As the best form of American Democracy Essay

The world of media is known to be the most important branch of the society which has the ability to influence different types of people due to the immediate access of technologies present in the current world. Individuals have different view points and priorities in which they believe that must be well represented to show the people that such topic must be addressed and given the proper acknowledgement. More and more people are able to show their view points through the use of the television, internet and the likes. There are individuals who only blog and write different articles but their impact has immense to the view points of individuals who are concern are also the same. In the past the media had created its own type of criteria of what not and what should not be. As we, the views see the former and veteran news anchors we often reflect that they are mostly stiff and very limited in the manner of their reporting. In the news broadcasting we often see veteran news anchors that have gained a lot of awards and confidence due to the credibility and long lived career they have. Thus, most of these anchors have entailed the importance of media from the old perspective which had been acknowledged many decades ago. However, due to the technological advancements of internet, computers, mobile phones and the likes, there had been a new trend in adding up information for people the conservatism and rules which must be adhered are now gone. Thus, the media had created a change been the Old Media and the New Media. Old Media and New Media The Old Media is known as the types of media which had been utilized by different personalities such as newspapers, television, radios, movies, books and the likes. These mediums are utilized in order to disseminate to people the current events, criticisms, issues which are in the trend during a certain amount of time. Therefore, the old media are types of materials which are utilized without the use of the latest technologies. The old technologies which use papers, radios and television are the old and classic style of presenting audiences what they want and need to hear from the government and other events which is up to date and certified as accurate. (Agincourt Computing, 2005) The New Media one the other hand is the latest innovation which is utilized by the any individual who is in the entertainment or media industry. The type of media which is mostly utilized by the new media is the internet which is sometimes described as unreliable, and could be effortlessly manipulated by anyone. However, due to the availability of the new media, sometimes the old media is already neglected by the people most especially the youth. The youth are currently much exposed to the effortless access of information in the internet rather than browsing swiftly to every page of the book and absorbing all possible concepts which the author would want to discuss. Most students would want to see a summarized article or a book which they could easily understand without even much analysis from their part. Some people that are on the go prefer some medium that they could put all their information in one single gadget and they could view it whenever they want. Some of these are the main reason for the great interest of people with the new media. However, we must take note that the new media and the old media have its own strengths and weaknesses due to the different aspect that each type of media has. (Vaina, 2008) Almost every individual in the world has their own website and blogsites which they proclaim various types of qualms and experiences during the day or an event. Every one also have Facebook, Twitter, Myspace and the likes that encourages online activities such as gaming, blogging, chatting and etc. as the main activities that individuals with accounts there could use for entertainment. Therefore people all around the world is able to express their emotions through their creativity in arts, and writing, and music while other people has the ability to see such works without even paying a single cent thus, making the internet world a world of different possibilities for those that are actively using it through different means. Though the secrecy and privacy provided by the internet many are capable of doing anything and everything they could possibly want without any types of limitation except for some few which is regulated by some countries. Matt Drugger, New Media and Democracy: In the world of new media, there is one of the many individuals who had became popular is Matt Drudger. He is a media personality who is very controversial in terms of the issues he is raising in terms of the democratic political party in his website. As on article stated he â€Å"is a self-styled seeker of truth, specifically of hidden and obscure truths. If there’s a Drudge brand he’s like to convey, it’s of the relentless, rumpled, ever-vigilant newsman—always connected and plugged into his network of operative (Pachter, 2003). During the controversy of the Bill Clinton and Monica Lewinsky was the epitome of the popularity of his website. As the more controversial he has gotten the type of issues he had been racing are being deeper and deeper compared before. Honestly, we know that nasty kinds of news makes some people interested and sometimes crave for more of it. Many individuals would want something that would ruin the clean slate individuals who are known as the goody-two-shoes and an issue would immediately turn them into vulnerable beasts. This is the action being done by Matt Drudge. Although his work is not as easy as they think it is, Drudge takes his work seriously that he has all the channels in the world that would be able to make him see issues in different parts of the country and the world. Thus, such old news sources will be his secondary sources for his new media business (Pachter, 2003). The internet personality has his website called, www. drudgereport. com which is very much notorious for all the news it publishes online. If the content of the website will be seen links of various types of news website if provided together with the list of the most controversial individuals we could possibly think in politics most especially in the world of Hollywood. In addition to this, he also has the news for the latest technologies, medical improvements, international news and the likes. Any individual who would like to have the latest news could be putting this website in his or her favorite or bookmarked page due to the up to the minute live updates the internet is providing. Although the updates that Drudge is providing are very beneficial for everyone however, the issues that he is creating sometimes disrupt the peacefulness of the American society. It is already a given that many issues will arise within the different aspects of life such as political, environmental, medical and etc. However, there must be a concept of media responsibility in the side of www. drudgesreports. com. Although the new media is not restricted of conservative with regards to information dissemination, it is important that every type of media will become responsible of the power that is given to them. Due to the fact that internet is a location where in anything is possible moral responsibility must be taken into consideration as a part of the rights provided to citizens in the United States. These types of websites are truly the expression of the democratic right of any citizen of the United States. Americans have the power to question and replicate their president in anyway they can. One good example is the Saturday Night Live (SNL) show which incorporates political personalities in their comedic scenes. Most of the time, political leaders are not treated as kindly as they are some political figures who had been part of the many skits the show had done are former President George Bush, President Barack Obama, and many others more. Most of the time, the most controversial individuals are those that are impersonated by great actors. Thus, such show expresses a strong democratic power which is actively exercised by many Americans. If television shows could easy perform such skits inform of millions of people how could a single webpage be stopped by the government. In addition to this, there are too many Americans in the United States and not everyone could be given an immediate response by the government. Through the internet access and web pages such as these the democratic power of Americans is exercised without question. Thus, such type of internet website enhances the ability of Americans to express their views without realizing that they are limited and needing a massive attention from big media corporations such as National Broadcasting Corporation (NBC) and the likes that needed the very unconventional and timely news to be aired in their channels. Through the use such internet websites, any individual could pasture the attention of anyone who is able to connect to the internet and type expound on any topic relevant for their own view point. Thus, the internet have created an a small community where in individuals are not hesitant of proclaiming their views for the reason that they are known to the public and afraid of the scrutiny they will be getting if they would present themselves. In addition, the life threatening possibilities could be done to anyone who contradicts any powerful individual. Although there are no publicized actions which truly contradicts the democracy of media personalities that could be near any human rights violations similar to other countries therefore; the reason for using the new media as a form of expression is also a protection against those who has violent tendencies with regards to this kinds of situation. In conclusion, the old media and the new media are currently the different types of mediums which is utilized and appreciated by all types of people. The old media views the television, books, news papers and the people behind them as the most important entities of media. Moreover the usage of lesser enhanced technology and the classic modes of communication with viewers are categorized as the old media. On the other hand, the new media uses the internet and the continuing technological development build after such as the main medium of its communication with its audience. The internet through blogging, podcasting, Youtube, various internet sites and etc. different information are provided to the various readers that have searched the link of the website. There is easier access, freedom but a great responsibility in publishing anything in the internet. Every sentence that is connected to any type of current issues should be proven and reflected before publishing the article. It is the right of any individual to state anything that is on his or her mind because it is the duty of the people to exercise checking and balancing any activities of any political party or political leader. This responsibility is under the democracy of any citizen of the state. It must be taken into consideration that there are many people in the world who are not able to go in front of a government office to rally and shout out loud against the policies that had been made. Some people chose to write, blog, Myspace, Facebook or Twitter their emotions to make the people understand them or pay attention to their view points. Given that technology is present, why not use it for the greater good? One of those is to exercise democracy and freedom of speech which is provided by the United States of America to all their citizens. Therefore, the website of Matt Drudge is only one of the many internet sites that launch different issues (true or not) that affects different communities most especially the political side of the state. Although some might say that he is very explicit and irresponsible with the news he is presenting but is could not be hindered that this is his right to apply his democratic rights an American Citizen. Taking into consideration the personal lives of the people who are being discussed in this kind of website, individuals who are actively participating must take away the concept of taking matters too personally. Providing too much democracy for people also steps on other people’s rights such as privacy. Therefore, the democracy is rights provided to everyone but a responsibility that must be seriously understand. References Patcher, R. (1 September 2003). â€Å"By linking news sites, Matt Drudge created an Internet success. † Retrieved on 1 April 2009 from http://www. wordsonwords. com/reviews/Drudge903. html. Vaina, D. (15 April 2008) â€Å"New Media Versus Old Media. † Retrieved on 1 April 2009 from http://www. america. gov/st/freepress-english/2008/April/20080513173802WRybakcuH0. 6948358. html Agincourt Computing. (15 December 2004). â€Å"Old Media, New Media. † Retrieved on 1 April 2009 from http://www. aginc. net/media. htm.

