Bata Shoes (Retailing Industry) Essay Example | Topics and Well Written Essays - 5000 words

Bata Shoes (Retailing Industry) - Essay Example A number of lower and middle price footwear business experienced the risk of collapse. Few number of large scale specialists in fashion and premium players were able to survive the trembled economic condition. In the coming future there would be certain factors which could affect the footwear industry. Venture capitalists have been the key driver in the growth of the footwear industry. However, due to the financial turmoil the venture capital sector was not able to offer any lucrative prospectus. That is why even the footwear industry had to bear a stalled growth in the last few years. During the global recession, the consumers had been very much selective about their spending. They would polish their old shoes rather than buying some new shoes. UK footwear industry also experienced less profitability due to the depreciation of Sterling against the US Dollar (Verdict, 2009). They were operating on low operating margins as low consumer confidence made it quite difficult for the retail ers to offer higher price to the customers. Now that UK is reviving from the trembled situation, one can expect a revival for the footwear industry. In the mid nineties, the demand in the footwear industry had seen a downturn. However, between 1996 and 1999, only the leather footwear industry saw a growth of nine percent. The demand for the footwear have been rising since then; the reasons are many including increased population, enhanced standard of living and continual increase in the shopping spree of the tourists. However, due to the financial downturn, consumers started looking for bargains and at the same time tourist spending was reduced to bare minimum. As a consequence the footwear industry saw a drop in sales in the last two years. With the economy recovering, the show retailers expect the shoe retail industry to rebound this year. The revival is indicated by the recovery in the local shopping sectors. The process

Management and Globalization Essay Example | Topics and Well Written Essays - 3000 words

Management and Globalization - Essay Example Coordinating: It is the function of any management to coordinate the organizational goals and objectives to every single member of the organization with a view to ensure that every member collaborates towards the achievement of the targets set by the management. Controlling: The management controls the flow of organizational activities and evaluates the direction towards which the organization is leading or being led by the management in order to avoid any missteps taken in the course of business operations. The theorists of scientific management have been engaged constantly to put forth theories of management that could be turned into practice. Management is a process carried out in an organization in order to achieve the desired results. The theories of management as brought forward by renowned theorists also attempt to put the view of management theory into practice with respect to organizations. The important theories of management are discussed below: These two theorists are known to be the pioneers of the scientific management. Frederick W. Taylor is known as the "Father of Scientific Management". He came up with the view that the productivity level of workers depends upon their frequency and propensity to rest during working hours. He was of the idea that a worker can only continue to work efficiently and productively if he takes rest during the work. A tiring situation can affect the working capacity of the workers and therefore, can hinder the way of achieving organizational goals (Taylor, 1911) Gilbreth introduced the idea that the working capacity and productivity of a worker can be enhanced by reducing the unnecessary tasks and exertions on the part of a worker during the course of his work. It would enable the worker to retain his energy throughout the work process. (Gilbreth, 1911) Therefore, both the theories given by these two theorists encompass the enhancement of workmen's working capability and efficiency and assessment of possible reasons that might be affecting the workers' productivity. Hawthorne Theory The theory put forth by the management scientists belonging to this school of thought mainly focused on the Taylor's theory of Scientific Management. They experimented on the theory and came up with interesting facts about the theory. They discovered that with the passage of time, one of the principles put forward by Taylor that enhanced lighting in the working environment could result into improved efficiency of the workers, helped to improve the workmen's working capacity even to a greater extent than anticipated. However, after further research, they figured out that the enhancement in worker's productivity was mainly due to the relationships between the managers and the workers, rather than due to lighting in the w

Continuous Flow in Lean Manufacturing

Continuous Flow in Lean Manufacturing Continous Flow In the majority of the lean manufacturing production systems, a U-shaped workcell is used.   This is because with a worker positioned in the interior of the U, one would save time by minimising movement of both the parts and of the worker by simply turning around and sending it to the next work station. In the case of very heavy parts,   mechanised conveyor belts are usually added to help the parts along from one value adding process to the next at a constant rate, however it is to be noted that manual push or gavity conveyors are the ideal method for moving parts, as their reliability is very high and their down times are low owing to their lack of complexity in their design. The corners of this workcell can cause alot of problems, as they have a tendency to slow down the production rates by holding some parts in that possible dead space.   For this reason, a ball roller transfer section is generally used to combat the dead space areas around the corners of the system. There may some instances where non-cyclical work has to be done to a part.   If this were to be passed through the system like normal, it would cause disruptions to the system.   To fix this problem, these operations are done outside the cell by support workers. Simplicity To cater for continuous-flow, one-at-a-time manufacturing each work station is made as compact as possible to reduce the waste of space, as well as to reduce possible storing space of parts and sub-assemblies, making batched processes imposible in this confiuration whilst also eliminating useless steps by the worker whilst in operation. To reduce the ammount of   floor space used, one must avoid standardised machines and instead specially designed machine bases must be used.   It is important to note that each machine base can vary from workstation to workstation to further optimise assembly subprocesses.   For the sake of convienience, modularity and cost, extruded aluminium members are bolted together to form the above mentioned machine bases.   Another essential reason   why the above set up is very effective is that due to its flexibility, it allows for quick and continuous improvements, which therefore directly impacts the set up time of the machine. Workplace Organization To ensure that no time is wasted looking for misplaced tools, all tools used at a work station has its own designated toolholder.   This would ensure the immediate detection of a displaced tool.   To further improve on this idea, some plants use modular tools holders to add more flexibility to the work station and therefore increasing the utility of the said workstation. Another trick used to reduce the downtime is to have backup tools available to the worker, but also out of their way   until they are required.   To this end, many companies tend to use tool holding structures that can be swung or slid into or out of the workspace with little to no effort required. So as to help the workers make fast decisions and to put them into effect, an information board is used.   The information board is a simple way of supplying relevant information at the workplace with anything from assembly processes, to production targets.   This feature takes out the need to chase down a busy supervisor, thus dramatically reducing the production downtime.   So as to increase its flexibility in the workplace and reduce waste, it is generally modular and reusable. Parts Presentation To reduce the number of interruptions to a minimum, all parts are generally supplied to each workstation outside of the workcell via gravity feed bins.   These bins are designed with simplicity and high reliability in mind to reduce the down times of the production line.   To make the bins even more flexible, they are usually designed to be stackable and to be fastened using key studs, thus further increasing the reconfigurability of the production line. In the case of larger parts however, the above system is shunned and a system of gravity feed conveyors are used instead.   On the other hand when parts are very heavy, a case lifter is used to raise the parts to the work station using electricity, pneumatics, or hydraulics. Reconfigurability To reduce the time wasted in the setting up of the line, reconfigurability is a very important factor to take in account when designing a workcell.   In light of this, quick-change fixtures are used due to their rapid changeover process.   Another perk of using this type of fixture is that since it is very compact, many fixtures can be stored at the workstation, further shortening of the changeover time is experienced. This arrangement allows for quick reconfiguration and movement to different parts of the workcell to accomodate for a new product, whilst also facilitating the change of the machine or workstation by using lockable casters. Quality One of the advantages of one-at-a-time manufacturing is the fact that a visual inspection can be done for every assembly.   In the case that gages are required, they would be mounted to the workstation while still allowing for quick and easy replacement. Some of the quality problems encountered may come from a malfuntioning machine or a faulty process.   These problems can be quickly solved be restructuring the machine frame system via the replavement of the bolted members. In the case of a faulty machine, this can also be quickly fixed, by first disconnecting all of the pneumatic or electric lines and then disconnecting the said machine to the frame via the lockable casters, eliminating the reluctance to change and improve the machines.   This in turn increases the quality of the assembly appreciably by not allowing anyone to settle for a part that is almost right. Maintainability So as to drastically reduce down times due to maintainance, a modular structural framing system is used.   This is to ensure that whilst the machine, or the machine frame is being serviced, another can easily take its place, minimising the already small downtime   of the reconfigureable defective part in question. By using this approach, one can standardize the components for most of the machine bases, guards, and workstations.   This significantly reduces the number of tools needed   to maintain the work cell, which in turn reduces the time needed to maintain the said structures.   It is also important to note that since most of the parts are standardised, the company needs less inventory space to house the spare parts needed for maintainance. Ease of Access By using aluminium framing system discussed above, all components can be easily accessed and the positions of the various accessories such as the bins, shelves and tool holders can be optimised to increase efficiency. Another advantage of using the above system is that not only is it possible to insure accessability for every worker by adding and repositioning components, but it also greatly increases the ease of maintainance of the work station by removing the parts in question via simple hand tools.

Antigone--Who is the REAL tragic Hero? Essay -- essays research papers

Who is the Tragic Hero?   Ã‚  Ã‚  Ã‚  Ã‚  Many may say that Creon is the tragic hero of Antigone. Creon and Antigone ¡Ã‚ ¯s personas are equal-and-opposite throughout this play. The story belongs to both of them. Creon is the one who makes a mistake; his figure is perhaps more tragic. He ¡Ã‚ ¯s the one that realizes that he ¡Ã‚ ¯s wrong, and he suffers for it. Antigone walks to her death with her eyes wide open, without shame.   Ã‚  Ã‚  Ã‚  Ã‚  Antigone is the true hero of the play because she makes a correct, justifiable decision and dies by it. Creon is wrong. He is forced to live, knowing that three people are dead because of his ignorance, which many may say is a punishment worse than death. Since Creon is ruined in the end of the play, we might pity him, but admiration ...

