great, it is helpful to compare the childs weight percentile to height and head circumference percentiles. These should be consistent with the position of height and head circumference percentiles of the patient.5 Another limitation of the third percentile as a criterion to define FTT is that infants can be failing to thrive with marked d eceleration of weight gain, but they remain undiagnosed and therefore, untreated until they have fallen below the arbitrary third percentile.6 These normal small children do not demonstrate the disproportionate failure to gain weight that children with FTT do.6 This approach attempts not only to prevent normal small children from being incorrectly labeled as failing to thrive, but also excludes children with pathologic proportionate short stature.14 Having excluded these easily distinguishable disorders from the differential diagnosis of FTT, simplifies the approach to evaluation of the child who has failed to thrive.6 A more encompassing definition of FTT includes any child whose weight has fallen more than two standard deviations from a previous growth curve.3,15,16 Normal shifts in growth curves in the first 2 years of life will result in less severe decline (i.e, less than 2 SD).13 Some authors have even limited the definition of FTT to only children less than 3 years old17,18 A precise age limitation is arbitrary. However, most children with FTT are under 3 years of age.6,8 EPIDEMIOLOGY In young children, FTT which does not reach the severe classical syndrome of marasmus is common in all societies.19 However, the true incidence of FTT is not known as many infants with FTT are not identified, even in developed countries.20-22 It is estimated to affect 5 10% of young children and approximately 3 5% of children admitted into teaching hospitals.3,5,23 Mitchell et al,24 using multiple criteria found that nearly 10% of under-fives attending primary health care centre in the United States showed FTT. About 5% of paediatric admissions in United Kingdom are for FTT.4 The prevalence is even higher in developing countries with wide-spread poverty and high rates of malnutrition and/or HIV infections.3,19 Children born to single teenage mothers and working mothers who work for long hours are at increased risk.22 The same is true of children in institutions such as orphanage homes and homes for the mentally retarded5,22 with an estimated incidence of 15% as a group.5 Under-feed ing is the single commonest cause of FTT and results from parental poverty and/or ignorance.19,22,24 Ninety five percent of cases of FTT are due to not enough food being offered or taken.25 The peak incidence of FTT occurs in children between the age of 9 24 months with no significant sex difference.22 Majority of children who fail to thrive are less than 18 months old.3 The syndrome of FTT is uncommon after the age of 5 years.3,22 AETIOLOGY Traditionally, causes of FTT have been classified as non-organic and organic. However, some authors have stated that this terminology is misleading.27 They based their opinion on the fact that all cases of FTT are produced by inadequate food or undernutrition and in that context, is organically determined. In addition, the distinction based on organic and non-organic causes is no longer favoured because many cases of FTT are of mixed aetiologies.3 Based on pathophysiology (the preferred classification), FTT may be classified into those due to: (i) Inadequate caloric intake; (ii) Inadequate absorption; (iii) Increased caloric requirement; and (iv) Defective utilization of calories. This classification leads to a logical organization of the many conditions that cause or contribute to FTT.10 Non organic (psychosocial) failure to thrive In non-organic failure to thrive (NFTT), there is no known medical condition causing the poor growth. It is due to poverty, psychosocial problems in the family, maternal deprivation, lack of knowledge and skill in infant nutrition among the care-givers5,11. Other risk factors include substance abuse by parents, single parenthood, general immaturity of one or both parents, economic stress and strain, temporary stresses such as family tragedies (accidents, illnesses, deaths) and marital disharmony.6,8,22 Weston et al,28 reported that 66% of mothers whose infants failed to thrive has a positive history of having been abused as children themselves, compared to 26% of controls from similar socioeconomic background. NFTT accounts for over 70% of cases of FTT.6 Of this number, approximately one-third is due to care-givers ignorance such as incorrect feeding technique, improper preparation of formula or