Main Issues In Combined Freight Transportation Engineering Essay

The chief issues in combined freight transit can be classified into six chief classs as shown in Figure 1. These classs include histrions and cardinal participants, operations, ordinances and policies, substructure, Information and Communication Technology, and environmental issues. Figure: Main classs of combined conveyance Actors and cardinal participants could be categorized by the type of operator and the operational jobs. The assorted undertakings along the transit concatenation are largely executed by four operators that could be distinguished in drayage, terminus, web, and intermodal operator ( Moccia et al. , 2008 ) . The undermentioned subdivisions give some farther information about each of them.Drayage OperatorDrayage operators are responsible for transporting the cargo between shippers and consignees severally and within the terminus ( Puettmann and Stadtler, 2010 ; Macharis and Bontekoning, 2004 ; Caris et al. , 2008 ) . Normally they are send oning companies that receive petitions for conveyance and make all the necessary agreements to transport the burden from its beginning to its finish. Rail terminuss, port installations and shipper/third party installations comprise the drayage location. In each drayage location there are many independent drayage operators who compete with one another to supply drayage services utilizing their ain assets ( i.e. forces, tractors, dawdlers, human body and containers, whether borrowed, owned or rented ) or frequently sub-contracting with many independent owner-operators ( Nadan, 2003 ) . The bulk of drayage operators are close ports. At the port there is a high volume of containers ‘ reachings. When a container arrives at the port, the latter can be delivered to its finish by train or truck. Some of those containers are transported by rail to nearby rail paces for long-haul bringing by train. But the bulk of the containers is hauled by short-haul truck, called drayage, and is less than 100 kilometres ( Robert and Poole, 2007 ) . A drayage operator picks up an empty dawdler or container either at an empty terminal, at a terminus or at a consignee. Then the operator provides it to the shipper and the subsequent transit of a full dawdler or container to the terminus. Delivery operation involves the distribution of a full container or dawdler from the terminus to a consignee. Then it collects the empty container or dawdler and transports it to the terminus, an empty terminal, or the shipper. Trucks are able to divide the tractor and dawdler which allows two processs. In the â€Å" stay-with † process the tractor and the driver stay with the container/trailer during the loading/unloading. In the â€Å" drop-and-pick † process a full or empty trailer/container is dropped off the shipper/receiver. During loading/unloading continuance the tractor and driver are free to transport out other activities. Each drayage company faces jobs such as trip programming between shipper, terminuss and receiving system ( Wang and Regan, 2002 ; Imai et al. , 2007 ) . This job could be enlarged from the terminus demands, client ‘s pick-up and bringing times, realistic bounds on the length of the on the job twenty-four hours, and on-road travel times. The bulk of the cargos normally are known in progress. Nevertheless, sometimes tonss have to be reassigned due to traffic or some terminuss ‘ holds. But the general job of drayage operations is its cost effectivity. In malice of the comparatively short distance alternatively of long-haul rail or flatboat, drayage histories for 25-40 % ( Macharis and Bontekoning, 2004 ) of transit concatenation disbursals. As a effect it affects a batch the profitableness of the whole transit service. For work outing this job a drayage operator should make up one's mind to collaborate with other drayage companies without impacting though the seasonableness of operations.Terminal OperatorTerminal operator manages the modal displacement which take topographic points at the terminus and is responsible for the transshipment operations from flatboat to thrust ahead, route to inveigh or thrust ahead, or rail to inveigh ( Puettmann and Stadtler, 2010 ; Macharis and Bontekoning, 2004 ; Caris et al. , 2008 ) . Normally a terminal consists of a route, rail, and flatboat gate where trucks, trains, or flatboats severally enter and leave the terminus. There is a storage country for hive awaying the tonss for more than a twenty-four hours and the buffer country ( cross-docking ) , which is for short continuance storage. There is besides storage and conveyance equipment and lifting equipment for lading or droping the trains, trucks, and flatboats. Different operations have to be carried out for different types of burden units i.e. containers, swap-bodies, dawdlers or complete trucks. It is besides of import to advert that the operations are non the same for every manner of conveyance. In add-on, the equipment which is used has to be suited and cater to the demands of the burden units. Terminals can use different transshipments techniques, layouts, dimensions, operational schemes etc. An optimum operation terminus is the basic end for the terminus operator. That depends on the demand volume and the type of the exchange i.e. road-barge, road-rail, or rarely rail-rail or barge-barge or rail-barge. Exchange increases the entire conveyance cost and the lead clip in concatenation. Consequently, exchange operations need to be efficient and fast. Terminal operators have to do strategic, tactical, or operational determinations to run into the demands. At strategic degree terminus operator takes attention of the design of the terminus ( Ferreira and Sigut, 1995 ; Meyer, 1998 ; Rizzoli et al. , 2002 ; Ballis and Golias, 2004 ; Bontekoning, 2006 ; Vis, 2006 ; Rijsenbrij and Wieschemann, 2011 ) . At the tactical degree terminus operators take determinations about the needed capacity degrees of equipment and labor ( Kemper and Fischer, 2000 ; Kozan, 2000 ; Kulick and Sawyer, 2001 ; Huynh 2005 ) and the redesign of the operational modus operandis and layout constructions ( Voges et al. , 1994 ; MartA ±nez et al. , 2004 ) . Finally terminus operator has to make up one's mind at operational degree for resource allotment ( John Hargreaves, 1990 ) and scheduling of occupations ( Alicke, 200 2 ; Corry and Kozan, 2006 ; Gambardella et al. , 2001 ) .Network OperatorNetwork operator takes attention of the substructure planning ( strategic degree ) and long-haul transit ( Puettmann and Stadtler, 2010 ) . He is responsible for the organisation of rail or flatboat conveyance ( Macharis and Bontekoning, 2004 ; Caris et al. , 2008 ) . At tactical degree has to take determinations about agendas of service and pricing services and about day-to-day operations of the services at operational degree. Infrastructure determinations trade with the interconnectivity of the manners in order to accomplish combined conveyance ironss ( Crainic et al. , 1990 ; Loureiro, 1994 ; Southworth and Peterson, 2000 ; Klodzinski and Al-Deek, 2004 ; Tan et al. , 2004 ; Groothedde et al. , 2005 ; Parola and Sciomachen, 2005 ) and besides the location of terminuss ( Meinert et al. , 1998 ; Rutten, 1998 ; Arnold and Thomas, 1999 ; Groothedde and Tavasszy, 1999 ; Macharis and Verbeke, 1999 ; Van Duin and Van Ham, 2001 ; Arnold et al. , 2004 ; Macharis, 2004 ; Racunica and Wynter, 2005 ; Kapros et al. , 2005 ; Limbourg and Jourquin, 2008 ; Soerensen et al. , 2011 ) . In some states authorities normally take these determinations and considers for the impact of a capacity addition and the effects of price/cost additions or lessenings on the usage of the different substructure webs. On the other manus, private sector hunts for the optimum location of terminuss and the authorities supports the most interesti ng investings. At tactical degree a web operator, foremost, has to find what sort of services itwill offer. Ithas to alter the attack of long draw conveyance services from travel on demand to a fix service agenda which has to be planned several months or a twelvemonth in progress. For accomplishing this end the operator has to make up one's mind what consolidation web to utilize i.e. a point-to-point web, a line web, a hub-and-spoke web and a trunk-collection-and-distribution web ( Janic et al. , 1999 ; Newman and Yano, 2000a ; Newman and Yano, 2000b ) . A 2nd tactical determination for a web operator is the type of production theoretical account, that is, how to run the trains and the flatboats. This involves determinations about the frequence of service, train length, capacity planning of equipment and allotment of equipment to paths ( Nozick and Morlok, 1997 ; Choong et al. , 2002 ; Lin and Chen, 2004 ; Li and Tayur, 2005 ) . In add-on, pricing scheme determinations has to be considered at this degree. Pricing a combined conveyance merchandise is a truly complicated issue. It requires an accurate cost computation and penetration in the market state of affairs as many histrions are related to the assorted parts of the combined conveyance concatenation ( Tsai et al. , 1994 ; Yan et al. , 1995 ; Li and Tayur, 2005 ) . Finally, at the operational degree, web operator has to take daily direction determinations. Mostly it has to pull off the fleet as the burden order of the flatboats and trains ( Feo and Gonzalez-Velarde, 1995 ; Powell and Carvalho, 1998 ) , redistribution of railway cars or push flatboats ( Chih and new wave Dyke, 1987 ; Chih et al. , 1990 ) , and the burden units. A typical job in combined road/rail conveyance is the assignment of a set of dawdlers and containers to the available flatbeds that can travel this equipment. This job is rather complex as there are different types of flatbeds, and many types of dawdlers and containers.Intermodal OperatorIntermodal operators are users of the intermodal substructure and services, and carry on the optimum path choice of cargos through the whole intermodal web ( Puettmann and Stadtler, 2010 ; Macharis and Bontekoning, 2004 ; Caris et al. , 2008 ) . Intermodal operators organize the transit of cargos on behalf of shippers. Intermodal operators buy the services offered by drayage, web, and terminal operators. At the operational degree they choose paths and services in bing intermodal webs ( Min, 1991 ; Barnhart and Ratliff, 1993 ; Boardman et al. , 1997 ; Ziliaskopoulos and Wardell, 2000 ; Erera et al. , 2005 ) . Taking such a determination is more complex than routing jobs of route draw. In route draw least dearly-won or less clip devouring path is more preferred. But in combined conveyance there is a big assortment of combinations of transit manners. So a average pick job has to take into history specific cargo volumes and specific clip restraints.Regulations & A ; PoliciesThe current policy of the European Commission requires that conveyance systems should be able to turn without serious negative impact on the environment, every bit good as on economic and societal costs. However, the sustainability of the European conveyance system faces some barriers such as: mutual exclusiveness of substructure, turning CO2 emanations from conveyance, dependance on fossil fuels, altering forms in mobility, low safety, lifting congestions, and charges and monetary values deformations ( REFERENCE ) .Incompatible substructureEurope consists of many states and as a consequence, the bulk of the bing substructure has been designed to function national instead than European economic system. This state of affairs created deficiency of comprehensive criterions on substructure design, traffic direction, power supplies and informations exchange. Since now more than 400 billion euros have been spent for developing Trans-European conveyance webs ( TEN-T ) ( REFERENCE ) . But still there are chief deficits in substructure as transalpine tunnels, rail corridors, intermodal nodes for rail and sea or air conveyance, and IT substructure to back up intermodal conveyance. Poor Trans-Europe substructure in combination with deficiency of i nternational cooperation consequences to the undermentioned inefficiencies ( Impact Assessment, 2010 ) : Lack of joint traffic prognosiss taking to differing investing programs ; Disconnected or even contradictory timelines ; Lack of joint investings computation and joint fiscal constructions ; Incompatible proficient features ; Inadequate joint direction of cross-border substructure undertakings. For sustainable substructure programs there are some actions to be taken. The list below shows some of them. Joined investings programs Coordinated land planning Further development of TEN-T web Open criterions for information exchange systems Open criterions for design of substructureTurning Greenhouse Gas emanationsTransport sector has greatly increased its activity for the last twosome decennaries now. The growing rate of GHG emanations in conveyance is higher than any other sector comparing to 1990. Harmonizing to the information of European Environment Agency in twelvemonth 2010, conveyance is accounted for 19.7 % of entire GHG emanations in EU-27, as it is shown in Figure 2.This growing of conveyance activities concerns for its environmental sustainability. The energy efficiency is increasing but the gait of betterments is non sufficient to make sustainable conveyance in Europe. Figure: GHG emanations by sector ( Source: EU statistical pocketbook 2012 ) The EU White Paper on Transport, ( 2011 ) refers that European committee has set specific ends. The first end of new conveyance policy is to maintain the conveyance turning and support mobility while accomplishing the end of 60 % GHG emanations decrease by 2050 comparing to 1990 degree. In order to accomplish