Only Christian believers can or should be theologians Essay

Using quotations from at least three written texts (ancient and/or modern), argue the case for or against the view that only Christian believers can or should be theologians Before attempting to answer this question, one must define some principles of the nature of Christian theology. It is obvious that anyone may create a theology based purely on ideas from one’s own imagination, with no boundaries or guidelines to it. Such a theology may be creative, intelligent, and reasonable, but could not be classed as Christian theology. Something must act as a rule and a guard, lest the Christian religion break down into nothing more than dispersed, individual, self-made theologies. Theology in a Christian context must and does find its foundation in Scripture, â€Å"the supreme authority to life and thought† (Vanhoozer 1998, p. 380). Now that the thing that is to be interpreted in the building of Christian theology has been identified as Scripture, one may ask the question of who is able and qualified to interpret it. In 1860, Benjamin Jowett published his essay, â€Å"On the Interpretation of Scripture†. He argued that the Bible should be regarded as any other ancient collections of literature, using tools of literary and historical scholarship. He implied that a critic who stands apart from traditional beliefs and practices is in a better position to find the true meaning of the text, as these traditions had obscured their true meaning. In other words, only those with the right scholarly tools and who were willing to suspend any belief in the text that they may have are able to correctly interpret it (Vanhoozer 1998, pp. 378-379). However, Jowett’s view of interpretation omits the spiritual and the ethical dimensions of Biblical interpretation. Vanhoozer writes: To call the Bible Scripture does not make its warnings or its promises something other than warnings or promises, but rather reorients them to the larger purpose of â€Å"making wise unto salvation†¦ â€Å". (Vanhoozer 1998, p. 380). Jowett’s approach to interpretation requires an objective reading of the text. But can one properly interpret the Scriptures from such a standpoint? To answer this, one must examine the relationship between the reader, the text, the author, and the story. Upon reading, the reader reads the text, and in doing so reconstructs the author in his own imagination, creating an ‘implied author’, and bringing the story to life (actualising the text) from the marks on the written page (Voelz 1995, 1997, pp. 218- 219). Voelz goes on to state that the intended recipient of the text is: †¦a reader of whom the author is conscious, one who may also be called â€Å"implied†. And this implied reader stands in the same relationship to the actual reader as the implied author stands to the actual author; he is, again, a construct, not in the real world, and he is detectable (only) in the text. Who then is a valid interpreter of a text? It is he who conforms to the expectations of the author. It is he who conforms himself to the given text’s assumptions. It is he who becomes the implied reader – and only such a one – of a given text. Which means that an â€Å"objective† reading of a text is not only impossible; it is not to be desired! (Voelz 1995, 1997, p. 219) One can see that what is needed for correct interpretation of Scripture, is a subjective, rather than objective reading of the text. Voelz argues a reader interprets within a community, having developed the beliefs and attitudes of the implied reader, through discussion, experience, and training within that community which understands and appreciates the context of the â€Å"implied reader†. Therefore: A valid interpreter of a text†¦ is that person†¦ who assumes the role â€Å"required† as it were, by a given text – who becomes the reader â€Å"implied† or called for by that very text. And such a one is formed to assume that role by a community, a community which has assumed that role itself. (Voelz 1995, 1997, p. 220) This, however, does not make every Christian community’s interpretation infallible, because humans err; thus different Christian communities often disagree on the interpretation of certain parts of Scripture. But, as the Church is a community within which these documents were produced, received, and preserved, Vanhoozer states: [The] Bible is more likely to be misunderstood by an unbelieving and unaffiliated individual than by a believing and practising member of the church. (Vanhoozer 1998, p. 378) In the case of the New Testament, the books were produced, received, and preserved by the Christian community, and following Voelz’s argument, one has to be within a Christian community, and taught to read Scripture by that community, to be able to correctly interpret the New Testament. The issue of the interpretation of the Old Testament is one that is referred to in the New Testament. Speaking of the reading of Scripture by the Jews: Yes, to this day, whenever Moses is read a veil lies over their hearts. But when one turns to the Lord, the veil is removed. (2 Cor. 3:15-16 ESV) According to Paul’s argument, the Jews do not believe, therefore they cannot, in their unbelieving state, be the â€Å"implied reader† of the Old Testament Scriptures. Apparently, simply being within the Jewish community is insufficient to correctly interpret these Scriptures, as more than a simple, straightforward understanding of the Hebrew text is needed. Luke 24:45 ESV reads, concerning Jesus and his disciples, â€Å"Then he opened their minds to understand the Scriptures.† Minds must be opened, veils taken away. The Christian community must teach readers to interpret even the Old Testament books. Only within the Christian community can one’s mind be changed in the proper way (Voelz 1995, 1997, p. 226). The reason for this is clear from the New Testament’s claims regarding the Christocentricity of all Scripture, Old and New Testaments: You search the Scriptures because you think that in them you have eternal life; and it is they that bear witness about me†¦ (Jn. 5:39 ESV. Cf. Mt. 2:4-6, 14-15; 1 Cor. 10:11, 15:3-4; 2 Cor. 1:20; Heb. 9:11-12; 1 Pet. 1:10-12) In order to be within the Christian community, one must adhere to and confess its creeds. Voelz writes: Therefore, to adhere to the creeds gives one an orientation to the books of the NT†¦. which is â€Å"congenial† to them and which†¦ allows/enables one to interpret them in accordance with their intention†¦ [Adherence] to the creeds enables one to â€Å"matrix† the signifiers and meanings of a text for interpretation and then to interpret that matrix in a way which is â€Å"congenial† to the text, for the creeds are of one piece with that text and provide, as it were, the interpretive â€Å"key,†Ã¢â‚¬ ¦Ã¢â‚¬ determinative for the meaning of the complex signifiers under construction†Ã¢â‚¬ ¦ [The] creeds help to determine which readings of Scripture are the apostolic/Christian readings which may legitimately be drawn from them. (Voelz 1995, 1997, p. 222) It was precisely the misuse of Scripture by heretics, which caused the early Church father, Tertullian, to write regarding them: [We] oppose to them this step above all others, of not admitting them to any discussion of the Scriptures. If in these lie their resources, before they can use them, it ought to be clearly seen to whom belongs the possession of the Scriptures, that none may be admitted to the use thereof who has no title at all to the privilege. (Roberts & Donaldson 1994, 1995, Vol. 1 p.250 -Chapter XV of On Prescription Against Heretics. See also: chapters XVI, XVII, XVIII, XIX pp. 250-252) Tertullian’s belief was that the Scriptures were the property of the Christian Church alone, and not to be handled by those outside of it. Irenaeus, Bishop of Lyons, against the Valentinians, wrote: [They] endeavour to adapt with an air of probability to their own peculiar assertions the parables of the Lord, the sayings of the prophets, and the words of the apostles, in order that their scheme may not seem altogether without support. In doing so, however, they disregard the order and the connection of the Scriptures, and so far as in them lies, dismember and destroy the truth. By transferring passages, and dressing them up anew, and making one thing out of another, they succeed in deluding many through their wicked art in adapting the oracles of the Lord to their opinions. (Roberts & Donaldson 1994, 1995, Vol. 3. p. 326 -Chapter VIII of Against Heresies) In conclusion, there seem to be many problems opposing the idea of those outside of the Christian Church being theologians, not least the question of motive, as the early Church fathers addressed. For these reasons, I believe that theology is a matter only for those within the Church. Bibliography * Roberts, A. & Donaldson J. (Editors); 1994, 1995; Ante-Nicene Fathers; Peabody, Massachusetts; Hendrickson Publishers, Inc. * Vanhoozer, K. 1998; Is There a Meaning in This Text?; Leicester; Apollos/IVP. * Voelz, J. 1995, 1997; What Does This Mean?: Principles of Biblical Interpretation in the Post-Modern World; St. Louis, Missouri; Concordia Publishing House. * The Holy Bible – English Standard Version; 2001, 2002; Wheaton, Illinois; Crossway Bibles