misconception of the infants nutritional needs,29 all of which are easily corrected. A cl ose look at these risk factors for NFTT suggest that infants with growth failure may represent a flag for serious social and psychological problems in the family. For example, a depressed mother may not feed her infant adequately. The infant may, in turn, become withdrawn in response to mothers depression and feed less well.10 Extreme parental attention, either neglect or hypervigilance, can lead to FTT.10 Organic failure to thrive It occurs when there is a known underlying medical cause. Organic disorders causing FTT are most commonly infections (e.g HIV infection, tuberculosis, intestinal parasitosis), gastrointestinal (e.g., chronic diarrhoea, gastroesophageal reflux, pyloric stenosis) or neurologic (e.g., cerebral palsy, mental retardation) disorders.6,19,22 Others include genitourinary disorders (e.g., posterior urethral valve, renal tubular acidosis, chronic renal failure, UTI), congenital heart disease, and chromosomal anomalies.6,7 Together neurologic and gastrointestinal disorders account for 60 80% of all organic causes of under nutrition in developed countries.30 An important medical risk factor for under nutrition in childhood is premature birth.1 Among preterm infants, those who are small for gestational age are particularly vulnerable since prenatal factors have already exerted deleterious effect on somatic growth.1 In societies where lead poisoning is common, it is a recognized risk factor for p oor growth.5,31 Organic FTT virtually never presents with isolated growth failure, other signs and symptoms are generally evident with a detailed history and physical examination.32 Organic disorders accounts for less than 20% of cases of FTT.6 Mixed failure to thrive In mixed FTT, organic and non organic causes coexist. Those with organic disorders may also suffer from environmental deprivation. Likewise, those with severe undernutrition from non-organic FTT can develop organic medical problems. FTT with no specific aetiology Review of the literature on FTT indicate that in 12 32% of cases of children who have failed to thrive, no specific aetiology could be established.23,33-34 Causes of failure to thrive A. Prenatal cases: (i) Prematurity with its complication (ii) Toxic exposure in utero such as alcohol, smoking, medications, infections (eg rubella, CMV) (iii) Intrauterine growth restriction from any cause (iv) Chromosomal abnormalities (eg Down syndrome, Turner syndrome) (v) Dysmorphogenic syndromes. B. Postnatal causes based on pathophysiology: A. Inadequate caloric intake which may result from: i. Under feeding Incorrect preparation of formula (e.g. too dilute, too concentrated). Behaviour problems affecting eating (e.g., childs temperament). Unsuitable feeding habits (e.g., uncooperative child) Poverty leading to food shortages. Child abuse and neglect. Mechanical feeding difficulties e.g., congenital anomalies (cleft lip/palate), oromotor dysfunction. Prolonged dyspnoea of any cause B. Inadequate absorption which may be associated with: Malabsorption syndromes e.g. Celiac disease, cystic fibrosis, cows milk protein allergy, giardiasis, food sensitivity/intolerance Vitamins and mineral deficiencies e.g., zinc, vitamins A and C deficiencies. Hepatobiliary diseases e.g., biliary atresia. Necrotizing enterocolitis Short gut syndrome. C. Increased Caloric requirement due to Hyperthyroidism Chronic/recurrent infections e.g., UTI, respiratory tract infection, tuberculosis, HIV infection Chronic anaemias D. Defective Utilization of Calories Inborn errors of metabolism e.g., galactosaemia, aminoacidopathies, organic acidurias and storage diseases. Diabetes inspidus/mellitus Renal tubular acidosis Chronic hypoxaemia Clinical manifestations of FTT3,22 Commonly the parents/care-givers may complain that the child is not growing well or losing weight or not feeding well or not doing well or not like his other siblings/age mates. Usually FTT is discovered and diagnosed by the infants physician using the birthweight and health clinic anthropometric records of the child. The infant looks small for age. The child may exhibit loss of subcutaneous fat, reduced muscle mass, thin extremities, a narrow face, prominent ribs, and wasted buttocks, Evidence of neglected hygiene such as diaper rash, unwashed skin, overgrown and dirty fingernails or unwashed clothing. Other findings may include avoidance of eye contact, lack of facial expression, absence of cuddling response, hypotonia and assumption of infantile posture with clenched fists. There may be marked preoccupation with thumb