this end the European Commission has defined ten ends for a competitory and resource efficient conveyance system which benchmarks for accomplishing the 60 % GHG emanation decrease mark ( see extensively in White Paper, 2011, pp. 9-11 ) . In general, actions that should be taken towards the rejuvenation of cargo conveyance are as follows: bing engineerings have to be replaced by green engineerings ; use of electric autos is preferred, phasing out â€Å" conventionally-fueled † vehicles from urban countries ; decrease of C in maritime and air power conveyance.Dependence on fossil fuelsConveyance is still 97 % dependant on fossil fuels ( REFERENCE ) . Since now Transport has non reduced significantly its GHG strength by exchanging to cleaner energy beginnings. European Union has adopted a adhering mark of a 10 % portion of renewable energy beginnings in conveyance by 2020 ( Directive, 2009 ) as portion of the clime alteration and energy bundle. Switching to greener vehicles will necessitate the development of alternate fuelling/charging substructure. Another of import action is concentrating on research in cost-efficient renewable fuels. The new green engineerings for green vehicles are important, so there is a demand for shorter design-to-market rhythms.Low safetyOne of the objects included in the EU White Paper ( 2001 ) , was to halve casualties in route conveyance by 2010. This end has non been achieved although different actions had been taken in many Member States. In air power sector was implemented a set of common, unvarying and compulsory statute law covering all the cardinal safety elements: airdrome care, airdrome direction, operations of air traffic direction systems. The most advanced regulative models for safety and pollution bar was established by EU in maritime sector. Another job is that European conveyance corridors are common for cargo and rider conveyance. This has caused many accidents with a consequence of over 40000 accident human deaths until 2000 ( White Paper, 2001 ) . For cut downing the sum of human deaths, EU has to take some steps i.e. dividing lading and rider corridors. Signing systems has besides to be improved and new vehicles safety systems to be implemented.Rising congestionRoad conveyance is the chief manner for goods motion. Harmonizing to the European Commission the portion of route conveyance is 73 % , somewhat decreased by 3.9 % from 2009 ( Road Freight Transport Vademecum, 2010 ) . At the same clip the portion of rail is merely 17 % with inland waterways and oil grapevines accounting for 5 % each ( Road Freight Transport Vademecum, 2009 ) .The congestion in urban countries and on the cardinal theodolite roads works as a barrier for the current capacity of conveyance webs run intoing the turning demand. The dependability of route conveyance suffers and the clip length of journeys is acquiring longer. Besides some airdromes are really engorged. For work outing this job, European Commission published the 2001 White Paper on European Conveyance Policy. The thought was to cut down that congestion by switching from route onto rail, waterways or short-sea transportation. In add-on, great accent is given on the usage of intermodal conveyance. Furthermore, harmonizing to the EU statistical pocketbook ( 2012 ) , route conveyance is the less environment friendly mode as it causes 71.7 % of entire GHG emanations. For that ground route conveyance has to go greener and more efficient excessively. New vehicle engineerings, better substructure, fuel efficiency and â€Å" eco-driving † are needed. There is a demand of assisting solution for take downing the congestion by intelligent mobility and conveyance demand direction. There is still a deficiency of concerted systems based on vehicle-to-vehicle and vehicle-to-infrastructure-communications that might in the longer term better well the efficiency of the traffic direction and relieve congestion ( Golinska and Hajdul, 2012 ) . In order to avoid addition in aviation congestion high-velocity rail should absorb much medium distance traffic. Another action is to increase the denseness of rail webs and make efficient and green cargo corridors. There is besides a demand for development of intermodal hubs and intermodal integrating of conveyance services.Mobility formsThe advancement in traveling traffic from route conveyance to other manners is still really limited. European Commission has tried a batch to convert companies to alter their organisation of logistics procedures and take into history when be aftering the impact of environment and society, but the consequences were negative. Entrepreneurs largely concern about the fiscal consequences and if there is non a strong statement of betterment, they are non interested in utilizing options to route conveyance manners. Therefore, it is deserving to observe that the pick of manners of conveyance straight affects some factors such as monetary value, the susceptibleness of the lading and the features of conveyance manners. Furthermore, sometime is impossible to utilize rail, inland waterway or intermodal conveyance. For work outing the above jobs, there is a demand for incorporate logistics systems which should be monitored enabling the co-modality, standardisation and interoperability across manners. Furthermore, a platform has to be created for linking the airdromes and ports with efficient rail services. Another action is the constitution of the model for European multimodal conveyance information, direction and payment system attractive frequences and comfort. Smart intermodal fining, with common EU criterions is another solution ( Golinska and Hajdul, 2012 ) .Monetary values and revenue enhancements deformationsThe distinction of monetary values for the usage of route in extremum and off-peak hours is really rarely. There is besides deficiency of inducements for use of more soundless vehicles, safer and more environment friendly manners of conveyance. Furthermore the congestion charges, which represent the cost of substructure scarceness, are non frequently imposed. On the other manus, conveyance system generates grosss for public budget including: Energy revenue enhancements ( 1.9 % of GDP ) coming from fuel revenue enhancements on route conveyance and private autos ( Eurostat, 2008 ) ; Vehicle revenue enhancements ( 0.6 % of GDP ) ; Tolls and charges for substructure usage. Although users pay a important sum, the monetary value frequently bears small connexion to the existent costs of conveyance in society. The rule â€Å" defiler wages † is non ever respected. The costs imposed on conveyance users do non reflect disbursals to keep and develop the substructure. Furthermore, the pricing system fails to maneuver the demand for most efficient and sustainable mobility picks. Therefore monetary values and revenue enhancements should be connected with sustainability. Local authoritiess have to self-finance the development and care of substructure giving besides incentives for local companies for use of intermodal conveyance. They besides have to follow purely the rules of â€Å" user wages † and â€Å" defiler wages † and extinguish the harmful subsidies. In add-on there is a demand of a regulative model and advanced fiscal instruments for unlocking the potency of private sector in co-financing substructure ‘s deployment and cares within public-private partnership ( PPP ) undertakings.InfrastructureTransport substructure is a cardinal component for the economic growing and development and it plays a cardinal function to increase the growing and occupations in Europe. An efficient substructure which warrants handiness could pull centres of production and ingestion and therefore impacts positively on the regional economic system. More eff icient substructures enable a better mobility for people and goods every bit good as a better connexion between parts. In add-on, planning, design and building of substructures have remained mostly unchanged over the last century ; therefore attending has to set besides on the research of new building stuffs processes with the purpose to introduce the sector. Research has to be concentrated on processs and stuffs that minimize nursery gas emanations, on design and planning that respect landscape and geographical diverseness whilst lending to decongestion major conveyance corridors, and on techniques that will guarantee longer life and reduces care intercessions.Road substructureEuropean Union has made great attempts to advance multimodality but route conveyance has still a turning tendency. For this ground there is an immediate necessity to increase route capacity and efficiency. Roads must be able to absorb the ongoing and increasing flow of vehicles and guarantee at the same clip an equal degree of safety. Such public presentations must be developed in largest portion on bing webs. Therefore non me rely new building methods, but besides sustainable care of the bing web is paramount. Care of route substructure deserves a particular attending for two chief grounds. First, many accidents ( e.g. rollovers of HV or skidding of vehicles in general ) have caused due to the hapless status of route substructure. Second, care plants hinder and disrupt the bringing ‘s free flow therefore increasing their costs. For avoiding these two scenarios, more effectual and lasting care techniques are needed i.e. safe and efficient night-time operations. Furthermore, there is a demand for more fluid traffic flow to cut down vehicles emanations, as transit sectors accounts the biggest per centum of CO2 emanations ( Laura, V, 2008 ) . Some of the most of import roads are included in the Trans-European route web. It includes more than 65.100 kilometer expresswaies and 5.000.000 kilometers paved roads ( Steer Davies Gleave, 2009 ) , whether bing, new or to be adapted which: Play an of import function in long-distance traffic Bypass the chief urban centres on the routed identified by the web Provide interconnectedness with other manners of conveyance Link landlocked and peripheral parts of the Union Beyond these, this web guarantees users a high, unvarying and uninterrupted degree of services, comfort and safety ( Bergmans, L, 2009 ) .Sea and river portsHarmonizing to ( CIA, 2011 ) in European Union there are 24 oversea ports. The most of import one is the Port of Rotterdam which is the largest one and located in the metropolis of Rotterdam. Such havens can function at their quayside deep-sea vass with a loading capacity of more than 8.000 container units ( TEU ) . Smaller regional ports are linked with the oversea ports by Feeder vass which have capacity up to 1.200 TEU. Inland flatboats are used to transport containers into the backwoods on rivers and channels and they are besides served by Cranes. Ports can be divided into two subdivisions: riders and lading. The latter one normally offers terminal installations. Such terminuss consist of two external interfaces. These interfaces are the quayside with burden and unloading of ships, and the landside where the containers are loaded and unloaded on/off trucks and trains. When a container vas arrives at the port, it is assigned to a position equipped with Cranes to lade and unload containers. At the instance of RoRo vass, trucks with their lading issue from the inclines. Unloaded import containers are transported to yard places near to put where they will be transshipped following. Containers geting by railroad or route are managing within the truck and train operation country ( Steenken et al. , 2004 ) . Seaport terminal.jpg Figure: Container terminus system ( Beginning: Steeken et al. , 2004 ) At every port terminus there is managing equipment such as Cranes, conveyance agencies and helping systems. The quay Cranes for lading and droping ships play a polar function. There are two types of quay Cranes: single-trolley Cranes and dual-trolley Cranes. Crane drivers are supported by a semi-automatic guidance system. These Cranes can function around 50 boxes per hr, while in operation the public presentation is about 25 boxes per hr. A 2nd class of Cranes is applied to tonss. There are either rail mounted gauntry Cranes ( RMG ) which are more stable, or rubber tired gauntries ( RTG ) which are more flexible, and over-head span Cranes which are mounted on concrete or tip pillars. At port terminuss there is besides a assortment of vehicles for the horizontal transit both for the ship-to-shore transit and the landside operation. The first category of vehicles is these which are non able to raise containers i.e. trucks with dawdlers, multi- dawdlers and automatic guided ( AGV ) ( Vis and Harika, 2004, Yang et al. , 2004 ) . Transport vehicles of the 2nd category are those which are able to raise containers i.e. Straddle bearers, forklifts, and range stackers. The first 1 is the most of import because it can besides stack containers in the pace. Last but non least are the helping systems which help for the organisation and optimisation of the work flow. Such systems are communication systems and positioning systems. Terminal operators support a really frequent communicating with external parties like agents, transporting lines, truck and rail companies, forwarders, governmental governments like imposts, waterway constabulary and others. The communicating is based on international criterions ( EDIFACT ) and every alteration of lading position is communicated between the several parties ( Steeken et al. , 2004 ) .Rail substructureHarmonizing to ( Steer Davies Gleave, 2009 ) in TEN-T web there are more than 212.000 kilometer of rail lines, out of which about 110.500 kilometers are electrified and the cargo conveyance trains could make a length up to 750 m. There are besides many road-rail container