No Pets Allowed! Professor Ramos Blog

No Pets Allowed! Lisa Towell has been a volunteer at her nearby pet safe house and recounts to a tale about what befell a creature which the proprietor gives up to them. â€Å"I recall one attractive, cordial high contrast tuxedo feline who was dropped off at the sanctuary some time prior. We had bunches of different felines accessible, and the tuxedo feline wasn’t embraced rapidly. He took care of his new world very well from the start, yet as the weeks transformed into months, he got bad tempered and troubled. In the long run, the asylum staff settled on the troublesome however empathetic choice to end his enduring by euthanizing (to death altruistically). He was only 5 years old† (Towell). No Pets permitted! This occasion is the most noticeably terrible and regular to see while searching for another spot to move into. Driving around and you see starving terrified homeless pooches and felines in the city, and why would that be? That is on the grounds that roughly 6.5 million partner c reatures enter the U.S. creature shields across the nation yearly (ASPCA.org). This occasion could be for some reasons yet one of reasons is relinquishment. One way that we can fix that is by more proprietors letting leaseholders have creatures, and landowners don’t like pets thus. They can make harm the property, creatures being snuck in, and creatures cause obligation. Pets for proprietors can profit landowners additionally by getting them more cash. Numerous creatures can cause from little to significant harm to a property. They do this by setting off to the washroom inside, biting on things, and scratching and shedding. landowner will persistently need to supplant floor covering and furniture particularly if the occupant has a miss acted hound. This occasion can be fixed by having pet lease, and a store for the future expense. Likewise, the proprietor can restrict the measures of the canine to littler mutts. This occasion would diminish the harm if there is any. As indicated by AAOA (American Apartment Owner Association) consistent issue landowners face is occupants who sneak in their pets. The Balance Small Business says â€Å"if you permit pets, it will diminish the odds of occupants attempting to sneak in pets that you have not affirmed (Eberlin). Likewise, you could state on the rent understanding if a surprising pet is discovered the violator will be charged an expense in addition to pet lease from the beginnings of their agreement. A few canines can be forceful or horrible ordinarily and proprietors fear being held at risk. On the off chance that you are a landowner to reduce the opportunity of that occurrence, you can limit the varieties and maintain a strategic distance from the more notable forceful or horrendous varieties. Be that as it may, the landlord’s obligation is constrained. As indicated by Nolo’s legitimate reference book, â€Å"in general courts hold a landowner subject just if the proprietor realized the canine was risky and could have had the pooch evacuated; or held or kept the occupants hound that is, thought about or had some command over the dog† (Randolph). In the event that you are stressed that a pooch may be an issue for you, proprietors could solicit that the proprietor would deliver from go get a Canine Good Citizen title. As per AKC (American Kennel Club) a Canine Good Citizen â€Å"is intended to remunerate hounds who have great habits at home and in the communi ty† (AKC). With the limitation on breeds, constrained obligation, and the Canine Good Citizen proprietors ought to have a bit of brain. All concerns you may have can be fixed and kept up, yet permitting these creatures open up the opportunity’s for proprietors to get considerably more cash-flow. By permitting creatures to your tenants opens up a mass pool of up-and-comers. â€Å"that practically half of tenants own a pet. Hence, on the off chance that you make your property pet-accommodating inhabitant as you will have a bigger gathering to pick from† (Eberlin). Progressively inhabitant alternatives make it more probable for you to rent units a lot quicker. For instance, â€Å"David Last, a property administrator, designer, and the originator of Last 2 Development, likewise in Boston, concurs and offers this model, â€Å"If you have 30 units that you can rent even 10 days quicker by permitting pets, that’s what could be compared to an extra 300 days of lease. Accepting the normal month to month lease is $2,000 per unit, that’s about $20,000 of extra (yearly) income† (Gallant). Pet proprietors get more cash-flow and are better inhabitants. â€Å"According to Practical Apartment Management, by Edward N Kelly, 65% of pet proprietors win over $50,000 a year† (Eberlin). Mindful Pet proprietors are increasingly dependable supposing that they can deal with a pet they can be progressively capable about what they are leasing. Pet proprietors will in general remain longer with their rent. This occasion is on the grounds that it is more earnestly for them to locate a pet neighborly spot. Since there are less pet neighborly places landowners can pull off charging somewhat more for lease on the off chance that you permit pets. On the off chance that we cut down the mass of dread that landowners have about pets on how they can make harm the property, creatures being snuck in, and creatures cause risk we can announce the odds of creatures being surrendered in the city or being placed into covers. What's more, we thump down that divider by making the pet having inhabitants have a pet store and pet lease, not holding known forceful creatures, and have a pet arrangements and limitations set up for creatures. By doing this, we can spare an animal’s life in light of the fact that â€Å"each year, around 1.5 million sanctuary creatures are euthanized (670,000 pooches and 860,000 cats)† (ASPCA), and evade the torment of family’s division from their pets. â€Å"6 Reasons to Allow or Not Allow Pets.† AAOA, 18 Jan. 2016, https://www.american-loft proprietors association.org/property-the board/most recent news/6-reasons permit pets/. Eberlin, Erin. â€Å"The Pros and Cons of Renting to Tenants Who Have Pets.† The Balance Small Business, The Balance Small Business, 30 May 2019, https://www.thebalancesmb.com/should-you-make-your-property-pet-accommodating 2125005. Kriss, Randa. â€Å"What Is Canine Good Citizen?†American Kennel Club, 26 Oct. 2017, https://www.akc.org/items administrations/preparing programs/canine-productive member of society/what-is-canine-productive member of society/. â€Å"Make Your Rental Properties Pet-Friendly.†Buildium, 4 Mar. 2019, https://www.buildium.com/blog/pet-accommodating properties-can-get more-cash-flow/. â€Å"Pet Statistics.† ASPCA, https://www.aspca.org/creature vagrancy/cover admission and-give up/pet-insights. Randolph, Mary, and J.d. â€Å"Landlord Liability for Tenants Dogs.†Www.nolo.com, Nolo, 23 June 2014, https://www.nolo.com/legitimate reference book/free-books/hound book/chapter4-7.html. Towell, Lisa. â€Å"Why People Abandon Animals.†PETA Prime, 20 Sept. 2018, https://prime.peta.org/2018/09/why-human desert creatures/.

Individual project Essay Example for Free

Singular venture Essay Andy Rexford has begun a bungalow industry in his carport for providing food for the specialty showcase. Before long that market develops thus does his business. With this quick pace development in the business Andy has extended his business from one join machine to six line machine in the brief timeframe. As of late, Andy has built up a marketable strategy which plainly expresses the great future development and heaps of financing required. Andy doesn't have a lot of cash of his own to put resources into the business, so he is searching for the outside financing sources. In this report, I will talk about the various wellsprings of outer financing alongside their favorable circumstances and disadvantages, and afterward I will be chosen which source is the best for the Andy’s business. Wellsprings of financing: There are different wellsprings of financing the business yet the most basic viewpoint is to comprehend which sources are fitting for that specific business and how much funds do we required. The appraisal of sources is absolutely critical. Alongside the judgment, it is likewise reliant on the fact that he is so ready to share the data about his business and possession with others. Wellsprings of funds are partitioned into 2 general classifications: - Internal financing - External financing. Andy’s reserve funds and pay are as of now been depleted during the time spent development, and he requires all the more financing. To assist Andy with taking the choice carefully I will talk about not many outside financing sources. Outer sources: External financing incorporates proprietorship capital and non-possession capital. These two classes are isolated into other a few classifications. For the efficient Andy’s following three non-proprietorship capital financing is appropriate. †¢ Banks †¢ Venture financial specialists †¢ Small business affiliation (SBA) Banks: They are the monetary organization who loans the cash to the organizations and people and charges a measure of enthusiasm against it. They are the hardest spot to discover the accounts as the bank doesn't concede the credit effectively yet the time is been changing currently bank has come up a wide range of advance plans against which individuals are been given advances. A bank credit is considered as most wanted method of financing. Individuals considered it as the most attractive on the grounds that it is now and again rapid on the off chance that you have great credit remaining in the market you can get an advance in the blink of an eye. Besides, you can utilize that cash in different manners and responsible for none. In spite of the fact that there are a few points of interest in getting a credit from the bank yet there are a few disservices too. Hindrances like, a few advances convey a prepayment bounty so the borrower couldn't pay the sum early (Scarborough, 2006). Adventure financial specialists: Venture speculators are those individuals who well off people, corporate and formal establishments who are eager to put resources into the new business and developing organizations. As a byproduct of giving the funding to the organizations, they typically require a level of possession in the organization alongside authority over the key course and installment grouped expenses. Private value gives capital and access to a system that can change an organization into an industry player, Karen E. Klein noted in Business Week. In any case, the cost is high: a lump of your business. Like each other financing source, there are a few focal points and inconveniences also. The fundamental favorable position for the new company is that they are not committed to reimburse the cash. What's more, the association of the prominent businesspeople can likewise build the believability of new business. The fundamental weakness a business person can have from the endeavor financial specialist is that they become the part proprietors of the business, and subsequently they have the rights have a state in the choices. The entrepreneur faces a weakening of their situation as proprietors and conceivable loss of intensity of controlling the business (Scarborough, 2006). Independent company affiliation: Small business affiliation is the associations in United States framed by the administration that causes the business visionaries to fire up their business. Private venture affiliation goes about as the underwriter of advances for the individuals who don't fit the bill for the business credits. The points of interest identified with the private venture affiliation are that since it’s an administration framed association to energize the specialist, they are charging extremely low loan cost as in contrast with the business banks. SBA takes an exceptionally brisk choice with respect to the endorsements of advances to the individuals. There are numerous preferences appended to the SBA that makes it is alluring for the agent however there is a bleak side of this advance too. Since its administration credit regardless of what befalls your business you need to take care of this advance before some other obligation. Also, there is more desk work required than in business bank. The administration needs to ensure that you are really qualified for this specific credit or not. Andy’s wellspring of financing: Andy ought to decide on the bank credit as it suits to the prerequisites of his business. Eventual fate of his business is extremely splendid and there is an assurance that his business will get twofold the size inside next two years. So giving the proprietorship in his business would not be fitting in the event that he needs to have all the benefit, and he can have them as the self evident actuality. With respect to the SBA, they have extremely long reimbursement plan however the rate is a low yet 20-30 years timespan doesn't worth for that sort of advance. Since Andy just needs $700,000, which can be reimbursed inside 2 years on the grounds that the yearly benefit of Andy is 750,000. He can without much of a stretch result this credit with 2 years. Consequently it is appropriate for Andy to take the bank credit. End: There are different wellsprings of funds. Some financing should be possible inside while some can be acquired from others. On account of Andy his gaining is as of now been devoured in the development of the business. So it is proposed to him that he should take the bank advance since he doesn't have to give the proprietorship to the endeavor speculators and doesn't have to give entire life to pay that credit. Bank advance will be the most attractive proposal as Andy can pay this credit result this advance inside two years. Also, he doesn't have to give any possession to anybody.