Building the Nation Future Leaders

â€Å"Building the Nation Future Leaders through the K to 12 Basic Education Program or The K to 12 Basic Education- Tungo sa Paghuhubog ng mga Makabagong lider ng Bansa. † By ANDEA, ISIDRO JR B. Great day to everyone! Warmest congratulations to the elite corps of successful graduates this school year 2012- 2013 especially to our ever loving parents and the teaching force of this institution. Ma’am and Sir, Good morning! With my great desire, to be one of the guest speakers at today's event; I accept the challenge and invitation of the teaching staff of this institution to challenge everyone today!It is a great privilege and opportunity for me to speak in front of you as a challenger of your mind and hearts to give an inspirational message that will challenge everyone today! You truly deserve to give pride to yourself as you step into another ladder of your success. It’s been unforgettable event that we should reminisce every now and then the significant marked o f our lives as we give priority to our achievement in the field of learning.We bind us one today to celebrate the fruit of our sacrifices; your unsung hero shows their unfading support behind your success as they watch you to recognize this day, your ever loving teachers honored you for the commendable appreciation of your great work during learning process and the person who is one way of molding your life interest and being proud to yourself that you have done the great job in schooling. Our Theme: â€Å"Building the Nation Future Leaders through the K to 12 Basic Education Program or the K to 12 Basic Education- Tungo sa Paghuhubog ng mga Makabagong lider ng Bansa. I would like to talk first about the program of Department of Education in order for us to understand well the message of our nation for us as a stakeholder of change. The K to 12 Program covers Kindergarten and 12 years of basic education (6 years of Primary Education, four years of juniors High School, and another t wo years of Senior High School) which provide our learners to undergo sufficient time for mastering the concepts and skills presented during learning process. Enhance the abilities and capacities of our learners, and prepare our graduate to higher education, job employment, and business or entrepreneurship.The K to 12 Basic Education Program is a key chain to success because it helps our graduates to become ready and more successful to go in their different paths, Maybe some them will proceed to tertiary education, for employment, or do a business. We strongly believed that this changes in our Educational Program will affect our way of living, to give us hope for a better future because our young leaders equipped with different skills in different learning areas, trained and prepared them to become an agent of change;Formal Education will make us living if we seized the right opportunity given to us. Let us work hand in hand for the betterment of our future, Let us let other known a bout this program, and encourage them to have a full support in achieving our Country’s progress. You as a graduate have a vital role to strengthen your great potential to become a partner of change. You will be one of the backbones of our K to 12 graduates sooner and later know that you will have to deal with changes, both big and small, continually. Be prepared to be flexible and to adopt as needed.Here are the three things to consider on becoming more successful in achieving our goals in life and to become a productive leaders someday: 1. Heads-up to your great potential. Sometimes, we may not realize the essence of our abilities. But there’s a gift given to us by our omnipotent master to give our full potential to become the most successful person. We may become successful beyond of our wildest dream. You should know yourself better, Identify your strength and weaknesses and facing the real you. The achievement of your goal is assured the moment you commit yourself to it and believe that you can do something.The first thing that we need to consider is to open your eyes to your great potential by setting your mind and goals in life. Mind setting (power of imagination) is a tool for showing your potential to become great individual for the next days. Because of it, you can now set your goals in life. Some great person believed that goal is vital. â€Å"People with goals succeed because they know where they're going. † According to -Earl Nightingale. â€Å"The achievement of your goal is assured the moment you commit yourself to it. † -Mack R. Douglas. Formal education will make you a living.Self-education will make you a fortune. † â€Å"Unless you change how you are, you will always have what you've got. † â€Å"We all have two choices; we can make a living or we can design a life. † I want you to â€Å"Take up one idea and act on it. Make that one idea your life. Think of it, dream of it, and live on that id ea. Let the brain, muscles, nerves, and every part of your body be full of that idea and leave all other ideas alone. This is the way to success. † According to SFI Rules to Success; setting goals is so easy to do, yet 95% of people never set goals.They just never take the time. And who do you think are the most successful, highest-earning people in the world? The 5% group of course! If you want to be in the 5% group, don't even think about ignoring goal-setting! 2. Begin with realistic plan (winning starts with beginning). If you sealed with something and you fell not moving on your way, start to get started and start whatever you had right now. There’s no perfect time to wait, do the best job you can and always keep learning and moving ahead. Who among you here have a Facebook account?What is the first thing you do in getting connected with that social networking? Just to sign up and get started, right? â€Å"You don't have to be great to get started, but you have to get started to be great. † -Les Brown, â€Å"Everyone who got where he is had to begin where he was. † -Richard L. Evans. â€Å"Failing to plan is planning to fail. † â€Å"Without goals, and plans to reach them, you are like a ship that has set sail with no destination. † -Fitzhugh Dodson â€Å"Most people have no idea of the giant capacity we can immediately command when we focus all of our resources on mastering a single area of our lives. – Anthony Robbins. â€Å"Nothing can add more power to your life than concentrating all your energies on a limited set of targets. â€Å"- Nido Qubein. â€Å"What you choose to focus your mind on is critical because you will become what you think about most of the time. â€Å"- Noel Peebles We cannot become successful in aiming at something, if we are trying to do many things just for once. We should be realistic in our planning and concentrate your thoughts upon working hand in hand. As they say, chase t wo rabbits and you'll catch neither! â€Å"Success demands singleness of purpose. – Vincent Lombardi â€Å"No life ever grows great until it is focused, dedicated, disciplined. – Harry Emerson Fosdick. 3. Live with your goals and persist until you win. We don’t need to invest so much to earn something and to pay for our reward. â€Å"Success seems to be connected with action. Successful people keep moving. They make mistakes, but they don't quit. â€Å"-Conrad Hilton. â€Å"It's when things get rough and you don't quit that success comes. † â€Å"Other people and things can stop you temporarily. You're the only one who can do it permanently. -Zig Ziglar Don't let little problems upset you. Concentrate on the positives†¦ and the â€Å"big picture. † Also remember that the only thing that will never change is that there will always be changes (especially in today's rapidly evolving world). Don't let changes upset you. Know that you will hav e to deal with changes, both big and small, continually. Be prepared to be flexible and to adapt as needed. â€Å"Learning is very fun and lifelong process† which I always emphasize in the field of learning because it awakens our interest to learned.At your youthful stage, there is an eagerness to learn in every chance as you participate inside the class. Your teacher taught you so much how to become smart, how to behave, how to learn, how to work effectively, how to perform a task and know how to accept student’s responsibility. I know each one of you possess a precocious gift from God. Who among you here wants to be a Doctor, Nurse, Lawyer, Engineer, Military, Teacher, or a President? Then don’t stop learning. ALWAYS REMEMBER THIS THREE WORDS: DON’T STOP LEARNING! ANDEA, ISIDRO JR B. KABACAN WESLEYAN ACADEMY HIGH SCHOOL DEPARMENT

Gender and Crime essays

Gender and Crime essays Crime and Gender: Does the punishment fit? Before the jury stands the defendant. There is overwhelming evidence in the favor of the prosecution. The verdict comes back from the jury, not guilty. Why? The defendant is a woman. In our era of equal rights and civil liberties women have made great strides in their advancement and role in society, yet it seems that gender segregates when it comes to crime. There have been countless cases where women and men have been tried for the same crime, yet when it comes to verdict and sentencing, the results dont necessarily match. If one commits a crime one should be punished accordingly regardless of gender. In our society we seem to have two separate rules for our criminals, one for men and one for women. The key issue is are men and women treated equally by the criminal justice system. Another issue in gender biased sentencing is in its is its severity. Are women sentenced heavier for certain crimes then men. From the start women who commit violent crimes are all ready in the spot-light. Society has grown quite accustomed to viewing the womens role in violent crimes as that of the victim. When the women is a violator it incites a gross media fascination as a novelty. Convicted women gain more notoriety then men who are found guilty of committing the same crime. In certain cases like Amy Fisher, Loren Bobbit and most recently Louise Woodward the media celebrate the violence of women. If it had been a man who shot his lovers mate in the head or slashed and dismembered their spouse or shook a baby to death things would be different. The media would not give as in depth of coverage to the trial and sentencing would be of a longer time. The media escalates these women to such extremes due to the fact that there are so few women who are tried for criminally violent acts. Society tends to be more sympathet ...

Critical Study of the Aetiology and Pathogenesis of Infantile Glaucoma The WritePass Journal