sucking. EVALUATION A. Initial evaluation It has been proposed that only three initial investigations are required to develop an economical, treatment-centred approach to the child who presents with FTT and this include:35 (i) A thorough history including an itemized psychosocial review; (ii) Careful physical examination including determination of the auxological parameters; and (iii) Direct observation of the childs behaviour and of parent-child interactions. The Psychosocial Review: The psychosocial history should be as thorough and systematic as a classic physical examination Goldbloom35 suggested that the interviewers should ask themselves three questions about every family: (i) How do they look; (ii) What do they say; and (iii) What do they do? a. HISTORY (1) Nutritional history Nutritional history should include: Details of breast feeding to get an idea of number of feeds, time for each feeding, whether both breasts are given or one breast, whether the feeding is continued at night or not and how is the childs behaviour before, after and in between the feeds. It would give an idea of the adequacy or inadequacy of mothers milk. If the infant is on formula feeding: Is the formula prepared correctly? Dilute milk feed will be poor in calorie with excess water. Too concentrated milk feed may be unpalatable leading to refusal to drink. It is also essential to know the total quantity of the formula consumed. Is it given by bottle or cup and spoon? Also assess the feeling of the mother e.g., ask how do you feel when the baby does not feed well? Time of introduction of complementary feeds and any difficulty should be noted. Vitamin and mineral supplement; when started, type, amount, duration. Solid food; when started, types, how taken. Appetite; whether the appetite is temporarily or persistently impaired (if necessary calculate the caloric intake). For older children enquire about food likes and dislikes, allergies or idiosyncracies. Is the child fed forcibly? It is desirable to know the feeding routine from the time the child wakes up in the morning till he sleeps at night, so that one can get an idea of the total caloric intake and the calories supplied from protein, fat and carbohydrate as well as adequacy of vitamins and minerals intake. (2) Past and current medical history The history of prenatal care, maternal illness during pregnancy, identified fetal growth problems, prematurity and birth weight. Indicators of medical diseases such as vomiting, diarrhoea, fever, respiratory symptoms and fatigue should be noted. Past hospitalization, injuries, accidents to evaluate for child abuse and neglect. Stool pattern, frequency, consistency, presence of blood or mucus to exclude malabsorption syndromes, infection and allergy. (3) Family and social history Family and social history should include the number, ages and sex of siblings. Ascertain age of parents (Down syndrome and Klinerfelter syndrome in children of elderly mothers) and the childs place in the family (pyloric stenosis). Family history should include growth parameters of siblings. Are there other siblings with FTT (e.g., genetic causes of FTT), family members with short stature (e.g. familial short stature). Social history should determine occupation of parents, income of the family, identify those caring for the child. Child factors (e.g., temperament, development), parental factors (e.g., depression, domestic violence, social isolation, mental retardation, substance abuse) and environmental and societal factors (e.g., poverty, unemployment, illiteracy) all may contribute to growth failure.5 Historical evaluation of the child with FTT is summarized in Table 1. (b) PHYSICAL EXAMINATION The four main goals of physical examination include (i) identification of dysmorphic features suggestive of a genetic disorder impeding growth; (ii) detection of under lying disease that may impair growth; (iii) assessment for signs of possible child abuse; and (iv) assessment of the severity and possible effects of malnutrition.36,37 The basic growth parameters such as weight, height / length, head circumference and mid-upper-arm circumference must be measured carefully. Recumbent length is measured in children below 2 years of age because standing measurements can be as much as 2cm shorter.36,37 Other anthropometric data such as upper-segment-to-lower-segment ratio, sitting height and arm span should also be noted. The anthropometric index used for FTT should be weight-for-length or height. Mid-parental height (MPH) should be determined using the formula.40 For boys, the formula is: MPH = [FH + (MH 13)] 2 For girls, the formula