HostGator Coupon Code Best Promo Discount Voucher 2020

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Treatment Of Schizophrenia And Generalized Anxiety Disorder

Some of the common psychiatric disorders that are experienced by patients include depression, schizophrenia and generalized anxiety disorder. The psychiatric disorders may be caused by both genetic and environmental factors. All these disorders of the mind greatly affect the quality of life of the sufferers. Depression may affect any individual at any stage of life and the symptoms include lack of interest and generalized low moods. The treatment for depression includes psychotherapy, pharmacotherapy and an unpopular method; electroconvulsive therapy when the disease is extensive (Watson, 2005). The complications in the treatment of the disease include headaches and disorientation. Schizophrenia is disease of the mind that makes it arduous for an individual to tell between the real and what is unreal. The symptoms of schizophrenia include obscured thinking depression and hallucinations among others. The treatment of schizophrenia ranges from pharmacotherapy to psychosocial interventi ons such as skills training, family therapy and cognitive remediation among others. Generalized Anxiety Disorder (GAD), in which the sufferer is constantly worried about several things, is characterized with incapability to let go of trivial matters that concern an individual. The sufferers are unable of thinking clearly as their mind is clouded with varied thoughts of worry. GAD has similar symptoms to panic disorder and other anxiety disorders. The Cognitive BehavioralTherapy (CBT)Show MoreRelatedAnalyzing Biopsychological Disorders1522 Words   |  7 PagesBiopsychological Disorders Bonnie Montgomery Analyzing Biopsychological Disorders Part A Biopsychology is a biological approach to psychology. Historically, researchers believed that neuropsychological disorders were of the brain, and psychological disorders were of the mind. Now, psychologists understand that these distinctions do not exist. Biological approaches to psychological disorders direct psychologists to consider the active cause and effective treatments of major psychological disorders. TheseRead MoreWhat Constitutes Cognitive Behavioral Therapy?846 Words   |  4 PagesThere is empirical evidence that shows that cognitive behavioral therapy is quite effective in treating several conditions, including personality, anxiety, mood, eating, substance abuse, and psychotic disorders. Treatment is often manualized, as specific psychological orders are treated with specific technique-driven brief, direct, and time-limited treatments. Cognitive behavioral therapy can be used both with individuals and in groups. The techniques are often adapted for self-help sessions as wellRead MoreEssay about The effectiveness of cognitive behavioral therapy2566 Words   |  11 Pagesinterventions. The main reason for this is that an ongoing adaptation of this form of psychotherapy makes it applicable to a vast amount of disorders and related problems (Rounsaville Caroll, 2002). Despite the relatively great amount of studies on the effectiveness of cognitive behavioral therapy, questions still remain about the levels of effectiveness for different disorders, about the effects of cognitive behavioral therapy on the longer term, and about the set up of the different studies on cognitiveRead MorePsychological Disorders Of The Brain1364 Words   |  6 PagesPsychological Disorders of the Brain What people overlook about psychological disorders like schizophrenia is that they are caused by chemical imbalances in the brain. The brain is a soft tissue muscle that has billions of nerves and cells. It controls our functions without it people would not be here. People look at schizophrenics like they are insane. This way of thinking needs to change. The brain is made up of many cells, neurons and glial cells. â€Å"Neurons are cells that send and receive signalsRead MoreEssay about Psy/240 Final Project: Analyzing Biopsychological Disorders1935 Words   |  8 PagesAnalyzing Psychological Disorders In an attempt to gain a position as a psychologist, I will be discussing schizophrenia and the disorder’s casual factors, associated symptoms, the areas of the brain it affects, and the neural basis of the disorder. I will continue on to discuss appropriate drug therapies. In addition I will also be reviewing two separate case studies, each on a different disorder. I will be examining each problem from the perspective of a bio psychologist. I will define theRead MoreEssay about Black Swan1087 Words   |  5 PagesThe main character in the film Black Swan, twenty-eight year old female Nina Sayers, displays signs of numerous disorders through her abnormal behavior. Nina’s life is consumed by her occupation: professional ballerina/dancer. Nina resides with her mother and rarely socializes with others. She has difficulty concentrating, is restless, irritable, suffers from muscle tension, and sleep disturbances from nightmares. Nina also feels very uncomfortable in social and intimate situations. She appears toRead More Substance-Related Disorders Essay examples795 Words   |  4 PagesThe Substance-Related Disorders category of the DSM-IV-TR, is subdivided into two groups: the Substance Use Disorders (Substance Abuse and Substance Dependence) and the Substance-Induced Disorders (Substance Intoxication, Substance Withdrawal, Substance-Induced Persisting Dementia, Substance-Induced Persisting Amnestic Disorder, Substance-Induced Delirium, Substance-Induced Psychotic Disorder, Substance-Induced Mood Disorder, Substance-Induced Anxiety Disorder, Substance-Induced Sexual DysfunctionRead MoreClient Demographics, History, And Presenting Problem1488 Words   |  6 PagesPresenting Problem D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for â€Å"extra support and someone to talk to.† D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for â€Å"hearing voices.† In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a varietyRead MoreMacbeth Mental Essay1536 Words   |  7 Pages With anger, illusions, stress and so much more I will analyze Macbeth and lady Macbeth for their problems and disorders. In my research I will decipher between certain diseases such as bipolar disease, anxiety disorder, obsessive compulsive, panic disorder, post traumatic stress disorder, stress disorder, borderline personality disorder, schizophrenia, sleeping disorder, and paranoia to see exactly which one of these stress/hurtful symptoms in which they both share. I’ve got my observationRead MoreSymptoms And Symptoms Of Generalized Anxiety Disorder1742 Words   |  7 Pages TERMINOLOGY CLINICAL CLARIFICATION Generalized anxiety disorder (GAD) is a DSM-V anxiety disorder characterized by excessive worry and apprehensiveness about a variety of present and future activities and events. 48 o Six-month duration of anxiety and worry about a number of activities and events o Difficult for the patient to control the worry o Three or more of the following associated symptoms NOTE: only one item is required for children Restlessness, feeling on edge Easily fatigued Trouble

