The Neurobiological Basis of Major Depressive Disorder (MDD)

The Neurobiological Basis of Major Depressive Disorder (MDD) Family name:  Batty Personal Name:  Therese Major depressive disorder (MDD) which is also known as either unipolar depression or major depression is a common yet disabling mental disorder affecting over 400 million people worldwide with a higher incidence in women than men (World Health Organisation, 2012). Depression may be endogenous where there is no discernible cause or reactive whereby the depression is a result of an incidence such as the loss of a parent, loved one or stress. Some of the emotions that individuals may experience with depression are, feelings of sadness, anger, bitterness and resentment, emotions which can last a few days or in some cases, months and have a huge impact on the individuals life. Some individuals suffering from MDD are also more likely to have a substance abuse problem, other mental and physical problems, and are likely to have a greater suicide risk. MDD is a widely researched topic with a sense of urgency to find the exact aetiology and pathophysiology behind the disease so that a more tho rough understanding can be reached and treatment can be uniquely designed for each individual. Researches surmise that various factors are involved such as the chemical changes in the brain, genetic predispositions and environmental factors. The aim of this essay, although not comprehensive enough, is to try and bring together research material from various sources and highlight some key areas around MDD such as a synopsis of the aetiology, pathophysiology, risk factors, treatments and test available today. Aetiology The underlying aetiology (causes) of MDD is so complex with many gaps that it appears that no-one is quite sure what causes depression, however much research done to date into this condition suggests that a combination of factors are involved, such as genetics, an individual’s biochemical environment, personal experiences and psychological factors. According to Dr Michael Miller, a Professor of Psychiatry at Harvard University (2013), several forces interact to bring on depression including faulty mood regulation by the brain, medications, medical problems, genetic vulnerability and stress. In as much as age related brain changes, disease related changes , for example, cerebrovascular disease, Parkinson’s disease, and epilepsy, lead to disruptions in the circuitry of emotion regulation and can cause the onset of depression (Wryobeck, Haines, Wynkoop and Swanson, 2013). Areas of the brain underpinned by major depressive disorders such as the thalamus, the hippocampus and the amygdala (Limbic circuitry) (Figure 1. Miller, 2013 ) include several groups of neurons and white matter. Cell connections, nerve cell growth, and the functioning of nerve circuits in the brain have a major impact on how the brain functions, particularly in the way they communicate with each other. Several different chemicals and hormones working within and outside these nerve cells play a key role, with reduced levels of serotonin and noradrenaline posit to be a huge factor associated with the disease (Miller, 2013). Similarly, Villanueva (2013) through the construct of a survey used to assess the neurobiology of MDD, found that brain-derived neurotrophic factor (BDFN) along with expressions of miRNA’s (involved in neural plasticity), abnormal gastrointestinal signalling peptides and proinflammatory cytokines are all causative factors of major depressive disorder. What proinflammatory cytokines do, is stimulate the hypothalamic-pituitary-adrenal axis, activate secretion of growth hormone and inhibits the thyroid stimulating hormone secretion, all of which are associated with depression. Whereas gut microbiota (flora), specifically leptin, ghrelin and cholecystokinin (signalling peptides), influence the central nervous system including modulation of neurogenesis which can influence brain chemistry and consequently an individual’s behaviour. According to Lopresti, Hood and Drummond (2013), as seen in figure 2 below, a bi-directional relationship is likely to exist between depression and lifestyle factors with key symptoms including changes in appetite, general energy levels, motivation levels and sleep, which in turn affect diet, exercise and sleep thereby creating a cycle of influence. A vicious cycle, all of which point to the necessity of promoting lifestyle changes Figure 2. Potential mechanism of diet, sleep and exercise on major depression. In Lopresti et al. (2013). Another avenue suggested by Dr Miller (2013), is that research has identified that genetics play a role, in that not only do certain genes make individuals more vulnerable to low moods, but it can influence how individuals respond to drug therapy. Likewise, Stanford school of medicine surmise that through its research on the study of identical (100% genetically identical) and non-identical twins (50% genetically identical) and major depression as a heritability factor, heritability shows to be a huge contributor in the development of this disease. Each individual inheriting a unique combination of genes, with a predisposition to certain illnesses (Levinson and Nichols, n.d.). Genes controlling either the production or utilization of serotonin plays and important role in the pathogenesis of depression and in particular with serotonin reuptake due to the fact that depressed individuals have a lower rate of serotonin uptake. In depression of the elderly or late onset depression, genetic s is less common or does not appear to play a role as genetic markers are not present (Halverson, Bhalla, Bhalla and Andrew (2014). In so saying then, non-genetic factors, many of which are not known, also need to be taken into account, as Levinson and Nichols (n.d) suggest, these factors also increase the risk and progression of depression. Pathophysiology Progression of the illness as indicated by Treadway et al.