Critical Study of the Aetiology and Pathogenesis of Infantile Glaucoma Introduction Critical Study of the Aetiology and Pathogenesis of Infantile Glaucoma IntroductionEpidemiology of Primary Infantile Glaucoma Signs, Symptoms and Consequences of Primary Infantile GlaucomaPathology, Pathogeneses and Causes of Primary Infantile GlaucomaOptic Cup Asymmetry in Primary Infantile Glaucoma Secondary infantile glaucomaReferencesRelated Introduction The incidence of glaucoma in the young population is incomparable to the incidence in the adult population, as it is very rare in infants, nevertheless it can significantly affect a child’s life, as vision is vital for a young child. Signs and symptoms of infantile glaucoma can commonly be overlooked and this can cause a delay to the treatment process. The underlying causes of infantile glaucoma have been agreed upon by most authors, however the exact mechanism by which the structures in the young eye are affected are debatable. As well as primary infantile glaucoma, young children can also be affected by secondary infantile glaucoma, which again can significantly impact a young child’s life. This paper looks at the classifications, epidemiology, signs, symptoms, aetiology and pathogenesis of primary infantile glaucoma, as well as touching upon the causes of secondary infantile glaucoma. ‘Glaucoma is an Optic neuropathy with characteristic appearances of the optic disc and specific pattern of visual field defects that is associated frequently but not variably with raised intra-ocular pressure (IOP)’ (Kanski, 2003). The ciliary processes of the eye produce aqueous humor; this is then drained by the trabecular meshwork; Figure 1. A balance of this production and drainage maintains a normal IOP. The aqueous humor produced flows into the posterior chamber, then through the pupil and into the anterior chamber. The trabecular meshwork drains the aqueous humor through Schlemm’s canal. Open angle glaucoma occurs when there is a decrease in the outflow of aqueous through the trabecular meshwork, and angle closure glaucoma occurs when the iris adheres to the lens leading to a build-up of aqueous humor in the posterior chamber   (Kanski, 2003). In addition to open and closed angle glaucoma there are other types of glaucoma which are classified in Figure 2. There are several classifications of congenital and infantile glaucomas, the most accepted and simplified version is presented in figure 3. Primary infantile glaucoma is defined as ‘the result of isolated abnormal development of the anterior chamber angle structures’ (Myron Yanoff, 2009) Secondary infantile glaucomas are ‘associated with a variety of ocular and systemic syndromes and with surgical aphakia’ (Myron Yanoff, 2009). Primary congenital glaucoma is present at birth however it is not always recognised at this stage and sometimes it is diagnosed later during infancy or in early childhood. To minimise problematic visual development, recognition of primary congenital glaucoma must be as early as possible followed by respective treatment or therapy, allowing the child to lead a ‘normal’ life (A.Armstrong, 2008). Glaucoma in infants and young children is relatively rare and in some cases asymptomatic (Kanski, 2003). And so, if an increase in IOP is not detected at an early stage then there is a greater risk of blindness (Robert N. Shaffer, 1970). Some cases of glaucoma in infants are only recognised and diagnosed after several months or years at which stage sometimes significant glaucomatous damage has already occurred (Robert N. Shaffer, 1970). Most cases will present bilaterally nevertheless this does not rule out the fact that it can sometimes present unilaterally   (Robert N. Shaffer, 1970). Epidemiology of Primary Infantile Glaucoma Primary infantile glaucoma is extremely rare and occurs in one out of 10,000 births (MillerSJ, 1966). It accounts for 0.01% to 0.04% of cases of total blindness (A.Armstrong, 2008) (Vincent P Deluise, 1983) In the Irish childhood population primary open angle glaucoma is the cause of blindness for 4% of the population. (Morin JD, 1974) The majority of cases in the US and Europe present with bilateral primary infantile glaucoma; 65%-80% (Moller, 1977). It is also well-known that it occurs greater in males compared to females with a ratio of 3:2 respectively (Vincent P Deluise, 1983). This is proven by a study with 125 infants from Westerlund, 76 of whom were male i.e. nearly 61% were males (Vincent P Deluise, 1983). On the other hand in Japan, this is no longer true and the ratio is actually reversed (Vincent P Deluise, 1983). In another study based in Japan out of 46 children with primary infantile glaucoma 63% were actually female (Vincent P Deluise, 1983). In the majority of cases the development of primary infantile glaucoma is found to sporadic, and so it is non-familial and nonhereditary, but approximately 10% of cases are familial, transmitted to the child via autosomal recessive inheritance (Vincent P Deluise, 1983). Signs, Symptoms and Consequences of Primary Infantile Glaucoma Children are commonly referred to the Ophthalmologist due to clinical evidence of corneal oedema. Primary infantile glaucoma is commonly misdiagnosed, hence causing a delay in the correct diagnosis, as it may initially show symptoms similar to conjunctivitis such as a ‘red eye’ (Becker B, 1965). There will also be evidence of the classic triage; epiphora, blepharospasm and photophobia. (Becker B, 1965). Further examination will reveal megalocornea (enlarged corneal diameter), buphthalmos (enlarged globe), Haab’s striae (breaks in Descemet’s membrane) and optic nerve head changes (Becker B, 1965). Buphthalmos; figure 4, or ocular enlargement, occurs in primary infantile glaucoma because the globe of neonates is still distensible (Vincent P Deluise, 1983). Collagen of the cornea and scleral have not hardened enough, so expansion of the fibrils occurs due to an increase in IOP (Vincent P Deluise, 1983). This therefore causes stretching to occur in several structures of the infant eye; such as the cornea, the anterior chamber angle, the sclera, the optic nerve, scleral canal and the lamina cribrosa (Becker B, 1965). This explains why ocular enlargement due to glaucoma does not occur in adults, as the globe is no longer distensible and collagen fibres of the cornea are sclera are hardened hence expansion doesn’t occur in adults. It is agreed that delayed therapy of infants with glaucoma, will result in a poor visual outcome for the infant, which could have been prevented or at least minimised. To understand why some infants had more advanced glaucoma than others; a study with 24 infants and children was conducted (David J. Seidman MD1, 3 March 1986). Their signs and symptoms were noted. The parents of the infant were asked to indicate whether they had noticed either epiphora or photophobia and only 32% said their infant had these symptoms. A small 21% of infants presented with only signs of glaucoma, noticed by the parents but no symptoms. And finally the majority of infants, 90%, actually did have signs when presenting to the physician. It has been noted that signs of infantile glaucoma are more difficult to notice when it is bilateral, as in all 3 cases where the physicians failed several times to refer the infant to an ophthalmologist the glaucoma was in fact bilateral   (David J. Seidman MD1, 3 March 1 986). A normal value for the corneal diameter of a neonate is approximately 10mm, an increase to 12mm or greater, along with expansion of the corneal-scleral junction, is usually due to increased IOP (Kwitko, 1973). Enlargement of the cornea due to an increase in IOP is most likely to occur up to the age of three (Scheie, 1955) after which the sclera may become deformed up to age ten (Mann, 1957). Breaks occur in the endothelium and Descemet’s membrane due to the increase in IOP which also causes stretching in these layers (Vincent P Deluise, 1983).   ‘Haab’s striae form as endothelial cells lay down new basements membrane (Descemet’s membrane) and hyaline ridges develop. Breaks in Descemet’s membrane from increased IOP rarely occur after age three’ (Vincent P Deluise, 1983).   Increased IOP also causes slow expansion of the sclera of the neonate. A ‘bluish’ scleral appearance is seen due to thinning of the sclera, causing the choro id to be more apparent (Vincent P Deluise, 1983). As the neonate becomes older and growth occurs the expansion of the sclera no longer occurs due to a build-up of extracellular connective tissue (Vincent P Deluise, 1983). Even if the IOP decreases back to a value within normal the globe does not usually return to normal size (Vincent P Deluise, 1983). Studies have shown that myopia and astigmatism are the consequence of an increase in the axial length of the globe, figure 5 (Robin AL, 1979). Robin et al also found that ‘In contrast to adult eyes, the scleral canal in children apparently enlarges with high IOP. Thus, disk cup size increase in children could occur from neural tissue loss, from scleral canal enlargement, or from a combination of the two processes’ (Robin AL, 1979). ‘Myopic astigmatism and anisometropia are particularly common in cases of unilateral or asymmetric primary infantile glaucoma’ (Vincent P Deluise, 1983).   A study carried out by Broughton and Parks found that all of their patients with unilateral primary infantile glaucoma had anisometropia; on the affected side an average difference of 4.93D of myopia was found (Broughton WL, 1981 May). Optic nerve changes which occur in adults with glaucoma are very different to the optic nerve changes which occur in children with glaucoma. At first Becker Shaffer initially thought that cupping in primary infantile glaucoma was a process which was gradual however it was soon discovered that optic nerve changes in primary infantile glaucoma could also occur early and rapidly (Becker B, 1965). In adults with optic nerve changes which occur due to an increase in IOP the change is very unlikely to be reversible, however in infants optic nerve cupping which occurs due to an increase in IOP can be reversed once the IOP is returned back to normal (Vincent P Deluise, 1983). The most accepted and most reasonable hypothesis which aims to explain why cupping is reversible in neonates is based on the fact that the connective tissue of the lamina cribrosa is not matured (Quigley, 1977 Sep). However there are cases when even though the pressure has decreased back to normal the Optic nerve head damage does not reverse, this is due to one of two reasons. Firstly it is possible that some of the stretching is permanent ‘with remoulding of the connective tissue’   (Vincent P Deluise, 1983). Secondly it could be due to ‘a loss of glial and axons’ (Vincent P Deluise, 1983).   ‘Adult optic nerve heads with their dense connective tissue investments are more resistant to remoulding, indicating that cupping is caused by permanent loss of glia and axons’ (Vincent P Deluise, 1983). Pathology, Pathogeneses and Causes of Primary Infantile Glaucoma The explanation for the increase in IOP in primary infantile glaucoma has been described using Barkan’s membrane theory. This theory is based on the fact that the anterior chamber angle is covered by a thin and imperforate membrane, which inhibits aqueous outflow, which in turn leads to raised IOP (Vincent P Deluise, 1983). According to the theory, this raised IOP is treated by goniotomy when the surface tissue of this membrane is detached, and so â€Å"the peripheral iris falls posteriorly,† subsequently there is aqueous outflow and a decrease in IOP (Vincent P Deluise, 1983). Worst also agreed with the Barkan membrane theory, â€Å"†¦in congenital glaucoma the chamber angle is filled with a band of persistent mesodermal tissue (persistent uveal meshwork or persistent pectinate ligament). This tissue completely covers the fetal corneoscleral system, but is not the cause of the obstruction to aqueous outflow in its own right. It is the presence of an imperforate surface layer on this persistent mesodermal tissue, which is the only cause of obstructed outflow. This surface membrane, Barkans membrane, is probably an endothelial surface, which normally breaks apart, but which persists in congenital glaucoma† (Worst, April 1968). There is no well supported histopathologic evidence to support Barkan’s membrane theory, despite this Worst still believes that the theory along with its concepts are valid, he says â€Å"though histopathologic proof of this structure is almost completely lacking†¦this has little influence on the probability th at this concept is valid† (Worst, April 1968). So if Barkan’s membrane theory has insufficient evidence to explain the cause of an increase in IOP in congenital glaucoma, then what is the alternative? There is some histopathologic evidence which aims to explain in detail the anterior chamber angle and its histopathology in infants with primary infantile glaucoma see Figure 6 (Vincent P Deluise, 1983). Anderson thoroughly researched the development of the trabecular meshwork in infantile glaucoma. He said that earlier thoughts were that â€Å"the anterior chamber recess deepens by atrophy of the rarified tissue that in the earlier stage separated the trabecular meshwork and ciliary body.