How to Use Conjunctions in Italian

Conjunctions serve as connector words, bringing clauses together and, depending on their role, establishing logical connection, heightening contrast of thought and feeling, expressing relationships of time, cause, and condition, and adding a variety of so-called complements or details to the sentence. Types of Italian Conjunctions There are two types of conjunctions in Italian: coordinating conjunctions (congiunzioni coordinative or coordinanti), which combine two independent clauses, and subordinating conjunctions (congiunzioni subordinative or subordinanti), which combine main and subordinate clauses. Both coordinating and subordinating conjunctions are then divided in several groups depending on the logical connection they establish; the purpose they serve. For example, among the coordinative, are copulative conjunctions, adversative, conclusive, and declarative. Among the subordinative are causal, conditional, relative, comparative, final, and the list goes on and on. Straddling that division is another: There are congiunzioni semplici—simple conjunctions—and congiunzioni composte, which are composed of more than one word. For example, e or ma are simple; oppure and poichà © are composed of two words (o and pure, and poi and che). There are simple and composed conjunctions among both coordinating and subordinating conjunctions. (Note that all conjunctions that end in che have an accento acuto on them: chà ©.) Dont get too bogged down on the divisions, except for organizational purposes; its more important that you learn what they mean, and from there their role and purpose will become obvious. Congiunzioni coordinative/coordinanti Congiunzioni coordinative join equivalent and independent clauses. For example: Siamo andati al museo e abbiamo visto un bel quadro. We went to the museum and we saw a nice painting.Siamo andati al museo; eppure non abbiamo visto arte bella. We went to the museum, yet we saw no good art.Siamo andati a casa sua, ma non cera. We went to his house but he was not there. Each of those sentences contain two independent clauses that stand on their own. Coordinating conjunctions also connect other parts of speech, but always of equal and homogeneous value: two adjectives, two complements, two adverbs: Ho mangiato la pizza e la pasta. I ate pizza and pasta.Ho mangiato poco, ma tuttavia bene. I ate little but well.La pizza era calda ma buonissima. The pizza was hot but delicious. Among the congiunzioni coordinative or coordinanti are: E and Io vado al museo e te vai al mercato. You go the museum and I go to the market. Anche/Pure also Ho comprato il latte e anche/pure il parmigiano I bought milk and also parmigiano. Nà © nor Nà © vado al mercato nà © vado al museo. I am not going to the market nor to the museum. Neanche/Neppure not even/nor/neither Non ho comprato il latte e neanche/neppure il parmigiano. I didn't buy milk or even parmigiano. O/Oppure or Vado al mercato, o/oppure vado al museo. I am going to the market or to the museum. Altrimenti or/otherwise Vai adesso, altrimenti fai tardi. Go now or you will be late. Ma but/rather 1. Non voglio il pane ma la crostata. 2. Mi piace la crostata ma preferisco il pane. 1. I don't want bread but rather crostata. 2. I like crostata but I prefer bread. Perà ² but Il maglione à ¨ bello, perà ² à ¨ troppo caro. The sweater is nice but too expensive. Tuttavia though/and yet Non voglio andare; tuttavia andrà ². I don't want to go, though I will go. Piuttosto rather Non voglio andare al cinema; piuttosto andiamo al mare. I don't want to go to the movies; rather, let's go to the beach. Invece instead/but 1. Voglio la pizza invece della pasta. 2. Lo aspettavo; invece non à ¨ venuto. 1. I want pizza instead of pasta. 2. I waited for him; instead/but he did not come. Bensà ¬ rather/to the contrary 1. Non à ¨ venuto, bensà ¬ ha chiamato. 2. L'omicidio non à ¨ successo di notte, bensà ¬ in pieno giorno. 1. He did not come; rather he called. 2. The murder did not happen at night; to the contrary, it happened in full daylight. Anzi even/moreover/to the contrary Quel colore non à ¨ vivace, anzi, à ¨ smorto. That color is not lively; to the contrary, it's washed out. Eppure and yet Non ho trovato Giulio; eppure sapevo che c'era. I didn't find Giulio; and yet I knew he was here. Cioà ¨ in other words/meaning Marco ha 18 anni, cioà ¨ à ¨ giovane. Marco is 18; in other words, he's young. Infatti in fact/indeed Non avevo studiato, e infatti sono bocciata. I hadn't studied, and in fact I flunked. Dunque/Percià ²/ Quindi therefore/and so Siamo stati alzati tardissimo, percià ²/quindi sono stanca. We were up very late, and therefore I am tired. Invece instead Pensavo di essere stanca, invece sto bene. I thought I was tired, instead I feel well. Non solo ... ma anche/neanche not only ... but also/not even Non solo non à ¨ venuto, ma non ha neanche telefonato. Non only did he not come, but he did not even call. Congiunzioni subordinative/subordinanti Congiunzioni subordinative or subordinanti create a relationship of dependence between one clause and another; a relationship in which one clause completes or clarifies the meaning of the first and could not stand on its own (or its meaning would not be complete or the same). The conjunction is followed by a complement that can be of cause, for example, or modal, or an object complement. For example, some of the most obvious subordinating conjunction are quando and perchà ©, which explain time and cause and are, in fact, called congiunzioni temporali and causali respectively. Non esco perchà © piove. I’m not going out because it’s raining.Non esco quando piove. I don’t go out when it rains.Esco sebbene piova. I am going out though it is raining. Among the subordinating conjunctions are: Perchà © because/for Ti amo perchà © sei gentile. I love you because you are kind. Poichà © because/since Poichà © il museo à ¨ chiuso andiamo a casa. Since the museum is closed, let's go home. Giacchà © since/given that Giacchà © siamo al mercato compriamo la frutta. Since we are at the market let's buy some fruit. Affinchà © so that/in order that Te lo dico affinchà © tu non pensi a male. I am telling you so that you will not worry. Cosicchà © so/therefore Non lo sapevo, cosicchà © non te l'ho detto. I didn't know, therefore I didn't tell you. Finchà © until Non smetterà ² di chiedertelo finchà © non me lo dirai. I will not stop asking you until you tell me. Quando when Smetterà ² di chiedertelo quando me lo dirai. I will stop asking you when you tell me. Dopo after Andiamo a casa dopo che andiamo al mercato. We will go home after we go to the market. Mentre while Mentre parlavo con la signora lui à ¨ scappato. While I was talking with the lady he ran away. Nonostante/ Sebbene even though/although Ha preso la macchina nonostante gli abbia chiesto di non farlo. He took the car although I asked him not to. Benchà © though Il ristorante era sempre pieno benchà © le recensioni fossero mediocri. The restaurant was always full though the reviews were mediocre. Se if Non vengo se viene Carlo. I am not coming if Carlo is. Qualora if/if at any time Qualora tu decidessi di partire, avvertimi. If at any time you decide to leave, let me know. Eccetto che/ Fuorchà © except/other than Sono venuti tutti alla festa fuorchà © Giorgio. Everyone came to the party except Giorgio. Che, cui that, which La cosa che le hai detto l'ha spaventata. The thing you told her scared her. Note that several of the subordinating conjunctions—among them sebbene, nonostante, and benchà ©Ã¢â‚¬â€are followed by the congiuntivo. Locuzioni congiuntive These are expressions that serve as multi-word conjunctions. Per il fatto che for the fact that Il ristorante fallirebbe se non per il fatto che Luigi ha molti amici. The restaurant would fail if not for the fact that Luigi has many friends. Di modo che in order that/so that Gli do i soldi di modo che possa partire. I am giving him the money so that he can leave. Anche se even though/even if Anche se non ti vedo, ti penso. Even though I don't see you I think about you. Dal momento che given that/since Dal momento che non mi aiuti, non siamo pià ¹ amici. Given that you will not help me, we are no longer friends. Subito dopo che immediately after/right after Subito dopo che lo vidi sparà ¬. Right after I saw him he vanished. Dopo di che after that Dopo di che partà ¬ e non lo vidi pià ¹. After that, he left and I never saw him again. Con tutto cià ²/cià ² nonostante that said/given all that Con tutto cià ², niente cambia. Given all that, nothing changes.

Child Protective Services The Role Of Substance Abuse,...

Engagement in Child Protective Services: The Role of substance Abuse, Intimate Partner Violence and Race Engagement can be defined in many ways including, attendance, participation, collaboration, compliance and motivation. Parents play a huge role in their children’s life, but, sometimes parents do not engage much with their children which can face significant negative consequences. Substance abuse affects lives in a negative way therefore, parents should be more engaging with their children so they can prevent their children of being victims of drugs, alcohol, or other substances. There are two primary factors for the focus on parental engagement. The minimal level of engagement is necessary in order for families to receive the benefit of child welfare services. The second primary factor is that the courts decides the legal actions of parental engagement. Some families who are victims of substances also struggle with housing or mental illness issue. There are several actions of behavior lack of engagement which includes parents not making appointments for their children on tim e, as well as not allowing a social work to enter to their home, and the lack of following up with treatment goals and inconsistent contract with their children. Parental engagement has been a challenge for child protection workers. When a family is going through issues like violence or substance abuse it is hard to focus on the children. Not having connection or communication with children canShow MoreRelatedDomestic Violence and Its Effect on Children4845 Words   |  20 Pagesdomestic violence homes are constantly being exposed to verbal and physical abuse, directly or indirectly, it has to account for some form of damage within them. They generally suffer in silence, but often develop high levels of aggression, anger issues and anxiety, and often become depressed, there is even a potential to develop Posttraumatic Stress Disorder. 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E-Voting System In Bangladesh