(2014), is linked to biological changes. Due to over-stimulation of steroidal and inflammatory signalling molecules by stress, structural abnormalities within the prefrontal cortex and hippocampus, known for regulating behaviour and endocrine responses to stress, can be damaged. Moreover diet, sleep and exercise not only play a significant role in the development and progression of the illness, it also impacts on the treatment. One research analysis undertaken by Maletic, Robinson, Oakes, Lyengar, Ball and Russell (2001), summarised that MDD involved structural, functional and molecular alterations within the brain. Similarly research conducted by Halverson et al. (2014), speculates that although the underlying pathophysiology of MDD has not been clearly defined, studies show a strong interaction between the neurotransmitter availability and receptor regulation, with emphasis again on serotonin activity disturbances in the cen tral nervous system. Other neurotransmitters such as epinephrine, dopamine, glutamate and brain derived neurotrophic factor (BDNF) are also implicated in depression. Cells within the hypothalamus are responsible for an individual’s emotional state which in turn link to the stress responses. Several studies , in particular Lopresti et al. (2013), show that during stressful times, the hypothalamic – pituitary-adrenal axis (HPA), the neuroendocrine circuit that manages stress in the body, becomes activated. This then leads to the release of epinephrine and glucocorticoids (cortisol) to assist the body in its adaptive response to stress. However, if the body remains under a constant state of stress, excitotoxicity of neurons, particularly in the hippocampus can occur leading to dendrite atrophy and apoptosis of neurons (Wryobeck et al. 2013). Research shows that while cortisol helps the brain to cope with stressful situations, it also damages and kills cells in the hippoca mpus. So it can almost be said that stress excites brain cells to death. Furthermore research shows that individuals experiencing depressive disorders have a smaller hippocampal volume than individuals who do not from depression and that positron emission tomographic (PET) showed a diminished activity in the area of the prefrontal cortex in individuals with depressive disorders. Thereby underlying the functional and structural abnormalities in the brain regions of individuals suffering from depression (Halverson et al. 2014). Most individuals with MDD present with normal appearance however, individuals with more severe symptoms may present with more significant signs such as, poor hygiene, poor grooming and changes in weight. Individuals with MDD have a distorted view of their life whereby negative attitudes make it more difficult to see a positive outcome from a difficult situation. Other symptoms such as psychomotor retardation, agitation or restlessness, suicidal thoughts or atte mpts, social withdrawal and in the elderly somatic complaints may also be evident. These however are only some of the underlying signs and symptoms as individuals vary from one to the next. Risk factors / causal agents It is a widely held view that there is an unambiguous relationship between physical, psychological, environmental, genetic and social factors as well as a dysregulated response to chronic stress as risk factors for depression. Halverson et al. (2014) infer that stress plays a dominant role in depression due to the chemicals involved throughout the body such as adrenaline and cortisol which in abundance, leads to other health complications. With the various types of onset of stress being for example, the loss of a parent prior to the age of 10 years, parent-child relationships, due to poor interaction between the two and child stressors, which can contribute to depression or thought to be associated with both early and late abuse and neglect. In addition, stressful changes in life patterns such as a serious loss, difficult relationships, trauma or financial problems can trigger a depressive episode. Women with a previous history of depression are at higher risk of menopausal depressio n while low testosterone levels in older men also aid in onset of depression (Halverson et al. 2014). Likewise Martin (2014) highlights that women may experience more episodes of depression than men due to hormonal changes such as during premenstrual phases, pregnancy, postpartum and menopause. Coupled with this is the additional stress of work-life balance where women take on the added responsibility of tending to children and or aging parents whilst still trying to forge a career for themselves. Individuals with a family history of depression tend to be at higher risk of developing depressive disorders. Psychosocial risk factors according to Halverson et al. (2014) can include