is: MPH = [(FH 13) + MH] 2 In both equations, FH is fathers height in centimetres and MH is mothers height in centimetres. The target range is calculated as the MPH Â ± 8.5cm, representing the two standard deviation (2SD) confidence limits.14 Assessment of degree FTT The degree of FTT is usually measured by calculating each growth parameter (weight, height and weight/height ratio) as a percentage of the median value for age based on appropriate growth charts3 (See Table 3) Table 3: Assessment of degree of failure to thrive (FTT) Growth parameter Degree of Failure to Thrive Mild Moderate Severe Weight 75-90% 60 -74% Height 90 -95% 85 89% Weight/height ratio 81-90% 70 -80% Adapted from Baucher H.3 It should be noted that appropriate growth charts are often not available for children with specific medical problems, therefore serial measurements are especially important for these children.3 For premature infants, correction must be made for the extent of prematurity. Corrected age, rather than chronologic age, should be used in calculations of their growth percentiles until 1-2 years of corrected age.3 Table 2: Physical examination of infants and children with growth failure. Abnormality Diagnostic Consideration Vital signs Hypotension Hypertension Tachypnoea/Tachycardia Adrenal or thyroid insufficiency Renal diseases Increased metabolic demand Skin Pallor Poor hygiene Ecchymoses Candidiasis Eczema Erythema nodosum Anaema Neglect Abuse Immunodeficiency, HIV infection Allergic disease Ulcerative colitis, vasculitis HEENT Hair loss Chronic otitis media Cataracts Aphthous stomatitis Thyroid enlargement Stress Immunodeficiency, structural oro- facial defect Congenital rubella syndrome, galactosaemia Crohns disease Hypothyroidism Chest Wheezes Cystic fibrosis, asthma Cardiovascular Murmur Congenital heart disease(CHD) Abdomen Distension hyperactive Bowel sound Hepatosplenomegaly Malabsorption Liver disease, glycogen storage disease Genitourinary Diaper rashes Diarrhoea, neglect Rectum Empty ampulla Hirschsprungs disease Extremities Oedema Loss of muscle mass Clubbing Hypoalbuminaemia Chronic malnutrition Chronic lung disease, Cyanotic CHD Nervous system Abnormal deep tendon Reflexes Developmental delay Cranial nerve palsy Cerebral palsy Altered caloric intake or requirements Dysphagia Behaviour and temperament Uncooperative Difficult to feed. Adapted from Collins et al 41 Growth charts should be evaluated for pattern of FTT. If weight, height and head circumference are all less than what is expected for age, this may suggest an insult during intrauterine life or genetic/chromosomal factors.2 If weight and height are delayed with a normal head circumference, endocrinopathies or constitutional growth should be suspected.2 When only weight gain is delayed, this usually reflects recent energy (caloric) deprivation.2 Physical examination in infants and children with FTT is summarized in Table 2. Failure to thrive due to environmental deprivation Children with environmental deprivation primarily demonstrate signs of failure to gain weight: loss of fat, prominence of ribs and muscles wasting, especially in large muscle groups such as the gluteals.6 Developmental assessment It is important to determine the childs developmental status at the time of diagnosis because children with FTT have a higher incidence of developmental delays than the general population.36 With environmental deprivation, all milestones are usually delayed once the infant reaches 4 months of age.42 Areas dependent on environmental interactions such as language development and social adaptation are often disproportionately delayed. Specific behavioural evaluations (e.g., recording responses to approach and withdrawal), have been developed to help differentiate underlying environmental deprivation from organic disease.43 Assess the infants developmental status with a full Denver Developmental Standardized test.44 Parent-child interaction: Evaluate interaction of the parents and the child during the examination. In environmental deprivation, the parent often readily walks away from the examination table, appearing to easily abandon the child to the nurse or physician.6 There is little eye contact between child and parent and the infant is held distantly with little moulding to the parents body.6 Often the infant will not reach out for the parent and little affectionate touching is noted.6 There is little parental display of pleasure towards the infant.6 Observation of feeding is an integral part of the examination, but it is ideally done when the parents are least aware that they are being observed. Breast-fed infants