Question: Describe about the Problems Faced By E-Voting System In Bangladesh Due To Lack Of Proper Management? Answers: Introduction Electronic Voting System is one of the emerging technological developments that can be viewed in most part of the world. It has been seen that E-voting system is adopted by the western country that removes the problem of corruption and fraud in voting. In recent years Bangladesh has also implemented the E-voting system to reduce the problems faced in the last elections. But the system itself is not the only solution to the problems faced by the government and the voting system of the country. The management team also needs to execute the plans for implementing the e-voting system in the country. This report is based on analyzing the problems faced by the management teams for implementing a proper E-Voting system in Bangladesh. Project Background IT projects highly depends on management team for implementing the entire system. Management and administrative department is the main people on whom the entire project depends on. The entire project depends on the capabilities of the management people. It is important to see how the management team takes care of the project for proper execution of the plans. As Bangladesh government wants a fare voting system, it is important for the government to check the registration system for voters. In a democratic country it is important to consider the public voting for determining the government of the country (Bangladesh voting project nears completion, 2008). But the government fails to meet the criteria of fare voting because the voting system in Bangladesh is earlier days were based totally on paper works and no electronic evidence were kept on who is voting and from were. To execute the problems the EVM system implemented by Bangladesh government but still there are some issues that ne eds to be considered while implementing the E-Voting system by the management team. This project talks about the problems that the E-voting system faces due to lack of proper administration and management techniques (Sarker and Uddin, 2014). Identify One Issue The most important problem that needs to be considered is that each person votes single time to exclude the problem of corruption and fraud through the E-voting system. This is the problem of communication that occurs among the members of the Voting committee that uses the system. It is the major issue that the government faces to stop fraudulent in e-voting system (Faisal, Hossain and Bhuiyen, 2014). The major problem that the management team faces or the technique that the government lacks in implementing a proper E-voting system is the communication technique. It is the main failure of the government. It is the most important problem issue that needs to be considered while implementing proper IT technique of voting. The government needs to develop a system that will help to know whether a person has voted or not, whether the citizen is voting on his behalf or whether or not the person has casted his or her own vote. A proper communication plan is the most important aspect that mus t be looked after while implementing an IT project plan. Without a proper communicational strategy a project cannot be developed and implemented to meet the requirement of the users. Research Question The major research question around which the entire hypothesis revolves is how communicational problems affect the E-voting System in Bangladesh? Some other questions that also needed to be answered in this research are: Is the communication strategy major failure for poor voting system in Bangladesh? What problems the system actually faces? How can these problems overcome? Research Objectives The hypothesis is done on the problems faced by the voting committee in properly using the EVM technology to remove the fraud in vote casting in Bangladesh. The main objective of the research is to know the loop holes of the voting committee in their communicational strategy and find proper solution for excluding the problems (Nasreen, 2003). It is important for the management to know the exact problems that can occur with the system and find out proper solution for the problems. Here, the proposal deals with the issue that the report is going to discuss as a whole. As it is known that the voting committee is not able to properly register the voters and check their identity while conducting the votes because all this procedures are done manually there occurs the problem of communication among the voting committee members. Though the records are kept electronically but the inputs are done manually while conducting votes (Schuessler, 1969). The research studies the problems faced in th e E-Voting system in Bangladesh due to the lack of proper communication among the members of the voting committee, and how can this problems be solved. Strategy of Research For conducting a research it is important to make plans and develop strategy to collect data and information on the given topic (Davenport, 1967). In this research two different methods will be used to collect data and information. The first and foremost strategy that is followed in this research is survey that is conducted with the help of studying internet sources (Sarker and Islam, 2013). To complete the research work a survey will be conducted with the help of questionnaires that will be asked to common people through social networking sites. The questions will contains the detail of the situations faced in the e-voting system of Bangladesh and people will be asked that what they think about the communication problem faced by the voting committee for implementing the e-voting system in the country. The second method used in this report is the observation method through which the data collected is observed to understand the problems faced in the E-voting system in Bangladesh. By u sing the observation strategy the data collected from the internet sources are analyzed to provide an outcome of the research in the forms of results and findings of the research. How will you collect and Analysis the Data Data collection is one of the major and the most difficult task for any researcher. Data is collected in two different ways. In the first way the data is collected from the primary sources through direct interviews and questionnaires. In the second method the data is collected from the secondary sources like, internets, books, journals etc. In this research the primary as well as secondary method of data collection is used. People have been as questions about the communication problem of the management in implementing the e-voting system and some data is being collected by studying several articles and journals that provides information about the e-voting system in Bangladesh and what problems are generally faced by the voting committee of Bangladesh in conducting a fare voting in the country that is fraud and corruption free (Haque, Azad and Rahman, 2010). Several journals have been studied and data collected are sampled out to provide proper analysis on the provided topic. Descriptive and Inferential Statistics Here in this research several types of statistical analysis have been made to find out the results of the analysis. Descriptive statistics method is a way of statistical analysis in which proper information is provided about the conditions discussed in the research. The descriptive method helps to provide statistical analysis of the group of data in the form of standard deviation and measures of central tendency. It helps to analyze the dependency and independency of the data and variables collected in conducting the research study (Denham, 1979). It helps to provide proper information on the given data and variables that helps the researcher to provide ample information on the given study. It does not provide any boundation on the data and variable populations that has been used in the research to provide the analysis. The population can be large or small depending on the research topic that has been used. But in this research the data collected is sampled with the help of probabili stic and non-probabilistic sampling method depending on the importance of the data to analyze the situation on the given topic (International Journal of Social Research Methodology: Theory Practice, 2012). Therefore in this research the inferential statistical method of analysis has been used to conduct the research analysis. Data Collection, Analysis and Interpretation Research study or hypothesis depends on proper collection of data and analysis of data. It is the most important part of hypothesis. This is because the entire outcome of the research depends on the data collected and how the researcher analysis the collected data. This section is divided into three sub-sections that will make the procedure easier to understand. Data Collection In this research the data is collected by secondary method by using the internet sources and social networking sites. People have been asked questions about the major issue faced by the e-voting system in Bangladesh that is the communication problem among the members of the voting committee for proper to know what people think about the system and the communicational strategy of the committee about implementing the e-voting system. Data collected are arranged with the help of spreadsheet and converted into variables for proper analysis (Goel and Blair, 1979).The data are converted into variables by proper sampling method. As it is know that the data collection involves a huge population therefore a proper data sampling technique has been used to arrange the variables for analysis. It is important for the researcher to identify proper data and describe it and summarize the data appropriately for representing the research report properly. Data Analysis After the collection of the data comes the analysis. It is important for the researcher to understand the relationship between the variables and make a comparative study with the different variables collected for analysis (Richter and Blair, 1980). Through a proper comparative study the researcher can identify the differences between the variables and forecast the outcome of the studies. For doing this statistical analysis have been made with the collected data to know the measures of the central tendencies, standard deviation and correlation among the variables. For doing the statistical analysis the SPSS analytical tool can be used that helps to find the dependency and independency of the variables. Hence, for completing the hypothesis and forecasting the outcomes, descriptive analysis has been done in this report. Data Interpretation As it is know that interpretation is the process of adding meaning to the variables and data presented in the report. Numbers dont speak and provides the outcome of the report. It is important to interpret the data and variables represented in the research report with the help of words, graphs and tables. In the research study the data and variables will be represented with the help of descriptive analysis and proper graphs and tables will be presented to support the data and variables (Goel and Blair, 1979).This graphs and explanations help to interpret the findings of the research study. The interpretation of the data helps to provide outcomes and provides the learning of the research. The interpreted data is used to provide proper recommendation to the management team or the voting committee to solve the problems of communication for proper implementation of the e-voting system in Bangladesh to remove the fraudulent in the voting system. Literature Review Communicational Problems Affect the E-voting System For successful completion of a specific project it is always needed to analyze the problem related to the project and try to find the relative answers according to solve the problems. In this project it has been seen that the communication among the people in Bangladesh proves to be a vital issue for E-voting system (Sarker and Uddin, 2014). As voting was done in the traditional way in the said country therefore to try a new voting system will be very tough at first. To start the E-voting system first of all people have been needed to make understand about the whole procedure. Also, a large number of manpower is also needed to complete the work (Richter, 1980). However here comes the main issue of communication. In Bangladesh most of the people are living in village areas and therefore to reach them in any situations proves very much demanding at times. Also, the literacy rate here in Bangladesh is very low (Voting Agreement or Voting Trust? A Quandary for Corporate Shareholders: Cor porations. Voting Trusts. Intercorporate Voting Agreement, 1958). The application of global internet is limited in urban sectors of Bangladesh while the rural people are very much below poverty level. So, the issue of communication becomes one of the hardest problems to face to apply E-voting in the country. Additionally, people are not so much interested here to the political issue as they are mostly unaware of the politics due to rural systems (Green-Armytage, 2014). The countryside people earns their living mainly by farming and fishing. Therefore it will be very hard to start the process. Also the national language of the country being Bengali the people here are mostly known this language only (Sarker and Islam, 2013). So, for the purpose of the cause one have to employ more and more Bengali knowing people by providing them enough training and support. In the past years here in Bangladesh the voting percentage is very low and due to the ignorance and mostly for the communicatio n gaps people here are not able to vote for the cause of the country. The area of voting always becomes a critical part for the country as no possible measures can help to improve the percentage of voting (Leech and Leech, n.d.). Not only the communicational problem is affecting the issues but also there are several more problems yet to be analyzed and to be solved. Since the independence of the country Bangladesh is a very poor country. The country has to face floods like natural calamities and that also does not help the cause. No specific industrial model is set up in the country (Goel and Blair, 1979). The civilians are therefore have to get the living mainly by farming and fishing in the rural areas. Therefore the poverty of the country does not help the people to adopt new functions. Besides, the illiteracy count since the independence is a lot higher. That also hinders to implement new computerized system in this country (Richter and Blair, 1980). From the history one can kno w that Bangladesh has been indulged in many civil wars and that is also one of the reasons why the country is so much backward in economic as well as educational sectors. Communication Strategies to Implore the System After all the analysis the first important thing is to help the civilians to be educated and show them the importance of education. Additionally, the improvement of science and technology is needed to be understood by the country people. Internet literacy as well as internet facility has to be arranged to promote E-voting system in the country (Voting Agreement or Voting Trust? A Quandary for Corporate Shareholders: Corporations. Voting Trusts Interoperate Voting Agreement, 1958). Through several campaigns and workshops the importance of the E-voting has to be told to the general people. The duty of voting and the importance of it have to be discussed in front of the crowd. The people must have been encouraged to participate in the political issues and also teach them to understand the E-voting system (Bangladesh voting project nears completion, 2008). The process is hard though but not impossible. It will take time to initiate the E-voting in the country. However if the group can me et the common people and encourage them day to day basis the future can be changed and the system of new voting techniques can be implemented in the country. Of course the time will prove to be a vital factor to implore the total project (Faisal, Hossain and Bhuiyen, 2014). The management has to observe each of these stated factors to make E-voting possible in Bangladesh. New Research Questions After conducting the research some new questions have been developed that will increase the interest of the readers. The new research questions are as follows (Imam, 2012): How can communication strategy be developed to meet up the problems of the E-voting system? Will the new communication strategy be effective in solving the problem? What more technical development can be implemented in the system? How to develop the system in a better way to exclude the communicational problems? Will Bangladesh be able to stop the fraudulent in the voting system of the country by implementing the new system and strategy? Conclusion The research studies about the problems faced by the E-voting system due to the lack of proper communication among the management team of the voting committee and the technical fault of the committee. It has been found that though the committee uses the advance technology of EVM, but still yet it faces some causes of fraud due to corruption and communicational problem in the manual system of the voting committee. The entire report is presented on knowing the actual problem of communication and how can this problem be solved to implement the e-voting system to reduce the occurrence of fraud in the voting system of Bangladesh. The committee must take proper technical steps to exclude the lack of communication in the E-voting system of Bangladesh. References Bangladesh voting project nears completion. (2008).Biometric Technology Today, 16(7-8), p.12. Davenport, H. (1967). Research versus Teaching: A Research Proposal.BioScience, 17(3), pp.156-156. Denham, W. (1979). RESEARCH DESIGN AND RESEARCH PROPOSAL CHECKLISTS.Anthropology News, 20(4), pp.9-11. Faisal, M., Hossain, M. and Bhuiyen, M. (2014). Design and Implementation of Electronic Voting System (EVS).IOSRJEEE, 9(5), pp.56-63. Goel, M. and Blair, H. (1979). Voting, Caste, Community, Society: Explorations in Aggregate Data Analysis in India and Bangladesh.The American Political Science Review, 73(4), p.1171. Green-Armytage, J. (2014). Direct voting and proxy voting.Constitutional Political Economy. Haque, M., Azad, J. and Rahman, J. (2010). Critical Appreciation of Power System in Bangladesh.Bangladesh Journal of Scientific and Industrial Research, 45(3). Imam, M. (2012). Ethics in the Judiciary System of Bangladesh.Bangladesh Journal of Bioethics, 1(2). International Journal of Social Research Methodology: Theory Practice. (2012).International Journal of Social Research Methodology, 15(6), p.ebi-ebi. Leech, D. and Leech, R. (n.d.). Voting Power and Voting Blocs.SSRN Journal. Nasreen, B. (2003). Bangladesh / Bangladeshthe present situation, problems and solutions in the legal system related to corruption control.Revue internationale de droit pnal, 74(1), p.469. Richter, W. (1980). Voting, Caste, Community, Society: Explorations in Aggregate Data Analysis in India and Bangladesh. By Harry W. Blair. New Delhi: Young Asia Publications, 1979. xvi, 199 pp. References, Index. $12.00.The Journal of Asian Studies, 39(04), p.850. Sarker, M. and Islam, M. (2013). Management of Sustainable, Credible and Integrated Electronic Voting (E-Voting) System For Bangladesh.Management of Sustainable Development, 5(1). Sarker, M. and Uddin, D. (2014). Electronic Voting Algorithm and Its Algebraic Formation.International Journal of Mathematics Trends and Technology, pp.26-33. Schuessler, K. (1969). Covariance Analysis in Sociological Research.Sociological Methodology, 1, p.219. Voting Agreement or Voting Trust? A Quandary for Corporate Shareholders: Corporations. Voting Trusts. Intercorporate Voting Agreement. (1958).Stanford Law Review, 10(3), p.565.