impaired social supports, caregiver burden, loneliness, bereavement and negative life events. Abused substances and pharmacological agents can increase depression risks due to altering brain chemicals. These include pain relievers, sedatives, sleeping pills, cortisone drugs and seizure drugs, to name but a few. Whilst in the elderly, neurodegenerative diseases particularly Alzheimer’s and Parkinson’s, stroke, macular degeneration (vision) and chronic pain can all contribute to higher rates of depression (Martin, 2014). Treatment strategies First and foremost, education plays an important role in the treatment of MDD as individuals may become aware of the signs of relapse thereby allowing them to seek early treatment. Family and support members also need to be educated about the nature of depression and the treatment involved so as to be able to give the support needed, ensure medication compliance and encourage a change in lifestyle such as keeping active (Halverson et al. 2014). Wryobeck et al. (2013), posit that with depression being a multi-factored illness, treatment should encompass a combination of therapies such as psychotherapy, electroconvulsive therapy, lifestyle management, psychosocial therapy and pharmacotherapy. Pharmacotherapy such as anti-depressants being one method affects the neurotransmitters. Selective serotonin re-uptake inhibitors (SSRIs), a new class of antidepressants, which allow for the increase of serotonin by blocking the re-uptake of serotonin into the presynaptic neuron, is according to Clarke and Gordon (2011), used as the first line of treatment. SSRIs allow for autoreceptors to be desensitised or down-regulated, nerve transmission and serotonin levels are normalised and mood is elevated. Figure 3 below, illustrates how the amount of neurotransmitters in individuals with depression are reduced and postsynaptic receptors are increased as a response to these lower levels. The re-uptake of serotonin adding to the decreased amount of neurotransmitters. When treatment of SSRIs take place, serotonin levels increase due to the blocking of the re-uptake and down-regulation of postsynaptic receptors occur (Clarke Gordon, 2011). Figure 3 Action of selective serotonin re-uptake inhibitor drug. In neurobiology of mental illness Clarke Gordon (2011). Psychotherapy can include behaviour therapy, cognitive-behaviour therapy, family therapy, interpersonal therapy, psychodynamic psychotherapy and supportive psychotherapy. Psychosocial therapies according to Halverson et al. (2014) and supported by The American Psychiatric Association (APA) is often a first-line of treatment for mild cases of depression however, in more severe cases this should be combined with antidepressant medication. Other approaches according to Wryobeck et al. (2014) and Halverson et al. (2014), can include electroconvulsive therapy (ECT) which is thought to increase neurogenesis, reversing degeneration and decreased proliferation of nerve cells, regulate neurotransmitters and correct dysregulation of neuropeptides. Stimulation techniques such as vagus nerve stimulation which involves the nerve to be stimulated with electrodes resulting in the assumption that it may alter norepinephrine release and elevating levels of inhibitory GABA. Transcranial magnetic stimulation concentrates magnetic energy over parts of the brain allowing for either an increase or decrease in cortical excitability depending on the frequency. Stimulation over the right frontal lobe apparently reduces the symptoms of depression. Talk therapy as well as exercise are more non-invasive forms for dealing with MDD allowing the individual to develop problem solving skills, coping mechanisms and in some instances to form a suppor t group. Relevant tests To date there are no physical findings that are specific to MDD, instead diagnosis is dependent on the individual’s history and mental state exam. As depression may be linked to an underlying physical problem, both a physical exam as well as thyroid function blood tests can be done. A psychological evaluation is also of benefit to gather information around an individual’s feelings and behaviour pattern. In New Zealand a wide range of tools are available such as the Kessler 10 (K10) for assessing depression, anxiety and general mental health, the patient health questionnaire (PHQ-9) for depression and the GAD-7 for anxiety assessment. According to the Best Practice Advocacy of New Zealand [bpac z](2009) these tools also allow for monitoring the response to an individual’s treatment regime to ensure that optimal health is being met. In conclusion, to date the specific causes of major depressive disorders (MDD) is still unknown, however a substantial amount of research has gone into and still continues in this area with a consensus that depression appears to be a multifactorial and diverse group of disorders involving the chemical reactions and nerve communication in the limbic circuitry of the brain and both genetic and environmental factors. Progression of MDD is linked to biological changes, diet, sleep and exercise. Treatment strategies appear to be multi-factored with underlying assumptions based on individual research results. Education is still an important element focusing on the individual and support structures while more up to date pharmacopeia such as serotonin re-uptake inhibitors, lead the market as the go to drug for antidepressants. Most literature to date however, underlines the need for more research to take place, in particular, within the area of the aetiology / pathophysiology of the disease and likewise specifically structured individual treatment strategies. References Clarke, G. Gordon, C. (2011). Neurobiology of mental illness. In J. Craft, C. Gordon A. Tiziani (Eds.), Understanding pathophysiology (pp. 1177-1180). Chatswood, NSW: Elsevier. Halverson, J. L., Bhalla, R. N., Bhalla, P. M. Andrew, L. B. (2014). Depression. Retrieved from http://emedicine.medscape.com/article/286759. Levinson, D.F. Nichols, W.E. (n.d.). Major depression and genetics. Retrieved from http://depressiongenetics.stanford.edu/mddandgenes.html. Lopresti, A. L., Hood, S. D. Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise. Journal of Affective Disorders 148 (2013), 12-27. Maletic, V., Robinson, M., Oakes, T., Lyengar, S., Ball, S. G. Russell, J. (2007). Neurobiology of depression: an integrated view of key findings. International journal of Clinical practice, 61 (12), 2030 – 2040. doi: 10.1111/j.1742-1241 Martin, B. (2014). What are the risk factors for depression? Retrieved from http://psychcentral.com/lib/what-are-the-risk-factors-for-depression. Miller, C. M. (2013). What causes depression. Retrieved from http://www.health.harvard.edu/newsweek/what-causes-depression.htm. The Best Practice Advocacy centre of New Zealand. Assessment of depression in adults in primary care. (2009). Retrieved from www.bpac.org.nz/BPJ/2009/adultdep/assessment.aspx. The world health organisation. (2012). Depression fact sheet. Retrieved from www.who.int/mediacentre/factsheets. Treadway, T. M., Waskom, M. L., Dillon, D. G., Holmes, A. J., Park, M. M., Charavarty, M. M., ‘†¦Ã¢â‚¬â„¢, Pizzagalli, D. A. (2014). Illness progression, recent stress and morphometry of hippocampal subfields and medial prefrontal cortex in major depression. Society of Biological Psychiatry. Retrieved from http://dx.doi.org/10.1016/j.biospych.2014.06.018 Villanueva, R. (2013). Neurobiology of major depressive disorder. Neural Plasticity, volume 2013. doi: 10.1155/2013/873278 Wryobeck, J. M., Haines, M. E., Wynkoop, T. F. Swanson, M. M. (2013). Depressive disorders. In C. Noggle S. Dean (Eds.). The Neuropsychology of psychopathology (pp 201-220). New York, NY: Springer Publishing. List of illustrations Figure 1. Miller, C. M. (2013). What causes depression. Retrieved from http://www.health.harvard.edu/newsweek/what-causes-depression.htm. Figure 2. Lopresti, A. L., Hood, S. D. Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise. Journal of Affective Disorders 148 (2013), 12-27. Figure 3. Clarke, G. Gordon, C. (2011). Neurobiology of mental illness. In J. Craft, C. Gordon A. Tiziani (Eds.), Understanding pathophysiology (pp. 1177-1180). Chatswood, NSW: Elsevier.

Strengths weaknesses and the strategy of IKEA

Strengths weaknesses and the strategy of IKEA IKEA is the worlds largest home-furnishing retailer. It was founded in 1943 by Ingvar Kamprad in Sweden. In terms of scope, IKEA is designed for the total home environment, in order to offer furnishings and fittings for every part of the home, both in- and out of doors. With the vision: To create a better everyday life for the many people, it offers a wide range of well designed, functional home furnishing products at prices so low that as many people as possible will be able to afford them. (IKEA.com). From it first store in Sweden, today, there are over 300 IKEA stores in 39 countries, with turnover in 2009 of more than à ¢Ã¢â‚¬Å¡Ã‚ ¬22.7 billion. According to Forbes Magazine, Ingvar Kamprad, now in his eighties, is the 11th-wealthiest person in the world, with a fortune estimated at U.S. $23 billion in 2010. (Mary Albon, The Sun Never Sets on IKEA, 2010). I would like to address some issues to understand more about IKEA success as follows: Since its establishment, IKEA has always taken care of people and the environment as it stated on its vision. That is the reason why in manufacturing process, IKEA tries its best to have a better use of both raw materials and energy. They even have a brochure presenting a brief overview of how the IKEA groups work to in a high sense of responsibility to people and environment. We also can easily see how much they concern people and the environment by knowing IKEA stakeholders. Like other business organisations, the stakeholders who have high power and high interest are Inter IKEA system BV, investors and customers. However to me the most impressive and important stakeholders of IKEA are environmental organisations of which IKEA Group also is a member such as: BCI, Better Cotton Initiative, aims to promote measurable improvements in the key environmental and social impacts of cotton cultivation worldwide. (IKEA.com) Building and Wood Workers International (BWI) is the Global Union Federation of democratic and free trade unions, protecting more than 12 million members in 350 trade unions around the world in the building, building materials, wood, forestry and allied industries. IKEA and BWI meet frequently to exchange experience and discuss working conditions and social responsibility. (IKEA.com) The IKEA Group is member of BSR and has an representative on the board is a global, non-profit organization that helps member companies achieve business success while respecting ethical