should be weighed before and after several feedings over a 24-hour period since volume of milk consumed may vary with each meal. In environmental deprivation, the parents often miss the infants cues and may distract him during feeding; the infant may also turn away from food and appear distressed.6 Unnecessary force may be used during feeding. Developing a portrait of the child-parent relationship is a key to guiding intervention.11 LABORATORY EVALUATION The role of laboratory studies in the evaluation of FTT is to investigate for possible organic diagnoses suggested by the history and physical examination.33,34 If an organic aetiology is suggested, appropriate studies should be undertaken. If history and physical examination do not suggest an organic aetiology, extensive laboratory test is not indicated.6 However, on admission full blood count, ESR, urinalysis, urine culture, urea and electrolyte (including calcium and phosphorus) levels should be carried out. Screen for infections such as HIV infection, tuberculosis and intestinal parasitosis. Skeletal survey is indicated if physical abuse is strongly suspected. In addition to being unproductive, blind laboratory fishing expeditions should be avoided for the following reason:5,6 (i) they are expensive; (ii) they impair the childs ability to gain weight in a new environment both by frightening him/her with venepuncture, barium studies and other stressful procedures and the no oral f eeds associated with some investigations prevent him/her from getting enough calories; (iii) they can be misleading since a number of laboratory abnormalities are associated with psychosocial deprivation (e.g., increased serum transaminases , transient abnormalities of glucose tolerance, decreased growth hormone and iron deficiency);21 and (iv) they divert attention and resources from the more productive search for evidence of psychosocial deprivation. In one study, a total of 2,607 laboratory studies were performed, with an average of 14 tests per patient. With all tests considered, only 10(0.4%) served to establish a diagnosis and an additional 1% were able to support a diagnosis.34 Further Evaluation (1) Hospitalization: Although some authors state that most children with failure to thrive can be treated as outpatients,4,5,11,45 I think it is best to hospitalize the infant with FTT for 10 14 days. Hospitalization has both diagnostic and therapeutic benefits. Diagnostic benefits of admission may include observation for feeding, parental-child interaction, and consultation of sub-specialists. Therapeutic benefits include administration of intravenous fluids for dehydration, systemic antibiotic for infection, blood transfusion for anaemia and possibly, parenteral nutrition, all of which are often in-hospital procedures. In addition, if an organic aetiology is discovered for the FTT, specific therapy can be initiated during hospitalization. In psychosocial FTT, hospitalization provides opportunity to educate parents about appropriate foods and feeding styles for infants. Hospitalization is necessary when the safety of the child is a concern. In most situations in our set up, there i s no viable alternative to hospitalization. (2) Quantitative assessment of intake: A prospective 3-day diet record should be a standard part of the evaluation. This is useful in assessing under nutrition even when organic disease is present. A 24-hour food recall is also desirable. Having parents write down the types of food and amounts a child eats over a three-day is one way of quantifying caloric intake. In some instances, it can make parents aware of how much the child is or is not eating.11 Table 4: Summary of risk factors for the development of failure to thrive Infant characteristics Any chronic medical condition resulting in: Inadequate intake (e.g, swallowing dysfunction, central nervous system depression, or any condition resulting in anorexia) Increased metabolic rate (e.g, bronchopulmonary dysplasia, congenital heart disease, fevers) Maldigestion or malabsorption (e.g, AIDS, cystic fibrosis, short gut, inflammatory bowel disease, celiac disease). Infections (e.g., HIV, TB, Giardiasis) Premature birth (especially with intrauterine growth restriction) Developmental delay Congenital anomalies Intrauterine toxin exposure (e.g. alcohol) Plumbism and/or anaemia Family characteristics Poverty Unusual health and nutrition beliefs Social isolation Disordered feeding techniques Substance abuse or other psychopathology (include Muschausen syndrome by proxy) Violence or abuse Adapted from Kleinman RE.1 Table 1: Summary of historical evaluation of infants