Amazing Grace and Relationships Essays

Amazing Grace and Relationships Essays Amazing Grace and Relationships Essay Amazing Grace and Relationships Essay The film Amazing Grace’ follows the quest of William (Wilber) Wilberforce to abolish slavery in the UK. He was a member in the House of Commons and his friend William Pitt became the Prime Minister. On Wilber’s endeavour he introduced a bill with the help of Pitt (who was also a strong believer of the movement, which is one of the factors that made them such close friends) and a group of anti-slavery activists which included Equiano, an ex-slave who was of African descent, and Thomas Clarkson, a friend devoted the abolition of slavery.Another on this team was former slave trader turned abolitionist John Newton, he knew what went on behind the scenes with the slavery business and found god and decided against what he had been doing. He wrote the hymn Amazing Grace’ which was a giant inspiration to Wilber, and guided him to spiritual peace with God, and encouraged him to the idea that he could best serve god in the House of Commons. Wilber’s relationship with Newton was special; they had respect for each other on not only a personal but also professional level.The relationship shared between this pair was so strong because of their mutual connection with god, they had both found what they believed in and could understand what each other was going through, as they were both of recognised members of enforcement and were openly Christian. But this anti-slavery bill put forward was abolished with the force of the likes of Lord Tarelton, leader of the pro-slavery head-liners, and the Duke of Clarence, who saw slavery as profitable and as no humanitarian issue.William saw no sense in him and found it utterly inhumane when they were playing cards and the Duke of Clarence put up his African coach drive as a prize, so he stormed off prize-less; undoubtedly this pair’s relationship was poor. After this bill was put down Wilber turned ill and had to leave London for a more relaxing location at a country home of his friends. He got his headspace cleared and re-connected with his lord that had been guiding him to humanitarian success.Here he properly met Barbara Spooner, who he fell in love with, and eventually married and had children with. Barbara had a unique relationship with Wilber, they first met and didn’t hit it off, but then as they began conversing and comparing views they fell deep into conversation and love; even though they did not agree on everything they could freely express their opinion with each other, without fearing that their relationship will break.It was Barbara who was the pushing force behind Wilber to put forward a second bill supporting the abolition of slavery. But before this happened England went to war with France, and this caused a rift in the relationship between Wilber and Pitt, as Pitt was focussed on the war but Wilber saw it beneficial to make peace and stay strong for the movement of anti-slavery rather than causing more trouble and getting too deep into the act of war.During the whole movie, which is about 20 years, this is the only bump in the relationship between these two, and it was resolved very quickly, so this shows that they obviously have a healthy relationship. They can express their opinion, and sometimes it may cause a jolt in their relationship, but this is because they are such highly recognised members of parliament, and they try to stick up for what they believe in but also the view of their each other at the same time, and this can obviously not always be done .The health of the Prime Minister took a turn for the worse and he died, one year before the passing of the anti-slavery bill. Throughout the more than 2 decade journey God was with Wilber the whole way, and was the main relationship in this story. Not only did their relationship grow stronger, but Wilber’s faith also kept him going, even against the opinions on how absurd it was that he believed in a higher power he had never even seen.

German Influence in Mexican Music

German Influence in Mexican Music Could an instrumental German polka band piece, or what seems to be one, may in fact not be a German song at all but a Mexican one? Wait for the words...Yes it could! The music you hear is a Mexican polka style of music known as norteà ±o. Mexican Music Style Influenced by Germans Music from the northern part of Mexico, norteà ±o, meaning  northern, or  mà ºsica norteà ±a, northern music, was influenced by German settlers in Texas around 1830. It is no coincidence that some types of Mexican music have the German polka oom-pah-pah influence. Migration Phenomenon There was a large migration of Germans to southern Texas from the 1830s to the 1840s. According to the Texas State Historical Association, the largest ethnic group in Texas born in Europe or whose parents came from Europe hailed from Germany. By 1850, Germans made up more than 5 percent of the entire population of Texas. This part of Texas  became known as the German Belt. At that time, as it is now, the Rà ­o Grande marked a political and geographical divide more than a cultural one. The musical style and even the instruments of the German immigrants were adopted and became popular among those of Mexican heritage. One of the most influential musical instruments of the Germans musical style, the accordion, became especially popular and was frequently used in dance music such as waltzes and polkas. Modernization of Norteà ±o The popularity of norteà ±o  among Mexican-Americans spread in the 1950s and overlapped with popular American styles of rock and roll and swing. This overlapping of musical styles became known as tejano, literally the Spanish word for Texan, or more appropriately, Tex-Mex, a blending of the two cultures. A conjunto norteà ±o, or norteà ±o  ensemble, features the accordion along with the bajo sexto, which is a Mexican instrument similar to a 12-string guitar. Over time, norteà ±o  mixed with other music styles to form unique Mexican music styles, including  quebradita, which is a style that is heavy on the horns, banda, a  style  similar to the polka, and  ranchera, a traditional Mexican music genre. Influence on Mariachi  and Mainstream Music The norteà ±o  musical style influenced music from other regions of Mexico, such as what is probably the most widely-recognizable form of Mexican music, the mariachi music from the Guadalajara region. Norteà ±o or  tejano-style music is nearly always performed in Spanish, even by Mexican-Americans who speak primarily English. For example, native Texan and Spanish-English crossover artist Selena sang in Spanish before she could properly speak Spanish. For Selena, later known as the Queen of Tejano Music, the competition was less fierce in the Mexican music market compared to the American music market. She rode  the Mexican music market to fame and ranks as one of the most influential Latin musicians of all time. The norteà ±o or  tejano-style genre in the United States is often erroneously viewed as synonymous with Hispanic music, but it is just a type of Spanish-language music and represents only one genre of Mexican music. Mexican music is incredibly diverse and Spanish-language music is even more diverse, spanning many continents and representing different nationalities around the world.