† He then confirmed that later thoughts highlighted the function of cleavage into the loose tissue, as there was no proof of atrophy (D.R.Anderson, 1981). These views may have seemed correct at the time however, evidence has proven that cleavage or atrophy are not the only explanations of the process of development. Both cleavage and atrophy would cause the uveal tract to become fragmented from the shell of the cornea and sclera as well as the tissue of the trabeculae (Fig 7A) (D.R.Anderson, 1981). This would result in extension of the ciliary muscle to the peripheral iris and on the posterior surface of the peripheral iris would be the ciliary processes (D.R.Anderson, 1981). However this does not actually occur, in fact the ciliary muscle and the ciliary processes continue to adhere to the envelope of the cornea and sclera although compared to their earlier position they do become depressed (Fig 7B) (D.R.Anderson, 1981). Anderson found that there is an overlay of the ciliary muscle in particular the ciliary processes over the trabecular meshwork; however they are subsequently depressed behind the scleral spur (D.R.Anderson, 1981). He found that â€Å"This repositioning can be explained only by a posterior sliding of the uveal tissues in relation to the cornea and sclera, presumably due to a differential growth rate of the various tissue elements† (D.R.Anderson, 1981). He concluded that this course of repositioning was not simply due to the â€Å"sliding of the uveal tract along the inner side of the sclera. There is also a repositioning of the various layers within the uveal tract in relation to one another: initially the innermost muscle fibers have a position relatively more anterior than the outermost fibers† (D.R.Anderson, 1981) Anderson also found that compared to the ciliary muscle the ciliary processes are at first a lot more frontward, as time passes both become level behind the scleral spur and meshwork (D.R.Anderson, 1981). So, far it has been established that primary infantile glaucoma occurs because the anterior chamber does not develop normally. At what stage of development do these changes or lack of changes occur? It has been noted that at week twelve of development â€Å"a wedge shaped mass of mesenchyme can be identified at the anterior chamber angle i.e. at the junction of the papillary membrane and the lateral margins of the cornea. Within this wedge shaped portion of the tissue there is a row of small capillaries, which are lined with mesoderm-derived vascular endothelial cells† (A.Armstrong, 2008). At the beginning of the fifth month â€Å"early trabeculae are apparent separated by intervening spaces† (A.Armstrong, 2008) subsequently the capillaries fuse to form the canal of Schlemm, this is continuous with the collector channels as well as the scleral vessels (A.Armstrong, 2008). â€Å"The meshwork becomes specialised into inner uveal trabeculae, numerous intermediate layers of lamellar corneoscleral trabeculae, and a more loosely organised cribriform meshwork† (A.Armstrong, 2008). The inner surface of the meshwork is lined with cuboidal cells, perforations of these cells occur onwards from 15 weeks (A.Armstrong, 2008). Communication between the meshwork and the anterior chamber occur via these cuboidal cells (A.Armstrong, 2008). Between the sixth and ninth month development of the anterior chamber occurs (A.Armstrong, 2008). It presents â€Å"as a chink in the mesoderm between the iris root and the developing trabeculum. If the mesoderm does not entirely regres s in this region, an impervious layer may remain bridging the angle between the iris and the cornea and which impedes access of aqueous to the trabecular meshwork† (A.Armstrong, 2008). Figure 8: Comparision of optic cup asymmetry in normal infants with unilateral glaucoma infants. Taken from (Richardson, April 1968) Optic Cup Asymmetry in Primary Infantile Glaucoma It has been established that chronic open angle glaucoma is found to be bilateral and symmetrical to a certain extent, however some meticulous studies may find that there is somewhat of asymmetry in the cupping of the optic discs (Richardson, April 1968). Nevertheless the asymmetry of the discs can be used to diagnose early signs of glaucoma (Richardson, April 1968). Although optic disc cupping is assessed in infantile glaucoma it is not used as prominently compared to chronic open angle glaucoma (Richardson, April 1968). One of the reasons for this is due to the obvious fact that it is not as easy to conduct ophthalmoscopy in infants especially with added factors such as hazy corneas, miotic pupils (Richardson KT, 1966). It is also a common misconception that cupping in the optic nerve occurs at a very late stage and so it is no longer relevant to aid diagnosis (Richardson, April 1968). The opposite is actually true, as changes to the optic disc in infantile glaucoma occur relatively early on, hence valuable factor to aid prognosis (Shaffer.RN, 1967). To emphasise the importance of asymmetry of optic discs in infantile glaucoma compared to chronic glaucoma, the following study was conducted by Kenneth Richardson. Normal newborn infants, 96 hours old or less, were randomly chosen and their optic discs were assessed. Out of 468 it was found that only 11 infants had optic cup asymmetry, 2.3%; figure 8 (Richardson, April 1968). Similarly Snydacker found that out a random 500 adults only 15 had any sign of asymmetry, 3% (SyndackerD, 1964). Going back to the infants it was found that only 3 out of the 11 actually had marked asymmetry between their optic cups i.e. only 0.6%; figure 8 (Richardson, April 1968). A very different but much predicted result was found when Shaffer conducted a slightly different study (Shaffer.RN, 1967). 27 infants with unilateral glaucoma were assessed and it was found that 89% or 24 out of 27 had marked asymmetry; figure 8 (Shaffer.RN, 1967). In other infantile glaucoma studies Schaffer also found that 61% (52/85) patients had optic cups with a disc diameter greater than 1/3 in comparison to 2.6%(26/936) normal newborns who had optic cups with a disc diameter greater than 1/3 (Shaffer.RN, 1967). The above data provides vital evidence supporting the views that optic disc assessment in newborn infants is extremely important and any asymmetry in optic cupping is very significant as ‘normal’ infants are expected and likely to have symmetrical optic cups. Hence any asymmetry of cupping could be indicative of congenital glaucoma. Also it can be said that optic cupping assessment is of more importance in congenital glaucomas â€Å"since these cases are prone to follow a more asymmetrical course than adult glaucomas† (Richardson, April 1968). In order chronic glaucoma in order to be able to determine whether cupping is physiological or pathological the disc appearance must be tracked over many years. Whereas in newborns the cupping is expected to be symmetrical at birth therefore any asymmetry should be and can be picked up at birth (Richardson, April 1968). Secondary infantile glaucoma There are several causes of secondary infantile glaucoma, the most important is ocular trauma and this is due to the fact that ocular trauma is common in young infants. Blunt trauma to the eye causes compression of the globe which in turn leads to a temporary increase in IOP. When a blunt object hits the eye its cause indentation of the cornea, this then forces the aqueous humor â€Å"laterally against the anterior chambers angle structures and backwards against the iris and lens† (Robert N. Shaffer, 1970). Thereafter â€Å"in the anterior segment the iris sphincter ruptures† (Robert N. Shaffer, 1970) the ciliary body could become separated from the scleral spur or it may just be split or torn (Robert N. Shaffer, 1970). Likewise the trabecular meshwork may become ruptured, consequently leading to glaucoma (Robert N. Shaffer, 1970). Traumatic iritis is another cause of secondary glaucoma. Blunt ocular trauma can cause inflammatory cells and increase in proteins in the aqueous humor, in the early stages. These cells along with the protein molecules then cause obstruction of the trabecular meshwork. (Robert N. Shaffer, 1970) Oedema of the trabecular meshwork will also lead to resistance in the outflow of the aqueous. Even though there is an increase in the resistance of outflow, the IOP will remain within a normal range and in some cases it may actually be lower than normal because the blow will have caused depression of the ciliary body along with hyposecretion (Robert N. Shaffer, 1970). Anterior chamber haemorrhage (hyphema) occurs due to trauma or injury to the eye. Small haemorrhages are unlikely to clot, however large haemorrhages may fill the anterior chamber and cause compression of the meshwork which in turn leads to an acute increase in IOP (Robert N. Shaffer, 1970). Another cause of secondary glaucoma is recession of the anterior chamber angle. â€Å"A significant percentage of traumatic hyphemas results from a longitudinal cleavage of the ciliary body† (Robert N. Shaffer, 1970). A chain of damage reactions which occur to the trabecular meshwork following this will decrease the outflow and lead to glaucoma. Contusion cataract can be caused by blunt trauma. â€Å"If the cataract intumesces, a phacogenic pupillary block glaucoma may result. If the cataract becomes hypermature the lens cortex which is liquefied may leak into the anterior chamber†¦Ã¢â‚¬ , (Robert N. Shaffer, 1970) a macrophage response occurs and these cells then cause an increase in IOP as they block access of the aqueous to the trabecular meshwork. (Robert N. Shaffer, 1970) This is known as phacolytic glaucoma. Dislocation of the lens most likely occurs due to trauma, and if the lens after dislocation ends up in the anterior chamber then pupillary block glaucoma is l ikely (Robert N. Shaffer, 1970). Secondary glaucoma is usually the result of a laceration to the globe. A blunt blow, by a child’s fist, is often very serious as the smaller size of the fist does not allow the orbit to provide protection and the blow lands straight on the eye (Robert N. Shaffer, 1970). Intra-ocular foreign bodies can also cause glaucoma; particles which contain iron will oxidise and can be toxic to structures within the eye such as the trabecular meshwork (Robert N. Shaffer, 1970). Severe iritis can lead to glaucoma, and transient or chronic glaucoma can result from inflammation of the trabecular meshwork with increased resistance to outflow (Robert N. Shaffer, 1970).   Inflammation of the cornea can also cause secondary glaucoma, due to further inflammation of the meshwork leading to obstruction of the aqueous outflow (Robert N. Shaffer, 1970). It is well-known that glaucoma can be induced by steroids. An increase in IOP can be induced by prolonged use of topical steroids, in susceptible individuals. Ocular tumours uncommon in children, however if one is present it can sometimes lead to secondary glaucoma (Robert N. Shaffer, 1970). Retinoblastoma, a well-known and common tumour found in the young can also cause glaucoma. The tumour will invade the anterior chamber angle structures; iris and trabecular meshwork. There is a very strong link between prenatal rubella infection and glaucoma and it is now well agreed upon that prenatal rubella can in fact cause glaucoma. It is estimated that rubella infantile glaucoma occurs in 2-4% of children with congenital rubella syndrome (Robert N. Shaffer, 1970). It usually presents in the first six months of life and the symptoms are identical to those of primary congenital glaucoma; an enlarged oedematous cornea which is cloudy, a deep anterior chamber and the classic high IOP (Robert N. Shaffer, 1970). Clinically it is found to be almost impossible to distinguish rubella infantile glaucoma from primary congenital glaucoma (Robert N. Shaffer, 1970). In conclusion, it has been determined that although rare conditions both primary and secondary infantile glaucoma can significantly affect the life of a child. Hence examination of the optic discs at birth is vital to ensure that any asymmetry of optic cups is detected and the possibility of the newborn developing glaucoma is known immediately, as it has been proven that infants with glaucoma are significantly more likely to show asymmetry of optic cupping compared to ‘normal’ infants. If the glaucoma is not detected at birth it is vital that healthcare professionals are able to recognise the signs and symptoms of infantile glaucoma so it can be treated before any significant damage has occurred, as it has been proven that the majority of children present with all or some of the signs and symptoms of glaucoma yet they are either overlooked by the parents or misdiagnosed by clinicians. In relation to the pathogenesis of infantile glaucoma significant evidence or lack of has proven that Worst along with Barkan’s Membrane theory are no longer valid. Vital histopathologic evidence undermines the theory; in fact Anderson has provided substantial evidence to prove that repositioning, sliding, cleavage and atrophy play a significant role in the development of primary infantile glaucoma. Along with the histopathologic evidence it can be concluded that Anderson’s findings can be accepted. References A. Edward Maumenee, M. (1962). Further observations on the pathogenesis of congenital glaucoma. TR. AM. OPHTH J. SOC, VOl. 60, 140-162. A.Armstrong, R. (2008, December 12th). Congenital Glaucoma; The genetics of primary congenital glaucoma. Optometry Today, pp. 40-43. Becker B, S. R. (1965). Diagnosis and Therapy of the Glaucomas. St Louis: CV Mosby. Broughton WL, P. M. (1981 May). An analysis of treatment of congenital glaucoma by goniotomy. Am J Ophthalmol. , 91(5):566-72. Ching Lin Ho, F. a. (September/October 2004). Primary Congenital Glaucoma: 2004 Update. Journal of Pediatric Ophthalmology and Strabismus , Vol. 41:271-288. D.R.Anderson. (1981). The development of the trabecular meshwork and its abnormality in primary infantile glaucoma. Trans Am Ophthalmol Soc, 79:458-85. David J. Seidman MD1, L. B. (3 March 1986). Signs and Symptoms in the Presentation of Primary Infantile Glaucoma. PEDIATRICS , Vol. 77 No. pp. 399-404. Harley, R. D. (1983). Pediatric Ophthalmology. Saunders. John S Crawford, J. D. (1983). The Eye in Childhood. New York: Grune and Stratton. Kanski, J. J. (2003). Clinical Ophthalmology A Systematic Approach. Butterworth Heinemann. Kwitko, M. (1973). Glaucoma in Infants and Children (ed 2). New York: Appleton-Century-Crofts. Mann, I. (1957). Developmental Abnormalities of the Eye. Philadelphia: JB Lippincott. MillerSJ. (1966). Genetic aspects of glaucoma. Trans Ophthalmol Soc U K., 86:425-34. Moller, P. (1977). Goniotomy and congenital glaucoma. Acta Ophthal, pp. 55: 436-442. Morin JD, M. S. (1974). Primary congenital glaucoma: a survey. Can J Ophthal, pp. 9:17-28. Myron Yanoff, J. S. (2009). Ophthalmology. Mosby Elsevier. NEI. (1968-date). Glaucoma. Retrieved February 2011, from National Eye Institue: nei.nih.gov/health/glaucoma/glaucoma_facts.asp Quigley, H. (1977 Sep). The pathogenesis of reversible cupping in congenital glaucoma. Am J Ophthalmol., 84(3):358-70. Richardson KT, S. R. (1966). Optic nerve cupping in congenital glaucoma. Am J. Ophth., 62: 507. Richardson, K. T. (April 1968). Optic Cup symmetry in normal newborn infants. Investigative Ophthalmology, 137-140. Robert N. Shaffer, D. I. (1970). Congenital and Pediatric Glaucomas. USA: The C. V. Mosby Company. Robin AL, Q. H. (1979). An analysis of visual acuity, visual fields, and disk cupping in childhood glaucoma. Am J Ophthal , 88(5):847-58. Scheie, H. (1955). Symposiumon congenital glaucoma: Diagnosis, clinical course and treatment other than goniotomy (ed 2). Trans Am Acad Ophthalmol Otolaryngol 59, pp. 309–321. Shaffer.RN. (1967). New concepts in infantile glaucoma. Canad J. Ophth, 2: 243. SyndackerD. (1964). The normal optic disc. Ophthalmoscopic and photographic studies. Arch Ophthal, 58:958. Vincent P Deluise, D. R. (1983). Primary Infantile Glaucoma (Congenital Glaucoma). 28(1). Worst, J. G. (April 1968). Congenital glaucoma Remarks on the aspect of chamber angle: Ontogenic and pathogenic background and mode action of goniotomy. Investigative Ophthalmology, 7:127-134.