terminuss which support this web. Such terminuss include: Gates, internal route web, Loading and driving lanes for the trucks, Storage or buffer lanes for IntermodalTransportUnits, Transshipment paths ( besides called as burden paths ) for the train loading/unloading operations, and Rail turnouts for train/wagon storage, marshalling and review The equipment which seems to rule among conventional equipment is reach stackers and rail-borne gauntry Cranes. On little terminuss reach stacker is the major mean for raising, managing, transporting, and stacking ITUs. This is due to the low cost and flexibleness that offers ( Ballis and Golias, 2001 ) . Unlike rider terminuss, rail cargo paces do non hold to be so centrally located because of the great trade of infinite for multiple paths for marshaling. Rail paces, could pull fabricating activities able to utilize distribution capablenesss of rail, and therefore go industrial zones. In add-on, rail cargo terminuss perform four major maps ( Rodrigue et al, 2009 ) : Majority: These rail terminuss are linked with extractive industries such as agribusiness, excavation and wood merchandises. Grain lifts are normally used to hive away, blend, and burden grain into railway cars. Roll on/ Roll off: Vehicles are rolled in a railway car utilizing a incline. This operation requires a big sum of parking vehicles. Intermodal: The map of burden and droping unitized cargo from railway cars demands specific intermodal equipment. Shunting: The map of piecing, screening and breakage of cargo trains. Trains can be composed of up to about 100 railway cars. The major job of cargo conveyance in European Union are the obstructions its faces on cross-border traffic. For case, the most dramatic grounds of such barriers is different path gages, electricity supply and the signaling systems. The deployment of ERTMS, the European signaling system, is come oning easy ; so far, merely discontinued subdivisions of lines are equipped, and engines still need to be to boot equipped with national systems. Furthermore, the length of trains is non harmonized across Europe. Another job is the deficiency of efficient and effectual intermodal terminuss, different service degrees across manners, deficiency of criterions, and losing substructure links, particularly across boundary lines ( Impact Assessment, 2010 ) .Freight VillageIn international bibliography, the term â€Å" nodal centre † or â€Å" freight nodal terminus † is encountered with assorted names: â€Å" Cargo Villages † ( United Kingdom ) , â€Å" Platformes Multimodales/L ogistiques † ( France ) , â€Å" Logistics Park, Interporto † ( Italy ) , â€Å" Gueterverkehrszentren † ( Germany ) ( Tsamboulas and Dimitropoulos, 1999 ) . The first cargo small towns were created in France around 1960 and subsequently appeared besides in Italy and Germany, Netherlands, Belgium, and the United Kingdom ( Kapros et. al. , 2005 ) . A freight small town is the hub of a specific country where all the activities associating to transport, logistics and goods distribution – both for national and international theodolite – are carried out, on a commercial footing, by assorted operators ( Ballis and Mavrotas, 2007, Pal otas, and Bazaras, 2004, Afandizadeh and Moayedfar, 2007 ) . It is noted that â€Å" intermodal † or â€Å" multimodal † terminuss constitute a chief constituent of nodal centres for goods where the transshipment of goods from one manner to the other takes topographic point. However, freight small towns reflect to a modern manner of forming logistics, conveyance and goods distribution activities. Normally provides subsidiary installations such as warehouses, distribution centres, storage countries, offices, truck services, bank, postal, insurance services and in certain instances Customs substructures ( Europlatforms, 2004 ) . In add-on, a cargo small town located in the locality of a big metropolis may supply an efficient solution to urban conveyance jobs including traffic congestion, regional competiveness, and quality of life. The cost of land acquisition and cargo small town buildings every bit good as with distribution systems and operations of storage is high plenty. For this ground, such an investing has to take attention of all related facets that include site location choice, site-level layout planning and warehouse design facets.Warehouse and cross-docking countriesCross-docking services are chiefly used by many companies in different industries ( e.g. retail houses and less-than-truckload ( LTL ) logistics suppliers ) . The thought behind cross-docking is to reassign incoming cargos straight to surpassing vehicles without the procedure of storage between these two operations. The end of this service is to consolidate the cargos, to cut down the bringing lead clip and costs, etc. The function of cross-docking in industry even seems to increase ( Boysen and Fliender, 2010, Apte and Viswanathan, 2000, Saddle Creek Corp. , 2011 ) . Cross-docking can be describes as the procedure of consolidating cargo with the same finish ( but coming from several beginnings ) , with minimum handling and small or no storage between droping and burden of the goods ( Belle et al. , 2012 ) . The focal point on cross-docking services is now on the transshipping, non keeping cost. On the other manus, warehousing includes four major maps: receiving, hive awaying, picking, despatching. Storage and picking are the normally the most dearly-won. Storage is expensive due to the stock list handling costs and picking due to labour intensive. Goods can be stored for several yearss or even hebdomads, alternatively of approximately 24h as many writers say in cross-docking ( Bartholdi and Gue, 2004, Li et al. , 2004, Vahdani and Zandieh, 2010, Wen et al. , 2009 ) . But many organisations use a mixture of warehousing and cross-docking to unite the benefits of both attacks. A terminus which its chief installations are for cross-docking is called cross-dock. Most cross-docks are long, narrow rectangles ( I-shape ) , but other forms are besides used ( L, T, X, aˆÂ ¦ ) ( Bartholdi and Gue, 2004 ) . There is no particular substructure to present cargo, a ‘strip door ‘ where the cargo is unloaded, and a ‘stack door ‘ where the cargo is loaded on the outbound trucks. The advantages of a cross-dock ( Belle et al. , 2012 ) are the undermentioned: Cost decrease ( warehousing costs, stock list costs, managing costs, labour costs, transit costs ) ; Shorter bringing lead clip ( from provider to consignee ) ; Improved client service ; Faster stock list turnover ; Decrease of storage infinite ; Fewer overstocks ; Reduced hazard for loss and harm ; Consolidation cargos ; Improved resource use ( e.g. full truckloads ) ; Better lucifer between shipment measures and existent demand. The advantages make cross-docking an interesting logistic scheme that can give companies considerable competitory advantages.EnvironmentTransport contributes significantly to general economic development. However, conveyance has negative influences on wellness and the environment, notably through air pollution, route traffic hurts, traffic noise, psychological and societal impacts, land usage and possibilities for physical activity ( WHO, 1999 ) . Harmonizing to ( UNECE/WHO Europe, 2004 ) , policy has besides focused on the function of conveyance on clime alteration.Air pollutionThe conveyance sector contributes about 25 per cent of the air pollution burden, most of it from vehicles. Air pollution is responsible for many symptoms and diseases. It leads to increased mortality ( premature deceases ) , increased admittances to hospital for respiratory and cardiovascular diseases, increased frequence of respiratory symptoms and usage of medicine by people with asthma, and reduced lung ma p ( WHO Europe, 1995 ) . It besides reduces life anticipation. Ozone ( O3 ) , airborne particulate affair ( PM ) and lead ( Pb ) are the transport-related pollutants that pose most concerns, but sulfur dioxide ( SO2 ) , nitrogen dioxide ( NO2 ) , C monoxide ( CO ) , lead scavengers and assorted carcinogens are besides noteworthy. In EU states life anticipation is estimated that it is shortened by 8.6 months by air pollution ( UNECE/WHO Europe, 2009 ) and at 2000 about 350,000 lives lost due to exposure to air pollution ( WHO Europe, 2005 ) . WHO has set an air-quality guideline degree at 20 I?g/m3. However, harmonizing to ( ENHIS, 2007 ) exposure degrees to PM10 ( Particulate affairs with diameter less than 10 I?g ) varied from 13 to 14 I?g/m3 ( Finland, Ireland ) to 53 to 56 I?g/m3 ( Bulgaria, Romania, Serbia ) . The study of ( ENHIS, 2007 ) besides summarized that 89 % of people in European part are exposed to more than the WHO ‘s bound and around 14 % of population exceeds the EU bound value of 40 I?g/m3.NoiseWHO guidelines limit noise degrees for residential countries to 55 dubnium ( A ) during the twenty-four hours and to 45 dubnium ( A ) during the dark ( WHO, 1999 ) . Conveyance is the most of import beginning of community noise across Europe. Approximately 30 % of the EU-15 population is exposed to degrees of route traffic noise of more than 55 dubnium ( A ) . In general, the WHO guidelines for noise are frequently exceeded in South East Europe on route with high traffic tonss ( UNECE/WHO Europe, 2009 ) . But noise is emanating non merely from the motion of conveyance vehicles but besides from the operations of ports, airdrome and rail paces. Break of communicating, damage of hearing, and bad sleep quality can be effects of noise. Continuous noise above 30 dubnium ( A ) and indoor noise above of 45dB ( A ) can impact sleep quality, cause weariness and reduced public presentation. Prolonged or inordinate exposure to resound ( e.g. 65-70 dubnium ( A ) ) can do lasting medical conditions such as high blood pressure ( Berglund et al. , 1999 ) . European Commission aims are to guarantee a high degree of wellness and environmental protection and at the same time to safeguard internal market for motor vehicles. To accomplish this Commission ‘s proposal foresees a entire decrease of 4 dubnium ( A ) for light vehicles and 3 dubnium ( A ) for heavy vehicles ( European Commission, 2011 ) . This measure will be introduced from 1 January 2015.Energy usageMotorized conveyance depends on fossil fuels, e.g. oil merchandises, which account for more than 98 % of the conveyance sector ‘s energy ingestion. Alternatively of fossil fuels, there are besides other prevailing options, such as biogas, H, electricity, and intercrossed vehicles. However, there is besides a strong trust on fossil fuels. As a consequence, GHG emanations from conveyance are closely tied to transport demand ( BRRT, 2007c, Woodcock et al. , 2007 ) . Since the terminal of 1990s, energy ingestion has been increasing across Europe. Coal is more competitory than the high gas monetary values. This tendency may go on if no extra policies and steps are implemented ( BRRT, 2007d ) . The ratio of addition from 1990-2000 is 2 % which is equal to 365 Mtoe ( million dozenss oil equivalent ) in 2000 ( some 35 % of all energy usage ) . As a effect, the more energy is consumed the more CO2 emanations from conveyance are produced. In add-on, energy ingestion per capita for conveyance is 2 or 4 times higher in Western Europe than in the other European parts ( UNECE/WHO Europe, 2009 ) . Harmonizing to International Energy Agency, conveyance sector consumed 42 % of the oil in 1973 and this portion climbed to 61.5 % in 2010. But in recent old ages oil monetary values have increased and this crated the demand to utilize more energy efficient manners. The two most energy efficient manners for freight transit are rail and maritime conveyance. Inland waterways besides provide an energy efficient method for transporting ladings. For illustration, a tow boat traveling a typical burden of 15 flatboats is tantamount to 225 railway cars or 870 truckloads ( Rodrigue et al, 2009 ) . Furthermore, oil militias are shriveling, costs of crude oil are increasing and the demand to cut down emanations of harmful pollutants is now more imperative. For this ground, the solution of alternate fuels in the signifier of non-crude oil resources is needed. The most prevailing options being consider are: Biogas such as ethyl alcohol, methyl alcohol and biodiesel can be produced from the agitation of nutrient harvests ( sugar cane, maize, cereals, etc. ) or wood-waste. Hydrogen which is produced by electrolysis of H2O or by pull outing it from hydrocarbon Electricity which is stored in a pure battery Hybrid vehicles dwelling of propulsion system utilizing an internal burning engine supplemented by an electric motor and batteries, which provides chances uniting the efficiency of electricity with the long drive scope of an internal burning engine. Monetary value of oil will surely go on to increase, as there are serious restrictions of non-fossil fuels in the transit sector.Climate alterationClimate alteration is already impacting human wellness, by doing new hazards and force per unit areas such as nutrient deficits and hungriness, change of H2O resources and harm to physical substructure ( peculiarly by low-lying rise and utmost conditions events such as inundations, heat moving ridges etc. ) . Harmonizing to UNECE C dioxide ( CO2 ) is non a pollutant but a nursery gas which contributes chiefly to planetary heating effects holding a prevailing portion of 55 % . ( OECD/ITF, 2008 ) and which is associated to climate alteration. As it is shown in Figure 12 conveyance sector ‘s portion of GHG emanations is about 30 % . Conventional engines besides produce other emanations such as methane ( CH4 ) , azotic oxide ( N2O ) , and ozone ( O3 ) which are besides responsible for the nursery phenomenon.