Addresssing human resource issues at Utiliscan Essay

Addresssing human resource issues at Utiliscan - Essay Example Human resource issues at Utiliscan identified by the survey. Paul, the former Director for Utilitiscan conducted a survey and th result revealed some troubling issue in the company that caused its employees to leave. The survey that Paul conducted reported that; Most employees view their job at Utilitiscan as career dead end. Meaning, most employees felt that their careers are not advancing in the company as Paul’s survey result revealed that 87% of the employees felt that there were no promotion opportunities in the company. 74% of the employees also felt that their pay does not increase even if they perform well. Employees were also complaining that performance appraisals were not done anymore. Some respondents commented that there were favoritism in the company. Most employees also no longer feel challenged by their jobs. This is corroborated by the fact that a resounding 89% of respondents also complaint that opportunities to grow and improve were rare in the company. 56 % of the employees felt that their non wage benefits were below industry standard. Only 55% of all employees felt safe working in Utilitiscan. Meaning, the other half or 45% felt that there is an occupational hazard associated with their physical environment and that safety is less than adequate. In sum, the problem of the employees at Utilitiscan was that they felt that their job is a career dead end without any prospect for advancement and non-challenging where there are no incentives to do a good job. The proposed conceptual plan as a solution to the problem Employees are leaving Utilitiscan, including the very person who conducted the survey which was Paul, because the company was perceived to be a dead end and that the jobs were boring thereby making employees not motivated to perform because there are no incentives available when they do a good job anyway. Thus, to address these issues, management has to; a. Make job interesting for the employees to engage b. Institute promotio nal plans for the career advancement for employees c. Provide incentive for good performance (including promotion) d. Perform performance appraisal to address the need for basis of incentive and to encourage high performance in the organization. These conceptual plan does not necessarily â€Å"breaks the bank† of Utilitiscan. Addressing the employees issue about their jobs as non-challenging by making their jobs interesting jobs do not have to cost the company a huge amount of money. This can be done through job-rotation whereby employees move through the various functions in the organization laterally doing functions other than they are accustomed to. This is consistent with the idea of a classical management theorist Frederick Herzberg that it is not only money that motivates people to work as what Taylor posits in his scientific management theory. Herzberg argued that it is intrinsic rewards such as challenging work and growth that gets employees motivated. True, pay can m ake people work better but they will only endure the drudgery of work until the next pay raise or promotion and will again be back to mediocre performance after taking the pay raise or promotion. This principle in motivating employees is corroborated by a more recent study conducted by Dan Pink. In his study, Pink illustrated how monetary rewards failed in motivating employees. It may sound baffling but the Pink experiment showed that the obvious does not always work. Giving monetary rewards as a basis for motivation on jobs that requires even the slightest cognitive skills such as the jobs of programmers and engineers in Utilitiscan do not always work. It can even be a source of demotivation as what Pink found out when he did the experiment of giving financial incentive to motivate people to do tasks that involves thinking. The same experiment was done in other countries and other cultures and the result are the same, money as an incentive is a demotivator to tasks that invol

Research Critical Appraisal Article Paper Example | Topics and Well Written Essays - 750 words

Critical Appraisal Article - Research Paper Example Need for urgent treatment and trauma undermine initiatives for preserving fertility and little knowledge exists on perception of the patients and their decisions on fertility preservation following availed information. The clinical problem was therefore preservation of fertility among cancer patients, who are still in their reproductive age, prior to treatment. The research problem however, was lack of knowledge on perception of cancer among patients of the reproductive age, based on availed information, and use of fertility preservation techniques. This knowledge, among care providers and patients, can inform decisions on preservation of fertility (Peddie, Porter, Barbour, Culligan, MacDonald, King, Horn, and Bhattacharya, 2012). The author established significance of the study through identifying the target population, significance of reproduction to the population, and threat to reproduction due to uninformed decisions into cancer treatment, following diagnosis. Importance of reproduction to the society identifies significance of the problem to every individual who has understood the role of procreation and wish for personal fertility of that of a friend, relative, or an associate. Identification of existence of fertility preservation techniques that were still underutilized also established significance of the study to diagnosed cancer patients and those who have not been diagnosed with cancer because everyone is at risk. The purpose of the study was to expand the audience’s knowledge on factors that influence people’s decisions to preserve their fertility following cancer diagnosis and current application of available fertility preservation methods. The study aimed at developing knowledge on patients’ perception on and use of fertility preservation method and these relate to the research problem of lack of knowledge on patients’ perception on and application of the preservation techniques. The objective