About Chloroform As An Anaesthetic Agent

About Chloroform As An Anaesthetic Agent Surgical procedures are painful, no doubt. Even with the advancement of medicine in the field of anaesthetic, certain complications are to be expected among patients who were receiving anaesthesia (regardless of types) such as bradycardia, post-puncture headache, hypotension and feeling pain despite an adequate dose of analgesia. How do we know exactly whether the patient who is being operated is in pain? Most of the indications were clinical (there is no machine which can tell you with an absolute certainty that the patient is in paint) and often judged based on the patients vital signs which can be quite suggestive of pain, for example, increase in blood pressure and heartbeat could indicate that the amount of analgesia being given to the patient was inadequate. Eventually, an anaesthetist in-charge will increase the analgesics/any other drugs dosage to achieve stabilisation which will provide a less painful experience for the patient. Being sedated during surgery is the main principle of anaesthesia (although some procedures dont require sedation; local anaesthetic for example) coupled with other agents which could alleviate pain and reduce movement to provide surgeons with optimal surgical conditions thus reducing post-operative complications. There are a lot of fine arteries, veins and nearby organs that can potentially be damaged during operation if patients were moving thus usage of muscle relaxants (either depolarising or non-depolarising) are justified to facilitate certain procedures. Even though nowadays, there are a lot of chemicals which can be used as anaesthetic agents, back in the day, the number of options to alleviate pain is quite limited. In 2250 BCE, most of the toothache cases experienced by Babylonians were treated by giving Henbane, a type of plant which is quite poisonous, often being used to treat some medical conditions such as asthma, cough, nervous system-related diseases and sure, a toot hache. If you were thinking, sedation before operative procedures are only practised after we discovered modern medicine, you were wrong. In 650 BCE, most of the priestesses utilise ethylene fumes to induce sedation among patients before any kind of procedure. In 400 BCE, Assyrians discovered that they can induce unconsciousness temporarily by compressing the carotid artery to carry out a few simple surgical procedures such as cataract surgery and circumcision without too much fuss. In the year 160, Hua Tuo performed surgery after patients have been induced with a method resembles the general anaesthesia by utilising a mixture of wine and herbs called Mafeisan. People generally understand the importance of putting patients in an unconscious state before starting an operation but as there were a lot of complications (including death) which have been documented in a lot of journals associated with certain types of anaesthetic agents, people grew restless. There are a lot of modern anaesthetic agents which are not being used anymore due to their fatal complications but people in the past dont have much choices on that matter, really. In this article, we will discuss regarding one of the anaesthetic agents which have been held in high regards in the past after it was used to ease up Queen Victoria, during her childbirth. Lets talk about @chloroform. Exploring A 170 Years Of Controversy Even though chloroform was discovered by three independent researchers in 1831, people are not aware of its anaesthetic properties until it was eventually demonstrated in 1847 by a Scottish obstetrician named Professor James Simpson. He tried to search for an ideal anaesthetic chemical that can be used to anaesthetise patients during operation while imposing minimal side effects (pain, for most of the parts). His determination stemmed from his bad experience of witnessing a breast-removal operation that was carried out in 1827 when he was a medical student. Back then, reliable anaesthetic agents were yet to be discovered thus surgical procedures were usually carried out with speed and precision to reduce patients suffering. Feeling pain was considered inevitable so patients depend heavily on surgeons skills while they were held down by devices to prevent movements. Throughout the surgery, Simpson felt traumatised as he had to witness suffering from the patient as surgical cuts were made. Her movements were restricted by both leather straps and a few other attendants, so it was pretty much messed up gores that had to be dealt with as soon as they were able. Its not a sight that you would have admired or cherished and he nearly quitted medical school because of that; fortunately, he didnt. Instead of quitting, he pledged himself to find a suitable anaesthetic agent that could alleviate suffering among patients especially in a surgical setting. Most of the answers he acquired from his professors when he was a medical student were discouraging and only when he was a full-pledged medical officer that he could experiment with a number of chemicals and procedures to test their efficacies on his patients; he ever tried mesmerism! People often used the word mesmerism and hypnosis interchangeably, but both of them induced trance (an altered state of consciousness) through different methods. Mesmerism focused on using non-verbal cues like gaze, strokes etc. while hypnotism used verbal cues. Of course, mesmerism is not a good choice when it comes to medicine, even its founder, Franz Anton Mesmer was chased out from Venice for practising it, but Simpson was willing to try anything for the sake of improving the current state of surgical protocols; still, none of it works. In 1846 he heard about a chemical called ether which can be used as an inhaled agent to alleviate pain during dental procedures. He tried to use it in his medical practice but he soon realised that there are a lot of side effects caused by that particular volatile agent, not to mention back then, a huge portion of the medical community opposed to the usage of volatile agents as anaesthesia. Despite the frustration, he learned a considerable amount of experience and knowledge regarding volatile compounds. Exposure to all kind of volatile compounds brought him to chloroform in 1847, a year after his failed attempt at using ether as an anaesthetic agent. Mind you, volatile compound is a hot topic since the discovery of chloroform in 1831, but their potential benefits were regarded less than what they deserved. On November 1847, he revealed chloroform as a potential anaesthetic agent that can be used to induce patient pre-operatively. His discovery is so significant to the point that he was credited for discovering it and responsible for saving Queen Victoria during her childbirth from suffering; neither of which is true. According to the history press, although Simpsons works after the discovery of chloroform can be thought as significant or probably greater than chloroform, it received less attention by the medical community and public alike; everyone wanted to celebrate or hate him for the discovery of chloroform; so unfortunate. He recognised the fact that chloroform is a powerful agent that can be used to sedate people during surgery and at the same time, took lives if the dosage applied to an individual were excessive. There were a lot of debates, quarrels and confusion regarding the usage of such agent which requires a careful consideration of patients condition which can ultimately cause death if it was to be miscalculated. It is, however, worth noting that, the usage of chloroform has revolutionised battlefield medicine due to its quick onset of action, ease of use and high rate of success which has been documented on numerous occasions during wars. In the war in the Crimea, the British used chloroform almost universally in their operations; the French also exhibited it very extensively, and Baudens, one of their leading military surgical authorities, declares that they did not meet with one fatal accident from it, although it was given to them during the Eastern campaign, thirty thousand times at least. In America, however, chloroform was only recognised as one of the most effective anaesthetic agents after a civil war in 1861 thus being used by physicians for routine surgeries. It was kinda appropriate to start using such inhaled agent after it was documented in the records regarding the use of chloroform as a preferred agent to treat 80,000 people (through surgical methods) without too much fuss; they either used chloroform alone or mixed it up with ether to enhance its therapeutic effects. Even though the success rate seems high, there were a lot of deaths that have been documented as a part of the consequences caused by chloroform, starting with a child in 1848, a year after Simpson started using it as a preferred anaesthetic agent. Miscalculation or overextending the exposure of such chemical to patients can cause cardiac arrest and thus death within 2 minutes. When Simpson first discovered the anaesthetic property of chloroform, he tried it on himself, putting him in a deep sl eep. Fortunately, he woke up the day after or the world will be deprived of such anaesthetic agent a few decades after his announcement. Chloroform In Criminal-Related Activities I think people are quite familiar with the idea of chloroform being used by criminals to induce their victims into an unconscious state so that they can be abducted or killed with ease. Even though this idea is quite popular, most of the papers out there seem to agree with the fact that applying chloroform to a handkerchief and such is considered a poor tool to be used in abductions and any related crimes that are required unconsciousness of non-consenting individuals. There are a few cases that can be given as evidence but most of the popular press seems to hate if this fact proved wrong; they still believe that in any criminal activity which used chloroform, the chemical itself is the reason for people to be unconscious. Well, the method of inducing victims seem to resemble the act of inducing patients before an operation but there are a lot of factors that can be considered before saying chloroform is the root of all evils. In 1850, an elderly clergyman stayed in Temperance Hotel located in Kendal, Cumbria, England. He was on a mission of collecting donation for the needy and successfully collected eleven gold sovereigns which are considered a lot. Unfortunately for him, a young man who travelled alongside him planned to steal those sovereigns so he soaked a towel with some chloroform and hid inside a closet while the clergyman was busy doing something else. When the clergyman about to go to sleep, he tried to lock the door by using a chair since the lock is broken and a few seconds after, the young man attacked him while covering his face with the towel, attempted to knock him down. It will be easier for him to hit the clergymans head rather than using chloroform, the clergyman scream and fight violently and the other guests from other rooms came to see what happen. The young man was arrested and he was sentenced to 18 months of jail time. There are many cases which resemble this one but none of it was accepted as the truth by the public presses in 1865. People wanted to hear that chloroform can actually be used to commit crimes. In 1854, an ophthalmic surgeon named William Wilde began treating Mary Travers for a few years until later in 1862, she claimed, allegedly, that she was raped under the influence of chloroform by the surgeon himself. The thing that was interesting regarding this case is, although she claimed that she was raped in 1862, the report which was written by her to the presses was submitted in 1864 when William Wilde was awarded a knighthood for his contribution in Irish census. She was treated by him for those 2 years and this accusation seems suspicious. Moving on, William Wildes wife submitted a letter to Mary Travers whos at the time working as a professor of medical philosophy in Dublin. When Mary Travers found out about this, she sued Lady Wilde for defamation. Mary Travers won that case but the penalty imposed on William Wilde was so low that it wouldnt affect his reputation at all. People started to become suspicious as to why this was the case. This case was then discussed by two jo urnalists which favoured Sir William Wilde and they were sued for defamation by Mary Travers too; only this time, she lost. There are a few possibilities that could have influenced Mary Travers as of why she behaved that way. The rape accusation might be alleged but when we are talking about the truth, Mary Travers might have spoken it, I mean the truth; only it never happened in the first place. A lot of this kind of accusations have been received throughout the years and some research which are conducted much later proved that chloroform can induce sexual hallucination. This effect, however, is not specific to chloroform but also the other inhaled anaesthetic agents. Apart from making you happy, it can strengthen sexual emotions which lead to hallucinations that can be considered erotic. In 1888, a paper written by Buxton DW described a case whereby a patient achieved sexual orgasm during induction with an inhaled anaesthetic agent. Quite interesting, isnt it? Oh yeah, chloroform also is quite addictive. There is some documentation (quite old) which described patients who are addicted to inhaled anaesth etic agents to improve sexual performances. Conclusion Even though chloroform was proven to be a great anaesthetic agent in the past, it was replaced by much better gases that would be able to maintain unconsciousness with fewer side effects. If someone said they were being raped under the influence of chloroform, that case needs to be investigated first. Even though chloroform is a poor tool to be used by a criminal, people can be knocked out by it; they just need to be still for a few minutes as the concentration of the chloroform used might have been mild than what have been calibrated for surgical uses.