values, people, communities and the environment. BSR provides information, tools, training and advisory services to make corporate social responsibility an integral part of business operations and strategies. (IKEA.com) Clean Cargo Working Group (CCWG) which is working to promote sustainable product transportation. (IKEA.com) European Retailers Round Table (ERRT) which is Focus for activities include consumer protection, food safety, environmental issues, corporate social responsibility and trade issues Forest Stewardship Council (FSC) (IKEA.com) Refrigerants Naturally is a United Nations initiative acting as a catalyst, advocate, educator and facilitator to promote the wise and sustainable development of the global environment. (IKEA.com) The Network for Transport and Environment (NTM), aiming to establish a common base of values on how to calculate the environmental performance of various modes of transport (IKEA.com) And IKEA also is the partner of: IKEA Foundation and UNICEF are long term partners working together on both a global and local level (IKEA.com) WWF and IKEA co-operate on projects which focus on sustainable forestry, sustainable cotton production and climate change (IKEA.com) During working and sharing experience with these organizations, IKEA not only has better knowledge about social responsibilities but also has built its reputation of being green. In 2010 and beyond, the world economy would be a key issue to impact Ikeas business. IKEA and other companies in the world had to face the worse economic situation since many decades as its financial sector was deeply in crisis and then the global economy was felt into the depth of recession. The world economic growth reached only 1.1 % if compared to about 5% in previous years (VietnamPlus and World Economy, n.d). However, the world economy improved in 2010 with the economic growth increased to 4.2% as the economy of the United States of America is expected to grow by 2.1 per cent in 2010, following an estimated downturn of 2.5 per cent in 2009. Recovery in both the European Union (EU) and Japan is projected to be much weaker, reaching GDP growth of no more than 0.5 and 0.9 per cent, respectively, in 2010. At this pace of recovery, the major developed economies are not expected to provide a strong impetus to global growth in the near term (World Economic Situation and Prospects 2010 Global outlook, p.2). Nevertheless, the UN stresses that the recovery is uneven and conditions for sustained growth remain Fragile. In 2010, global growth will remain below potential and unemployment will stay high ( p.1 ). Though the situation was still difficult because fewer people have moved home but the company sales increased 7.7% in 2010 compared to fiscal year 2009 is surprised outcome. The company also faces increased competition of other competitors all over the world. For example, it is ddifficult to sustain good design quality products at low cost when the number of competitors keep increasing e.g. In the US, Kmart, Target Corp, Fly in France and Japan Nitori Co in Japan (Ikea case study). In particular sales case, competition cut Ikea sales in UK as profits dropped to  £17 million to August 2009, according to documents filed at Companies House last week. Sales fell 1.4 per cent to  £1.23 billion. The company has reported falling profits for five years and falling sales for three years in Britain. Ikea has come under increasing pressure from DIY retailers that are selling more home furnishings, as well as growing competition from supermarkets (Neil Craven, daily mail, n.d) IKEA is positioning as a cost leader of home furnishing retailers. Ikea states firmly its market position by a statement that Your partner in better living. We do our part, you do yours. Together we save money (Ikea Portal, Student Info, n.d). It is clear to see that IKEA is regarded as low price products with high quality by using inexpensive materials in a novel way and minimizing production, distribution and retail costs, customers benefit from low prices. This cost leadership has been making IKEA differently from other competitors. Due to high inflation increasing every year, it is hard to find any other companies who can announce that last year our price is 8.99 euros, this year 4.90 euros or 10 year ago 260 euros, today 169 euros (Ikea Welcome inside 2010, p.20). Ikea has been making it for many decades. Low prices are one of the cornerstones of the IKEA concept and help to make customers want to buy from IKEA. This low price strategy is coupled with a wide range of well designed, functional products. IKEAs products cater for every lifestyle and life stage of its customers, who come from all age groups and types of households. This is vital in times when the retail sector is depressed, as it increases IKEAs potential market. While the price of other companies products tends to rise over time, Ikea says it has reduced its retail prices by a total of about 20 percent during the past four years. Ikeas corporate mantra is Low price with meaning. The goal is to make things less expensive without ever making customers feel cheap. Striking that balance demands a special kind of design, manufacturing, and distribution expertise. But IKEA pulls it off in its own distinctive way: tastefully, methodically, even cheerfully, and yet somehow differently than any other company anywhere. Lisa