Background Information On Undernutrition Health And Social Care Essay

Background Information On Undernutrition Health And Social Care Essay Malnutrition could be defined as an imbalance between nutrients and energy supply to the cells and the bodys requirement for growth, maintenance and specific functions (1). That is, malnutrition could be over nutrition, in which case the bodys nutrients and energy supply exceeds what the body requires, or undernutrition, in which case the nutrients and energy supply does not meet the bodys demand. An example of over nutrition is obesity whiles and example of undernutrition is marasmus or kwashiorkor. Malnutrition is responsible for about 5.6 to 10 million child mortality annually, 1.5million of these deaths is as a results of severe malnutrition (). Nutritional status of an individual reflects the balance between the nutrients consumption and its utilization in the processes of growth, health maintenance and reproduction (). Thus, it extends from nutrient levels in the body, the end products of metabolism to the functional activities that they control (). Undernutrition is disturbing because it is responsible for more than a third of all child deaths in developing countries (1). It blunts the mind, affects the productivity of its victims and brings about poverty (24). It is important to address the issue of undernutrition if there is any hope of achieving the Millennium Development Goals (MDGs), especially MDG 1 which is to eradicate extreme poverty and hunger. Proper nutrition helps give every child the best start in life. Beside every child has a right to adequate nutrition. However, there are a significant proportion of children who are denied this right for reasons that could easily be prevented. An estimated 13 million children under 5years globally are severely undernourished and 50% of them die from preventable causes (1). Interestingly, 99% of the child deaths occur in the developing countries (24). Up to date studies point out that, one in three children less than five years in the developing world are undernourished with sub -Saharan Africa and Asia having high rates, of 40 per cent and 35 per cent respectively (24). Currently, it is estimated that one-third of children less than five years of age in developing countries are stunted (low height-for-age), whiles significant proportion of them, are also deficient in one or more micronutrients (24). Studies shows that, a child with severe undernutrition enrolls late in school and also affects his or her performance in school (26).This contributes significantly to the increased rates of school drop- out and undoubtedly contributing to the issue of meaningful access and educational outcome (25). This could be attributed to the fact that, the harm caused by undernutrition to children during the first two years, especially between 6 months and 24months is irreversible because it is the period of rapid brain development (25). In order to ensure that all children achieve optimal nutrition as well as low incidence of infectious disease and infant mortality from malnutrition, it is important that we understand the factors that contributes to undernutrition (23). CONCEPTUAL FRAME WORK OF CHILD UNDERNUTRITION. According to the United Nations Childrens Emergency Fund (UNICEF), the theoretical outline of child malnutrition shows numerous interventions that can decrease morbidity and mortality associated with malnutrition (23). To prevent or manage malnutrition, the factors implicated needs evaluation. In addition, the various causes of malnutrition overlap, that is: immediate causes, underlying causes and basic causes (23). Figure 1: conceptual framework of childhood undernutrition 1.2.1 IMMEDIATE CAUSES The immediate causes of childhood malnutrition is classified as, insufficient diet as well as stress, trauma, diseases (such as HIV, TB etc) and poor psychosocial care. Poor dietary ingestion may refer to poor breastfeeding practices, early weaning, delayed introduction of complementary feed. It is known that the stage from birth to two years of age is the significant period for the promotion of good growth, health, behavioral and cognitive development (24). Therefore, optimal infant and young child feeding is crucial during this period. Regrettably, this period (especially between 6 to 24months after birth), is often marked by growth faltering, micronutrient deficiencies as well as common childhood illnesses such as diarrhoea and acute respiratory infections (ARI) (24). The WHO therefore recommends Optimal feeding practices during this period, which involves early initiation of breastfeeding, exclusive breastfeeding during the first 6 months of life, continued breastfeeding for up to two years of age and beyond, timely introduction of complementary feeding at 6 months of age, frequency of feeding, solid/semisolid foods, and the diversity of food groups fed to children between 6 and 24months of age (1). Exclusive breastfeeding is an excellent way of providing adequate food for a babys first six months of life (21). An estimated 1.4 million deaths occurs globally among under five children every year because of inadequate or suboptimum breastfeeding (22). The most recent data suggest that, in the developing world, 36 per cent of 0-5 month olds are exclusively breastfed, whiles 60 per cent of 6-8 month olds are breastfed and given complementary foods and  55 per cent of 20-23 month olds are provided with continued breastfeeding (22). Also among newborns, 43 per cent started breastfeeding within the first hour after birth (22). Adequate complementary feeding of children from 6 months to two years is critical in preventing undernutrition. Proper timing of complementary feed introduction also helps prevent undernutrition. Early beginning of complementary food is found to be associated increased risk of acute respiratory tract infections, eye infections and high malaria morbidity. This is because, when complementary feeding is initiated, it results in reduced breastmilk consumption which could results in the loss of passive immunity from the mother to the child (23). Thus causing higher morbidity especially when unhygienic foods are used, as a results of development of diarrhoea (23). This is supported by a study done in India, which shows that growth curves weaken by 4months of life as a consequence of early initiation of complementary feeding (23). Evidence further shows that, complementary feeding practices are generally poor among developing countries, thus children continue to be vulnerable to permanent o utcomes like stunting and impaired cognitive development (24). Currently in Ghana, there is widespread child malnutrition, contributing to the continuous high child mortality (25). About 39% of all Ghanaian 2 year olds are moderately or severely stunted with the incidence rising in the Northern regions (25). Studies show that undernutrition is more prevalent in the rural than the urban areas of the country (3). Almost one in five children under age five in Ghana are underweight (18 percent) and 3% are classified as severely underweight (25). Nearly a quarter of children (22%) are stunted or too short for their age and 5 percent are wasted or too thin for their height (1). 1.2.2. UNDERLYING CAUSES: It include inadequate levels of household food security, inadequate care of infant and children, low levels of education of mother/caregivers, inadequate health care and insanitary environment (23). 1.2.3. BASIC CAUSES OF MALNUTRITION This is also called the root causes of malnutrition and it include deprived and control of resources (such as political, social, ideological and economic), degradation, of the environment, poor agriculture, war, political instability, urbanization, population growth and seize, distribution, conflicts, trade agreements and natural disasters, religious and cultural factors (23). PROBLEM STATEMENT. Globally it is estimated that 60 million children have moderate acute and 13 million have severe acute malnutrition(SAM) (23) . 50% of 10 to 11 children below five years die from preventable causes such as undernutrition (23). Studies have also shown that 9% of children in the sub-saharan Africa have moderate acute malnutrition whiles 2% of them are severely malnuhrised (23). One of the identified factors contributing to high mortality rates from undernutrition is because, only severe cases of malnutrition are reported with most of them reporting late. According to a press released by the Central Regional Nutrition Officer on 20th September 2011, Four hundred and twenty seven (427) severe malnutrition cases among children were recorded (from January to June, last year) by the Central Region Health Administration, with Agona West having the highest of 113 followed by Upper Denkyira East with 83 cases. Eighty two percent (82%) of the cases were children from zero to two years. Fifty four per cent (54%) are females with forty six percent (46%) being males (4). According to the Ghana demographic and health survey report released in 2008, out of a total number of 246 children from the central region involved in the study, 47.8% of them had height for age below -3SD (indicating severe stunting), 22.6% had weight for age below -3SD (indicating severe wasting) and 13.7% had weight for height below -3SD (indicating severe undernutrition) (19). According to the report, out of 292 children born in the region over the period of the research, 9 9.3% were breastfed (19). Out of this, 55.5% of them breastfeeding was started within an hour after birth whiles 79.1% of them were breastfeed within 24hours after birth (19). The burden of undernutrition cannot be ignored when considering the health of a country, most importantly in a developing country like Ghana. Although Ghana recently attained a lower middle income country status, the prevalence of undernutrition has been persistently high. More needs to be done in terms of childhood nutrition if the millennium goals 4 is to be achieved. Undernutrition reduces an increased susceptibility to infections, slow recovery from illness and poor outcomes from simple medical conditions. The critical window , which is the period of birth up to two years (24 months) of life, is an important period of preventing undernutrition . If undernutrition is not taken care of during this critical period, it may lead to irreversible damage for future development towards adulthood such as low intellect which may eventually affect productivity. RATIONAL OF STUDY. Infant and child morbidity and mortality as well as the economic ability of the country will always continue to be a problem if the nutritional status of young children(6 to24months) is overlooked. If infant and child mortalities goes high, the government spends huge sums of money to reduce or prevent them. This could be avoided by just identifying and addressing the factors that are associated with undernutrition. For example, an inexpensive way of ensuring good child nutrition is to educate mothers to engage themselves in good child feeding practices such as exclusive breastfeeding for 6months and timely introduction of quality complementary feeding. This study seeks to assess the nutritional status of children 6months to 24months in order to identify those who have any form of undernutrition which is indicated by stunting, wasting and underweight. This will help identify the common factors that contributes to undernutrition so that programmes could be geared towards children 6 months to 24 months as a whole. STUDY HYPOTHESIS: Childhood undernutrition is influenced by socio-demographic factors, child feeding practices and the health history of child and mother/caregiver pair. GENERAL OBJECTIVE To assess the nutritional status of children 6months to 24months attending child welfare clinic in the cape coast metropolis and examine the factors associated with it. SPECIFIC OBJECTIVES The specific objectives are to: Determine the socio demographic background of mother/caregiver and child (6 to 24 months old) pair. Determine the nutritional status of children between the ages of 6months and 24months. Determine the child feeding practices of mothers/ caregivers and its association with child nutritional status. Identify the common food items used in complementary feeding of children 6 to 24months. Determine the health history including acute (diarrhoea, respiratory tract infection, anemia and malaria) and chronic illnesses such as TB and HIV) of children between 6months and 24months and their association with undernutrition. CHAPTER 2 2.1. INTRODUCTION Worldwide, hunger and malnutrition are the two most significant public health challenges (23). Malnutrition increases the risk for illness and death with millions of both children and women being affected as a results of infections, poor and inadequate diet (23). Reports suggest that infants and young children are the most venerable to malnutrition because of their increased nutritional needs to support growth (23). Nutritional disorders arise from imbalance between supply of protein-energy and the bodys demand for them to ensure optimal growth and function (23). This imbalance includes both inadequate and excessive nutrient intake; the former leading to malnutrition in the form of wasting, stunting and underweight whilst the latter results in overweight and obesity (23). Malnutrition is often used to in place of PEM (protein energy malnutrition), which is commonly regarded and its severe forms are called marasmus, kwashiorkor and miasmic kwashiorkor (23). SAM is a term used to describe a combination of all the different forms of PEM, it refers to weight for height 2.2. PREVALENCE OF MALNUTRITION Globally, the nutritional status of children is improving with the exception of sub-Saharan Africa. This progress is however hindered by poverty, infection and inefficient governance (22). In a study conducted among developing countries, was second to Asia in terms of the number of children who are stunted, underweight and wasted (23). Table 2.1. Prevalence of PEM among children under 5years in developing countries, 1995. REGION WASTING /% STUNTING /% UNDERWEIGHT /% Africa 39 28 8 Asia 41 35 10 Latin America and Caribbean 18 10 3 Oceania 31 23 5 (Muller and krawntel, 2005). In the state of the worlds children report released in 1998, malnutrition resulted in about seven million deaths which are about 55% of all child deaths (23). Of these, three quarters are mild to moderately malnourished without obvious signs of problems (23). According to a press released by the Central Regional Nutrition Officer on 20th September 2011, Four hundred and twenty seven (427) severe malnutrition cases among children were recorded (from January to June, last year) by the Central Region Health Administration, with Agona West having the highest of 113 followed by Upper Denkyira East with 83 cases. Eighty two percent (82%) of the cases were children from zero to two years. Fifty four per cent (54%) are females with forty six percent (46%) being males (4). In the 2008 Ghana demographic and health survey, out of a total number of 246 children from the central region involved in the study, 47.8% of them had height for age below -3SD (indicating severe stunting), 22.6% had weight for age below -3SD (indicating severe wasting) and 13.7% had weight for height below -3SD (indicating severe undernutrition) (19). In the report, out of 292 children born in the region over the period of the research, 99.3% were breastfed (19). Out of this, 55.5% of them breastfeeding was started within an hour after birth whiles 79.1% of them were breastfeed within 24hours after birth (19). 