E-commerce Coursework Example | Topics and Well Written Essays - 7500 words

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Rise of Civilizations - Essay Example The old world began to flourish with the Nile culture. It was around this time that the Egyptian began building sophisticated technologies and interactions with other cultures through trade important new techniques to Egypt. It is from this background that this paper seeks to inquire into the role of women in the rise of civilization in the old world in the Eastern and African civilization. An explosion of knowledge and the curiosity of adventure facilitated the revolution from the old world to the new world of civilization. In the pre-history of civilization, the role of women cannot be ignored. The first section of this paper inquires into the pre-historical times of North Africa and Europe and tracks the rise of civilization among the primitive humans. Egyptian civilization dominates discourse in early civilization as early as in the 4th century. The spread of this civilization to other parts of Africa, Asia and Europe through human contact saw the rapid increase in knowledge and sophisticated architectural advancement. The second part inquires into the emergence of new world characterized by a rampant technological advancement. Focus is narrowed to North America, Central America, the Caribbean and the South American. The Pre-European age and the role of women in the age is discussed in detail. ... 1). It is evident that political unification was a key played in shaping the cultural patterns of Egypt in the old kingdom. The entire period of Egyptian civilization was a systematic continuum of socio-cultural changes. A civilization is the starting point of any society. This has been the foundation of great societies like the Greeks and Romans. The rise of cities in North Africa as a feature of civilization is traced to cultivation activities along the Nile. The production of surplus food energized the people and expanded the population. Massive population growth led to the expansion of villages into cities along the villages of Tigris and Euphrates in the Middle East. The fertile land between the two rivers led to the development of powerful dynasties to control and protect this treasurer from intruders. Archaeological evidence shows piles of ruins in the valleys of Nile as the remains of opulent cities, well-organized social structures and political organization. From this archaeological evidence, it is clear that ancient civilization never began in the West. It originated in Africa, Southern Europe and Eastern Asia, as John G. Jackson writes. "Those piles of ruins which you see in that narrow valley watered by the Nile, are the remains of opulent cities the pride of the ancient kingdom of Ethiopia They are a people now forgotten. A race of men now rejected from society for their supple skin and frizzled hair" (Jackson, 1939). The position of women in ancient civilization varies in Egypt, Ethiopia, Sudan, Levant, Greek, Romans and Anatolia civilizations. The Egyptians are said to have treated their women better than any other civilization and this was prompted

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Human Memory - Essay Example e details of a story that had occurred a long time ago, the flow of complicated phrases of long songs, and many other such features, is because of memory. This occurs as a process of information retention in which one’s experiences are archived, and these can be recovered when recalled. Memory and learning are mutually and closely interrelated. Learning is the acquisition of new knowledge and skills, and memory is the retention of this knowledge. Ability to consider the past, think in the present, and predict the future, as well as the use of language are all based on learning and human memory. Memory is also understood as a comprehensive term ranging from memories of childhood and autobiographical memory, to the stream of facts recalled as a result of a trigger. It includes the memory for faces, both familiar and those that require concentration to recognise. â€Å"The memories for taste and smell, sounds and shapes as well as the feel of things are directly related to the senses†, and can trigger off a flood of nostalgia (Samuel, 1999: 49). 1) Information flows through the brain: Sensory iinformation is stored in the sensory store in the cortex. Then some of the information is quickly transferred before it is lost, into the short-term store, and then the rehearsal buffer, and finally into long-term memory storage in the sensory cortex, state Loftus and Loftus (1976). The Papez circuit travels from the hippocampus, around the limbic system and cortex, back to the hippocampus. The strengthened memory paths become a part of long-term memory (Squire, 1991). 2) How neuron networks store and retrieve memories: Neuron networks such as the Papez circuit entrenches temporary connections between visual, hearing and limbic neurons to form a new lasting memory. A network in the cortex that contains a particular sensation forms a path defined by its synapses. This is the firing path for nerve impulses that stores and invokes the particular sensation to evoke a related

Submit a brief profile of the organization and the leader For your Coursework

Submit a brief profile of the organization and the leader For your Final Research Paper - Coursework Example Autocratic leadership style generally provides for â€Å"managers to make decisions alone without the input of others† (Johnson, 2012). It has been argued that on the surface, no leadership style may be generally judged as effective or ineffective unless the situation to which it was applied has been tested (Saunders et al, 2003). To this end, a number critical ways in which the autocratic leadership style has been applied in the given organization are enumerated below with a conclusion on how effective or ineffective this leadership style has become in the organization. Largely, the autocratic leadership style is exhibited in character and with qualities which include the fact that major decisions on the day to day running of the organization are taken at the management level alone. In most cases, workers and employees take specific instructions as to how each day of the week is going to proceed in terms of activities and working roles. Issues of reshuffling at portfolios, recruitment and promotions are also done at the management level without the input of other subordinate workers and employees. Because this leadership style is commonly perceived by followers as rigid and undemocratic to the growth of their knowledge and skill (Gray-Toft, and Anderson, 2008), they often wish to meet it with stiff opposition. However, the leader has adapted a rigid approach whereby it is almost impossible to contact the management with one’s suggestions for change. The leader has also adapted a system of motivation that considers only people who adhere to i nstructions for rewards and promotions. This has been a motivational tool that the leader employs to ensure that his orders are adhered to. To a very large extent, it can be concluded that even though the leadership style used by the leader has often succeeded in getting the motives and directions of the leader established at the work place, it has often