Magonelly therefore presents guide to how IKEA designs, builds, and distributes the furniture that the entire world wants to buy. Based on low prices strategy, IKEAs segmentation is targeting to young low and middle-income family who are willing to do a little bit of work serving themselves, transporting the items home and assembling the furniture for a better price. IKEA offers customer experiencing in actively involve in shopping at its stores. Definitely, customers involvement contributes to IKEA low prices. To explore the successful of the IKEA, analyzing its opportunities and threats is an essential. Before looking at the opportunities of IKEA, we can come over its strengths. First of all, Brand is one of the most important that IKEA has. It is already a global brand therefore it will be a very attracted factor to customers because it like a promise to customers that where ever they are, they will be provided the same quality. Second strength is its vision to create a better everyday life for many people. The concept that offers a wide rage of well designed and functional home furnishing products at the inexpensive prices is the third strength. Fourth is the sustainability is fully-integrated into all business strategies.   The IKEAs strengths bring its opportunities, especially in this dedicate, people more and more care a bout a sustainable environment. By caring about environment, people will care about Green products and IKEA has reputation of being green so that its products will be their choices. IKEA shows their care about environment clearly on its statement: Each and every one of our business strategies whether local, national or global must now clearly and systematically integrate sustainability as a part of everyday operations.   I see this as a milestone. It will help us move forward in our relentless work with the many challenges we have to solve on our route to becoming a sustainable company. (Greeneconomics.com) As a member of number of environmental organizations enables IKEA to work with sustainability in different ways: IKEA reduced overall CO2 emissions by 5% in FY 2009.   The company plans on participating in the Greenhouse Gas Protocol in 2010. (Greeneconomics.com) The company has a pilot program with select suppliers to reduce energy consumption by 30% or more by 2011. (Greeneconomics.com) IKEA has also started four new climate change projects with the WWF, which will focus on measuring supply chain emissions, helping our customers tackle climate change through transport initiatives, reducing emissions from IKEA food product transport, and improving the reuse and recycling of used products. (Greeneconomics.com) One climate change project is to install solar panels in 150 of its stores, with the long-term goal of supplying all buildings with 100% renewable energy. (Greeneconomics.com) Because of the economic downturn, customers tend to be looking for products with low prices than expensive one. The excellent thing to be come IKEA customer is you can buy good things with well designed and good quality but inexpensive prices. It means that, even the economic crisis, the demands for IKEA products still raising and the turnover also high more than à ¢Ã¢â‚¬Å¡Ã‚ ¬22.7 billion in 2009 (Mary Albon, The Sun Never Sets on IKEA, 2010). However the strengths and opportunities of IKEA can also drive the organisation to its weaknesses. IKEA with hundreds stores in different countries is really hard to control the quality as well as the standard of the products and services. The low cost is a strength however in the management aspects it is not easy to control the low cost but keep the standard of quality in the same time. The threats that IKEA is facing are: The competition in the retails market: there are more and more organsations have strategy of producing products with high quality with reasonable prices. They will become competitors of IKEA so this will be one of the main factors can impact to IKEA. The economics down turn in 2010 and will continues in 2011 makes the disposable income decrease but the living expense is rising. This will definitely affect the business operation of IKEA. By analyzing these factors IKEA can have plan to reduce the threats and take advantage of the opportunities.

Puberty Essay -- Human Development Papers

Puberty Let's talk about puberty. What is the first thing that comes into our minds when we say puberty? Well, sex is the most common thought that pops out from the head of many people. But there is much more than sex to puberty. Puberty is a very unique and important evolving stage of all males and females. During puberty, guys and girls go through many changes that we might find funny, scary and weird. During puberty, the level of testosterone and estrogen in both boys and girls increases greatly. The rapid increase of testosterone and estrogen is what triggers the beginning of puberty. Now lets give the changes that boys and girls experience during puberty. During puberty, some changes happen only to girls, and some happen only to boys. What type of changes can are expected to happen to girls? First of all, the girl's breasts will begin to grow and get fuller. Sometimes, one breast may grow faster than the other. Some girls' breasts grow more rapidly than other girl's. Some girls' breasts remain small throughout their adult lives. Also during puberty, the girl...