and children with growth failure Prenatal General obstetrical history Recurrent miscarriages Was the pregnancy planned? Use of medications, drugs, or cigarettes Labour, delivery, and neonatal events Neonatal asphyxia or Apgar scores Prematurity Small for gestational age Birth weight and length Congenital malformations or infections Maternal bonding at birth Length of hospitalization Breastfeeding support Feeding difficulties during neonatal period Medical history of child Regular physician Immunizations Development Medical or surgical illnesses Frequent infections Growth history Plot previous points Nutrition history Feeding behavior and environment Perceived sensitivities or allergies to foods Quantitative assessment of intake (3-day diet record, 24-hour food recall) Social history Age and occupation of parents Who feeds the child? Life stresses (loss of job, divorce, death in family) Availability of social and economic support (Special Supplemental Nutrition Program for Women, Infants and Children; Aid for Families with Dependent Chi

Child Labor Essay example -- essays research papers fc

Child Labor   Ã‚  Ã‚  Ã‚  Ã‚  Child Labor, refers to the economically active population under the age of fifteen years old, who are employed in various industries (Grootaert, 2). Recently, child labor has become a large topic of debate; however, in most cases, it is very unfavorable. The perception that globalization is leading towards the exploitation of children, is becoming an important problem for international business. In my opinion, child labor should be eradicated. It is not only harmful to the health of children, but it takes away their chance for an education, and simply takes away their childhood.   Ã‚  Ã‚  Ã‚  Ã‚  The International Labor Organization estimates that 250 million children around the world, between the ages of five and fourteen, work. Out of the 250 million, 120 million of them work fulltime (ILO, 5). Child labor is common in industries such as agriculture, domestic services, carpet and textile, quarrying and brick making, and also prostitution. Some children work in factories and other workplaces in the â€Å"formal economy;† however, many work on farms or in homes. Child labor has many hazardous effects on the health of children. Some children work in areas such as stone quarries, tanning leather, and electroplating metals. All of these working conditions endanger the health of the child. Children in different occupations face different fatal diseases. Silicosis, which is caused from working in stone cutting, brick factories, granite and slate factories is one such disease. Tuberculosis, is also another disease endeared by children in pottery related i ndustries. Another very big problem, because of poor living conditions, is malnutrition.   Ã‚  Ã‚  Ã‚  Ã‚  The lack of education for working children is also another very serious problem. Child laborers work for most of the day, and in some cases 16 hours a day. There is no question, that education is a major contributing factor to the overall development of the child. Yet, because of the long working hours, children are deprived of time for education. Some children are more or less slaves, controlled by their employer to work all the time. In other cases, the parents are even responsible for child labor, because they give priority to labor and making money, over education. Some children must earn the income for the entire household (Grootaert, 3). Asi... ...). However, developing countries including Brazil and India, which have very high rates of child labor, rejected the proposal. But the rate of child labor is still dropping. In 1996, Brazil had 3.3 million child laborers. Soon after, international pressures, forced President Fernando Henrique Cardoso to create an anti-child labor initiative. This program basically paid parents to send their children to school. By the year 2000, the amount of child workers decreased to 2.5 million.   Ã‚  Ã‚  Ã‚  Ã‚  Today, child labor is still decreasing, but it seems almost impossible to eradicate. Child labor is ethically wrong and immoral; and yet, there are still businesses that choose to turn their heads away. Works Cited: Bachman, S. L. â€Å"The Political Economy of Child Labor and its Impacts on International Business.† Business Economics Jul. 2000: 1-4. Buckley, Stephen. â€Å"The Littlest Laborers: Why does Child Labor Continue to Thrive in the Developing World?† Washington Post 16 Mar. 2000: 1-5. Grootaert, Christian. â€Å"Child Labor: an Economic Perspective.† International Labor Review 136. 1995: 2, 3, 7. International Labor Organization. 1996. 20 Jun. 2001.