Precocious Puberty

The difference between Precocious Puberty and puberty itself is Precocious Puberty is normally found in children between the ages 8 and 11. While puberty normally does not hit children till around age 11-14. The Mayo Clinic best describes Precocious Puberty as: â€Å"Precocious Puberty is when the body changes from that of a child into an adult. It includes rapid growth of bones, teeth and muscles; changes in body shape and size; and development of the body's ability to reproduce. Precocious Puberty normally begins in girls between ages 8 and 12 and in boys between ages 9 and 14.The cause of precocious puberty often cannot be found. † Rarely, conditions such as infections, hormone disorders, tumors, brain abnormalities or injuries may cause precocious puberty. Treatment for precocious puberty typically includes medication to delay further development. There are 5 different types of Precocious Puberty. Gonadotropin-dependent precocious puberty is very common and affects mostly girls and half of the boys. This is a disorder which is triggered by premature secretion of puberty controlling hormones or higher levels of gonadotropins.Gonadotropin-independent precocious puberty mostly affects boys with low gonadotropin levels. Central precocious puberty is not triggered by any underlying reason. It is merely a body response to changes that concern the central nervous system. Isosexual precocious puberty causes the sign of femininity in girls and masculinity in boys. Heterosexual precocious puberty is just opposite of Isosexual precocious puberty which brings the sign of femininity in boys whereas masculinity in girls. Early onset of puberty can cause several problems.The early growth spurt initially can cause tall stature, but rapid bone maturation can cause linear growth to cease too early and can result in short adult stature. Most children, boys and girls alike that have Precocious Puberty end up being less than 5 feet tall. According to Kids Health (1995) t here are signs to be on the lookout for. For instance, â€Å"in girls the telltale signs of precocious puberty include any of the following before 7 or 8 years of age include: breast development, pubic or underarm hair development, rapid height growth, and onset of menstruation.In boys, the signs of precocious puberty before 9 years of age include: enlargement of the testicles or penis, pubic, underarm, or facial hair development, rapid height growth — a growth â€Å"spurt†, and voice deepening. † Both girls and boys will have an onset of acne and adult mature body odor. An 8 year old child having such things causes problems for that child. It’s always difficult to be different, and maturing into an adult-looking body earlier than your peers puts a lot of pressure on children. A child I know, Roberta, is only 7 years old and has Central Precocious Puberty.The mental affects it has on Roberta is outrageous; she is a second grader having to deal with wearin g sanitary napkins, the â€Å"smell† associated with periods, the self-image problems of already growing breast, among many more issues. This can really wear on a child, especially one that is so young. Roberta is finding it hard to maintain her friends, once they find out about her already having periods their mom’s want them to not be friends anymore. One little girl had been friends with Roberta since Preschool then the mom found out that Roberta was wearing sanitary napkins and told her daughter she could not be friends with Roberta anymore.Roberta’s mom went to talk to this lady, and her response was, she was not ready to have â€Å"the talk† with her daughter yet. It was better they not be friends to prevent Roberta from telling her daughter anything. It is more difficult for girls than boys. Girls have undeniable signs that are visible to everyone. Boys can hide their growing penis and chest hair from their friends, the only thing they cannot hide is their facial hair if that is coming in early. Both boys and girls can have a tough time when they go through pubertal changes.Children who go through the changes at the age of 8-11 while their friends do not hit puberty till 11-14, makes it even harder for those early bloomers to cope. Children with Precocious Puberty may be stressed because of physical and hormonal changes; they are just too young to understand all the changes their body is making. These children will be teased and may end up having body image or self-esteem problems. Girls who reach menarche before age 9-10 may become withdrawn and may have difficulty adjusting to wearing and changing sanitary napkins.Roberta has had problems adjusting to wearing the sanitary napkins and she wants to make sure no one can see them from her pants. It is very confusing and traumatizing for her. Both sexes, boys more often than girls, may have increases in libido leading to increased masturbation or inappropriate sexual behaviors a t a young age. Girls with a history of early puberty have a slightly earlier age of initiation of sexual activity. Some girls with Precocious Puberty enter the dating scene much earlier than their classmates.Early-maturing girls may also have behavior problems and a greater risk for substance abuse and suicide. The best thing for the children struggling through precocious puberty is for someone to be there for them, listen to them, encourage them, let them know there are others who are just like them, and what they are going through is normal. It may not normal for their age, but normal none the less. All children go through adolescences. Those with Precocious Puberty are just going through adolescences sooner. In order to diagnose Precocious Puberty the doctor will perform a work up on the child.The doctor normally begins by reviewing the medical history of the family, doing a physical exam, reviewing blood work to measure hormone levels, and taking x-rays of the child’s han d and wrist to determine bone age. When diagnosing a child with Precocious Puberty, a doctor will look at the Tanner Stages to determine where the child is at. Tanner Stages is a system that was developed in 1969 it grew out of a two-decade-long study of girls as they transitioned through puberty. â€Å"The Tanner staging system is named after Dr. James Tanner, who was a British pediatrician.He performed a longitudinal study in which the subjects were observed repeatedly over a period of time in the same context. † (Dr. Greenspan 2006) In an experiment; the girls underwent examinations and photographs every three months. Dr. Tanner and his research group studied the progress and developed the 5 Tanner Stages that we use today. The Tanner Stages deal with both breast and genital development. Roberta (the afore mentioned child) has a Breast Tanner Stage 3 and a Pubic Hair Tanner Stage of 4; this happens more times than not for girls to be more advanced in one area over the othe r.She is biologically age 7 but her bone age is 11. Girls will have Tanner Stages numbered 1-5; childhood through adulthood. Boys will have only one Tanner Stage, Tanner Stages numbered 1-5; childhood through adulthood. According to the Mayo Clinic (1998) there is treatment for Precocious Puberty. The children can receive a treatment called Gn-RH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child continues to receive this medication until he or she reaches the normal age of puberty.Once he or she stops receiving the medication, the process of puberty begins again. The goal of treatment for Precocious Puberty is to stop puberty from progressing so the child can have a normal healthy childhood. Treatment will also depend on the type of Precocious Puberty and the underlying cause, if known. According to Health of Children, there are several drugs that have been developed for trea tment: histerlin, nafarelin, synthetic gonadotropin-releasing hormone agonist, deslorelin, ethylamide, triptorelin, and leuprolide.If parents opt to have treatment, there is some after care that is required. The child will have follow up visits every 3-6 months to ensure that progression of puberty has been slowed or halted altogether. Normalization of accelerated growth, reduction in size of breasts and suppression of gonadotropin levels after receiving Gn-RH. Monitor bone age yearly to confirm that the rapid advancement seen in the untreated state has slowed typically to a half year of bone age per year or less.If parents opt to not have treatment, the child might need therapy to help with self-esteem issues, high anxiety, irritability or even withdrawal. Some studies have shown that not treating children has no effect on them at all with the exception to early adolescences. The best thing a parent can do is to discuss the ends and outs with the Endocrinologist about which treatme nt if any will be best for their child. Precocious Puberty is something a child can live with. Most importantly, there is help out there if they want it.