2.3. CLASSIFICATION OF MALNUTRITION Malnutrition, defined in this context as nutritional deficiency, is a serious public health problem that has been linked to a substantial increase in the risk of mortality and morbidity. It is normally used to describe protein energy malnutrition. Protein energy malnutrition (PEM) refers to a group of related disorders which include marasmus, kwashiorkor and marasmus-kwashiorkor (2). Marasmus involves inadequate intake of protein and calories and is characterized by emaciation or wasting (2). Kwashiorkor refers to an inadequate protein intake with reasonable caloric (energy) intake and it is characterized by edema (2). Therefore the major clinical difference between marasmus and kwashiorkor is the wasting which is seen in marasmus but absent in kwashiorkor and edema which is present in kwashiorkor but absent in marasmus. Moreover, in the intermediate state of marasmus kwashiorkor, there is both wasting and edema. Studies suggest that marasmus represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to starvation (2). Children, usually present with a mixed picture of marasmus and kwashiorkor, hence the term protein- energy malnutrition is commonly used in child malnutrition (2). Pati ents with protein-energy malnutrition may also have deficiencies of vitamins, essential fatty acids, and trace elements (2). In marasmus the insufficient energy intake to match the bodys requirements causes the body draw on its own stores thus resulting in emaciation (2). In kwashiorkor, because there is adequate carbohydrate ( caloric) consumption but inadequate protein intake leads to decreased synthesis of visceral proteins (2).This result in hypoalbuminemia (low albumen in blood) which contributes to extravascular fluid accumulation as a result of reduced intravascular oncotic pressure (2). Another effect is the impaired synthesis of B-lipoprotein thus leading to a fatty liver (2). Marasmus and kwashiorkor could both be associated with impaired glucose clearance that relates to dysfunction of pancreatic ÃŽÂ ²-cells (2). Protein-energy malnutrition also involves an inadequate intake of many essential nutrients such as zinc, vitamins e.t.c (2). The WHO classifies malnutrition into moderate and severe malnutrition (23). Malnutrition is classified as severe when there is the presence of symmetrical edema (malnutrition edema), weight-for-height SD-score 2.4. ASSESSMENT OF NUTRITIONAL STATUS The severity of malnutrition varies in terms of its clinical, biochemical and physiologic features. These features are also affected by the age of the child, nutritional deficits and infections. Diagnosis of child malnutrition is made by taking a detailed dietary history and demonstrating the presence of clinical features, which are weight loss, slow growth/ growth retardation, childs physical activity and energy levels, the recent history of diarrhoea, immune-suppression and many other features. The assessment of nutritional status according to weight-for-height, height-for-age and presence of nutritional edema is the WHO standard criteria for diagnosing undernutrition (1). Whilst the child with edematous malnutrition could easily be identified by most clinicians, wasting as a form of malnutrition could easily be missed if anthropometric measurements are not done. Growth assessment in terms of anthropometry is routinely done at child welfare clinics and at the end of all physical examination of a child during all hospital visits (1). 2.5. COMPLICATIONS / EFFECTS OF UNDERNUTRITION In 2000, the WHO estimated that malnourished children numbered 181.9 million (32%) in developing countries. In addition, an estimated 149.6 million children under 5 years are malnourished when measured in terms of weight for age (2). Approximately 50% of the 10 million deaths each year in developing countries occur because of malnutrition in children under 5 years (2). In kwashiorkor, mortality tends to decrease as the age of onset increases (2). Marasmus usually occurs in children under 5years; this may be due to the fact that this period is characterized by increased energy requirements and increased susceptibility to viral and bacterial infections (2). Also weaning (the gradual withdrawal of breast milk and the commencement of nourishment with other food) occurs during this high-risk period (2). Weaning is usually complicated by geography, socio-economy, hygiene, public health, culture, and dietetics (2). Due to the complex nature of weaning, it could become ineffective when the f oods introduced provide inadequate nutrients, when the food and water are contaminated, when the access to health care is inadequate, and/or when the patient cannot access or purchase proper nourishment (2). Since low intake of calories or an inability to absorb calories is the key factor in the development of kwashiorkor, variety of syndromes could be associated with kwashiorkor (2). Clinically children would have poor weight gain or weight loss (slowing of linear growth) and behavioral changes such as, irritability, apathy (characteristically, the child is apathetic when undisturbed but irritable when picked up), decreased social responsiveness, anxiety, and attention deficit (2). In marasmus, the child appears emaciated with significant loss of subcutaneous fat and muscle wasting. Other features include; xerotic, wrinkled, and loose skin; loss of buccal fat pads given rise to what is called monkey face (2). In protein-energy malnutrition, more hairs are in the telogen (resting) phase than in the anagen (active) phase, a reverse of normal (2). Kwashiorkor typically presents with failure to thrive, edema, moon face, a swollen abdomen (potbelly), and a fatty liver (2). Skin changes are c haracteristic and could progress over few days, thus the skin becomes dark, dry, and then splits open when stretched, revealing pale areas between the cracks(2). Globally, the most common cause of malnutrition is inadequate food intake (2). Preschool-aged children in developing countries are often at risk for malnutrition because of the following factors: their dependence on others for food; increased protein and energy requirements; immature immune systems causing a greater susceptibility to infection; and exposure to non-hygienic conditions (2).Another important factor is ineffective weaning as a result of ignorance, poor hygiene, socio-economic factors, and cultural factors (2). Diseases such as gastrointestinal infections can and often do precipitate clinical protein-energy malnutrition because of associated diarrhea, anorexia, vomiting, increased metabolic needs, and decreased intestinal absorption (2). 2.6. TREATMENT AND MANAGEMENT OF SEVERE UNDERNUTRITION In the first step in the treatment of protein-energy malnutrition (PEM), which is also known as the initial phase/stabilization phase, the aim of treatment is to correct fluid and electrolyte abnormalities and to treat any infections (2). Macronutrient repletion or dietary treatment with F75 and F100 should be commenced within 48 hours under the supervision of nutrition specialists (2). Other treatment action in this stage includes, correcting hypoglycemia, hypothermia and dehydration among others. The second step in the treatment, referred to us the rehabilitation phase, may be delayed 24-48 h in children. The aim is to supply macronutrients by dietary therapy to rapidly replenish the energy stores depleted by malnutrition (2). After a week, intake rates should approach 175 kcal/kg and 4 g/kg of protein for children (2). A daily multivitamin should also be added (2). Any child who is at risk of nutritional deficiency should be referred to a registered dietitian or other nutritional professional for a complete nutritional assessment and dietary counseling (2). Subspecialty referrals should be considered if the underlying cause is not poor nutritional intake e.g. if clinical findings indicate malabsorption, a gastroenterologist should be consulted (2). Children with poor nutrition as a result of inadequate intake and/or neglect should be referred to the appropriate social agencies to assist the family in obtaining resources and providing ongoing care for the child (2). The last phase which is ignored by most health workers is the follow up, its to be done at appropriate intervals to enable the child and mother/caregiver pair to have counseling and guidance. 2.7. CHILD MALNUTRITIONAL STUDIES In a randomized community based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status, infants fed with weanimix had better iron stores and vitamin A status than those fed on nonfortified foods(13) . Therefore, mothers practicing complementary feeding should be encouraged to use fortified foods such as weanimix, NAN 1e.t. c. The study, however used limited food variety and also did not include simple local foods like groundnut paste, millet e.t.c. As said by a case-control study, on Risk factors for severe acute malnutrition in children under the age of five, there is an association between severe acute malnutrition and inappropriate infant and young child feeding practices (16). This suggests that, adequate or proper child feeding practices could prevent childhood undernutrition. Hence efforts, aimed at reducing child undernutrition needs to emphasize the proper feeding of children. In reference to a study on undernution as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles, significant proportion of deaths in young children worldwide is attributable to low weight-for-age (underweight). The study also showed, 52.5% of all deaths in young children were attributable to undernutrition, which is different form 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea (). This shows that, the fight against childhood killer disease should involve the fight against undernutrition since it is a significant co-morbidity for child mortality. A different study, on a multilevel analysis of individual and community effect on chronic childhood malnutrition , revealed that individual and community characteristics are important predictors of childhood malnutrition(). This indicates that, there are individual factors which are dependent on the child as well as environmental factors which are determined by the community. Thus the geographical location as well as individual traits could predispose a child to undernutrition. Another study also revealed that, Household Food Security is inversely proportional to undernutrition (). This indicates that once food security levels in households increases, the prevalence of undernutrition decreases. Several factors affects food security, such factors includes; conflicts, war, political instability, famine, poor food storage systems e.t.c. In this regard, policies addressing these factors will improve food security levels in the country which will intern improve child undernutrition. A crosectional study on potentially modifiable micro-environmental and co-morbid factors associated with severe wasting and stunting in children , identified social class and feeding practices as the significant risk factors associated with wasting (). This indicates that, improving the living standard of citizenry ultimately improves the incidence of childhood undernutrition. A research on Prevalence of Malnutrition and Effects of Maternal Age, Education and Occupation Amongst Children showed high prevalence of stunting, medium wasting and underweight had no statistically significant association with educational level and occupation of the mothers(). Thus indicating that, mothers/caregivers do not need to have high educational level or white color job to prevent or reduce child undernutrition. Therefore, policies aimed at educating mothers/caregivers should be directed to everyone without prejudice of the persons work or educational level. 2.8. CONCLUSION Child undernutrition is a problem that affects individual, society, ethical, moral and political levels. Factors associated with it cuts across socio-demographic, health and geographical location. CHAPTER 3 METHODOLOGY 3.1. Study design: This was a crosectional study involving 100 child and mother/caregiver pair sampled from five health facilities randomly selected. The study was conducted over a one month period. Mothers/Caregivers of children between 6months and 24months old were eligible for participation and were randomly selected after they had consented. 3.2. Study setting: The Cape Coast Metropolitan is bounded on the south by the Gulf of Guinea, west by the Komenda / Edina / Eguafo /Abrem Municipal, east by the Abura/Asebu/Kwamankese District and north by the Twifu/Hemang/Lower Denkyira District (4). The Metropolis covers an area of 122 square kilometers and is the smallest metropolis in the country and is also the capital city of the Central Region of Ghana (4). The total population of the cape coast metropolis is 217,032 with a population growth rate of3.1%(5). Generally, there are two rainy seasons in the metropolis (4). The peak of the major season is in June (4). The vegetation is divided into dry coastal savanna stretching about 15 km inland, and a tropical rain forest with various reserve areas (5). The major economic activities are agriculture andfishing (5). 3.3. Samples seize: The formular used in calculating the sample seize is: Sample Size = n [1 + (n/population)] Where n = Z ÃÆ'- Z [P (1-P)/(DÃÆ'-D)] P = True proportion of factor in the population, or the expected frequency value D = Maximum difference between the sample mean and the population mean, Or Expected Frequency Value minus (-) Worst Acceptable Value Z = Area under normal curve corresponding to the desired confidence level The prevalence of undernutrition among children under 5 years in Ghana was 28.60% at the end .of 2008 (3). The population of children between 6months and 24 months of age registered at the health facilities within the cape coast metropolis, attending child welfare clinic is 238. The desired confidence level used was 95% with the value of Z = 1.960, from the confidence level. The confidence limit (D) of 4% (i.e.  ±4). Hence, n= 1.960ÃÆ'-1.960[0.286 (1-0.286)/(0.04ÃÆ'-0.04)] = 489.804 Therefore sample seize = 489.804 = 160.1714 [1+(489.804/238)] Hence the sample seize was ~ 160. 3.4. Sampling: There are ten health facilities within the cape coast metropolitan catchment area. These ten health facilities include both rural and urban Health centers, CHIP centers, University hospital, Metropolitan hospital and a Regional hospital. These health facilities were subjected to random selection and five of them were selected to participate in the study. The random selection was done by assigning all the facilities to numbers and these numbers were written separately on small sheets of papers and folded. Five different individuals, who are have no idea about the study nor were the health facilities involved, at separate times asked to pick one of the folded papers. All the health facilities had equal chance of selection. The selected health facilities included the Central Regional Hospital, Akotokyire CHPS Center, Adisadel Urban Health Ce