It Should NOT be a Crime to Smoke :: essays research papers

It Should NOT be a Crime to Smoke Out in the cold, a lone member of society stands alienated from the rest of the world. A plume of smoke rises from her mouth; this is what sets her apart from the rest of the population, the fact that she smokes. In the last decade, this has been happening as people become staunchly more politically correct. It has almost become a crime to smoke in this country as the year’s progress. Is this right? Should smokers be treated this way, are they worse than the rest of society just because of their habit?   Ã‚  Ã‚  Ã‚  Ã‚  Smokers have been banned from almost ever facility in this nation, save some fast food restaurants and bars. Almost all the nice restaurants have eliminated smoking sections, and for what reason: to quell the cry of all the nonsmokers in this world? If these people had their way all the smokers would be crammed into a rocket and shot off to farthest reaches of the universe. Why have smokers been driven out of public places when there are efficient ways of eliminating secondhand smoke? There are machines called smoke eaters that have been scientifically proven to eliminate 98% of the toxins found in secondhand smoke. Why are these overlooked when legislation is passed making it illegal to have smoking sections in public buildings? I do not have the answers to these questions, only the politicians do.   Ã‚  Ã‚  Ã‚  Ã‚  Ithaca College is not above these ridiculous laws. Ithaca College is trying to pass legislation that bans smoking from certain out door areas of the campus. How ridiculous is this. Smokers are not only banned from all indoor areas but now we are confined to certain outdoor areas. President Peggy Williams wants this to go through and says it is time to make a stand. I say that all the smokers of this nation should ban together and put an end to this tyranny that makes our lives more difficult every year. We must stop them from discriminating against us.   Ã‚  Ã‚  Ã‚  Ã‚  I believe that smokers should have the right to smoke anywhere outdoors and in certain areas indoors where efficient second hand smoke elimination procedures are in place. I need no backing for the outdoors claim because if smokers are not permitted to smoke outdoors than where are they allowed to smoke, only in their houses with the windows closed and the blinds drawn?

English Patient

This key passage is from Michael Nonnative's The English Patient, found in the first few pages of chapter four. Before, this passage, Hanna is sitting beside Llamas while he begins to describe his first expedition in the deserts in the asses. After, Llamas explained how he came to hate nations, but was attached to the desert as It could not be claimed or own. The passage between reinforces the Idea that Identity Is not fixed, It changes over time as people grow and gain experience.This Is made evident through Almanacs character which Is portrayed through the symbol of the desert. Symbolism Is used to encapsulate plot elements that are crucial to the theme and allow the reader a deeper level of Interpretation of the novel. The desert represents transience; It Is neither fixed nor unitary. Further, It cannot be claimed, owned or defined similar to Almanacs Identity, which Is constantly shifting. Llamas explained: â€Å"The breeze that had been refreshing had gradually strengthened.Eve ntually we coked down, and the surface of the desert was changed. † This demonstrates the desert's refusal to use anything artificial such as borders, or names as a landscape because it's continuously changing by sandstorms, similar to how Llamas refuses to reveal his identity because it changes over time and does not reflect where he comes from. Identity is dynamic, and many factors are needed to create an identity. The reader is prompted to reconsider what exactly makes up an identity, what defines who are. Identity should be chosen rather than inherited.

The pursuit of one’s goals

The pursuit of one’s goals and dreams are journeys that oftentimes take a lifetime to accomplish.   There are those who reach the end of their lives not accomplishing what they wanted to do because they were either too intimidated by the prospect of even embarking on such a quest or they did not have the right opportunities in life.I have been working for eight (8) years and during that time I have had plenty of time to see my career develop as my life passed by.   Yet, there comes a certain point in one’s life when one must make a firm decision, a commitment to something much more than one’s own personal goals.   Oftentimes, this means sacrificing one for the other.There are those, however, who are lucky enough to have their own personal goals and that pursuit for higher objectives converge.   For me, this is the pursuit of a career in nursing.I have always wanted to help change the world.   As a child, I believed that if everyone did their own little part in taking that extra step to help others, the world would be a much better place for everyone.The stark reality of it all hit me not long after that but it did not lessen my resolve.   I figured that if so many people I knew did not want to do their part in changing the world then I would probably have to do their share.   This is where my motivation to pursue nursing comes from; the drive to go the extra mile just to make a difference in this world.I see my goal in life as similar to that of Nurse Leader Mary Breckenridge in that I understand that nursing plays a very important role in the world today.   There are few jobs and professions that are as rewarding as nursing.   While other jobs may get more publicity, the role that nurses play in the health care industry is highly valued and appreciated.My desire to be a nurse has to do with the fact that nursing is one of the ways by which I am able to do something that I really want to do in my life and that is to care a nd help other people.   