Research Analysis of H.R.1540 National Defense Authorization Act under Paper

Analysis of H.R.1540 National Defense Authorization Act under the 111th Congress Specifically - Research Paper Example The Act according to NDAA renders the state to be a police state. In addition, the Act was signed with acknowledgment that some provisions that are in NDAA are objectionable. It was signed without disallowing the NDAA (H.R 1540) or even sending it back to the congress for the objections that were raised. Justification of the NDAA as a way of combating terrorism is not convincing. According to Trautman (2010, 16), the Act can also be viewed as a counter terrorism agenda. This is because any American who is opposed to the Act or policies of the state can in the provisions of the Act, be labeled as a suspected terrorist. Moreover, such a person can be arrested under the military detention. Although, during the signing, the president did emphasize that the government would not detain any citizen without trial, this can be unattainable. It was proposed by Yarling (2012, 24), that, this is so, as the provisions of the Act do provide for detention when one is a suspect of terrorism. The NDA A repealed the US Constitution and the passage has frActured the American democracy because the Act as created a military government and totalitarian State that is in civilian clothes. This Act was passed after the military agenda in Washington. The pursuit by military of worldwide hegemony required the â€Å"militarization of the Homeland† that led to the end of the American Republic. The Act has misled the citizens of America as it gives the president a democratic face. In addition, the Act unfolds the 911 Military police state tools. The values and traditions of the people of America that were in derogation have been repealed in the US Constitution from the day the Act was signed. The Act allows for the indefinite and arbitrary military detention. The Act is from the Senate Republicans and Democrats who want further sanctions to the Iran government (â€Å"A One-Two punch† 2012). This is due to the fear that the developing of the nuclear weapons will outweigh the con cerns raised. The oil prices will be driven up, and the Americans will feel the effects at the gas pumps. The Senate has weighed options in adding sanction measures to the defense bill to a massive $662 billion. Trautman said (2010, 45), â€Å"The lawmakers, on the other hand, voted to limit the debate on legislation†. This in effect, wrapped up the bill in a weeks time. The legislation is to authorize funds for weapons, military personnel, national security programs on Energy sector, and wars in Afghanistan and Iraq. However, the bill is less than what the President had requested for in the budget. At the same time, it is less than what the Congress had also requested for in the financial year. The Congress has a wider support on sanctions against Iran, which is a concern for Israel and U.S national security. The government has announced new penalties that are to be taken against Iran that includes identifying Iran’s banking sector as a money laundering concern, among others. The U.S banks, therefore, needs to increase monitoring to ensure that they avoid trading with the Iranian financial institutions plus their foreign affiliates. The lawmakers wanted tougher penalties that the administration was avoiding. The defense bill got an amendment from a senator, which was to target the foreign financial instit

Genetically Modified Food Speech or Presentation

Genetically Modified Food - Speech or Presentation Example There is immense turbulence in the food industry because of the adverse effects of the genetically modified foods on human body, their minimal nutritional value, and their potential to cause diseases. The high cost and lack of awareness among farmers are factors that might hinder the growth of food industry that has otherwise immense potential of growth. This report based on primary and secondary research discusses food industry’s growth in relation to a range of technological, economic, and political factors. Primary survey conducted with focus group interview was based on 4 respondents’ groups including company executives, government agencies, investors, and people. Two genetically modified food making companies’ executives were asked questions. They emphasized upon the role of technology and market dynamics in making and sale of genetically modified foods respectively. The importance of technique of production varies from one industry to another, with techniqu e being more important in the manufacturing of genetic foods, but the role of supply chain is the same in all industries. Company executives generally believe that supply chain management and logistics services are vital to food industry’s growth. Interview with the Associations 1 employee from two NGOs each were asked questions regarding food industry’s ethics. ... NGOs conduct research to minimize the possible environmental effects of genetically modified foods. NGOs are proactively ensuring food security and safety along with taking measures for environmental health and safety. Interview with Government official 1 government official was asked about the policies regarding production and distribution of genetically modified foods. He told that government obliges food manufacturers to mention the type and nutritional value of food. While there are no government-sponsored schemes of food-labelling in the US, yet the government prohibits the presence of genetically modified materials in organic foods so that it can label GMO-free foods. Government offers certification and encourages consumers to use renowned brands for their security. Government has established three levels of legislative framework for consumers’ security; one being government’s assessment of genetically modified crops for environmental and health safety, the second being government’s prohibition of sale of unsafe genetically modified foods, and the third being food labelling. Government is proactively managing genetically modified foods. Interview with Customers Companies can determine future state and plan strategically by conducting consumer survey. In this survey, 5 consumers were asked questions. Consumers don’t mind buying genetically modified foods provided that they are cheap and their nutritional value is preserved. Consumers feel confident buying genetically modified foods with governmental support and security. Consumers clearly understand the differences between organic and genetically modified foods saying that the former grown naturally while the latter are grown technologically. Consumers think that genetically

Marketing Essay Example | Topics and Well Written Essays - 3000 words - 2

Marketing - Essay Example outside of the marketing function impact upon marketing efforts. The report, takes the help of Sam’s Tailor, a fashion retailer in the Hong Kong market, to apply relevant methods of market analyses to the company’s marketing mix in order to determine the relationship between external market factors and other business units like finance, human resources and production, and their role in enforcing marketing efforts. ... The report will attempt to investigate all the above factors in relation to a fashion retailer in the Hong Kong retail market. It has to be noted that since the report is based on analysis of a fabricated situation in said market, whilst relevant background information is provided on the chosen company, an assumptive format will be employed when applying theory to the situation(s) explored. I.1 The organisation, Sam’s Tailors: Known as a tourist’s must visit enterprise, whether the tourist is a celebrity or a common person visiting Hong Kong, Sam’s tailors has earned a great reputation since its establishment in 1957 for providing high quality tailored suits for men and women. The company operates on the core traditions of quality and value for money. Their concept of the 24 hour suit has traditionally drawn many famous names like Bill Clinton, and Michael Palin, who in fact had a suit made within 24 hours whilst he was shooting his BBC travel documentary, Ã¢â‚¬Ë œAround the World in 80 Days’ (www.samstailor.biz; http://www.time.com/time/asia/2004/boa/boa_body_tailor.html). The current owner, Manu Melwani, son of the founder Sam Melwani, is very particular about maintaining strong relationships with past and present customers, as he thoroughly believes that a good tailor needs to know a lot about his customers. He travels extensively to Europe and America, where the majority of his clientele are, in order to understand more of their daily habits, personalities and public opinions about them to create suits tailor made for their image. The core competencies are the amount of research that goes into studying the behaviours of a considerably small but elite customer base, and a small corporate structure

Alternatives to both criminal and civil court actions in Scotland Essay

Alternatives to both criminal and civil court actions in Scotland - Essay Example Look at the Asylum and the Immigration laws; both are applicable in the whole territory of England (Miller, Richard & Sarat 1980, p. 531). The Employment Tribunals in England have the same jurisdiction as the other courts. Such tribunals are functional within the territory of Northern Ireland. In addition, Military Courts are operating as independent courts in the United Kingdom to deal with the issues of military offences. In Scotland, the Supreme Court is restricted to hear civil cases, appeals of Scottish cases and to determine the violation of human rights (Newburn 2007, p. 159). Courts and the Legal System of Scotland In every democratic state, modern legal framework reflects the confidence of its citizens, which protects them from unfair treatment of State, business entities and people in all fields of life (Miller, Richard & Sarat 1980, p. 534). The legal system of Scotland is based upon its strong traditional values and fairness. With the passage of time, the norms of society have changed radically over the last two decades. Therefore, it is the need of the hour to introduce modern legal institutions, which have the capability and the capacity to deliver in line with the requirement of modern legal framework of justice besides retaining its traditional values (Galanter & Cahill 1994, p. 1339). ... Initially, the procurator conducts preliminary investigations about the issues highlighted in criminal cases and obtains written statements of the witnesses as important ingredients for the prosecution. The procurator may seek assistance of the police to complete investigation where need arises. However, in murder cases, the police officers complete the investigation without involving procurator (Galanter 1985, p. 16). According to High Court procedure, once a person is found guilty of an offence and remanded in custody, he becomes the responsibility of the Crown to bring the case of accused for a preliminary hearing within the specified time. Under the mentioned set up, defendant and petitioner have no right to take a decision on whether to try him by jury or on the summary of procurator. The Criminal Justice Act 1987 delegated power to procurator to offer determinable penalties instead of prosecution. Initially, the maximum amount of penalty was GBP 25, which later on increased to GBP 300 in phases (Bottomley & Bronitt 2012, p. 183). The curator can issue warning, impose penalties, award compensation to the aggrieved party, provide counselling to psychological patients and give them treatment according to the advice of psychiatrist. A fiscal procurator is a part of Court of Lord Lyon. The court in question hears the cases of criminal and civil law. The cited Court is unique in terms of Scottish culture. The court under reference plays a pivotal role regarding to the clan system. If any of the rules related to coat of arms are not adhered, the procurator as an independent official of the court may decide to initiate criminal proceedings against the defaulter (Galanter & Cahill 1994, p. 1345). Judicial