Comparative Essay Of 4 Poems Essay

In this essay I will be talking about the comparison of characters in the following poems: Mother any distance, Havisham, The Laboratory and My Last Duchess. When we first look at these poems they all have something in common, they are all about relationships. Mother any distance is about a mother and son relationship, Havisham shows a failed relationship with her fiancà ¯Ã‚ ¿Ã‚ ½, The Laboratory shows a relationship in shreds that leads to the use of poison and finally My Last Duchess shows the differences between two people in a relationship and what it can lead to. The structure in Mother any distance is approximately sonnet length but not exactly, this could show that it is a loving relationship but in a different way, as it is a mother and son. This shows that they are very close to each other. Havisham on the other hand has 4 x 4 line stanzas and is very precise. This could mean that it has been rehearsed over the years and she knows exactly what to say. The Laboratory is very different from Havisham structure wise as it has 12 stanzas varying in length and split up. This shows that she is making it up as she goes along. Finally My Last Duchess is only1 stanza, which adds more flow to the overall piece. The duke in my last duchess is a rich, handsome man who believes that he deserves to be treated better than anyone else. When talking to an envoy he recalls the story of how his wife acted and that he had her killed because she treated everyone equally not just him and was quite flirtatious. The duke can be compared to the poisoner in The Laboratory as they both are involved in death/murder. The poisoner however wants revenge on her husband as he is cheating on her. Compared to the duke the poisoner acts much less calm and more psychotic. The idea of revenge also appears in Havisham, she is an old woman who was jilted on her wedding day. She now hates all men and wishes to have her revenge on the man that ruined her life. Havisham uses bitter and twisted language to portray her emotions. As with all of these poems love appears somewhere and it is the same with Mother any distance but this time with a mother and son. The writer uses measurements and distances to show a parting relationship, as the son is moving into a new house. Havisham and The Laboratory are very similar if we look at thoughts and attitudes. They both show strong hatred/anger and they both want revenge so much that they seem to turn psychotic with insanity. Mother and my last duchess on the other hand are possessive and controlling. The mother wants her son to stay and always tries to help him as she thinks he needs a second pair of hands. The duke tries to control his wife and expects her to let her beauty speak not her mouth. â€Å"Seen not heard† and thought that she would respect his 900-year-old name. The difference though is that the duke acts very calm about it all so much so that it almost justifies his actions. In conclusion all 4 poems are related to each other yet are about different subjects. My last duchess shows the duke seeing his wife as an object not a person. The laboratory shows how far people will go to get revenge. In Havisham we see the effect of breaking someones heart and finally we see how we need to let go of those who we love and let them make their own path.

How to Write an Abstract for a Business Research Paper

How to Write an Abstract for a Business Research Paper How to Write an Abstract for a Business Research Paper An abstract for business research paper is a summary of the entire paper. Students doing business research papers often mistake abstracts to be the introductory paragraph since abstract appears at the beginning of the work. Business research papers are general audience papers that are likely to be read by any member of the society. The abstract is given much attention by the audience since it is a snapshot of the entire work. There are two types of abstract that can be developed in a business research paper: descriptive and informative abstracts. Students must decide which type of abstract to include in their business research papers though they accomplish the same goal. Descriptive abstracts are best suited for shorter business research papers while informative abstracts are for lengthy and technical research papers. Concisely, an abstract is supposed to explain the purpose of business research paper, its goals and methodology used for research. Results can be included in the abstract but they are only relevant if the paper if lengthy. In most cases, students use informative abstracts when they write their business research papers. Informative business research papers can be one page long. Students state the business problem or idea in the first sentence of abstract. This can be followed by a brief description stating why the idea is interesting or why the problem is worth consideration. Keen students always include reasons that motivate them to develop business research papers on the stated topic. It is important to state the scope of the paper in the abstract so that readers can understand the main target of the paper. The methodology sentence in a business research paper abstract gives an overview how the study was accomplished, how the researcher did his work and a brief description on the work of others who did business researches under the same topic. In an informative abstract, results must be discussed. Results are s imply the findings or the answers that the research sought to investigate. These are usually general findings, which support the hypothesis or the business idea under discussion. An abstract for business research papers should be able to summarize the whole business idea making the information understandable without necessarily reading the full report. A concise business abstract will be able to capture the reader’s imagination hence providing them with full and conclusive information should they otherwise decide not to read it in full. As the researcher, one must state the goals and objectives he or she intends to achieve. This is done by presenting a clear and critical outlining of the approach for achieving those goals i.e. the available research methodology and the thoroughness employed will help in capturing the reader’s confidence.