More importantly, I greatly feel that by taking up Nursing I will be able to proceed with my plans in life.The decision to pursue a career in nursing is not something that just occurred overnight.   Instead, it is the result of an active commitment to being able to carry out my passions in life.   The human involvement that is critical in nursing makes it the ideal profession for me.The remunerations that one can receive from being a nurse are only secondary to the feeling of fulfillment from knowing that one was able to provide support to those in need.   These experiences that I took with me during my time in the hospital shaped my future and opened my eyes to the benefits that a career in nursing can provide.As the world continues to change and the workplace becomes more and more challenging and competitive, it becomes imperative for anyone looking for a successful career to not only have the drive to succeed but also the training and expertise to do so.I am not saying that I do not have the training and expertise at the moment but I do believe that there is still room for more.   That is why I strongly feel that nursing is the profession for me because it not only allows me to become what I want to be but it also allows me to become who I want to be in life.My previous experiences as a certified nursing assistant and psych counselor have served well to prepare me for what lies ahead.   It has made me realize that what I really want to do in life is to help other people and become an excellent nurse.   I know that I can do more to further this goal by entering a registered nurse program and by getting the training that I need.   Ã‚  However, I feel that this is the crucial step that will herald my success in this profession.With all of the technological advancements in health care that have indeed raised the standard of health care being provided in the United States, there are a few intangible factors that can never be replaced.   I see my future role, as a member of the nursing profession, as being able to develop these intangibles.   One important example is the special type of manner by which a nurse must conduct herself in order to be effective in performing her task.The bedside manners are very important and it is something that just cannot be taught in classrooms.   Nurses need to be more than just machines that come in and punch in their time cards but rather professional registered nurses who show their passion and dedication to the profession through their approach and practice.With this role in mind, I feel that I am not only prepared to take on the challenges of pursuing a career in nursing but that I also have the proper mindset for this type of career.

Communication Clashes and Aircraft Crashes Essay

One of the most dangerous conflicts and errors man could ever have is flying a large aircraft with airy heads and angry mouths. This happened in one of the flights of the Korean Airlines particularly the Korean Airlines flight 2033, an Airbus A300 which happened four years ago. Piloted by Captain Barry Woods, a Canadian national and co-piloted by a Korean national Chung Chan Kuy. The clashed between the two started when the Airbus was approaching a rain slicked airport when Co-pilot Chung asked Captain Woods to â€Å"go around† because he is hesitant to land the craft due to insufficient distance of Runway 6 of Cheju Airport in South Korea. The captain did not mind his Co-pilot’s concern regarding the runway and told his Co-pilot to get off while flying the through a tropical storm with up to 30 mph gusting winds. On the runway, Co pilot Chung pulled the plane off when the plane has touched the ground that made the Pilot Woods furious about what Chung has done and instructed the cockpit crew to open the cockpit window and get their evacuation slides. Being in the matter of life and death situation made these two pilots unmindful of whatever positions they have. They even forgot to follow the standard operating procedures, protocols or guidelines that the cockpit crew should follow during emergency situations. In this incident, the Co-pilot insubordinates his superior by not following the captain’s call or decision making them clash putting their passengers’ life at risk. The Co-pilot’s action in this situation drifted the pilot’s decision in landing the craft safely and made it more dangerous for the lives of their passengers because of unethical insubordination the Co-pilot has caused. Chung might have thought that landing the craft in a slippery and short runway would led to accidental landing so he decided to pull off the plane without his captain’s orders causing them to argue on this matter. Imagining the situation while on board a beleaguered airbus, the cockpit crew might have been hesitant to land the aircraft due to the raging storm and miscalculated the runway making the two pilots disagree whether to land or abort the landing. Being board on a troubled plane triggered uncontrollable conflicts or disagreements because of the tensed and uneasy situation. In whatever situation man would be, crew or staff, especially those on board the plane or ship maybe, the staff should have the instinct to be calm in whatever situation they might be and practice the standard operating procedures or protocols that they had undergone during trainings and execute the emergency procedures effectively and efficiently to avoid further accidents and they should always follow instructions given by their superiors no matter what happen because they were trained to do so. References Fatal Words – Communication Clashes and Aircraft Crashes, (1994), Steven Cushing, University of Chicago Press http://www. airdisaster. com/cvr/kal2033. shtml http://www. airfleets. net/vcrash/crash_report_Korean%20Air_HL7296. htm http://www. planecrashinfo. cpm/1994/1994-50. htm