Business Corporate Strategy (Starbucks in China) Essay

Business Corporate Strategy (Starbucks in China) - Essay Example To go ahead with this task, Starbucks needs to have a detailed customer profile depending on the targeted segments because in general, as a long term strategy, customers are segmented based on their demographics, marketing habits etc. Such an analysis is to be preceded by a detailed analysis of the company, with a Chinese perspective, using some of the following strategic tools. A committed managerial team is headed by Howard Schultz, the present Chairman, who has proved to be a man with a mission. A dynamic person, he known to be full of energy who successfully transformed the US operations to their present proposition. Over time and with experience, Starbucks has developed a sophisticated store-development process based on a six-month opening schedule. This target driven strategy helped the company in opening large number of stores in US and elsewhere. Starbucks has been doing the ground work in China since 1994. Therefore comparing the growth of its operations in other nations, Starbuck could not successfully implement this experience in China and had to be content with relatively modest success. The company has taken little too long in building the foundation. Though Starbucks has shown its commitment to environment and health by maintaining a no-smoking policy, but in this part of the world, people prefer to sit out and chat with a cup of coffee on the table and a cigarette in hand. Opportunities For long China carried the reputation of being the world's greatest opponent of globalisation. But now things are perceptibly different. Today China has transformed itself into a committed member of WTO. Under the globalization, China is a rapidly growing market Though dominantly a tea drinker nation, Chinese consumer is rapidly accepting Coffee as one of the main beverages. According to Euromonitor, total sales of coffee in China has grown by nearly 90% between 1998 and 2003. Estimates for future point out that the market is bound to grow by about 70% in the period 2004-2008. Consumption of coffee has so far been concentrated in big cities only. Now with the establishment of a firm foundation the company can plan out a formidable plan for mediums sized cities and hamlets. Chinese beverages market is still vastly (more than 42%) dominated by Tea drinkers, this leaves enough room for inviting these people

Human Memory Essay Example | Topics and Well Written Essays - 1000 words

Human Memory - Essay Example e details of a story that had occurred a long time ago, the flow of complicated phrases of long songs, and many other such features, is because of memory. This occurs as a process of information retention in which one’s experiences are archived, and these can be recovered when recalled. Memory and learning are mutually and closely interrelated. Learning is the acquisition of new knowledge and skills, and memory is the retention of this knowledge. Ability to consider the past, think in the present, and predict the future, as well as the use of language are all based on learning and human memory. Memory is also understood as a comprehensive term ranging from memories of childhood and autobiographical memory, to the stream of facts recalled as a result of a trigger. It includes the memory for faces, both familiar and those that require concentration to recognise. â€Å"The memories for taste and smell, sounds and shapes as well as the feel of things are directly related to the senses†, and can trigger off a flood of nostalgia (Samuel, 1999: 49). 1) Information flows through the brain: Sensory iinformation is stored in the sensory store in the cortex. Then some of the information is quickly transferred before it is lost, into the short-term store, and then the rehearsal buffer, and finally into long-term memory storage in the sensory cortex, state Loftus and Loftus (1976). The Papez circuit travels from the hippocampus, around the limbic system and cortex, back to the hippocampus. The strengthened memory paths become a part of long-term memory (Squire, 1991). 2) How neuron networks store and retrieve memories: Neuron networks such as the Papez circuit entrenches temporary connections between visual, hearing and limbic neurons to form a new lasting memory. A network in the cortex that contains a particular sensation forms a path defined by its synapses. This is the firing path for nerve impulses that stores and invokes the particular sensation to evoke a related

Business Corporate Strategy (Starbucks in China) Essay

Business Corporate Strategy (Starbucks in China) - Essay Example To go ahead with this task, Starbucks needs to have a detailed customer profile depending on the targeted segments because in general, as a long term strategy, customers are segmented based on their demographics, marketing habits etc. Such an analysis is to be preceded by a detailed analysis of the company, with a Chinese perspective, using some of the following strategic tools. A committed managerial team is headed by Howard Schultz, the present Chairman, who has proved to be a man with a mission. A dynamic person, he known to be full of energy who successfully transformed the US operations to their present proposition. Over time and with experience, Starbucks has developed a sophisticated store-development process based on a six-month opening schedule. This target driven strategy helped the company in opening large number of stores in US and elsewhere. Starbucks has been doing the ground work in China since 1994. Therefore comparing the growth of its operations in other nations, Starbuck could not successfully implement this experience in China and had to be content with relatively modest success. The company has taken little too long in building the foundation. Though Starbucks has shown its commitment to environment and health by maintaining a no-smoking policy, but in this part of the world, people prefer to sit out and chat with a cup of coffee on the table and a cigarette in hand. Opportunities For long China carried the reputation of being the world's greatest opponent of globalisation. But now things are perceptibly different. Today China has transformed itself into a committed member of WTO. Under the globalization, China is a rapidly growing market Though dominantly a tea drinker nation, Chinese consumer is rapidly accepting Coffee as one of the main beverages. According to Euromonitor, total sales of coffee in China has grown by nearly 90% between 1998 and 2003. Estimates for future point out that the market is bound to grow by about 70% in the period 2004-2008. Consumption of coffee has so far been concentrated in big cities only. Now with the establishment of a firm foundation the company can plan out a formidable plan for mediums sized cities and hamlets. Chinese beverages market is still vastly (more than 42%) dominated by Tea drinkers, this leaves enough room for inviting these people

The Fundamental Changes of Adolescence Essay Example for Free

The Fundamental Changes of Adolescence Essay Puberty is the sum of all the changes that occur in the growing girl or boy as the individual passes from childhood into adulthood. This phase of rapid physical and psychological and social changes prepares the child into a period of full sexual maturation. Furthermore, this phase is manifested by growth spurt and development of secondary sex characteristics. Growth hormones are the reason for the development of secondary sex characteristics which can be described as the changes in the outward appearance that signal the onset of reproductive maturity. These include growth of pubic hair, changes in the appearance of sex organs and breast development. Accompanying these changes is the feeling of anxiety and shame of these rapid bodily changes so without proper guidance during this turbulent stage in his life may not prepare him for the more complex problems of adulthood. Not all adolescents undergo these changes at the same time; some mature late while some mature early. The onset of puberty can occur as early as age 7 years in girls and 9 and ? in boys or as late as 13 in girls and 13 ? in boys. In girls, the interval between the first sign of puberty and complete physical maturation can be as short as six years and in boys, the comparable interval ranges from about two years to five years (J. Tanner, 1962. ) For the boys, the sign that he has reached sexual maturity is termed spermache. Spermache is the first ejaculation of the seminal fluid generally occurring a year after the beginning of growth of his primary sexual organ, the penis. On the other hand, girls have reached sexual maturation with the onset of her first menstruation and the term for this occurrence is menarche. Psychological Effect of Puberty The bodily changes during adolescent stage can affect teen’s behaviour and psychological functioning. The increase of hormone testosterone is directly linked to the increase in boy’s sex drive. Bodily changes will also make the children more conscious with his physical appearance. There is also a change in how others react to the adolescents’ new image in turn these reaction will elicit change in the adolescents’ self-image. During this period, the adolescent also sets high ideals, dreams and aspirations. They wanted to act like an adult but society cannot yet grant him the privileges that adults enjoy. In wanting to reach his high ideals, adolescents can realize that they cannot reach those ideals and this leads to loss of self-confidence and may experience a feeling of inadequacy. Timing and Tempo of Puberty There are factors which can affect the timing and tempo of puberty. One of the prime reasons is the genetic makeup of the individual. There are studies which reveal that African-American female mature earlier than their American counterparts. Study also shows that maturity occurs much earlier in prosperous countries as compared to less developed countries and scientists believe that better nutrition, improved sanitation and better disease control caused the early maturation. Those teens that have experienced maturity during normal period have the high incidence of having less emotional and psychological problems than those who matures early or late because they have the right amount of time spent in childhood which can make them cope better with the demands of adolescence (Fundamental Changes in Adolescents, p. 26.). Reaction to Early Maturation Boys and girls have different reactions when dealing with early maturity. For the girls, it has both positive and negative effects. The positive effect is that when compared with late maturing, early maturing girls are more independent minded, more popular with boys and felt better with their figure. They also dated more frequently. Because of their more independent attitude, they can be more likely to get into trouble at school because they tend to speak their mind without thinking if their comments might hurt another’s feelings. Girls who mature early also have the tendency to get low grades in class because they are in dates often and they neglect their school duties. Early maturers are treated as more mature by peers and adults so they have the tendency to show adult behaviours and can cope easily with the emotional turmoil brought about by the sudden physical and psychological changes. For boys early maturation mean competitive advantage over peers in the field of sports and in leadership. They are also more attractive to girls than their awkward looking peers and are often viewed as sophisticated, poised and self-confidence. One disadvantage is that early maturers have less time for childhood games and fun because adults expect them to do more mature roles. There is less time to adjust to physical maturity so they tend to be socially immature. Reaction to Late Maturation Same as with early maturation, boys and girls have different reaction to late maturation. Girls who are late maturers are under less pressure because adults don’t expect her to behave and act maturely. Late maturers also mature at the same time as boys so they are in the same social and psychological level that they don’t have difficulty in forming intimate relationship with the opposite sex. Potential disadvantage of late maturity in boys is that late-maturing boys cannot compete with early maturers in forming boy-girl relationships because they are still conscious with their physical appearance and because they still have underdeveloped muscles and hoarse voice and this leads to the development of negative self-concept: a feeling of inadequacy, a feeling of hopelessness and rejection. It is easy to spot late and early maturers. Physically, their difference is marked by their body built. Those with athletic build are likely to be early maturers but those with slight build are the late maturers. Knowing the potential advantages and disadvantages of these types of adolescents may help the parents and adult guardians understand the crisis they face and can easily formulate methods to help these adolescents pass this rite of passage and built a positive self-image. References: Tanner, J. M. , 1962, Growth at Adolescence, 2nd edn (Oxford: Blackwell Scienti ®c Publications). â€Å"Development Needs of Children and Adolescents†, retrieved May 20, 2010 at the website http://www. bhojvirtualuniversity. com/ss/online_cou/b_ed/secp_02/cp2b2u2p3. asp â€Å"The Fundamental Changes of Adolescence† retrieved on May 20, 2010 at the website http://highered. mcgraw-hill. com/sites/dl/free/0072414561/16698/ch01. pdf