Benefits of Opening a Franchise Hospice Facility vs. Non-Franchise Research Proposal

Benefits of Opening a Franchise Hospice Facility vs. Non-Franchise - Research Proposal Example Indeed, the fact that there are two schools of thought means that in each case, there are associated benefits and corresponding demerits. To ordinary citizens and particularly the ageing, their concern will continue to be for them to receive the very best of healthcare service from hospice facility operators. It is important to state however that in the midst of managerial and organizational challenges resulting from the wrong choice of a mode of operating a hospice, an investor or entrepreneur may be underpinned with poor service delivery to customers over a very long period of time (Muhammad, 2009). This brings out the need for individual entrepreneurs to carefully assess the weights behind each of the forms of having hospice facility in place before deciding on one of the choices. This research work therefore seeks to identify the benefits of opening a franchise hospice facility as against non-franchise so that entrepreneurs will be well informed in their selection decisions, basi ng their decisions on factors that best suit their immediate premises. 1.2 Research Aim This research work will be embarked to identify the benefits of opening a franchise hospice facility as against non-franchise hospice facility. To achieve this overall aim, there should be some specific objectives that should be achieved first. The over all achievement of the specific objectives would constitute the achievement of the research aim. 1.21 Specific Objectives 1. To identify the various options for owning a hospice facility that are at the disposal of an entrepreneur. 2. To assess the various ways in which franchise hospice facility would be advantageous or disadvantageous to an entrepreneur 3. To assess the various ways in which non-franchise hospice facility would be advantageous or disadvantageous to an entrepreneur 4. To find various factors that should be considered in the opening of the hospice care facility 5. To come out with recommendations on the method of opening of the bu siness 1.3 Significance of the Study Successful completion of the research work shall be of immense benefit to several groups of persons. Some of the specific benefits include: 1. Entrepreneurs will be well informed on the right method of opening a hospice care facility that would best suit their needs. 2. As entrepreneurs make the right selection regarding the method of opening hospice care facility, they are sure to have formidable corporate and institutional financial base with which to expect profits (Muhammad, 2009). 3. A profit making hospice is likely to be a well managed and well equipped hospice care facility that would address the health needs of the populace, especially the ageing. 1.4 Research Questions The researcher puts forward the following research questions to serve as guidelines for the conduct of the research; especially in secondary data collection where data shall be sought from existing literature. The questions are: 1. What are the various methods of starting hospice care facility? 2. How does each of the methods of starting hospice care facility serve as an advantage or disadvantage to the entrepreneur? 3. What factors should inform individual entrepreneur’s decision on the selection of franchise hospice

Research on Sure Thing by David Ives Paper Example | Topics and Well Written Essays - 1250 words

On Sure Thing by David Ives - Research Paper Example The actions, reactions, beliefs, attitude and character psychology become the most important part of the play and create the definite response that is expected in the play. The concept of Sure Thing is then dependent on the psychological associations and expectations that change throughout the play and are defined by the layers to the character. The main concept that Ives uses to characterize the changes in the psychology is through Betty and Bill and their relationship that grows as they get to know each other. The psychology of the characters and the way that they relate to each other changes when the bell rings. By this occurring, the correct scenario is created in the end, which the author creates as being significant by the statement of â€Å"sure thing.† The bell changing the scene becomes the signifier that is attributed to the play and leads to the main concepts of psychological relationships and how this creates both the play and the relationships which are held betwe en two individuals. The changes in relationship become the stabilizer in the play because of the continuous changes in the character. This is done to define the main attributes of the characters while changing these with acceptance or rejection based on personality (Hauptmann 1). The dimensions of the characters and displays which are created by building continuous changes in identity as a psychological, as opposed to a physical, attribute (Rusko Hamar 509). The concept of character identity expression is one which is traditionally used in places to identify the specific attributes which each individual has. Voice fluctuations, differences in costumes and divisions are used to create the identity. Within each of these are symbols to show that the individual represents a specific set of characteristics, specifically which they never go out of. The personality features are then able to create an understanding that specific psychological attributes are associated with the main classifi cations of the day while building changes that relate only to the main characteristic and identity. This specific concept is used with a variety of plays and is expected as a main component in traditional theater (Rusko Hamar 509). The difference with Ives work is that the same characters are used. The only difference is in how the character chooses to respond and what is associated with this alteration. For instance, when Bill is talking to Betty, both make several statements that are not considered as psychologically acceptable by Betty. At these times, the bell rings and a different persona is taken. An example of this is when Bill starts to ask Betty more personal questions. â€Å"Bill: Do you come in here a lot? Betty: Every once in a while. Do you? Bill: Not so much anymore. Not as much as I used to. Before my nervous breakdown. (bell)† (Act 1, scene 1). This is one of several examples that show the transparent psychology which is stated becomes unacceptable. The bell a llows this to be avoided and a different characteristic or psychological response to be replaced with the information that is given. By changing the response and characteristic, there is the ability to create the right layers to the character until one fits with the other in terms of psychological responses. The ability to break the psychological attributes and characteristics of both of the characters is one which doesn’t take place as a voice only of the several sides of Betty and Bill. There are also

Native American Spiritual Artwork Essay Example | Topics and Well Written Essays - 1000 words

Native American Spiritual Artwork - Essay Example Similarly, the beautifully art-worked moccasin foot ware of Cherokee tribe are also seen as something sacred and this is evident when in a poem, the Native American man sings, â€Å"I put them on. I walked sacred on the land† (Williams et al., 31). On the performance side also, it can be seen that Native American dance is not simply an art form or a mode of entertainment but is deeply embedded with spiritualism (Sun Dance). Dance even becomes a form of prayer for these tribes (Sun Dance). In this way, â€Å"American art provides a mean for people to connect to the sacred† (Zimmerman, 94). It is observed that â€Å"animism† is the prevalent common theme of all Native American art (Dagan). The spiritual meaning of animism is a belief that â€Å"all things (in this world) are in unity† with each other (Dagan). Animism is also considered as the â€Å"oldest spiritual perspective in the world† (Dagan). The visualization of animism in Native Indian art ca n be seen as â€Å"spirals or zigzag lines† in paintings and carvings (Dagan). An interesting aspect of Native American art is that a spiritual experience is what ends up as an art work for a tribesman (Zimmerman, 94). Zimmerman has given an example for this when he said, â€Å"a dream might reveal to the artist a design for a warrior’s shield or part of a dancer’s regalia† (94).... It was a spiritual retreat in which a large number of participants would fast, pray and dance for a period of days. They asked for answers to events going on in their lives† (Sun Dance). Half-man-half –beast images are also part of this spiritual philosophy (Dagan). It is these spiritual creatures that are supposed to guide the shaman through the path between the two worlds (Dagan). The same figures can be seen in the paintings, carvings and performance arts of Native Americans (Dagan). While exploring Native American performance art, it has to be kept in mind that â€Å"Native American dance is meant to channel spiritual energies or reanimate ancient stories that can be caused to re-appear in the world today† (Dagan). A magical web, the dream catcher, is yet another figure that appears in many forms of Native American art (Dagan). Also, the wolf being a sacred animal for Native Americans, it has gained a place in Indian art as well (Dagan). Apart from these commo n themes, there are different concepts of art and spirituality prevalent among different Indian tribes. For example, many â€Å"clan crests, songs, stories, (and) regalia (hats, blankets, tunics etc.) and clan houses† are considered ‘at.o?ow’ by Tlingit clan thereby wiping out the difference between what is art and what is mundane (Willaims et al., 139). The borders of physical and spiritual worlds thus overlap. An at.o?ow is a clan property that has social and spiritual importance (Williams et al., 139). From this example, it can be seen that traditional artworks as well as art forms like songs and stories have a spiritual role in Native American culture. Similarly, in the Pueblo community, the embroidery done by traditional weavers

SALARY CAP Research Paper Example | Topics and Well Written Essays - 1250 words

SALARY CAP - Research Paper Example In order to address the problem that occurs as a result of placing the salary cap, players union had came up with measures to negotiate for the welfare of players in a team to ensure that a the teams do not infringe the rights of their players (Rosner & Shropshire, 2011). For example, players union has put forth collective bargain agreement to negotiate with the Nation League on the amount of salary that each team should spend to their players. The aims of collective bargain agreement is to ensure that the National Federation league become more competitive. In addition, the salary cap helps to ensure that there is harmonization of salaries among different teams. This further prevents migration of players from one team to the other. Additionally, salary caps helps to ensure that each team retains the right talent and skill among its players. Moreover, the salary cap helps to prevent inequality among organizations sponsoring different players. For example, if there are no salary cap so me teams could be spending quit a lot of financial resources to fetch the best players from other teams but through salary cap such events may be prevented (Bryant, 2009). The benefits of putting in place the salary cap are numerous to both the organization and players. For instance, salary cap help prevent unnecessary inequality between clubs/organizations sponsoring the players by ensuring that no particular organization can spend more money in paying their players than the others. Further, it ensures that there is conformity with rules and regulations establish by the National Federation League. The first salary cap was introduced in 1994 where thirty four point six million dollars was set as the salary limit. The salary cap has been reported to continue increasing over the years and in 2011, collective bargain agreement was reached. The salary cap of one hundred and twenty million dollars was put forth. Moreover, in 2013, a