Critical Reading Final 2 Essay Example

Critical Reading Final 2 Essay Example Critical Reading Final 2 Essay Critical Reading Final 2 Essay After reading the article on Image busters by Todd Gitlin you will see that the author provided the best argument. The Authors purpose in this article was made clear and supported by the evidence. The author’s purpose was to educate the reader on the severity of who is to blame for the amount of violence in society today and is it to blame on television. TV is being called a major determinant regarding media violence. The author is matter of fact and provides support in the majority of his statements. The premises of this article are on if television contributes to the violence in our society today.When reading this article it gives you a lot of insight on how the media can contribute to a lot of violence on the street. The author states in the conclusion that, for that matter the drug epidemic, the crisis of the family and the shortage of serious jobs that the image busting campaigns permit without having to take on specific associations. The author seems to have a mutual bias in this article he seems to support his facts with evidence but at the same time also justifies how television shows could not be to blame for all the violence in America.He seems to be open minded and take all of the facts into consideration when writing this article. This gives the reader a fair shot at making up their own decision by having information on both sides of the story. After reading Imagebusters the article has some assumptions from the author such as he states in his first sentence that I consider Hollywood’s slashes, splatters, chain saws and car crashes a disgrace, a degradation of culture and a wound to the souls of producers and consumers alike.He also gives a conservative argument in paragraph six by saying that our culture looks to violence to resolve conflicts, and parental authority so the author is giving a broad range of things that actually could be contributing to the violence in America today. A metaphor is used to describe how today’s censorious forces smell smoke; it is not in the absence of fire and again in paragraph five by saying a child who shoves another child after watching a fistfight on television is not committing a drive by shooting. Todd Gitlin uses a couple different forms of fallacies in his article.You will find in the paragraph two shows a hasty generalization that says that the Senator and Attorney General against violence on television are only cheap shots. Then if you read onto paragraph three there are bandwagon techniques that show two other authority type figures have signed on to the traditional pastime. This article does also use some cross clarification when presenting its facts by stating that television is to blame for the violence then going on to say it is caused by other actions such as parenting and authority such as in paragraph nine.After reading and reviewing again the article IMAGEBUSTERS I am still in the middle on whether I think that television is a factor in the violence in society today. The author made very good points and did not have a bias in this article because he was able to provide information from both points of view. With having to young children I do not feel it is in their best interest to watch violence on TV or movies but at the same time it is so common on television and even in cartoons that it is impossible to prevent them from seeing it.I agree with the author on parenting and authority at the end of the day you are the main example and role model in your child’s eyes and by teaching them right and wrong and by them having a understanding of what is right and wrong will help them to see that violence is not the answer and does not solve problems. Overall this was a great article it covered many points of views and made me as the reader consider different scenarios of why or how violence is interpreted today and what is the cause and who is to actually blame.I feel out of the two articles this one carried the best argument because in the first article TV ISNT VIOLENT ENOUGH by Mike Oppenheim the author seems to already have a bias and provides a lot of information and to me it was k ind of misleading because it went into detail about stabbing and arteries and was kind of all over the place. Todd Gitlin did a better job in organizing his thoughts and supplying significant support and was open minded in his article leaving it to the reader to decide what their thoughts where on the subject.