Crimes Essay Example for Free

Crimes Essay Aside from the identified purpose of the Uniform Crime Report (UCR), it is formulated in such a way that it classifies the types of crimes under two categories: Part I and Part II. The facts and data of the UCR under Part I is more extensive in terms of the scope of the information in the report when compared to Part II. The facts and data in Part I include other necessary information such as profile of the criminal. In Part II, the rate of arrests for specific crimes are only present in the UCR. Part I crimes are closely monitored by law enforcement because crimes categorized under Part I are violent crimes and crimes against property. Categorizing crimes under two parts, I and II, determines the gravity or the impact of crimes to the public. Part I crimes are more grave, considering that crimes under Part I include rape, robbery, burglary, larceny, arson, etc. These are potentially serious crimes that law enforcement should prioritize in order to uphold peace and order to society. Part II offenses are less serious including crimes such as vandalism, fraud, drug abuse violations, etc. In some instances, law enforcement implements measures that seem to increase the statistics of crime occurrences. However, when we look deeper into the matter, we realize that the increase in crime statistics contribute to the improvement of society. In such instances, positive results from increased crime statistics are observable in Part II crimes. Increasing crime statistics catch the attention of the public, alarming them to be vigilant about their surroundings in order to prevent criminal offenses from taking place. For instance, reports reveal to the public that there is an increase in the number of reported stolen property crimes in the community. This raises the awareness of the people, and since it is a non-violent crime, they are willing to get involved with crime prevention. People decide to engage in neighborhood watch, community policing, and other law enforcement activities that will assist official law enforcement agencies in preventing crime, affording them enough time and manpower to focus on grave crimes categorized under Part I. Offenses such as prostitution and drug abuse violations motivate people in the community to get involved with discovering or reporting violators to law enforcement agencies. Another advantage of reporting increase in crime rates is to empower people to get involved with crime prevention. Offenses against family and children, for instance, have increased. Law enforcement will interpret the statistic in such a way that it expresses the increase in the number of people who reported criminal offenses, and further continue that the increase in the number of people who report criminal violations to the police helps law enforcement in crime prevention. The police might convince the people to report criminal violations because it is one way for law enforcement agencies to know criminal trends and analyze these trends to come up with plans and resolutions to prevent crime.

Predictors of Patient Satisfaction

Predictors of Patient Satisfaction CHAPTER 1: Introduction In this chapter we will briefly discuss the background of the research area. At first an overview of the patients satisfaction concept will be introduced. This will be followed by the relevance of this thesis to the country of Kuwait. After that, we will present a discussion of the problem that will give a better understanding to the reader for our subject. The chapter ends with a brief description of the thesis structure follow. 1.1 Overview: The patient experience reflects the way in which a person perceives the sum total of his experiences with the health system throughout the continuum of care. This experience is influenced by the total of the encounters between the patient and the caregiver, of the patient’s expectations from the health system and from the organizational culture in all of the frameworks with which the patient comes in contact. In recent years, the patient experience has become a central talking point in the ongoing discourse of the health systems in Israel and worldwide, which coincides with numerous social trends: Increasing public awareness of the patient’s rights. Public demand for transparency in conduct and for exploiting opportunities to improve. Activity of patient safety organizations. Changes in the service and consumer cultures. Demand for equality and accessibility to each and every individual. Increasing use of electronic communication and social media in search of medical information, knowledge sharing among patients, recommendation of specialists, alternative treatments and facilities and so on. Patient satisfaction is generally considered as the extent  to which the patients feel that their needs and  expectations are being met by the services provided[4]. Patient satisfaction predicts both compliances [5] and  utilisation [6] and may even be related to improved  health [7]. It also contributes to the atmosphere  prevailing in a PHCC [7,8]. It is associated with  continuity of care [3], the doctors communication skills  [9], the degree of his or her patient centeredness [10]  and the congruence between intervention desired and  that received by the patient [11] . Other factors  influencing satisfaction with medical care include  confidence in the system and a positive outlook on life  in general[12] . Finally, satisfaction is the judgment of  the patient on the care that has been provided [13]. The  physician remains a key element in patient satisfaction  [14]. Summarize chapter 2 in one a half page start with small problem definition, actually there are determinants 1.2 Relevance of this thesis to the country of Kuwait With the huge growing number of cancer patients worldwide in recent years the needs of effective and capable health care suppliers is mandatory. The health care sector in Kuwait has been occupying very important position among the public, as it takes the responsibility to maintain peoples heath and to prevent disease as well to secure complete coverage of the health care services. Kuwait consists six general hospitals for several specialty, and more than 70 care clinics. With an aging facilities and growing population, hospitals have become overused with empower of tools and equipments and the care clinics are not serving dangerous situations or real disease. Cancer cases in Kuwait has reached the top of disease and have been recognized as a main cause of deaths in the country (Alduaij 2012). Kuwait control cancer centre (KCC) comprehensive cancer center have 600 qualified medical staff and 459 beds. KCCC treats over 2000 new cancer patients each year and total of 28,697 from Kuwait and the region(Kuwaitcancercenter.com 2014)[50]. Identification of predictors of patient satisfaction (what aspects of care matter the most to patients) enables policy makers at the Ministry of Health in Kuwait to focus on these aspects and improve them. The correlates of socio-demographic characteristics of patients with satisfaction allow the health care providers to cater to the different needs of patients based on their socio-demographic characteristics. This study aims at identifying predictors of patient satisfaction in the primary care clinics of the Ministry of Health, Kuwait (factors leading to patient satisfaction or dissatisfaction) and its socio-demographic correlates. 1.3 Problem Definition: Lack of proper strategies and support system by Ministry of Health (MOH). There are many obstacles interfering the treatment of patients in Kuwait due to poor system and insufficient management strategies that is related to health care services (Alduaij 2012). Kuwait Cancer Control Center (KCC) which was built back in the 70s is considered as one of the important medical centers in Kuwait for the reason of increasing number of cancer patients in Kuwait (KCC 2014)[51]. KCC have a capacity of 459 beds against 28,697 patients with 1643 employeed,490 nursed, and 11 physicians. Based on that, the hospital have witnessed a migration of the experienced staff which results in shortage of human resources and accordingly leads to instability and sub-optimal medical system (Annaharkw.com, 2014)[53]. Huge public demand to improve hospital services. According to Arab Times (2014)[52] the previous Kuwaiti parliament members have step against the low performance of Ministry of Health (MOH) and of KCCC in particular. They have raised their disagreement over the government’s failure to control the disease and to provide adequate services to satisfy the patients. Many issues were declared to the ministir of health seeking for urgent solutions such as: long waiting time, unavailability of beds , lack of the hospital human resources and machinery as well financial and administrative capabilities. Temporary recovery plan but not permanent solutions. His Highness the Amir Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah, at the end of year 2013 gave instructions to the government to send cancer patients for treatment abroad at the States expense and to expedite with actions (Kuna, 2014)[50]. The reason for the urgency of this new law was due to public dissatisfaction, and the continuous complaints toward cancer treatment in Kuwait. Dire personnel experience A personnel experience with the cancer disease has been the real motivation behind this study. Watching a dear person suffering not just because of the disease, but because of shortage of resources and lack of proper support system, is the hardest thing ever especially when it comes to losing that dear person forever. 3.6 Research objectives The research objectives are as the following: To explore and review the available international literature about the cancer patents satisfaction. To discuss the determinant of cancer patients satisfaction. To identify service quality dimensions related to cancer patients. To investigate the importance of quality of life for cancer patients. To find out the impact of socio demographic characteristic on cancer patients in Kuwait. 3.7 Research questions Based on the objectives of the study, key questions should be addressed: 1. What are the determinants needed to reach an effective cancer patients satisfaction in Kuwait? 2. What are the health related service quality dimensions? 3. What are the quality of life factors that contribute cancer patients satisfaction? 4. What is the effect of socio-demographic characteristic on cancer disease in Kuwait? 1.6 Research Methodology Our research is considered deductive, quantitative, descriptive and explanatory based on the experiments presented in our literature review. This study is focusing on cancer patients and the benefits that are provided by KCCC hospitals and their personnel life. The questionnaire is in two language English and Arabic and have been randomly distributed in Kuwait cancer control centre and on website. The study population consisted of the patients who came for therapy in KCCC ( outpatients) and the sample size consisted of 300 patients based on total cancer patients in Kuwait which are approximately 28,697 patients. The eligibility criteria included patients who have been diagnosed with different types of cancer as a minimum of 6 months ,above 21 years old and currently are undergoing treatment. The questionnaire contained a socio-demographic characteristics as well as the overall satisfaction with the different aspects of quality of services and quality of life. At last, The data analys is is obtained through using different statistical techniques by using the SPSS software version 17. 1.7 Thesis structure This thesis is divided into five chapters. In the first chapter, we will be providing a background and an overview of the selected research subject, followed by the problem area discussion and description of the thesis structure. In chapter two, an academic literature review related to patients satisfaction and the different independents variables such as physcian concern,staff concern, convenience of care process, tangibles, social well-being, emotional well-being, and information knowledge will be introduced based on theories, academic studies and reports. Chapter three explains the methodology and techniques that have been used in our thesis to analyze and carry out this study. In chapter four, an analysis of the empirical data will be presented along with a discussion of the survey findings and results. Last chapter, number 5, is summarizing the results that have been achieved in our study along with a comparison with other studies. At the end of the final chapter, we will be pro viding a conclusion and recommendations for management and future research. A definition of quality of life The quality of life can only be described and measured in individual terms, and depends on present lifestyle, past experience, hopes for the future, dreams and ambitions. Quality of life must include all areas of life and experience and take into account the impact of illness and treatment. A good quality of life can be said to be present when the hopes of an individual are A good quality of life is therefore usually expressed in terms of satisfaction, contentment, happiness and fulfillment and the ability to cope. This definition emphasizes the importance of personal growth. (K. Chambers et al., 2011) Calman, K. 1984. Quality of life in cancer patients -an hypothesis. Journal of medical ethics, [Accessed: 16 Nov 2013].